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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Therapeutic footwear with cushioned insoles was supplied to 50 diabetic patients with severe peripheral neuropathy and/or peripheral vascular disease (age 59(SD 12) years, known duration of diabetes 17(7) years), 36 of whom had a history of foot ulceration. A follow-up examination was carried out 25(14) months later, except in 8 patients who died from conditions unrelated to their foot lesions, and 1 patient who died from sepsis due to upper limb amputation. Among the surviving 41 patients, intercurrent foot lesions during follow-up occurred in significantly fewer (42%) of the 26 who had worn the shoes regularly than of the 15 who had worn the shoes irregularly (87%, p less than 0.01). At follow-up, only 15% of the 41 patients were being treated for foot-lesions, compared with 78% of these 41 patients before cushioned shoes were provided. It is concluded that the availability of therapeutic shoes with cushioned insoles for diabetic patients at risk of foot lesions decreases the morbidity due to the diabetic foot syndrome.
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PMID:How effective is cushioned therapeutic footwear in protecting diabetic feet? A clinical study. 214 90

Patients with multilevel atherosclerotic disease represent a difficult surgical challenge. This report is a retrospective review of 46 patients who were treated using a combination of iliac transluminal angioplasty and infrainguinal reconstruction. There were 42 male and 4 female patients with an average age of 62 years (range: 40 to 74 years). Follow-up ranged from 1 month to 10 years (mean: 27.3 months). These patients had multiple health problems typical of patients with peripheral vascular disease, including coronary artery disease (67%), hypertension (61%), and diabetes mellitus (42%); 80% of the patients were smokers. Forty-one patients were treated for rest pain and/or tissue loss, while five were treated for incapacitating claudication. Forty-three patients had a combination of angioplasty and distal bypass, while 3 patients had a form of femoral endarterectomy. Iliac artery pressure gradients were reduced from 35.4 +/- 4 mm Hg preangioplasty to 0.6 +/- 0.3 mm Hg postangioplasty. The procedures were well tolerated with no mortality and four serious complications. Vascular laboratory studies showed an improvement in the mean ankle-brachial index from 0.35 +/- 0.03 preoperatively to 0.71 +/- 0.04 postoperatively (p less than 0.05). Life-table analysis revealed a 72% 5-year primary patency rate, with a 93% 5-year limb salvage. Eight patients required a secondary procedure to maintain limb salvage. Five patients underwent amputation, three due to early graft thrombosis and two due to late graft failure. We conclude that combined iliac angioplasty and infrainguinal reconstruction is a safe and effective method for managing the patient with severe multilevel atherosclerotic disease.
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PMID:Combined transluminal angioplasty and infrainguinal reconstruction in multilevel atherosclerotic disease. 214 99

The prevalence of microalbuminuria was assessed in 149 consecutive, newly-diagnosed and untreated patients with Type 2 diabetes, 129 of whom were followed up for 1 year, with at least three urine specimens being obtained during this period. At initial presentation, 39 (26%) patients had a urinary albumin to creatinine ratio (ACR) of greater than 2.5 mg mmol-1 and compared with patients who had a normal ACR, they were older (64 (11) (SD) vs 58 (11) yr, p less than 0.002), with higher random blood glucose (14.4 (4.5) vs 12.3 (4.4) mmol l-1, p less than 0.02) and glycosylated haemoglobin (13.0 (3.1) vs 11.3 (2.7)%, p less than 0.01) concentrations. An elevated ACR was also associated with a higher systolic blood pressure (149 (22) vs 140 (22), p less than 0.05) and the presence of macrovascular disease, particularly peripheral vascular disease (p less than 0.001), with this association persisting after adjustment for the effect of age. Ten patients reverted to normal albumin excretion on improving blood glucose control, this group having a significantly higher glycosylated haemoglobin concentration at initial presentation than the group with a persistently elevated ACR (14.4 (2.5) vs 12.0 (3.0)%, p less than 0.05). The 21 (16%) patients with a persistently elevated ACR from diagnosis of Type 2 diabetes were older than those with normal albumin excretion throughout (64 (7) vs 58 (10) yr, p less than 0.02) and it is probable that these patients have abnormal albumin excretion secondary to established renal pathology.
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PMID:The natural history and associations of microalbuminuria in type 2 diabetes during the first year after diagnosis. 214 87

Serum levels of angiotensin-converting enzyme (ACE) were measured in 53 patients with type II (non-insulin-dependent) diabetes (25 without ophthalmologic complications, 20 with background retinopathy, and eight with proliferative retinopathy) and in 33 healthy nondiabetic subjects. Diabetic subjects were excluded if they had hypertension, ischemic heart disease, peripheral vascular disease, or an elevated urine albumin level. After an overnight fast, blood was taken for determination of ACE, blood glucose, glycosylated hemoglobin (HbA1), and C peptide levels. Data were analyzed according to the nonpaired Student's t test and linear regression analysis. Levels of ACE were significantly elevated in the whole diabetic group as compared with control subjects (334.0 U/L +/- 97.0 vs 250.5 U/L +/- 85.5, P less than .001). This elevation was more marked in those diabetics with background retinopathy (344.6 U/L +/- 96.8, P less than .001) and proliferative retinopathy (357.3 U/L +/- 93.2, P less than .01); no significant difference was found between ACE levels of diabetics without complications and those of control subjects. No correlation was found between ACE levels and HbA1, blood glucose, or C peptide values. We conclude that ACE levels are elevated in type II diabetes, chiefly in patients with retinopathy. This finding may reflect microvascular damage caused by secretion of ACE by the vascular endothelial cells.
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PMID:Elevated serum levels of angiotensin-converting enzyme in patients with diabetic retinopathy. 215 94

