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Query: UMLS:C0011860 (type 2 diabetes)
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OBJECTIVE--To investigate the relationship between asymptomatic hyperglycemia (IGT or newly diagnosed NIDDM) and atherosclerotic vascular disease. RESEARCH DESIGN AND METHODS--A representative cross-sectional population sample of 1431 subjects (511 men, 920 women; 65-74 yr old). Altogether, 312 men and 515 women had NGT, 84 men and 158 women had IGT, 33 men and 59 women had newly diagnosed NIDDM, and 82 men and 188 women had previously diagnosed NIDDM. Participation rate was 71%. Main outcome measures were prevalence rates of CHD, stroke, and intermittent claudication. RESULTS--There was no difference in the prevalence of definite or possible MI verified at hospital between subjects with asymptomatic hyperglycemia and NGT (15.5 vs. 13.3% in men, 6.3 vs. 5.3% in women). Men with asymptomatic hyperglycemia had 1.5 x higher prevalence of angina pectoris (29.4 vs. 19.3%, P less than 0.05), major Q-QS changes (21.1 vs. 12.0%, P less than 0.05), ischemic ECG changes (59 vs. 45%, P less than 0.05), and silent MI on ECG (14.8 vs. 7.9%, P less than 0.05) compared to men with NGT. Women with asymptomatic hyperglycemia had more often ischemic ECG changes compared to women with NGT (48.3 vs. 39.7%, P less than 0.05). There was no difference (NS) in the prevalence of verified stroke (3.5 vs. 4.6% in men, 2.7 vs. 2.5% in women) or claudication (7.0 vs. 7.7% in men, 4.6 vs. 4.3% in women) between subjects with asymptomatic hyperglycemia and NGT. In multiple logistic regression analyses, the association between risk factors and MI or ischemic ECG changes in subjects with asymptomatic hyperglycemia was not consistent. CONCLUSION--Elderly subjects with asymptomatic hyperglycemia (particularly men) tended to have an increased prevalence of CHD. Thus, asymptomatic hyperglycemia in the elderly is not a benign phenomenon but is associated with cardiovascular morbidity.
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PMID:Asymptomatic hyperglycemia and atherosclerotic vascular disease in the elderly. 150 3

Coronary heart disease in insulin-dependent (IDDM) and in non-insulin-dependent diabetes (NIDDM) is associated with lipid and lipoprotein changes favouring atherosclerosis. Whether lipid and lipoprotein abnormalities are associated also with peripheral vascular disease in both types of diabetes is largely unknown. Therefore, we studied lipid and lipoprotein levels and their association with claudication in a representative sample of diabetic and non-diabetic subjects in East Finland. Altogether 87 subjects had IDDM (43 men, 44 women), 264 subjects NIDDM (126 men, 138 women) and 120 subjects were non-diabetic controls (63 men, 57 women). Patients with IDDM had an increased level of HDL and HDL2-cholesterol and patients with NIDDM a decreased level of HDL and HDL2-cholesterol and an increased level of total, LDL and VLDL triglycerides than did non-diabetic subjects. Analyses in both types of diabetes by claudication status revealed that total and LDL-cholesterol and total and VLDL triglycerides tended to be higher and HDL and HDL2-cholesterol lower in those having claudication as compared to those without a claudication symptom. Similarly, total cholesterol/HDL-cholesterol ratio and LDL-cholesterol/HDL-cholesterol ratio were also more atherogenic in patients with claudication than in those without claudication. In conclusion, our results indicate that in both types of diabetes peripheral vascular disease is associated with lipid and lipoprotein abnormalities favouring atherosclerosis.
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PMID:Lipid and lipoprotein abnormalities in diabetic patients with peripheral vascular disease. 321 81

Exercise rehabilitation has traditionally been part of the management of patients with coronary artery disease, particularly in the recovery period from a myocardial infarction or after coronary artery bypass surgery. The benefits of exercise training and formal rehabilitation programs are not limited to patients with coronary artery disease, and special populations described in this article should be considered for rehabilitation services. Patients with PAD are frequently severely limited by claudication pain. Exercise rehabilitation is an effective means to improve exercise performance without the use of drugs or operation. In patients with NIDDM, an exercise program not only improves exercise performance (which is impaired as compared with age-matched controls) but also improves glucose metabolism and insulin sensitivity. Patients with left ventricular dysfunction have a severely limited peak exercise performance. In these patients, an exercise program can be conducted safely in a supervised setting and will result in a significant improvement in peak oxygen consumption.
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PMID:Special populations in cardiovascular rehabilitation. Peripheral arterial disease, non-insulin-dependent diabetes mellitus, and heart failure. 850 56

