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)

The obese patient with osteoarthritis, arterial hypertension, type 2 diabetes, hyperuricaemia, mixed dyslipidaemia and moderate renal insufficiency is commonly seen in clinical practice. Besides life-style changes, the optimal management of such patient requires the use of a polymedication therapy whose choice should take into account not only possible pharmacological synergistic effects to warrant the best protection, but also contra-indications due to the presence of comorbidities or the risk of drug interferences.
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PMID:[Drug selection guided by known and newly diagnosed comorbidities in a multi-risk patient]. 1911 97

The study included 105 patients (63 men and 42 women) aged 34-84 (mean 63.8 +/- 5.1) years with ischemic renal disease (IRD). All of them underwent routine medical examination, blood homocysteine was measured in 30 patients. IRD was always associated with other manifestations of disseminated atherosclerosis and cardiovascular risk factors. Plasma homocysteine increased with decreasing glomerular filtration rate (GFR) that was especially low in patients with isolated systolic arterial hypertension, smoking, and type 2 diabetes. In 34.3% of the patients, IRD associated with other chronic conditions and in 49% with cardiovascular complications and/or the development of terminal renal insufficiency. It is concluded that IRD is characterized by a large number of concomitant manifestations of disseminated atherosclerosis and a high probability of irreversible deterioration of renal functions related to cardiovascular risk factors. IRD may be associated with other chronic renal diseases and a high risk of cardiovascular complications and terminal renal insufficiency.
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PMID:[Ischemic renal disease (atherosclerotic renovascular hypertension), a clinical variant of disseminated atherosclerosis and a cause of chronic renal insufficiency]. 1914 Apr 63

It has been recently reported that a considerable portion of diabetic patients with renal insufficiency show normoalbuminuria. As little is known about normoalbuminuric renal insufficiency in the Asian population, we examined its prevalence and clinical characteristics in Korean type 2 diabetic patients. We studied 562 patients with type 2 diabetes from Seoul National University Hospital. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula and the degree of albuminuria was evaluated by spot urine albumin-creatinine ratio. Of 562 patients, 151 (26.9%) patients had renal insufficiency (eGFR <60 mL/min/1.73 m(2)). Among them, 44 (29.1%) patients had normoalbuminuria. After excluding the patients using renin-angiotensin system (RAS) inhibitors, the prevalence of normoalbuminuric renal insufficiency was 35.3% (18 of 51 patients). Compared with micro- and macroalbuminuric renal insufficiency, normoalbuminuric renal insufficiency was associated with the female predominance, shorter duration of diabetes, lower prevalence of diabetic retinopathy, and lower prevalence of using antihypertensive drugs except RAS inhibitors. The prevalence decreased progressively with an increase in the duration of diabetes and an increase in the severity of retinopathy. Normoalbuminuric renal insufficiency was prevalent in Korean type 2 diabetic patients. The association with a shorter duration of the diabetes and a lower prevalence of retinopathy suggests that it might be an early stage renal complication.
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PMID:The clinical characteristics of normoalbuminuric renal insufficiency in Korean type 2 diabetic patients: a possible early stage renal complication. 1919 67

The prevalence of end-stage renal disease (ESRD) is uprising in the paralleled with the increase of chronic kidney disease (CKD) patients. Diabetic nephropathy (DN) is the most important underlying disease of CKD and a leading cause of ESRD in Japan. Intensified multifactorial intervention in patients with type 2 diabetes with microalbuminuria slows the progression to nephropathy, and progression of retinopathy and autonomic neuropathy. However, further studies are needed to establish the effect of intensified multifactorial treatment on DN with overt proteinuria. In this trial, doctors and co-medicals collaborate to treat the DN patients to prevent the deterioration of DN by multifactorial intensive therapy. Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan) is an open, randomized controlled trial to evaluate the efficacy of renal protection of multifactorial intensive therapy in type 2 diabetes patients with overt proteinuria (urinary albumin-to-creatinine ratio > or =300 mg/g creatinine). The study has a targeted enrollment of 600 Japanese patients, and divided into two protocols by renal insufficiency (protocol A: serum creatinine: <1.2mg/dl in male and <1.0mg/dl in female, and protocol B: serum creatinine: 1.2-2.5mg/dl in male and 1.0-2.5mg/dl in female). The patients were allocated standard treatment or intensive multifactorial treatment. Intensive treatment was a stepwise implementation of behavior modification, pharmacological therapy targeting hyperglycaemia, hypertension, dyslipidaemia, and proteinuria. The primary outcome is the proteinuria in protocol A and the composite endpoint of time to the first occurrence of doubling of serum creatinine, ESRD (the need for chronic dialysis, or renal transplantation) or death in protocol B. The follow-up period is 5 years and the study ends in 2014.
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PMID:Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan): Rationale and study design. 1988 69

