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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Studies of the characteristics of coronary artery disease (CAD) in diabetic patients have shown conflicting results. Only 2 studies exploring the severity of CAD, specifically in type 1 diabetes, have been published, and neither of them has used computer-aided quantitative coronary angiography. This retrospective study comprised 64 (24 women and 40 men) type 1 diabetic patients and nondiabetic control subjects. To estimate the severity, extent, and overall "atheroma burden" of CAD, we used quantitative coronary angiographic-based segmental analysis of coronary angiograms. Type 1 diabetic patients had greater global severity (p < 0.001), global extent (p < 0.001), and global atheroma burden (p < 0.001) indexes than nondiabetic control subjects. Quantitative coronary angiographic-derived indexes of CAD were, on average, 1.4- to 4.3-fold higher in diabetic than in nondiabetic patients. These differences were particularly marked in women. We found that type 1 diabetic patients with a clinical indication for coronary angiography, especially women, have more severe, extensive, and distal type of CAD than individually matched nondiabetic control patients. Our findings, including a loss of sex difference for CAD among type 1 diabetic patients and a marked impact of type 1 diabetes in women, are not explained by established risk factors.
Am J Cardiol 2000 Nov 15
PMID:Angiographic severity and extent of coronary artery disease in patients with type 1 diabetes mellitus. 1107 3

Measures of endothelial dysfunction can be used to stratify risk in coronary artery disease and diabetes. Two studies are reviewed in which endothelial dysfunction was shown to be associated with an increased risk of cardiovascular events and to predict long term atherosclerotic disease. A study that showed reduced microvascular and macrovascular reactivity in subjects at risk for type 2 diabetes, and a study indicating that endothelial dysfunction precedes the development of microalbuminuria in type 1 diabetes are reviewed.
Can J Cardiol 2001 May
PMID:Use of measures of endothelial function to stratify risk. 1138 Dec 90

Despite the growing consensus that postprandial glucose levels provide a more accurate and valuable early marker of diabetes symptoms than fasting plasma glucose, the ability to forestall diabetic complications by managing postprandial hyperglycemia has not been proved. Patients who are not considered to have diabetes mellitus may have impaired glucose tolerance (and increased risk for developing cardiovascular disease), and targeting nonfasting glucose can reduce insulin requirements for patients with insulin-dependent diabetes mellitus (type 1 diabetes mellitus). The challenge now is to determine what fasting glucose levels merit intervention, when and how they should be determined, and who should measure them. After outlining the discrepancies and lack of consensus between measurement guidelines developed by different professional organizations, the author then reviews options for treating postprandial hyperglycemia, including prepackaged meals, alpha-glucosidase inhibitors, acarbose therapy, and fast-acting insulin preparations.
Am J Cardiol 2001 Sep 20
PMID:Postprandial hyperglycemia: implications for practice. 1157 24

The heart, like other organs, possesses an internal circadian clock. These clocks provide the selective advantage of anticipation, enabling the organ to prepare for a given stimulus, thereby optimizing the appropriate response. The heart in diabetes is associated with alterations in morphology, gene expression, metabolism and contractile performance. The present study investigated whether diabetes also alters the circadian clock in the heart. Insulin-dependent diabetes mellitus was induced in rats by treatment with streptozotocin (STZ; 65 mg/kg). STZ increased humoral (glucose and non-esterified fatty acids) and heart gene expression (myosin heavy chain beta, pyruvate dehydrogenase kinase 4 and uncoupling protein 3) markers of diabetes. The circadian patterns of gene expression of seven components of the mammalian clock (bmal1, clock, cry1, cry2, per1, per2 and per3), as well as three clock output genes (dbp, hlf and tef), were compared in hearts isolated from control and STZ-induced diabetic rats. All components of the clock investigated possessed circadian rhythms of gene expression. In the hearts isolated from STZ-induced diabetic rats, the phases of these circadian rhythms were altered (approximately 3 h early) compared to those observed for control hearts. The clock in the heart has therefore lost normal synchronization with its environment during diabetes. Whether this loss of synchronization plays a role in the development of contractile dysfunction of the heart in diabetes remains to be determined.
J Mol Cell Cardiol 2002 Feb
PMID:Alterations of the circadian clock in the heart by streptozotocin-induced diabetes. 1185 61

