Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 361 Chinese patients with type 2 diabetes were studied for the association between peripheral vascular disease (PVD) and the insertion/deletion polymorphism involving a 287-bp alu repeat sequence at intron 16 of the angiotensin-converting enzyme (ACE) gene. The patients were divided into PVD (+) (n=45) and PVD (-) (n=316) based on an ankle-brachial index <0.9 and > or =0.9, respectively. Polymerase chain reaction was used to identify gene polymorphism. Results showed that D allele frequency in the patients without and with PVD was 31.8% and 33.3%, respectively (p=NS). The prevalence rates of II, ID and DD genotypes in the PVD (-) group were 45.6%, 45.3% and 9.2%, respectively; and the respective values for the PVD (+) group were 44.4%, 44.4% and 11.1% (p=NS). Prevalence rates of PVD in genotypes II, ID, and DD were 12.2%, 12.3% and 14.7%, respectively (p=NS). In logistic regression analyses, the unadjusted and adjusted odds ratios for DD vs II and ID vs II genotypes for PVD were not statistically significant. The respective adjusted odds ratios were 1.88 (0.56-6.29) and 1.33 (0.63-2.80). In conclusion, there was not a significant association between the ACE genotype and PVD in Chinese type 2 diabetic patients. However, a type 2 error can not be ruled out.
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PMID:Lack of association between angiotensin-converting enzyme gene polymorphism and peripheral vascular disease in type 2 diabetic patients in Taiwan. 1241 32

Diabetes mellitus increases the risk for hypertension and associated cardiovascular diseases, including coronary, cerebrovascular, renal and peripheral vascular disease. The risk for developing cardiovascular disease is increased when both diabetes and hypertension co-exist; in fact, over 11 million Americans have both diabetes and hypertension. These numbers will continue to climb, internationally, since the leading associated risk for diabetes development, obesity, has reached epidemic proportions, globally. Moreover, the frequent association of diabetes with dyslipidemia, as well as coagulation, endothelial, and metabolic abnormalities also aggravates the underlying vascular disease process in patients who possess these comorbid conditions. The renin-angiotensin-aldosterone system (RAS) and arginine vasopressin (AVP) are overactivated in both hypertension and diabetes. Drugs that inhibit this system, such as ACE inhibitors and more recently angiotensin receptor antagonists (ARBs), have proven beneficial effects on the micro- and macrovascular complications of diabetes, especially the kidney. The BRILLIANT study showed that lisinopril reduces microalbuminuria better than CCB therapy. Numerous other long-term studies confirm this association with ACE inhibitors including the HOPE trial. Furthermore, the European Controlled trial of Lisinopril in Insulin-dependent Diabetes (EUCLID) study, showed that lisinopril slowed the progression of renal disease, even in individuals with mild albuminuria. In fact, there are now five appropriately powered randomized placebo-controlled trials to show that both ACE inhibitors and ARBs slow progression of diabetic nephropathy in people with type 2 diabetes. These effects were shown to be better than conventional blood pressure lowering therapy, including dihydropyridine CCBs. In patients with microalbuminuria, ACE inhibitors and ARBs reduce the progression of microalbuminuria to proteinuria and provide a risk reduction of between 38 and 60% for progression to proteinuria. This is important since microalbuminuria is known to be associated with increased vascular permeability and decreased responsiveness to vasodilatory stimuli. Recently, increased AVP levels have been lined to microalbuminuria and hyperfiltration in diabetes. The microvascular and macrovascular benefits of ACE inhibition, ARBs and possible role of AVP antagonists in diabetic patients will be discussed, as will be recommendations for its clinical use.
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PMID:Treatment of the diabetic patient: focus on cardiovascular and renal risk reduction. 1243 44

