Cardiovascular events in patients with over 10 years history of type 2 diabetes mellitus

BackgroundDiabetes is one of the concerns of today's public health and patients with type 2 diabetes are at increased risk of death due to cardiovascular diseases. The aim of this study was to evaluate the prevalence of cardiovascular diseases in patients with over 10 years history of type 2 diabetes mellitus referred to the Sanandaj Diabetes Clinic.MethodsIn this study, 400 patients with type 2 diabetes who had over 10 years history of diabetes were selected and the required information was prepared based on taking their history and files. Finally data were analyzed using T-test, Chi-square and Fisher test methods.ResultsIn this the mean duration of diabetes was 14.59 ± 4.07 years. 95.25% of patients had dyslipidemia. The frequency of history of cardiovascular events was 78.25%. 12.25% of patients had a history of ischemic heart disease and 82.75% had a history of high blood pressure. There was a significant relationship between the incidence of cardiovascular events with hypertension, HDL level and family history of early cardiovascular disease (p < 0.05).ConclusionThe high risk of cardiovascular events in diabetic patients it strongly emphasizes the need for quick and serious approaches to prevent cardiovascular events in diabetic patients.     

Mortality in youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth study

Aims

To estimate short-term mortality rates for individuals with type 1 or type 2 diabetes diagnosed before age 20?years from the SEARCH for Diabetes in Youth study.

Effect of pioglitazone on decreasing of proteinuria in type 2 diabetic patients with nephropathy

IntroductionDiabetic nephropathy that means albuminuria greater than 30 mg/day, affects about one third of diabetic patients. There are many studies about the effect of different medications for diabetic nephropathy with controversy in their results. So, the aim of the study was to investigate the effect of pioglitazone on decreasing of proteinuria in type II diabetic patients and nephropathy.Methods and materialsIt is a double blind clinical trial. At first, 2356 medical carts of the patients were evaluated and 76 patients with type 2 diabetes mellitus with proteinuria greater than 250 mg / day were enrolled in 2 equal groups. In the case group, pioglitazone 15 mg/day was prescribed and patients in the control group received placebo for two months. At the beginning of the study and after 2 months, urinary protein during 24 h was measured in all of the patients and data were entered to SPSS (version23) and evaluated by using Chi- square, Mc Nemar, paired t-test and logistic regression model.ResultsAt the beginning of the study, urine protein during 24 h in the case and control groups were 957.7 ± 385.1 and 972.1 ± 378.6 respectively (P = .872). So, after 2 months the mean proteinuria in the case and control groups were 647.3 ± 367.2 and 896 ± 372.4 respectively that is valuable (P = 0.005). Pioglitazone had the considerable effect on FBS,HbA1c and blood triglyceride too.ConclusionThe study showed that low dose of pioglitazone is an effective, safe and inexpensive method in reducing of proteinuria in type2 diabetic patients with nephropathy.     

Anaemia, independent of chronic kidney disease, predicts all-cause and cardiovascular mortality in type 2 diabetic patients

Objective

There is limited and controversial information on whether anaemia is a risk factor for cardiovascular mortality in type 2 diabetes, and whether this risk is modified by the presence of chronic kidney disease (CKD). We assessed the predictive role of lower hemoglobin concentrations on all-cause and cardiovascular mortality in a cohort of type 2 diabetic individuals.

Methods

The cohort included 1153 type 2 diabetic outpatients, who were followed for a mean period of 4.9 years. The independent association of anaemia (i.e., hemoglobin <120 g/l in women and <130 g/l in men) with all-cause and cardiovascular mortality was evaluated by Cox proportional hazards regression models and adjusted for several potential confounders, including kidney function measures.