Temperature biofeedback (TBFB) is designed to alter cutaneous temperature in treated extremities by providing information corresponding to minor temperature fluctuations in the context of therapeutic structure and reinforcement. Toe TBFB may improve vascular flow and walking tolerance in patients with peripheral vascular disease. This case study documents improved walking in a diabetes patient with lower extremity complications, and suggests TBFB might increase lower extremity temperature and blood flow volume pulse in uncomplicated diabetes. Ankle-brachial index (ABI) and walking function were assessed in a 60-year-old woman with type 2 diabetes and intermittent claudication, before and after five sessions of TBFB applied to the ventral surface of the great toe. Toe temperature increased during feedback phases but not during baseline phases. Improvements were seen in ankle-brachial index, walking distance, walking speed, and stair climbing. This case indicates the need for extended and controlled study of TBFB for improved vascular and ambulatory function in diabetic claudication.
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PMID:Thermal biofeedback for claudication in diabetes: a literature review and case study. 1023 10

This cross-sectional study presents the first normative data on pedometer-determined ambulatory activity, defined as steps/day, in 160 (98 males, 62 females; age=52.4 +/- 5.3 years; BMI=32.3 +/- 5.7) free-living individuals with type 2 diabetes. Participants took 6662 +/- 3077 steps per day, less than that reported in nondiabetic samples and more than that reported for samples living with more restrictive chronic conditions including claudication, joint replacement, chronic obstructive lung disease, and chronic heart failure. Steps/day and BMI were inversely and significantly correlated (r=-0.27, P<0.01). Further, there was a significant difference between BMI categories (from normal weight to obesity class III) with regard to steps/day (F=2.96, P<0.05). The difference was most apparent between the highest obesity classes (II and III) and normal weight categories. This data is useful for sample comparison purposes. In addition the standard deviation or variance estimates can be used to calculate samples sizes for intervention efforts. Objective quantification of ambulatory activity via simple and inexpensive pedometers permits researchers and practitioners to easily screen for level of activity along a continuum. This study opens the door for future research and clinical applications including identifying threshold values related to important health outcomes and evaluating incremental change due to various interventions in this population.
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PMID:Pedometer-determined ambulatory activity in individuals with type 2 diabetes. 1185 95

The paper deals with pharmacotherapeutical approaches to decreasing hematocrit in order to improve macro and microcirculation in arteries of lower limbs of type 2 diabetes patients. The study included 37 patients with diabetic angiopathy, all of whom had inoperable changes to arteries. In order to decrease hematocrit and cause haemodilution, we used 10 % solution of hydroxyethyl starch. Indications for inclusion in the study were carried out in close cooperation with a vascular surgeon. We applied hydroxyethyl starch according to a predetermined scheme. Using normovolemic and hypervolemic haemodilution, we decreased hematocrit to 0.41-0.42. Patients underwent a treadmill examination at the beginning of the study and then repeatedly during the course of study, when we measured the claudication distance to quantify, the effects of decreased hematocrit. The results show that the effect is most pronounced after 6 weeks, when hematocrit fell from a baseline of 0.435 to 0.421 (p < 0.01) and claudication distance increased to 51% (also significant). On average the claudication distance rose from 55.7 m to 84.6 m (p < 0.01). In the following weeks (after the sixth week of the study), the studied parameters changed only insignificantly (p > 0.05).
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PMID:Pharmacotherapeutical approaches to decreasing hematocrit and increasing claudication distance in diabetic patients with peripheral vascular disease. 1660 68

