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Prevention of macrovascular complications in patients with type 2 diabetes mellitus: Review of cardiovascular safety and efficacy of newer diabetes medications

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World Journal of Diabetes 2019年第6期10卷 324-332页

作者： Ravi Kant Kashif M Munir Arshpreet Kaur Vipin Verma Division of Endocrinology Diabetes and Nutrition Medical University of South Carolina/Anmed Campus Anderson SC 29621 United States Division of Endocrinology Diabetes and Nutrition University of Maryland School of Medicine Baltimore MD 21201 United States Division of Endocrinology Diabetes and Nutrition Sinai Hospital Baltimore MD 21215 United States Department of Medicine Medical University of South Carolina/Anmed Campus Anderson SC 29621 United States

Lack of conclusive beneficial effects of strict glycemic control on macrovascular complications has been very frustrating for clinicians involved in care of patients with diabetes mellitus (DM). Highly publicized controversy surrounding cardiovascular (CV) safety of rosiglitazone resulted in major changes in United States Food and Drug Administration policy in 2008 regarding approval process of new antidiabetic medications, which has resulted in revolutionary data from several large CV outcome trials over the last few years. All drugs in glucagon-like peptide-1 receptor agonist (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitor classes have shown to be CV safe with heterogeneous results on CV efficacy. Given twofold higher CV disease mortality in patients with DM than without DM, GLP-1 RAs and SGLT-2-inhibitors are important additions to clinician’s armamentarium and should be second line-therapy particularly in patients with T2DM and established atherosclerotic CV disease or high risks for CV disease. Abundance of data and heterogeneity in CV outcome trials results can make it difficult for clinicians, particularly primary care physicians, to stay updated with all the recent evidence. The scope of this comprehensive review will focus on all major CV outcome studies evaluating CV safety and efficacy of GLP-1 RAs and SGLT-2 inhibitors.

关键词： Newer antidiabetic medications Glucagon-like peptide-1 receptor agonist Sodium-glucose cotransporter-2 inhibitors Type 2 diabetes mellitus macrovascular complications Cardiovascular outcome trials Major cardiovascular events Heart failure Prevention of heart disease

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Changes of macrovascular endothelial ultrastructure and gene expression of endothelial nitric oxide synthase in diabetic rats

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Chinese Medical Journal 2004年第8期117卷 1165-1169页

作者：陆颖理胡申江沈周俊邵一川 Department of Endocrinology Sir Run Run Shaw Hospital HangzhouChina Departments of Internal Medicine First Affiliated Hospital Medical College of Zhejiang University Hangzhou310003China Departments of Internal Medicine and Urology First Affiliated Hospital Medical College of Zhejiang University Hangzhou310003China

Background The most intimidatory pathological changes in patients with DM are cardiovascular illnesses, which are the major causes of death in diabetic patients and are far more prevalent than in nondiabetics because of accelerated atherosclerosis In this study, we tried to clarify the changes in macrovascular endothelial ultrastructure and in the gene expression of endothelial nitric oxide synthase (eNOS)mRNA in diabetic rats KH*2/5DMethods The study was conducted on 52 of 10-week old Sprague Dawley (SD) rats with body weight of (320±42) g SD rats were divided into: experimental group treated with a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg), (male, n=20, diabetes mellitus (DMM)); female, n=12, diabetes mellitus female (DMF)) and control group (male, n=10, diabetes mellitus male control (DMMC); female, n=10, diabetes mellitus female control (DMFC)) Four weeks after treatment, half of the rats were sacrificed; the remainders were sacrificed ten weeks after treatment One part of the abdominal aortic sample was stored under glutaraldehyde (volume fraction ψ B = 2 5 %) After the process of chemical fixation, chemical dehydration, drying and conductivity enhancement, all samples were observed and photographed using scanning electron microscopy (Leica-Stereoscan 260, England) The other part of the abdominal aortic sample was treated with liquid nitrogen and the expression of eNOSmRNA was assessed by semi-quantitative RT-PCR Results The aortic lumen of both experimental groups adsorbed much more debris than that of either control group The endothelial surfaces of diabetic rats were coarse, wrinkled and protuberant like fingers or villi The vascular endothelial lesions of diabetic male rats were very distinct after 4 weeks, and as obvious as those at 10 weeks The vascular endothelial lesions of diabetic female rats were not severe at 4 weeks and only became marked after 10 weeks In both males and females, the

关键词： diabetes mellitus macrovascular ultrastructure eNOSmRNA

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Effects of long-term monotherapy with glimepiride vs glibenclamide on glycemic control and macrovascular events in Japanese Type 2 diabetic patients

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Journal of Diabetes Mellitus 2014年第1期4卷 33-37页