Results

During follow-up, 166 (14.4%) patients died, 42.2% (n = 70) of them from cardiovascular causes. In univariate analysis, anaemia was associated with increased risk of all-cause (hazard ratio HR 2.62, 95% confidence intervals 1.90–3.60, p < 0.001) and cardiovascular mortality (HR 2.70, 1.67–4.37, p < 0.001). After adjustment for age, sex, body mass index, smoking, hypertension, dyslipidemia, diabetes duration, hemoglobin A1c, medication use (hypoglycemic, anti-hypertensive, lipid-lowering and anti-platelet drugs) and kidney function measures, the association of anaemia with all-cause (adjusted HR 2.11, 1.32–3.35, p = 0.002) and cardiovascular mortality (adjusted HR 2.23, 1.12–4.39, p = 0.020) remained statistically significant.

Conclusions

Anaemia is associated with increased risk of all-cause and cardiovascular mortality in type 2 diabetic individuals, independently of the presence of CKD and other potential confounders. The advantage to treat anaemia in type 2 diabetes for reducing the risk of adverse cardiovascular outcomes remains to be demonstrated.     

Impaired peripheral circulation in lower-leg arteries caused by higher arterial stiffness and greater vascular resistance associates with nephropathy in type 2 diabetic patients with normal ankle-brachial indices

Diabetic nephropathy is a major cause of lower-limb amputation. We enrolled 250 type 2 diabetic patients without apparent occlusive peripheral arterial disease (ankle–brachial indices >0.9) and 40 age-matched nondiabetic subjects consecutively admitted to our hospital. Flow volume and resistive index (RI), an index of vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial–ankle pulse wave velocity (baPWV) was measured as an index of arterial distensibility. Flow volume was negatively correlated with both baPWV (p = 0.0009) and RI (p < 0.0001) among the patients. When the patients were grouped into four subgroups with or without albuminuria and renal insufficiency according to the levels of urinary albumin excretion rate (≥20 or <20 μg/min) and estimated glomerular filtration rate (eGFR) (<60 or ≥60 ml/min/1.73 m²), albuminuric patients with renal insufficiency (n = 30) showed the lowest flow volume (p = 0.0078) and the highest baPWV (p = 0.0006) and RI (p = 0.0274) among the groups. Simple linear regression analyses demonstrated that eGFR correlated positively with flow volume (p = 0.0020) and negatively with baPWV (p = 0.0258) and RI (p = 0.0029) in patients with albuminuria (n = 92), but not with normoalbuminuria (n = 158). Impaired peripheral circulation in lower-leg arteries associates with nephropathy in diabetic patients even though they have normal ankle–brachial indices.     

APP17肽对糖尿病KK小鼠肾脏的保护作用

目的：观察App17肽对2型糖尿病小鼠尿白蛋白、总蛋白排泄量和肾脏超微结构的影响。方法：KKAy小鼠，根据血糖水平分为：血糖正常组（C组），糖尿病组（D组）和17肽治疗组（D＋17P组），17肽治疗组给予APP17肽皮下注射。12周后将3组小鼠处死。处死前1d，用代谢笼收集小鼠24h尿量，测总蛋白、白蛋白值；处死时心脏取血测血糖及血胰岛素水平；取肾皮质送电镜检查。结果：（1）D组小鼠肾小球基底膜明显增厚，近曲小管出现大量空泡和退变钙化的线粒体，而线和D＿17P组小鼠无此改变。（2）三组小鼠尿总蛋白和尿白蛋白排泄量由低到高依次为C≤D＋17P≤D（P＜0．05）。（3）D组和D＋17P组小鼠的血糖、糖化血红蛋白、胰岛素水平比C组明显升高（P＜0．05），D组和D＋17P组之间差异无显著性（P＞0．05）。结论：App17肽对KKAy糖尿病小鼠肾脏病变具有保护作用，但不是通过影响血胰岛素和血糖水平实现的。     

Mortality in an elderly type 2 diabetic patients' cohort who attended a self-management educational workshop

Aims

To compare the all-cause mortality rate in elderly type 2 diabetic patients who attended self-management educational workshops compared with those who did not.

Methods

Retrospective cohort study in a Health Maintenance Organization in Buenos Aires, Argentina. Patients older than 64 years with type 2 diabetes before December 2003 conformed the cohort followed from January 01, 2001 until death, censored date or December 31, 2007. All-cause mortality rate was ascertained from vital status reports and assessed according to educational workshops attendance. Results were adjusted for baseline variables, co-morbidities and A1C levels using Cox proportional hazards model.