The purpose of this paper is to highlight specific considerations in the medical management of women with type 2 diabetes mellitus (T2DM). T2DM, a significant source of morbidity and mortality, has become an ever growing epidemic within the United States. Although it is well understood that diabetes can significantly increase the risk for microvascular and macrovascular complications, there has been limited research examining the differential impact of these complications on men and women. Women, in particular, are subject to especially high risk for the development of myocardial infarction (MI), claudication, and stroke and are disproportionately afflicted by cardiovascular, cerebrovascular, and peripheral vascular disease. There is new evidence that tight glycemic control and earlier initiation of insulin therapy can improve outcomes and thereby reduce the risk for development of both macrovascular and microvascular complications of the disease. Although there are many commonalities in the treatment of men and women, women with diabetes have several unique issues, including the possible effects of therapy on reproductive health, fetal health, breastfeeding, potential interactions with hormonal contraceptives, and effects on bone health, that should be considered when determining a therapeutic approach. This paper presents evidence-based treatment strategies for reducing the risk of diabetes-associated complications overall and cardiovascular disease in particular through glycemic control. Special attention is paid to the selection of antidiabetic agents that are best suited to the unique needs of women.
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PMID:Type 2 diabetes among women: clinical considerations for pharmacological management to achieve glycemic control and reduce cardiovascular risk. 1832 Nov 76

Empirical evidence from the Diabetes Control and Complication Trial (DCCT) suggests that maintaining normal glycemic control can prevent both micro vascular and macro vascular diseases in persons diagnosed with type 2 diabetes mellitus (T2DM) (DCCT, 1993). Adults with T2DM are also more likely to have hypertension (73% [HTN]) and patients with both are 2 to 4 times more likely to develop diabetic complications compared with the general population (CDC, 2005). The purpose of this descriptive study was to 1) describe the quality of diabetes care received by Gullah families who participated in the Project SuGar research study; and 2) compare the Gullah's quality of care to the national sample in the Center for Disease Control (CDC) Diabetes Report Card using the two indicators of blood pressure and HbA1c. This was a secondary analysis from a parent study that compared selected data to the CDC Diabetes Report Card, the National Health and Nutrition Examination Survey (NHANES III), and the Behavioral Risk Factor Surveillance System (BRFSS). Socio-demographic and clinical data were obtained from 1,057 research participants (N = 1,057). Overall, when compared to the national sample in the CDC Report Card, the HbA1c greater than 9.5% mg/dL was higher among the Gullahs, (30.2% vs. 18%), and blood pressure greater 140/90 mmHg was lower (29% vs. 34%) among the participants. Almost half of the Gullahs (45.9%) self-reported neurovascular complications such as foot pain, claudication, and renal complications of kidney infection and dialysis (7.3%). The Gullah study participants are at risk for diabetes-related complications. Results suggest a quality gap in diabetes care and it suggests health disparities in outcome measures as well. Optimal care that is consistent with clinical guidelines could have a significant impact on decreasing complications and health disparities.
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PMID:The quality of diabetes care to Gullah families of South Carolina. 1939 50

The risk of peripheral vascular disease (PVD) is increased in diabetic patients, occurs earlier and is often more severe and diffuse. Endothelial dysfunction, vascular smooth muscle cell dysfunction, inflammation and hypercoagubility are the key factors in diabetic arteriopathy. The presence of PVD, apart from its increased risk of claudication, ischemic ulcers, gangrene and possible amputation, is also a marker for generalized atherosclerosis and a strong predictor for cardiovascular ischemic events. However, despite the recognition that PVD is associated with increased ischemic event rates and death, particularly in diabetic patients, this specific manifestation of systemic atherosclerosis is largely underdiagnosed and undertreated. In type-1 diabetes, early intensive insulin treatment reduces both microvascular (nephropathy, retinopathy and neuropathy) and macrovascular complications of diabetes (DCCT/EDIC study). In type-2 diabetes, UKPDS showed that tight glucose control reduces micro- and macrovascular complications, when therapy is started early after diagnosis and that early intervention has long lasting protective effects. However recently published trials (ADVANCE, ACCORD and VADT) pointed out that lowering glycemic targets to nearly normal glycaemia does not further reduce cardiovascular events in individuals with longstanding type 2 diabetes and that hypoglycaemia is to be avoided in individuals with ischemic heart disease. Finally, the small but important Steno-2 trial demonstrated that to significantly reduce peripheral vascular disease, ischemic events and mortality in type-2 diabetes, intensified multifactorial treatment of all modifiable risk factors is needed. Therefore, to prevent micro- and macrovascular complications, like PVD, in type-1 and type-2 diabetes, intensive therapy, targeting glycemia and all other modifiable cardiovascular risk factors, should be initiated as soon after diagnosis as possible and maintained in a safe way throughout life.
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PMID:Diabetes and peripheral vascular disease. 1999

Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective.
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PMID:[Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure]. 2198 1


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