Foot problems are the most common cause of hospital admission in patients with type II diabetes mellitus (DM). Poor muscle perfusion of lower extremities is thought to be the major component in the pathogenesis of foot problems. We used a well-established and non-invasive radionuclide method to objectively evaluate the anterior tibial muscle perfusion of 120 type II DM patients without symptoms/signs of peripheral vascular disease (PVD) in the lower extremities. The patients were separated into groups according to the duration of the disease and condition of blood sugar control. Meanwhile, 60 normal control males with a matched age distribution were also included for comparison. The muscle perfusion were of significant difference between (1) 120 type II DM patients and 60 normal controls, (2) 72 patients with good sugar control and 48 patients with poor sugar control, as well as (3) 64 patients with short disease duration and 56 patient with long disease duration. Based on the objective radionuclide method, we concluded that the muscle perfusion in the lower extremities of type II DM patients without symptoms/signs of PVD is significantly decreased and related to the duration of the disease and condition of blood sugar control.
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PMID:Prediction of asymptomatically poor muscle perfusion of lower extremities in patients with type II diabetes mellitus using an objective radionuclide method. 1248 75

The incidence of type II diabetes mellitus is rising rapidly, both in the United States and worldwide. Often, the disease is first diagnosed by cardiologists during an evaluation for coronary or peripheral vascular disease. It is therefore important to understand the basic pathophysiology of insulin resistance, its role in the development of type II diabetes, and its association with accelerated atherosclerosis. An appreciation of when to begin testing for diabetes, how to make the diagnosis, and what treatment strategy to choose is imperative. While there are as yet little randomized data to guide hypoglycemic therapy as it pertains to reducing cardiovascular risk, evidence is accumulating that treatment of diabetes will have an impact on cardiovascular outcomes.
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PMID:Oral treatments for type II diabetes in patients with cardiovascular disease. 1249 34

The most common and clinically important complication in adults with diabetes is cardiovascular disease (CVD), which includes coronary heart disease, peripheral vascular disease, and stroke. Both type 2 diabetes and the insulin resistance syndrome are associated with a marked increase in the risk for CVD. The metabolic syndrome and the closely related insulin resistance syndrome have recently been recognized as important disorders, each being associated with an increase in CVD risk even in the absence of glucose intolerance. Given the significant public health burden of CVD, risk reduction has emerged as a significant clinical challenge for most practitioners. Diabetes and the insulin resistance syndrome are closely related disorders, with insulin resistance being more than a key pathogenic defect in type 2 diabetes. Even in the absence of glucose intolerance, these 2 disorders are both associated with a number of distinct pathologic findings, including hypertension, atherogenic dyslipidemia, a prothrombotic environment, and significant vascular and hemodynamic abnormalities that result from endothelial cell dysfunction. Insulin resistance is now recognized to be closely associated with the development of each of these risk factors. This article uses a case-based approach to discuss the unique features of insulin resistance and type 2 diabetes considered to be key contributors to CVD risk. A systematic approach to both evaluation and management is proposed, with priority given to therapies of demonstrated clinical benefit. Because of its critical and central role in the development of many CVD risk factors, targeted treatment of insulin resistance will also be discussed as such therapy may prove to be a critical component of care in years to come.
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PMID:The metabolic syndrome, type 2 diabetes, and cardiovascular disease: understanding the role of insulin resistance. 1251 Jul 88