Results

1730 elderly diabetic patients were included, yielding 8685 person/years of observation. Educated and non-educated groups were similar regarding sex, co morbidities, diabetes duration, prevalent cases, insulin treatment, tobacco use, clinical and laboratory measures. All-cause mortality rate was 5.53 (4.04–5.07) per 100 person/years for non-attendants and 3.06 (2.39–3.91) for attendants. Crude hazard ratio for exposure to workshops was 0.68 (0.52–0.88); p = 0.004. After adjustment, attendance to diabetic workshops decreased its effect from 33% to 18% (HR 0.82; 95%CI: 0.61–1.08).

Conclusions

Workshop attendants had 33% lower all-cause crude mortality rate at 6 years of follow-up. More research is needed to explore whether these findings are explained by education itself, behavioural or personal characteristics of workshop attendants, the intensified participation in an integral diabetes programme, or a combination of them.     

Meta-analysis of the relationship between alcohol consumption and coronary heart disease and mortality in type 2 diabetic patients

Aims/hypothesis This systematic review examines the relationship between alcohol consumption and long-term complications of type 2 diabetes. Meta-analyses could only be performed for total mortality, mortality from CHD, and CHD incidence, because the availability of articles on other complications was too limited. Materials and methods A PubMed search through to September 2005 was performed and the reference lists of relevant articles examined. Among the relevant articles there were six cohort studies reporting on the risk of total mortality and/or fatal and/or incident CHD in alcohol non-consumers and in at least two groups of alcohol consumers. Results Statistical pooling showed lower risks in alcohol consumers than in non-consumers (the reference category). The relative risk (RR) of total mortality was 0.64 (95% CI 0.49–0.82) in the <6 g/day category. In the higher alcohol consumption categories (6 to <18, and ≥18 g/day), the RRs of total mortality were not significant. Risks of fatal and total CHD were significantly lower in all three categories of alcohol consumers (<6, 6 to <18 and ≥18 g/day) than in non-consumers, with RRs ranging from 0.34 to 0.75. Conclusions/interpretation This meta-analysis shows that, as with findings in the general population, moderate alcohol consumption is associated with a lower risk of mortality and CHD in type 2 diabetic populations.     

Haemoglobin A1c and 5-year all-cause mortality in French type 2 diabetic patients aged 70 years and older: The GERODIAB observational cohort

Aim

The role of glycaemic control in the mortality of elderly diabetic patients remains uncertain. GERODIAB is the first multi-centre, prospective, observational study that aims to describe the link between HbA1c and 5-year mortality in French, type 2 diabetic patients aged ≥ 70 years.

微量清蛋白尿与2型糖尿病合并冠心病的关系

目的:探讨2型糖尿病患者微量清蛋白尿(MA)与冠心病的关系。方法:342例2型糖尿病患者根据冠状动脉(冠脉)造影结果分为合并冠心病组(106例)和不合并冠心病组(236例),测定2组24h尿清蛋白、血糖、糖化血红蛋白及血脂等相关指标;比较MA阳性组(139例)和MA阴性组(203例)冠心病的发病率及冠脉造影特点。采用多元Logistic回归方法分析2型糖尿病患者冠脉病变的危险因素。结果:糖尿病合并冠心病组MA水平明显高于不合并冠心病组(P<0.01),多元逐步回归分析也表明MA与糖尿病患者冠心病的发生显著相关(P<0.05);MA阳性组冠心病发病率明显高于MA阴性组(42.5%比23.2%,P<0.01);此外,与MA阴性组比较,MA阳性组重度血管狭窄、弥漫性和闭塞性病变更多(P0.05)。结论:MA是2型糖尿病患者冠脉病变的重要危险因素,且伴MA的2型糖尿病合并冠心病患者冠脉病变更严重。     

Association of diabetic retinopathy, ischemic heart disease, and albuminuria with diabetic treatment in type 2 diabetic patients