Amino acids are essential for body protein synthesis. Moreover, they can be used to produce energy within the cells. For protein turnover, normal plasma amino acid concentration enhances proteolytic suppression by insulin; furthermore, hyperaminoacidemia can stimulate protein synthesis both in the presence of baseline insulin and in hyperinsulinemic subjects with type 1 diabetes. In humans, the availability of amino acids represents a factor more important than insulin in maintaining protein synthesis in skeletal muscle. Among amino acids, branched-chain amino acids exert an anabolic effect on heart protein metabolism, and their uptake by the myocardium is increased by increasing their circulating concentrations. An important aspect of branched-chain amino acid metabolism in the heart (mainly in the ischemic heart) is that branch-chain amino acid infusion can diminish myocardial lactate; in this way, the inhibition of anaerobic energy phosphate caused by accumulation of lactate can be overridden. Plasma amino acid availability plays an important role in promoting protein synthesis and in energy production, both in peripheral skeletal muscle and in the myocardium.
Am J Cardiol 2004 Apr 22
PMID:Oral amino acid administration in patients with diabetes mellitus: supplementation or metabolic therapy? 1509 1

Data on the long-term prognosis of acute myocardial infarction (AMI) in young patients are limited. This study investigated long-term survival and risk predictors in a series of 108 consecutive patients </=40 years old who represented 4% of 2,644 patients who presented with AMI at a single center between June 1986 and April 1992. Four patients died soon after admission. The overall mortality rate of the 104 survivors was 25.5% at 15 years. The mortality rate was higher in patients who had type 1 diabetes mellitus (p = 0.01), long-term excessive alcohol intake (p = 0.035), peripheral arterial disease (p = 0.004), previous AMI (p = 0.04), anterior AMI (p = 0.01), and depressed left ventricular ejection fraction (p <0.0001). Cumulative survival rates (Kaplan-Meier analysis) at 1, 5, 10, and 15 years were 99%, 95%, 86%, and 75%, respectively. Event-free survival rates (death, AMI, coronary intervention, severe angina pectoris, malignant arrhythmias, and congestive heart failure) at the same times were 88%, 76%, 60%, and 43%, respectively. The strongest independent predictors of the long-term mortality rate were ejection fraction </=45% (odds ratio 4.4, 95% confidence interval 1.6 to 12.4, p <0.001) and peripheral arterial disease (odds ratio 45.9, 95% confidence interval 3.79 to 555, p <0.0001). These data suggest that the long-term prognosis and functional status of young patients who have AMI are not benign, especially when ejection fraction is decreased or peripheral atherosclerotic disease is present.
Am J Cardiol 2004 Oct 15
PMID:Long-term prognosis of patients having acute myocardial infarction when </=40 years of age. 1547 9

Patients with diabetes mellitus are at increased risk for repeat interventions and mortality after coronary angioplasty and stenting. The efficacy of sirolimus-eluting stents (SESs) to improve the outcomes of these patients is a focus of interest. In the first 1,407 patients treated with SESs at our institution, 492 were diabetic (insulin dependent diabetes mellitus [IDDM], n = 160 and non-insulin-dependent DM [NIDDM], n = 332). The in-hospital and 1- and 6-month clinical outcomes were compared with those of 915 patients without DM (non-DM). The baseline characteristics were similar, except for more women, obesity, previous myocardial infarction, coronary artery bypass grafting, and renal insufficiency in the DM group (p <0.001). Compared with non-DM patients, DM patients had higher in-hospital (p <0.05) and 1-month mortality (p = 0.02). IDDM patients had more in-hospital renal failure (p = 0.04) and Q-wave myocardial infarctions (1.6% vs 0%, p = 0.04) compared with NIDDM patients, and higher mortality (3.1% vs 0.8%, p = 0.04) and subacute stent thromboses (2.3% vs 0.5%, p = 0.07) than non-DM patients at 30 days. At 6 months, DM patients had a higher incidence of Q-wave myocardial infarction, target lesion revascularization-major adverse cardiac events, and composite of death and Q-wave myocardial infarction than non-DM patients (6.0% vs 2.7%, p = 0.01). Late outcomes between the IDDM and NIDDM groups were similar. Multivariate analysis showed diabetes and acute renal failure as independent predictors of target lesion revascularization-major adverse cardiac events. In conclusion, our data showed that, despite a reduction in repeat revascularization, coronary intervention with SESs in diabetic patients is limited by higher mortality at 1 month and a higher incidence of Q-wave myocardial infarction and target lesion revascularization-major adverse cardiac events at 6 months compared with non-DM patients. Careful surveillance is required in IDDM patients undergoing SES implantation.
Am J Cardiol 2005 Oct 15
PMID:Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients. 1621 45