The study included 20 patients aged 61-86 (mean 73.1 +/- 3.1) years with stage II hypertensive disease, type 2 diabetes and nephropathy with signs of grade I chronic renal insufficiency (CRI). The major parameters measured were AP, HR, laboratory characteristics of carbohydrate metabolism and renal function. Prestarium given at a dose of 4 mg BID had not only antihypertensive but also negative chronotropic effect, decreased energy consumption by myocardium, and normalized daily AP profile (24 hr AP monitoring). Adequate control of diabetes ensured close-to-normal carbohydrate metabolism. Prestarium therapy did not cause further aggravation of renal insufficiency in patients with grade I CRI, nor did it alter creatinine and urea levels.
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PMID:[Use of prestarium (perindopril) in patients with polymorbidity syndrome (AH, DM, nephropathy)]. 2001 55

Extreme hyperkalaemia is a life-threatening electrolyte disorder. It is relatively common in patients with severe renal insufficiency. This report describes a case of extreme hyperkalaemia caused by drugs in an 82-year-old female patient without severe renal insufficiency, who was successfully treated without haemodialysis. The patient had been treated for arterial hypertension and type 2 diabetes mellitus for 30 years. Over the last years she had been receiving enalapril and metformin. Three weeks before the admission to the hospital, she was receiving a non-steroidal anti-inflammatory drug (NSAID) because of the back pain. She was admitted to hospital due to a collapse and weakness in the limbs. Laboratory tests showed extreme hyperkalaemia, high blood sugar, metabolic acidosis, elevated serum creatinine and blood urea nitrogen (BUN), and a slightly elevated serum sodium. On ECG, we noticed typical signs of hyperkalaemia.The patient was treated with a slow intravenous bolus of calcium gluconate and intravenous infusion of sodium chloride with insulin, glucose with insulin and sodium bicarbonte. After the treatment, all laboratory findings normalised together and the patient felt better. This case shows that physicians should be very careful when prescribing NSAIDs to elderly patients treated with drugs that affect renal function.
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PMID:Extreme hyperkalaemia caused by concomitant use of a NSAID and an ace inhibitor in an elderly patient. 2058 99

Metformin is an oral antidiabetic agent, widely used in the treatment of type 2 diabetes mellitus. The serious side effect of metformin therapy is lactic acidosis. Contraindications for metformin therapy include renal insufficiency. A cut off value of 60 ml/min in creatinine clearance is suggested. Hundred type 2 diabetics receiving metformin as monotherapy or in combination with insulin/other oral antidiabetic agents, were enrolled in the study. Patients were on metformin for atleast one month prior to being enrolled. Patients' demographic data were taken. Baseline serum creatinine and bicarbonate were estimated. Creatinine clearance (Clcr ml/ min) was calculated. Patients were grouped into group 1-4 depending upon the doses of metformin they received. Patients were again grouped based on their Clcr as groupA (Clcr < 60 ml/min), group B (Clcr > 60.01 ml/min). Data was analysed using student's t test. Out of 100 patients 52 were males, 48 females. Mean age and SD of males and females were 69.92 +/- 6.95 and 66.85 +/- 5.72 respectively. Comparison of mean bicarbonate level in different doses of metformin did not show any statistical significance. But comparison of bicarbonate levels based on Clcr were highly statistically significant (p = 0.0084). In three patients whose bicarbonate level was very low (15, 16.4 and 19.2 mmol/L), doses of metformin was reduced and after one month their bicarbonate levels returned to normal (27.4, 25.6 and 26.2 mmol/L). Hence serum bicarbonate can be a marker to assess metformin induced acidosis in geriatrics patients with low creatinine clearance.
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PMID:Serum bicarbonate: can it be a marker of metformin induced acidosis in geriatrics? 2063 4