The management of type 2 diabetes has been a controversial issue. The objective of the present study was to estimate patients' characteristics, particularly diabetes treatment, associated with retinopathy, coronary heart disease, and microalbuminuria in an unselected population of 532 type 2 diabetic individuals from three communities. Questionnaires, clinic record review, and physical examination were used for the assessment of the three conditions. Fasting C-peptide was measured in all insulin-treated participants to establish type 2 diabetes. Patients with and without each of the studied complications were matched for age at diagnosis of diabetes and duration of diabetes. Univariate matched and multivariate conditional logistic regression analyses were used to estimate the independent association between each of the various factors studied and the three complications. Insulin treatment was the only factor independently associated with all three complications (odds ratios 3.3, 3.4, and 5.3 for diabetic retinopathy, coronary heart disease, and albuminuria, respectively). Glycosylated hemoglobin, uric acid, systolic blood pressure levels, and body mass index were also independently associated with at least one of the complications but not with all of them. Although no cause-effect relationship can be established from this cross-sectional design, insulin therapy seems to be a marker of severer diabetes from the time of diagnosis. Received: 14 March 1997 / Accepted in revised form: 4 September 1997     

Effect of glycemic control on periodontitis in type 2 diabetic patients with periodontal disease

Aims/Introduction

Diabetes mellitus and periodontitis are closely related. A huge number of reports has addressed the effect of periodontal intervention therapy on glycemic control, but no reports have addressed the effect of glycemic intervention therapy on periodontal disease in type 2 diabetic patients. The aim of this study was to examine the effect of improved glycemic control by glycemic intervention therapy on periodontitis in type 2 diabetic patients.

Materials and Methods

A total of 35 patients underwent intervention therapy to improve glycemic control without periodontal treatment. Glycohemoglobin (HbA_1c), high‐sensitivity C‐reactive protein (hs‐CRP), bleeding on probing (BOP), probing pocket depth (PPD) and intraoral community periodontal index (CPI) codes of the World health Organization (WHO) were examined at baseline, and 2 and 6 months after the intervention therapy to improve glycemic control.

Results

After the improvement of glycemic control, BOP lesions improved, but deep PPD lesions and WHO CPI codes did not improve. Subanalyses showed that effective glycemic control (average HbA_1c reduction 1.8%) improved BOP lesions, but did not affect deep PPD lesions and WHO CPI codes. In addition, high BOP lesions at baseline responded more effectively to glycemic intervention. Further analysis of CPI codes in all individual periodontal sites independent of WHO CPI codes in 35 patients showed that only gingival inflammation without a deep periodontal pocket improved after glycemic intervention.

Conclusions

Effective glycemic control improves BOP lesions in type 2 diabetic patients with periodontitis through ameliorating inflammation at the gingival sites of periodontal tissue. This trial was registered with the University Hospital Medical Information Network (no. UMIN000007670).     

Improving neuropathy scores in type 2 diabetic patients using micronutrients supplementation

Aim

The aim of the present study was to determine if micronutrients supplementation can improve neuropathy indices in type 2 diabetes.

Materials and methods

In this randomized, double-blind, placebo-controlled clinical trial, 75 type 2 diabetes patients were assigned to three treatment groups, receiving one of the following daily supplement for 4 months: Group MV: zinc (20 mg), magnesium (250 mg), vitamin C (200 mg) and E (100 mg); Group MVB: both of the above mineral and vitamin supplements plus vitamin B1 (10 mg), B2 (10 mg), B6 (10 mg), biotin (200 μg), B12 (10 μg) and folic acid (1 mg); Group P: placebo.

Results

67 patients completed the study. Neuropathic symptoms based on the MNSI questionnaire improved from 3.45 to 0.64 (p = 0.001) in group MVB, from 3.96 to 1.0 (p = 0.001) in group MV and from 2.54 to 1.95 in placebo group after 4 months. There was no significant difference between three treatment groups in MNSI examinations after 4 months supplementations. Over 4 months of treatment, patients showed no significant changes in glycemic control, capillary blood flow or electrophysiological measures in MV and MVB groups compared with placebo group.