Left ventricular (LV) diastolic dysfunction is a main feature of diabetic heart disease. The aim of this prospective study was to evaluate the influence of glycemic control on diastolic function in type 1 diabetes mellitus. Thirty-six normotensive (24-hour blood pressure <130/80 mm Hg) subjects with inadequately controlled (glycated hemoglobin >7%) type 1 diabetes, without clinically detectable heart disease, were enrolled. After the basal evaluation, insulin therapy was modified to improve glycemic control. Glycated hemoglobin, LV echocardiography, 24-hour blood pressure monitoring, and laboratory tests were repeated after 6 months in all patients and after 12 months in 27 patients. At the basal evaluation, LV anatomy and systolic function were normal in all, and diastolic function was impaired in 14 patients. After 6 months, the mean values of body mass index, 24-hour blood pressure, and LV anatomy and systolic function were unchanged; mean glycated hemoglobin was decreased (p < 0.001), and mean values of diastolic parameters were significantly improved. After 12 months, the mean values of all blood pressure, metabolic, and LV parameters were unchanged. Percent changes of diastolic parameters were inversely correlated with percent changes of glycated hemoglobin, considering changes from the basal to the 6-month evaluation, as well as changes from the 6- to the 12-month evaluation. In conclusion, in normotensive patients with type 1 diabetes, a close relation was found between glycemic control and LV diastolic function, which improves when glycemic control improves. Therefore, diastolic dysfunction can be prevented or reversed, at least partly, by tight glycemic control.
Am J Cardiol 2006 Jan 01
PMID:Effect of glycemic control on left ventricular diastolic function in type 1 diabetes mellitus. 1637 87

The present study sought to examine the occurrence of subclinical markers of cardiovascular risk and cardiac dysfunction with increasing disease duration in type 1 diabetes mellitus (DM). There are few data on subclinical cardiovascular abnormalities in type 1 DM. The study included 100 patients without any cardiovascular complaints (mean age 46.6 years, range 22 to 63), with a history of type 1 DM ranging from 2 to 36 years, and 75 age-matched controls. Standard 2-dimensional and Doppler echocardiography and pulse-wave tissue Doppler (tD) mapping of systolic (Sm) and diastolic (Em, Am) velocities (12 left ventricular [LV] segments and right-sided cardiac) were performed. An Em/Am ratio of <1 was considered to represent abnormal segmental diastolic function. Flow-mediated dilation (FMD) of the brachial artery, carotid intima media thickness (IMT) measurement, and extensive laboratory analysis were performed. The FMD was reduced, and IMT increased in patients (p < 0.01). Regional tD-derived diastolic and systolic functional abnormalities were observed within the first decade of the disease. Significant correlations were found between FMD and LV segments with tD-derived dysfunction, the duration of DM, and fibrinogen (p < 0.0001 for all). Stepwise regression analysis showed that FMD was the strongest predictor of abnormal segmental function (p < 0.0001). Data further presented as an analysis of tertiles by DM duration show an increasing occurrence of subclinical cardiac dysfunction and cardiovascular risk markers compared with age-matched controls. In conclusion, FMD is associated with abnormal segmental cardiac function in type 1 DM.
Am J Cardiol 2006 Jan 01
PMID:Flow mediated dilatation and cardiac function in type 1 diabetes mellitus. 1637 88

This study sought to determine the frequency of aspirin resistance in an ambulatory population of patients with type 1 diabetes mellitus (T1D) or type 2 diabetes mellitus (T2D). Platelet aggregation was assessed during the routine clinical evaluation of 203 ambulatory patients with diabetes (T1D, n = 92; T2D, n = 111) who were recommended aspirin for primary or secondary cardiovascular protection. Consecutively received laboratory samples were evaluated using the Ultegra Rapid Platelet Function Assay-ASA. Resistance to aspirin was detected in 18.7% of diabetic aspirin users, with similar rates in T1D (21.7%, p = 0.5) and T2D (16.2%, p = 0.6). Aspirin resistance was not related to age, glycohemoglobin, total cholesterol, or a history of cardiovascular disease. Female gender was a strong independent predictor of aspirin resistance in patients with T1D (p = 0.001). Platelet aggregation was correlated with high-density lipoprotein (HDL) cholesterol in the entire cohort (r = 0.21, p = 0.005) and in patients with T1D (r = 0.32, p = 0.04) or T2D (r = 0.21, p = 0.04), such that patients with low HDL cholesterol levels were more likely to be aspirin sensitive. The results suggest that aspirin can inhibit platelet aggregation in most patients with diabetes and is a reasonable first-line antiplatelet agent in patients with diabetes.
Am J Cardiol 2006 Feb 15
PMID:Comparison of aspirin resistance in type 1 versus type 2 diabetes mellitus. 1646 Oct 58


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