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

Measurement of the ankle-brachial index (ABI) can provide important information about the presence of subclinical atherosclerosis. Performing the ABI in the overall population is not feasible, but it can be used in a selected population. A simple prediction rule could be of much use to estimate the risk of an abnormal ABI. This was designed as an observational study in the setting of 955 general practices in The Netherlands. A total of 7454 patients aged > or = 55 years presenting with at least one vascular risk factor (smoking, hypertension, diabetes, and hypercholesterolemia) and no complaints of intermittent claudication were included. Patients were selected by the general practitioner during visiting hours and from medical records. Main outcome measures included the prevalence of PAD, defined as an ABI below 0.9, which was related to vascular risk factors using regression analyses on which the PREVALENT clinical prediction model was developed. The overall prevalence of PAD was 18.4%. Since the treatment of individuals with a history of coronary heart disease and cerebrovascular disease will not be influenced by the finding of asymptomatic PAD, these individuals were not taken into account for the development of the clinical prediction model. Analyses showed a significantly increased risk for PAD with increasing age, smoking, and hypertension. The clinical prediction model giving risk factor points per factor (age: 1 point per 5 years starting at 55 years; ever smoked: 2 points; currently smoking: 7 points; and hypertension: 3 points), showed a proportional increase of the PAD prevalence with each increasing risk profile (range: 7.0-40.6%). In conclusion, based on the PREVALENT clinical prediction model, the general practitioner is able to identify a high-risk population in which measurement of ABI is useful.
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PMID:A clinical prediction model for the presence of peripheral arterial disease--the benefit of screening individuals before initiation of measurement of the ankle-brachial index: an observational study. 1745 Oct 87

Peripheral artery disease is a global disease. When present, the occurrence of cardiovascular events and death rises. Patients suffering from peripheral artery disease belong to the high CV risk category. Based on the prevention recommendations when PAD is present, treatments with and without medicine are equally necessary. A change in life-style, blood pressure reduction, diabetes mellitus treatment, reaching the target cholesterol values, treatments with ACE inhibitor, statin and thrombocyte inhibitor all lower the occurrence of CV events. The early identification of the Doppler index can help in the early diagnosis of atherothrombosis.
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PMID:[Cardiovascular prevention with peripheral artery disease]. 1761 Nov 80

The authors have analyzed clinical and laboratory risk factors of 168 patients with PAD and 82 control persons. Among the patients the prevalences of diabetes, coronary heart disease (CHD), and cerebrovascular disease (CVD) were 30.4%, 39.9%, and 6.5%, respectively. 7.1% of the patients had CHD and CVD. Among patients with PAD and control persons, the prevalences of hypertension and current smoking were 76.2% vs 46.3% and 49.4% vs 28%. HDL-cholesterol and ApoA1 levels were significantly lower, while the triglycerides, fibrinogen, hsCRP, homocysteine, creatinine, uric acid levels, and white blood cell count as well as plasma viscosity were significantly higher in the patient group compared with the values of control persons. Among the PAD patients the diabetics and the smokers had further unfavourable significant differencies in the laboratory findings compared with the data of non-diabetics and non-smokers. Correlations were detected between the hsCRP level and the white blood cell count, the plasma viscosity and the fibrinogen level, respectively. Examining 16 selected risk factors the average risk factor count of the patients was 7.79. 118 patients had lipid-lowering, and 142 patients had antithrombotic therapy. Our results emphasize the necessity of the secondary prevention among PAD patients.
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PMID:[Risk status of patients with peripheral arterial disease (PAD)]. 1807 94

The pathophysiology of chronic wounds differ from that of acute wounds, and the etiology has various, for example decubitus, diabetes, insufficient venous circulation, radiation, et al. Now, for diabetic foot ulcers with/without PAD, internist (diabetologist, interventionalist), radiologist, vascular surgeon, orthopedic surgeon, dermatologist, plastic surgeon tackle this difficult problem respectively. But it is far from total medical care as a team medicine. In this mini-review, I want to introduce our project for diabetic foot ulcers and gangrene with /without PAD, presenting our cases. I shall be happy if I can be of any help to any neurogenic foot problems in Hansen's disease.
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PMID:[Therapy for diabetic foot ulcers or gangrene with/without PAD]. 1880 Jun 47