作者： Hirohisa Onuma Kouichi Inukai Masaki Watanabe Yoshikazu Sumitani Toshio Hosaka Hitoshi Ishida Third Department of Internal Medicine Kyorin University School of Medicine Tokyo Japan Watanabe Medical Clinic Hiroshima Japan

We investigated whether long-term glimepiride (GP) monotherapy improves insulin resistance and exerts a beneficial effect on beta cell function, as compared with glibenclamide (GC). One hundred Japanese Type 2 diabetic patients were randomly assigned to the GP (n = 50) or the GC (n = 50) group. During a 5-year monitoring period, patients received the indicated SU monotherapy, while changes in SU doses were allowed as needed to maintain HbA1C below 7.0%. The GC group, in parallel with fasting insulin, showed a rapid homeostatic model assessment (HOMA)-R increase and maintained a high HOMA-R level. In contrast, HOMA-R in the GP group decreased continuously, from 2.9 at baseline to 1.8 at study completion. In the GC group, HOMA-b was markedly increased in the first 6 months, then gradually decreased through 18 months. While the HOMA-β elevation in the GP group was more moderate than that in the GC group, HOMA-β levels were maintained with a slight decrease. The cumulative macrovascular disease outcome was 1 for the GP and 7 for the GC group, showing a significant difference. These results suggest that glimepiride monotherapy markedly improved HOMA-R with moderate insulin stimulation, which may account for the difference in macrovascular disease development as compared with the group receiving glibenclamide.

关键词： Glibenclamide Glimepiride macrovascular Events HOMA-R/β

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Evaluation of serological indicators of intravenous thrombolysis bridge stent combined with aspiration embolectomy for intracranial macrovascular infarction

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Journal of Hainan Medical University 2018年第22期24卷 39-43页

作者： Ming-Juan Ge Qin Zhao Department of Neurology Xianyang Hospital of Yan'an UniversityXianyangShaanxi Province712000China Life Science Laboratory of Xizang Minzu University XianyangShaanxi Province712082China

Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.

关键词： Intracranial macrovascular infarction Intravenous thrombolysis bridge stent Aspiration embolectomy Inflammatory response Nerve function

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Obstructive sleep apnea:Overlooked comorbidity in patients with diabetes

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World Journal of Diabetes 2024年第7期15卷 1448-1460页

作者： Eric D Tenda Joshua Henrina Jin H Cha Muhammad R Triono Ersananda A Putri Dahliana J Aristy Dicky L Tahapary Division of Respirology and Critical Care Department of Internal MedicineFaculty of Medicine Universitas Indonesia-Cipto Mangunkusumo HospitalDKI JakartaJakarta Pusat 10430Indonesia Head of Research Group Artificial Intelligence and Digital Health Indonesian Medical Education and Research InstituteFaculty of Medicine University of IndonesiaDKI JakartaJakarta Pusat 10430Indonesia Division of Endocrinology Metabolism and DiabetesDepartment of Internal MedicineFaculty of Medicine Universitas Indonesia-Cipto Mangunkusumo HospitalDKI JakartaJakarta Pusat 10430Indonesia

In this review article,we explore the interplay between obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2DM),highlighting a significant yet often overlooked *** delve into the pathophysiological links between OSA and diabetes,specifically how OSA exacerbates insulin resistance and disrupts glucose *** research examines the prevalence of OSA in diabetic patients and its role in worsening diabetes-related *** the importance of comprehensive management,including weight control and positive airway pressure therapy,the study advocates integrated approaches to improve outcomes for patients with T2DM and *** review underscores the necessity of recognizing and addressing OSA in diabetes care to ensure more effective treatment and better patient outcomes.

关键词： Obstructive sleep apnea Type 2 diabetes mellitus macrovascular Microvascular Weight loss Positive airway pressure

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Do we need to screen every patient in intensive care unit for diabetes in community with high prevalence of diabetes?

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World Journal of Diabetes 2019年第3期10卷 137-139页

作者： Taru Dutt Rahul Kashyap Salim Surani Department of Neurology Research Mayo Clinic Rochester MN 55902 United States Department of Anesthesiology and Peri-operative Medicine Critical Care IMP Mayo Clinic Rochester MN 55902 United States Health Science Center Texas A and M University Corpus Christi TX 78404 United States

Diabetes mellitus (DM) is marked as global health care challenge with almost 10% of the United States population being diagnosed with DM. A sizeable percentage of patients are oblivious of their disease, in spite of easily accessibility knowledge about its early signs and symptoms and rapid diagnostic modalities. Critically ill patients with undiagnosed DM are likely to have an increased mortality as compared to intensive care unit (ICU) patients with diagnosed DM. DM may have adverse effect on ICU patients causing organ failure and complications. Early Screening of patients at the risk of developing disease may prevent long term complications. Early screening and management may be beneficial as controlled DM patients have similar morbidity as non DM patients in ICU. An intense glycaemic and blood pressure control improves retinopathy and albuminuria, but may not affect the macrovascular outcomes.