Activation of the peroxisome proliferator-activator receptor gamma (PPARgamma) improves insulin resistance and glycemic control in patients with diabetes. As PPARgamma is expressed in the endothelial cell, we have investigated the effect of troglitazone, a PPARgamma activator, on the endothelial function in people with type 2 diabetes in a 12-week, prospective, randomized, double-blinded clinical trial. We studied 87 type 2 diabetic patients who were divided into 3 groups. Group A consisted of 27 patients with recently diagnosed diabetes and no clinical manifestations of macrovascular disease; group B, 29 patients with long-term diabetes and no clinically evident macrovascular disease; and group C, 31 diabetic patients with documented macrovascular disease (cardiovascular, cerebrovascular, or peripheral vascular disease). High-resolution ultrasound images were used to measure the flow-mediated dilation (FMD, endothelium-dependent) and nitroglycerin-induced dilation (NID, endothelium-independent) in the brachial artery. Laser Doppler perfusion imaging was used to measure vasodilation in the forearm skin in response to iontophoresis of 1% acetylcholine (Ach, endothelium-dependent) and 1% sodium nitroprusside (NaNP, endothelium-independent). The plasma concentrations of von Willebrand factor (vWF), soluble intercellular adhesion molecule (sICAM), and soluble vascular cell adhesion molecule (sVCAM) were also measured as indicators of endothelial cell activation. The FMD improved in the troglitazone-treated patients in group A (7.72 +/- 3.4 v 5.27 +/- 2.0, P <.05 [exit visit v baseline, percent of increase in brachial artery diameter, mean +/- SD]). The fasting insulin level also improved in this group (15.6 +/- 10 v 19.7 +/- 10, P <.05) and was strongly correlated to changes in FMD (r = -.73, P <.01). No changes were found in the FMD or the fasting insulin levels in the troglitazone-treated patients in groups B or C. The NID was not changed by troglitazone treatment in any of the 3 groups. Also, no differences were found in the microcirculation reactivity measurements or in the biochemical markers of endothelial dysfunction in all 3 groups. A small, but significant, improvement of the FMD was found in placebo-treated patients in group B, probably related to the low FMD levels at baseline in the patients (5.40 +/- 3.0 v 4.36 +/- 2.4, P <.05). We concluded that troglitazone treatment for 12 weeks improved endothelial function in the macrocirculation of patients with recently diagnosed type 2 diabetes and no clinical evidence of macrovascular disease. This improvement was strongly associated with the improvement of fasting plasma insulin concentrations.
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PMID:The effects of troglitazone, an insulin-sensitizing agent, on the endothelial function in early and late type 2 diabetes: a placebo-controlled randomized clinical trial. 1260 28

Diabetes mellitus is one of the main threats to human health in the 21st century. The prevalence of diabetes ranges from nearly 0 per cent in New Guinea to 50 per cent in the Pima Indians. The past two decades have seen an explosive increase in the number of people diagnosed with diabetes world-wide. The World Health Organization (WHO) estimated that there were 135 million diabetics in 1995 and this number would increase to 300 million by the year 2025. India leads the world today with the largest number of diabetics in any given country. In the 1970s, the prevalence of diabetes among urban Indians was reported to be 2.1 per cent and this has now risen to 12.1 per cent. Moreover, there is an equally large pool of individuals with impaired glucose tolerance (IGT), many of whom will develop type 2 diabetes mellitus in the future. Diabetes can affect nearly every organ system in the body. The Chennai Urban Population Study (CUPS) showed that prevalence of diabetic retinopathy, nephropathy and neuropathy is not very different in urban south Indians compared to that reported among Europeans. However, coronary artery disease (CAD) occurs with increased prevalence and at a younger age (premature CAD), while peripheral vascular disease showed the opposite trend, with lower prevalence compared to that reported in Europeans. There is an urgent need for lifestyle intervention, with the incorporation of a healthy diet, an increase in physical activity and weight reduction as a means of preventing diabetes in those who are in the prediabetic stage and thus prevent the diabetes epidemic, which is looming large in our country.
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PMID:The changing scenario of the diabetes epidemic: implications for India. 1267 25

Smokers are insulin resistant, exhibit several aspects of the insulin resistance syndrome, and are at an increased risk for type 2 diabetes. Prospectively, the increased risk for diabetes in smoking men and women is around 50%. Many patients with type 1 and type 2 diabetes mellitus are at risk for micro- and macrovascular complications. Cigarette smoking increases this risk for diabetic nephropathy, retinopathy, and neuropathy, probably via its metabolic effects in combination with increased inflammation and endothelial dysfunction. This association is strongest in type 1 diabetic patients. The increased risk for macrovascular complications, coronary heart disease (CHD), stroke, and peripheral vascular disease, is most pronounced in type 2 diabetic patients. The development of type 2 diabetes is another possible consequence of cigarette smoking, besides the better-known increased risk for cardiovascular disease. In diabetes care, smoking cessation is of utmost importance to facilitate glycemic control and limit the development of diabetic complications.
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PMID:Cigarette smoking and diabetes. 1270 97