This is a 77-year-old diabetic woman with history of claudication (Rutherford Category 2). Due to fear of underestimating disease with ankle-brachial index in a person with diabetes and advancing age, a CT angiogram was performed. The right common iliac artery had aneurysmal disease (3.4 cm) and a thrombus of right internal iliac artery. There was also a 40% stenosis of right external iliac artery and a left subtotal internal iliac stenosis at the origin. Given it's non-invasive nature and high diagnostic accuracy, CTA is poised to become the noninvasive test of choice in patients with suspected PAD or in patients at risk for obstructive vascular disease.
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PMID:Right common iliac aneurysm by peripheral computed tomographic angiography. 1949 38

Carotid duplex ultrasonography (DUS) is routinely performed prior to coronary artery bypass graft surgery (CABG) on all patients > 65 years old because of the reported associated risk of finding concomitant carotid artery stenosis. Identifying risk factors that correlate with severe carotid stenosis may result in more cost-effective screening for patients with asymptomatic carotid artery disease prior to CABG. We performed a retrospective study to identify risk factors for significant carotid artery disease in patients scheduled to undergo CABG between March 2005 and March 2008 at the Massachusetts General Hospital. Patients with carotid stenosis >or= 70% identified by DUS (n = 50) were matched by age and sex to control patients who had < 50% stenosis (n = 50). Data were analyzed using the chi-squared test or analysis of variance as appropriate. Logistic regression was used to examine multivariate correlates of carotid stenosis. A total of 643 patients were screened to arrive at the patient cohorts described below. This produced a prevalence of 7.7% for significant (> 70%) carotid disease. The patient cohorts were predominantly male with no significant difference in the incidence of diabetes, hypertension, extent of coronary artery disease (CAD) (i.e. left main coronary artery disease (LMCA) and one, two-, or three-vessel CAD) or lipid abnormalities in the two groups. Univariate analysis identified the presence of peripheral arterial disease (PAD, p = 0.001), a cervical bruit (p < 0.0001), a prior neurological event (p = 0.020), and the presence of an abdominal aortic aneurysm (AAA; p = 0.046) as significant predictors of >or= 70% internal carotid artery stenosis. Logistic regression analysis revealed that the presence of a carotid bruit (p = 0.0068) and PAD (p = 0.0194) were associated with an increased risk of significant carotid artery disease. In conclusion, the presence of a carotid bruit or PAD predicts an increased likelihood of significant carotid artery disease in patients undergoing CABG. Unlike previous studies, LMCA or extent of CAD did not correlate with significant carotid artery disease. Using these predictive models, a prospective outcomes trial is required to validate these criteria.
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PMID:Correlates of carotid stenosis in patients undergoing coronary artery bypass grafting--a case control study. 1965 73

The number of diabetics will increase almost 70% in developed countries during the next 20 years. Peripheral arterial disease is a common and costly complication among diabetics. The incidence of cardiovascular disease (mortality and morbidity) due to atherosclerosis, is higher among patients with diabetes than in those without diabetes. Also, amputation incidence is 5-10-fold higher compared to nondiabetics. Due to neuropathy, infections and underlying PAD, ulcers in diabetic foot leads too often to amputation. Urgent evaluation of lower extremity circulation, treatment of infections and surgical procedures, including revisions and revascularizations, are often needed. Intensive management of diabetes, including glycaemic and platelet aggregation control, treatment of hypertension and dyslipidemia, as well as nonpharmacological interventions, decreases both micro- and macrovascular complications.
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PMID:Diabetic foot: prevention and interventions. 1979 27

