Home Healthc Nurse. 2009 Jan; 27(1): 7-11
Nero-Reid V, Alexander-Knight A
Continue reading about Research on patient-provider communication and management of diabetes.
Am J Ther. 2008 Dec 23;
Chahwala V, Arora R
Data from the Centers for Disease Control and Prevention indicate that the prevalence of diabetes is increasing steadily and is coupled with a rise in obesity. Studies such as the Nurses’ Health Study show that even slight glucose abnormalities, namely insulin resistance, increase the risk of myocardial infarctions, strokes, other cardiovascular disease, and mortality. Insulin resistance was found to accelerate atherosclerosis, inflammation, the onset of diabetes, cardiovascular disease, obesity, hypertension, chronic kidney disease, and dyslipidemia. Adiponectin was found to have potent antiinflammatory and antiatherosclerotic effects. Similarly, studies indicate that peroxisome proliferators-activated receptor agonists have the potential to treat obesity, diabetes, and atherosclerosis. From a preventive standpoint, it was shown that intensive glucose control reduces long-term cardiovascular risk. This intensive control approach included the use of thiazolidinediones (TZDs; troglitazone, pioglitazone, and rosiglitazone), which were demonstrated to have vascular and nonglycemic effects beyond glucose-lowering. A drawback of using TZDs is peripheral fluid retention. The DREAM study showed that participants with impaired fasting glucose or impaired glucose tolerance who are free from cardiovascular disease benefited significantly from taking 8 mg rosiglitazone per day. The ADOPT study provided evidence that rosiglitazone is more efficient at controlling glycemic loss and maintaining low glycosylated hemoglobin levels than metformin and glyburide. Data from the CHICAGO study indicate that the progression of carotid artery intima-media thickness, a marker of atherosclerosis and a surrogate end point for cardiovascular disease, was slowed more with pioglitazone than glimepiride in a racially diverse population of men and women with diabetes mellitus type 2. Overall, investigators have shifted from a focus on hyperglycemia to a multifactorial approach to risk management in diabetes. This multifactorial approach includes intensive glycemic control, lifestyle intervention, and intensive management of comorbid (dyslipidemia, hypertension, early renal disease) conditions. The implementation of a regular, rigorous exercise and diet program greatly decreased insulin resistance and allowed far more patients to reach their glycosylated hemoglobin goals. Studies with atrovastatin show significant improvement in cardiovascular risk factors in patients with diabetes and hypertension. Short-term studies provide support for the administration of a combination of TZD + sulfonylureas in patients with diabetes mellitus type 2. Likewise, studies have shown that a combination of TZDs + metformin reduced the risk of myocardial infarction. Finally, dipeptidyl peptidase-IV inhibitors and glycolipoprotein-1 analogs show potential for helping prevent the deterioration of glucose metabolism in early diabetes mellitus type 2.
Continue reading about Cardiovascular Manifestations of Insulin Resistance.
Am J Ther. 2008 Dec 23;
Ravipati G, Aronow WS, Ahn C, Alappat RM, McClung JA, Weiss MB
We investigated in 306 patients, mean age 57 +/- 10 years, with diabetes mellitus (202 patients) or hypertension (179 patients), whether treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ARBs) reduced the incidence of new stroke or new myocardial infarction (MI) or death. At 39-month follow up, new stroke or new MI or death developed in 49 of 228 patients (21%) treated with ACE inhibitors or ARBs and in 33 of 78 patients (42%) treated without angiotensin-converting enzyme inhibitors or ARBs (P = 0.0001). Stepwise Cox regression analysis showed that significant independent predictors of the time to development of new stroke or new MI or death were 1) use of angiotensin-converting enzyme inhibitors or ARBs (risk ratio, 0.21), 2) diabetes (risk ratio, 4.01), 3) left ventricular hypertrophy (risk ratio, 6.71), 4) prior stroke (risk ratio, 4.00), and 5) prior MI (risk ratio, 3.69).
Crit Care Med. 2009 Dec 26;
Stegenga ME, Florquin S, de Vos AF, van der Poll T
OBJECTIVE:: Thiazolidinediones (TZDs) are synthetic agonists for the peroxisome proliferator-activating receptor-gamma receptor and are currently in use as oral glucose-lowering drugs. TZDs have immune-modulating effects in vitro and in vivo. Because patients with type 2 diabetes have an increased risk for pneumonia, we evaluated the influence of ciglitazone, a TZD, on markers of inflammation and outcome during pneumonia caused by Streptococcus pneumoniae. DESIGN:: In vivo animal study and in vitro study. SETTING:: University research laboratory. SUBJECTS:: Female C57Bl/6 mice and murine alveolar macrophage-like MH-S cells. INTERVENTIONS:: C57Bl/6 mice were inoculated with 10 colony-forming units of S. pneumoniae intranasally. The following interventions were studied: 1) vehicle at t = 0; 2) ciglitazone 5 mg/kg intraperitoneally at t = 0; and 3) ciglitazone 5 mg/kg intraperitoneally at t = 0 and 24 hours. Mice were killed at either 24 or 48 hours after infection. Additionally, phagocytosis and killing of S. pneumoniae by MH-S cells were assessed in vitro. MEASUREMENTS AND MAIN RESULTS:: Single treatment with ciglitazone reduced bacterial loads at 24 hours but not at 48 hours, whereas repeated ciglitazone treatment did diminish bacterial loads at 48 hours. After 24 hours, cytokine levels in lung homogenate were lower in single-dose ciglitazone-treated mice; however, after 48 hours, there was no difference in lung cytokines between any of the experimental groups. Repeated ciglitazone treatment was associated with less pulmonary inflammation, as judged by histologic examination. On both time points, there was no difference in plasma cytokine levels or lung myeloperoxidase levels between experimental groups. In an additional experiment, ciglitazone treatment (given once daily) tended to reduce mortality. Ciglitazone did not influence phagocytosis or killing of S. pneumoniae by murine alveolar macrophages. CONCLUSIONS:: Ciglitazone reduces bacterial outgrowth and local inflammation at least during the early stage of S. pneumoniae pneumonia in mice.
Med Sci Monit. 2009 Jan; 15(1): CR5-9
Yaturu S, Humphrey S, Jain SK, Landry C
Background: Metabolic syndrome is associated with decreased physical activity and increased incidence of diabetes. Bone Mineral density (BMD) is positively associated with physical activity. Lower BMD is a risk factor for bone fractures. Whether subjects with metabolic syndrome alone show early signs of lower BMD and osteoporosis similar to those present in diabetic is not known.
Material/Methods: This cross-sectional study in male veterans examined the BMD in 3458 non-diabetic men and 735 men with type 2 diabetes. In addition, the BMD changes in non-diabetic men without any metabolic syndrome were compared with non-diabetic men with metabolic syndrome as established by the criteria of the Adult Treatment Panel III.
Results: BMD of hip was significantly lower and incidence of osteoporosis higher in diabetic subjects compared with age and body mass index (BMI) matched non-diabetic subjects. BMD of AP spine was significantly higher in diabetic subjects compared with non-diabetics but similar when subjects were matched for BMI. Men with metabolic syndrome alone had higher osteoporosis and lower BMD of hip compared with those without metabolic syndrome.
Conclusions: The BMD of hip is lower in diabetics compared with age and BMI-matched non-diabetic men, and its level is similar in age and BMI-matched diabetics and non-diabetic men with metabolic syndrome. This suggests that both diabetes and metabolic syndrome are associated independently with higher osteoporosis and lower BMD of hip and are risk factors for increased incidence of hip fractures in men.