关键词： Diabetes mellitus Intensive care unit Microvascular macrovascular Diabetes screening

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Assessment of the correlation between serum prolidase and alpha-fetoprotein levels in patients with hepatocellular carcinoma

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World Journal of Gastroenterology 2015年第22期21卷 6999-7007页

作者： Sevil Uygun Ilikhan Muammer Bilici Hatice Sahin Ayse Semra Demir Akca Murat Can Ibrahim Ilker Oz Berrak Guven M Cagatay Buyukuysal Yucel Ustundag Department of Internal medicine Bülent Ecevit University Faculty of Medicine Department of Family Medicine Bülent Ecevit University Faculty of Medicine Department of Biochemistry Bülent Ecevit University Faculty of Medicine Department of Radiology Bülent Ecevit University Faculty of Medicine Department of Biostatistic Bülent Ecevit University Faculty of Medicine Bülent Ecevit University Faculty of Medicine Department of Gastroenterology

AIM: To determine the predictive value of increased prolidase activity that reflects increased collagen turnover in patients with hepatocellular carcinoma(HCC).METHODS: Sixty-eight patients with HCC(mean age of 69.1 ± 10.1), 31 cirrhosis patients(mean age of59.3 ± 6.3) and 33 healthy volunteers(mean age of51.4 ± 12.6) were enrolled in this study. Univariate and multivariate analysis were used to evaluate the association of serum α-fetoprotein(AFP) values with HCC clinicopathological features, such as tumor size,number and presence of vascular and macrovascular invasion. The patients with HCC were divided into groups according to tumor size, number and presence of vascular invasion(diameters; ≤ 3 cm, 3-5 cmand ≥ 5 cm, number; 1, 2 and ≥ 3, macrovascular invasion; yes/no). Barcelona-clinic liver cancer(BCLC)criteria were used to stage HCC patients. Serum samples for measurement of prolidase and alphafetoprotein levels were kept at-80 ℃ until *** levels were measured spectrophotometrically and AFP concentrations were determined by a chemiluminescence immunometric commercial diagnostic ***: In patients with HCC, prolidase and AFP values were evaluated according to tumor size, number,presence of macrovascular invasion and BCLC staging classification. Prolidase values were significantly higher in patients with HCC compared with controls(P <0.001). Prolidase levels were significantly associated with tumor size and number(P < 0.001, P = 0.002,respectively). Prolidase levels also differed in patients in terms of BCLC staging classification(P < 0.001).Furthermore the prolidase levels in HCC patients showed a significant difference compared with patients with cirrhosis(P < 0.001). In HCC patients grouped according to tumor size, number and BCLC staging classification, AFP values differed separately(P = 0.032,P = 0.038, P = 0.015, respectively). In patients with HCC, there was a significant correlation(r = 0.616; P< 0.001) between prolidase and AFP values in

关键词： Alpha-fetoprotein Hepatocellular carcinoma Prolidase Cirrhosis macrovascular invasion

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Evidence for current diagnostic criteria of diabetes mellitus

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World Journal of Diabetes 2016年第17期7卷 396-405页

作者： Ritesh Kumar Lakshmana Perumal Nandhini Sadishkumar Kamalanathan Jayaprakash Sahoo Muthupillai Vivekanadan Department of Endocrinology and Metabolism Jawaharlal Institute of Postgraduate Medical Education and Research

Diabetes mellitus is a non-communicable metabolicderangement afflicting several millions of individuals globally. It is associated with several micro and macro-vascular complications and is also a leading cause of mortality. The unresolved issue is that of definition of the diagnostic threshold for diabetes. The World Health Organization and the American Diabetes Asso-ciation(ADA) have laid down several diagnostic criteria for diagnosing diabetes and prediabetes based on the accumulating body of *** review has attempted to analyse the scientific evidence supporting the justification of these differing criteria. The evidence for diagnosing diabetes is strong, and there is a concordance between the two professional bodies. The controversy arises when describing the normal lower limit of fasting plasma glucose(FPG) with little evidence favouring the reduction of the FPG by the ADA. Several studies have also shown the development of complications specific for diabetes in patients with prediabetes as defined by the current criteria though there is a significant overlap of such prevalence in individuals with normoglycemia. Large multinational longitudinal prospective studies involving subjects without diabetes and retinopathy at baseline will ideally help identify the threshold of glycemic measurements for future development of diabetes and its complications.

关键词： Diabetes Prediabetes Post glucose Microvascular complications macrovascular complications

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