We describe the prevalence and risk factors for PAD in Asian Malays with diabetes. A population-based study of 3,280 (78.7% response) Malay persons aged 40-80 years in Singapore was conducted. ABI was measured in all participants with a history of diabetes (N=634). PAD was defined to be present if ABI <or= 0.9. All participants had standardised interviews, clinical examinations and laboratory investigation for risk factor assessment. The crude prevalence of PAD was 10.4% (95% CI: 8.3%-13.0%). After age standardisation to the 2000 Singapore Census population, the prevalence was 5% (95% CI: 3.8-8.6). In multivariate analyses, the presence of PAD was associated with older age (OR 1.05; 95% CI: 1.01-1.09, per year increase), female gender (OR 4.18; 95% CI: 1.67-10.43), cigarette smoking (OR 2.55; 95% CI: 1.05-6.20), higher systolic blood pressure (OR 1.28; 95% CI: 1.13-1.45), a history of myocardial infarction (OR 3.69; 95% CI: 1.79-7.61) and stroke (OR 3.06 95% CI: 1.25-7.50). In this Asian Malay population with diabetes, we found a high prevalence of PAD.The major risk factors for PAD among persons with diabetes are similar to studies in Caucasian populations, suggesting that strategies aimed at controlling the modifiable factors may reduce the prevalence of PAD in Asian populations.
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PMID:Prevalence and risk factors for peripheral artery disease in an Asian population with diabetes mellitus. 2036 97

1-Deoxynojirimycin (DNJ) occurs in mulberry and other plants and is a highly potent glycosidase inhibitor reported to suppress blood glucose levels, thus preventing diabetes. Derivatization is required for quantification of DNJ upon use of spectral detection methods. Because of this difficulty, the DNJ contents of mulberry-based food products are rarely stated, even if DNJ is their active component. A simple, selective, and rapid method of high-performance anion-exchange chromatography with pulsed amperometric detection (HPAEC-PAD) to quantify DNJ in mulberry-based food products was developed. Stability testing of DNJ under heat treatment was also performed. A water extract of mulberry tea sample was subjected to HPAEC-PAD in a CarboPac MA1 column with a sodium hydroxide gradient. DNJ was clearly separated at a retention time of 7.26 min without interference and was selectively detected in the water extract. The detection limit was 5 ng. Heat stability studies suggested that DNJ was heat stable. HPAEC-PAD was not subject to interference, was highly selective for DNJ, and was superior to other high-performance liquid chromatography (HPLC) techniques in terms of sample preparation, resolution, and sensitivity. The method allowed simple, selective, and rapid analysis of DNJ in food matrices and might be useful for development of mulberry-based food products. Heat treatment could be an option for sterilizing mulberry-based products.
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PMID:Simple, selective, and rapid quantification of 1-deoxynojirimycin in mulberry leaf products by high-performance anion-exchange chromatography with pulsed amperometric detection. 2049 74

Patients suffering from both diabetes and PAD (peripheral arterial disease) are at risk of developing critical limb ischaemia and ulceration, and potentially requiring limb amputation. In addition, diabetes complicates surgical treatment of PAD and impairs arteriogenesis. Arteriogenesis is defined as the remodelling of pre-existing arterioles into conductance vessels to restore the perfusion distal to the occluded artery. Several strategies to promote arteriogenesis in the peripheral circulation have been devised, but the mechanisms through which diabetes impairs arteriogenesis are poorly understood. The present review provides an overview of the current literature on the deteriorating effects of diabetes on the key players in the arteriogenesis process. Diabetes affects arteriogenesis at a number of levels. First, it elevates vasomotor tone and attenuates sensing of shear stress and the response to vasodilatory stimuli, reducing the recruitment and dilatation of collateral arteries. Secondly, diabetes impairs the downstream signalling of monocytes, without decreasing monocyte attraction. In addition, EPC (endothelial progenitor cell) function is attenuated in diabetes. There is ample evidence that growth factor signalling is impaired in diabetic arteriogenesis. Although these defects could be restored in animal experiments, clinical results have been disappointing. Furthermore, the diabetes-induced impairment of eNOS (endothelial NO synthase) strongly affects outward remodelling, as NO signalling plays a key role in several remodelling processes. Finally, in the structural phase of arteriogenesis, diabetes impairs matrix turnover, smooth muscle cell proliferation and fibroblast migration. The review concludes with suggestions for new and more sophisticated therapeutic approaches for the diabetic population.
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PMID:Diabetes impairs arteriogenesis in the peripheral circulation: review of molecular mechanisms. 2054 27


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