Conclusions

These studies suggest that micronutrients supplementation might ameliorate diabetic neuropathy symptoms.     

Anaemia in patients with type 2 diabetes mellitus without nephropathy is related to iron deficiency

Background and aimsIron deficiency anaemia, although well reported in diabetic nephropathy, has not been well studied in type 2 diabetes patients in the absence of nephropathy. We studied the prevalence of anaemia and iron deficiency in type 2 diabetes patients without nephropathy.Material and methodsA total of 89 patients were selected for this study. 24 h urine protein less than 500 mg was used as the criteria to rule out diabetic nephropathy. Complete hemogram, iron profile and high sensitivity C reactive protein (hs CRP) levels were performed in each patient.Functional iron deficiency (FID) was defined as serum ferritin more than 100 μg/l with serum transferrin less than 20% and total iron deficiency state was defined as serum ferritin less than 100 μg/l.ResultsFifteen patients (16.8%)had anaemia out of which 13 had total iron deficiency and one each had functional iron deficiency and normal iron status respectively. Assessment of the iron status overall showed that 49 patients had TID (55.05%), 16 had FID (17.9%)and 24 (27.05%) had normal iron status. The hs-CRP was significantly higher in those with iron deficiency.ConclusionsThe present study found a high prevalence of iron deficiency anaemia in type 2 diabetic patients even in the absence of nephropathy. Most of the diabetic subjects also displayed an iron deficiency state the cause of which needs further investigation.     

老年糖尿病患者的胰岛功能变化

目的　探讨年龄对老年糖尿病患者胰岛分泌功能的影响。方法　 2型糖尿病患者 61 0例 ,按年龄分为 4组 :A组 <44岁 ;B组 45～ 59岁 ;C组 60～ 74岁 ;D组 75岁。并收集同期 NGT和 IGT患者共 1 92例作为对照。结果　 (1 )方差分析显示 ,随年龄增加老年糖尿病患者的体重、BMI、PINS、HOMA- IS明显增加 ,FBG、PBG、Hb A1 c显著降低 ,而 FINS、HOMA- IR、IAI各年龄组间差异无显著性。 (2 )协方差分析表明 ,仅控制 FBG的影响时 ,糖尿病患者各年龄组的 HOMA- IS仍有显著性差异 ,老年糖尿病患者的 HOMA- IS明显增加 ,而控制 BMI的影响后 ,各年龄组 HOMA- IS差异无显著性。 (3)糖尿病病程对 FINS、PINS、HOMA- IS的影响未达到显著性水平。 (4)决定 FINS的主要变量是 BMI,决定 PINS的主要变量是 BMI和 PBG。结论　老年糖尿病患者的胰岛素分泌功能主要决定于 BMI。年龄和糖尿病病程虽然对胰岛素分泌有负性影响但作用较弱 ,因此表现为伴随增龄的 BMI逐渐增加 ,胰岛素分泌功能也逐渐加强。校正 BMI的影响后 ,胰岛素分泌功能与年龄的关系不明显 ,但随糖尿病病程延长而逐渐减弱。     

2型糖尿病患者甲状腺功能的状态及其临床意义

目的 探讨2型糖尿病患者血清甲状腺激素水平的变化及其临床意义.方法 选择179例住院2型糖尿病患者,根据病情将其分为单纯血糖升高组（A组）58例,急性代谢紊乱组（B组）55例,严重合并症组（C组）66例,设正常对照组34例.所有患者入院后检测血清TT3、TT4、FT3、FT4、TSH,同时检测血糖、C肽和血脂水平.治疗后死亡18例,存活161例,存活者于出院前复查甲状腺激素水平.结果 女性患者的TSH水平显著高于男性（P〈0.01）,FT3,和FT4水平则低于男性（P〈0.05）;存活者治疗后各组TT3、FT3较治疗前有明显升高（P〈0.05或P〈0.01）,C组TSH治疗后有所下降（P〈0.05）;死亡者治疗前TT3、FT3水平明显低于存活者（P〈0.01）;相关分析显示,随着糖尿病患者FBG和HbAlc的升高,FT3、TSH呈下降趋势.结论 2型糖尿病患者甲状腺功能状态与血糖、年龄、性别、病程和疾病严重程度有关;监测血清甲状腺激素水平可作为2型糖尿病病情严重程度及估计预后的一项参考指标.     