Exercise is a cornerstone in the management of diabetes, yet many persons with diabetes fail to participate in basic physical activity due to secondary diabetic complications. This inactivity can lead to disuse syndrome--a deterioration of functional capacity. Disuse syndrome, coupled with diabetes, can produce significant physiological problems and further disability. This review provides the health educator with information about the pathology and role of exercise for persons with diabetic complications. Examples of exercise to minimize disuse syndrome are given for individuals with peripheral vascular disease, retinopathy, neuropathies, and nephropathy.
Diabetes Educ
PMID:Exercise options for persons with diabetic complications. 218 7

Current methodology for the in vitro determination of aortic and large artery stiffness is reviewed and involves three approaches: (1) the estimation of distensibility by pulse wave velocity measurement; (2) the estimation of distensibility from the fractional diameter change of a given arterial segment by imaging techniques (e.g., angiography, Doppler ultrasound) against pressure change; (3) the estimation of compliance by determining volume change against pressure change in the arterial system during diastolic runoff from the Windkessel model of the circulation. Clinical correlations may be summarized as follows: (1) age: a progressive stiffening on aging due to structural changes up to the seventh decade; (2) sex: a lower degree of stiffness in women until menopause, after which they show an accelerated stiffening, catching up with men by the seventh decade; (3) atherosclerosis: a dissociation between degree of stiffness and extent of atherosclerosis, with a suggestion that in advanced atherosclerosis the extensive calcification may lead to increased stiffness; (4) coronary disease: an inconsistent correlation by pulse wave velocity studies, but a strongly positive correlation by angiographic study of the aortic root; (5) diabetes mellitus: a significant correlation by pulse wave velocity study, particularly in the presence of advanced peripheral vascular disease; (6) hypertension (both essential and elderly patients with systolic): positive correlation but only referable to the stiffening effect of a higher mean arterial pressure (i.e., unrelated to structural changes), although an experimental study did show a loss of compliance unrelated to the mean arterial pressure level in baboons with chronic renovascular hypertension.
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PMID:Aortic and large artery stiffness: current methodology and clinical correlations. 218 12

We note that diabetes mellitus and hypertension coexist at a greater rate than would be indicated by chance. The combination of these two chronic disorders increases the risk of and mortality from such conditions as peripheral vascular disease, stroke, and nephropathy. Despite the importance of high blood pressure in diabetes, the underlying physiological mechanisms in this combined condition are poorly understood. This review explores the epidemiology, cardiovascular risks, pathophysiology and evaluation of this condition as well as outlining a general approach to treatment in the hypertensive diabetic.
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PMID:Clinical implications of hypertension in the diabetic patient. 219 Jun 11

Several investigations have assessed the relationship between glycemic control and complications in diabetes mellitus. Key evidence is reviewed that supports the beneficial effects of "tight" blood glucose control. Pertinent animal data show that good blood glucose control is associated with less retinopathy and nephropathy and fewer congenital anomalies in offspring. Short-term studies in humans show similar trends in microvascular complications and pregnancy. Similarly, peripheral neuropathy may be lessened with lower blood glucose. Although no studies have demonstrated a reduction in atherosclerotic disease with improved glycemic control, dyslipidosis frequently improves, which should reduce the risk for coronary heart and peripheral vascular disease.
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PMID:Tight blood glucose control: is it worth it? 219 4

To investigate the possible etiologic factors of late onset seizures of unknown origin, 50 consecutive patients whose seizures started after age 50 and who had a normal CT, were screened. The seizures in this group were generalized in 70% and infrequent. The hypothesis that late-onset seizures of unknown origin were frequently due to microinfarcts, was evaluated by comparing the frequency of arterial hypertension, coronary heart disease, peripheral vascular disease, carotid bruits, diabetes mellitus and smoking in these patients with appropriate control groups. The results showed that the frequencies of these cardiovascular risk factors were similar to those of sex and age-matched controls and much lower than in a comparable series of patients whose seizures followed a stroke, or patients with stroke but not seizures. These data suggest that subclinical cerebrovascular disease is probably not a frequent etiology of late-onset epilepsy of unknown origin. The cause of these seizures remains to be elucidated.
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PMID:Seizures of unknown origin after the age of 50: vascular risk factors. 223 42

We investigated the incidence of silent myocardial ischemia and infarction as assessed by dipyridamole thallium scintigraphy in 30 diabetic patients with peripheral vascular disease and without clinical suspicion of coronary artery disease. Seventeen patients (57%) had thallium abnormalities, with reversible thallium defects compatible with ischemia in 14 patients (47%) and evidence of prior, clinically silent myocardial infarction in 11 patients (37%). Thallium abnormalities were most frequent in patients with concomitant hypertension and cigarette smoking (p = 0.001). These results suggest that unsuspected coronary artery disease is common in this particular group of patients with diabetes mellitus.
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PMID:Silent myocardial ischemia and infarction in diabetics with peripheral vascular disease: assessment by dipyridamole thallium-201 scintigraphy. 223 59


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