The prognostic importance of electrocardiographic ventricular repolarization QT parameters (maximum rate-corrected QT interval-QTcmax, QT interval dispersion-QTd, and QTcd), in relation to other risk markers, on cardiovascular and cardiac mortality, and on total fatal or nonfatal cardiovascular events, was evaluated prospectively in 471 type 2 diabetic outpatients. During a median follow-up of 57 months (range: 2-84), 121 (25.7%), patients died, 44 (36.3% of them) from cardiovascular causes and 106 (22.5%) fatal or nonfatal cardiovascular events were observed. In Cox proportional hazards multivariate analysis, both QTd and QTcmax were independent predictors of cardiovascular and cardiac mortality (hazard ratio [HR]: 1.34, 95% confidence interval [95% CI]: 1.12-1.59, for each 10-ms increments in QTd and HR: 1.17, 95% CI: 1.03-1.21 for 10-ms increments in QTcmax, for cardiovascular mortality). They were also predictors of total fatal or nonfatal cardiac and cardiovascular events (HR: 1.18, 95% CI: 1.05-1.33 for QTd and HR: 1.09, 95% CI: 1.04-1.15 for QTcmax). Additional independent prognostic markers for total cardiovascular events were the presence of previous cardiac disease, cerebral or peripheral vascular disease, age, male gender, known diabetes duration, heart rate, and serum triglycerides. Excluding patients with prior cardiac disease did not change significantly the prognostic performance of QTd but decreased that of QTcmax. In conclusion, QT interval parameters give additional prognostic information in patients with type 2 diabetes mellitus, beyond that obtained from traditional risk factors. QT interval dispersion seems a better prognostic marker than maximum QT interval, particularly in patients without previous cardiac diseases.
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PMID:Prognostic value of QT interval parameters in type 2 diabetes mellitus: results of a long-term follow-up prospective study. 1281 Feb 39

Hypertension is a nutritional-hygienic disease. Long-term caloric intake in excess of energy expenditures, chronic supraphysiological intake of dietary sodium, excessive alcohol consumption, and psychosocial stressors all contribute to the development of hypertension throughout the world. Elevated BP, particularly systolic BP, has been linked to multiple adverse clinical outcomes including stroke, heart failure, myocardial infarction, renal insufficiency/failure, peripheral vascular disease, retinopathy, dementia, and premature mortality. These undesirable clinical outcomes are typically, although not invariably, preceded by pressure-related target-organ injury such as left ventricular hypertrophy, renal insufficiency and proteinuria. The relation of BP and CKD and, in turn, the prevention of CKD or forestalling its progression by hypertension treatment, will be the focus of this manuscript. In hypertensive persons with reduced kidney function and/or proteinuria, lowering BP with multidrug therapy that is inclusive of pharmacologic modulators of the renin-angiotensin-aldosterone-kinin system is an effective strategy to forestall the progressive loss of kidney function. The totality of data support low therapeutic BP targets for persons with proteinuria >1 g/d. Nevertheless, in persons with CKD, even those with proteinuria below the dipstick positive level (approximately 300 mg/d or urine protein to creatinine ratio of 0.22), aggressive BP control also may be warranted because of the high risk of nonrenal cardiovascular disease. Multiple antihypertensive drugs will be required in the vast majority of patients with diabetes and/or reduced kidney function to attain BP goal. Renin-angiotensin system (RAS) modulator therapy is indicated among persons with diabetes mellitus and CKD. Available data support the use of angiotensin receptor blockers in persons with type 2 diabetes and overt nephropathy for preservation of kidney function. Among persons with type I diabetes with or without overt nephropathy, type 2 diabetes without overt nephropathy and in nondiabetic CKD, the available clinical data support the use of angiotensin-converting enzyme inhibitors as the RAS modulator of choice. Low therapeutic target BP levels <130/80 mmHg in persons with type 2 diabetes mellitus also appear warranted based on available data mostly for reducing the risk of nonrenal cardiovascular disease and overall mortality.
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PMID:Prevention of hypertension and its complications: theoretical basis and guidelines for treatment. 1281 10


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