2型糖尿病患者和一级亲属血浆胆囊收缩素的变化及意义

目的观察2型糖尿病患者(T2DM)及其一级亲属(FDRs)血浆胆囊收缩素(CCK)水平的变化并分析其相关因素。方法2003-062003-10将河北省人民医院的观察对象分为正常对照组(21例)、FDRs组(35例)、T2DM组(32例),检测受试者体重、空腹胰岛素、空腹血糖及血浆CCK水平变化,对比各组之间生化指标变化。以体重指数(BMI)=25kg/m~2为界限重新分组后进一步分析CCK与BMI的关系。结果血糖、BMI在对照组、FDRs组、T2DM组有逐渐升高趋势,但只在T2DM与对照组间差异有统计学意义(P<0·05)。CCK、胰岛素在对照组、FDRs组、T2DM组逐渐增高,且差异显著(均P<0·01)。以BMI为据分组后,FDRs组、T2DM组BMI>25kg/m~2的受试者胰岛素、CCK水平均明显高于同组BMI<25kg/m~2,血糖差异无显著性。结论T2DM及FDRs血浆CCK水平明显增高,其变化与胰岛素水平变化相似。肥胖可能与CCK、胰岛素水平变化有关。     

The prognosis for type 2 diabetic patients with heart disease. A 10-year observation study of 385 patients

The objective was to study the development and progression of heart disease in type 2 diabetic patients and to evaluate the influence of revascularisation procedures on its outcome. A 10-year observation study in 385 patients attending a hospital-based outpatient clinic was performed. A total of 156/385 patients developed myocardial infarction (n=68), angina (n=44), heart failure (n=34) or died (n=109). A high mortality was seen in patients with myocardial infarction (73%) and heart failure (71%), in contrast, to patients with angina (25%). Thirty patients had a coronary angiography because of angina, out of which 23 were revascularised. Four (17%) of patients with bypass surgery or angioplasty died compared with 57 (67%) of the patients with no intervention (p<0.001). The occurrence of myocardial infarction was associated with age (p<0.0001), and mean systolic (p<0.05) and diastolic (p<0.05) blood pressure and degree of albuminuria at entry (p<0.05). Heart failure was associated with age (p<0.0001), and mean HbA_1c levels (p<0.05), while angina was associated with age only (p<0.05). Death was associated with age (p<0.0001), diabetes duration (p<0.05), mean diastolic blood pressure (p<0.05), and degree of albuminuria at entry (p<0.0001). This study shows a high incidence of heart disease in patients with type 2 diabetes. The prognosis was better in patients who had had a revascularisation procedure. Thus, a more active attitude towards revascularisation may potentially improve the prognosis for type 2 diabetic patients with atherosclerotic heart disease.     

2型糖尿病患者血清胱抑素C与冠心病的关系

目的探讨2型糖尿病患者血清胱抑素C（CysC）与冠心病的相关性。方法行冠脉造影检查的106例2型糖尿病患者,根据有无并发冠心病分为糖尿病合并冠心病组（36例）和糖尿病无冠心病组（70例）,检测空腹血糖、餐后2小时血糖、糖化血红蛋白、三酰甘油、胆固醇、血肌酐、高敏C反应蛋白、CysC、同型半胱氨酸等。分析冠心病与CysC的相关性,并用二元Logistic回归方法分析CysC和其他相关因素与冠心病之间的相关性。结果糖尿病合并冠心病组CysC含量明显高于无冠心病组（P〈0．001）,应用二元Logistic回归方法进行分析,发现CysC、高敏C反应蛋白、餐后2小时血糖、收缩压、体重指数与冠心病相关。结论CysC是2型糖尿病患者发生冠心病的独立危险因素,检测CysC是预测2型糖尿病患者冠心病发病的有意义的指标。