Type 1 Gaucher disease is currently categorized as non-neuronopathic, although recent studies suggest peripheral neurological manifestations. We report prevalence and incidence data for peripheral neuropathy and associated conditions from a multinational, prospective, longitudinal, observational cohort study in patients with type 1 Gaucher disease, either untreated or receiving enzyme replacement therapy. The primary outcome parameters were the prevalence and incidence of polyneuropathy, evaluated by standardized assessments of neurological symptoms and signs, and electrophysiological studies. All diagnoses of polyneuropathy were adjudicated centrally. Secondary outcome parameters included the prevalence and incidence of mononeuropathy, other neurological or electrophysiological abnormalities not fulfilling the criteria for a mono- or polyneuropathy and general type 1 Gaucher disease symptoms. Furthermore, a literature search was performed to identify all studies reporting on prevalence and incidence of polyneuropathy in the general population. One hundred and three patients were enrolled [median (range) age: 42 (18-75) years; disease duration: 15 (0-56) years; 52% female]; 14 (13.6%) were untreated and 89 (86.4%) were on enzyme replacement therapy. At baseline, 11 patients [10.7%; 95% confidence interval (CI): 5.9-18.3] were diagnosed with sensory motor axonal polyneuropathy. Two (1.9%; 95% CI: 0.1-7.2) had a mononeuropathy of the ulnar nerve. The 2-year follow-up period revealed another six cases of polyneuropathy (2.9 per 100 person-years; 95% CI: 1.2-6.3). Patients with polyneuropathy were older than those without (P<0.001). Conditions possibly associated with polyneuropathy were identified in four patients only, being monoclonal gammopathy, vitamin B(1) deficiency, folic acid deficiency, type 2 diabetes mellitus, renal insufficiency, alcohol abuse and exposure to toxins related to profession. The 11 cases of polyneuropathy found at baseline were confirmed during follow-up. According to the literature, the prevalence of polyneuropathy in the general population was estimated between 0.09 and 1.3% and the incidence was estimated between 0.0046 and 0.015 per 100 person-years. Thus, we conclude that the prevalence and incidence of polyneuropathy in patients with type 1 Gaucher disease is increased compared with the general population.
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PMID:Peripheral neuropathy in adult type 1 Gaucher disease: a 2-year prospective observational study. 2069 42

An eroded atheromatous aorta may be a source of cholesterol crystal embolism(CCE). Embolization of atheromatous material accounts for obstruction of distal arterioles around which a foreign-body giant cell granuloma inflammatory reaction develops. The diagnosis is often delayed or un recognized because of varying or misleading clinical signs, such as renal insufficiency, digestive or neurological symptoms, or both or unexplained multiple-system disease. Although CCE can occur spontaneously, it has been increasingly recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery. It has also been reported to occur following anticoagulant therapy or thrombolysis. Patients undergoing coronary artery bypass grafting (CABG) often experience a combination of these factors: anticoagulation, intra-arterial angiographic procedures and intraoperative aortic cross-clamping. These multiple factors could account for the acute and severe postoperative clinical and biological findings observed in the case reported here. A 65-year-old Saudi man was admitted to our hospital on July 9, 2008 due to chest pain at rest. He had suffered from type 2 diabetes mellitus on Oral hypoglycemics, hypertension on treatment, impaired renal functions and hypercholesterolemia, he was an ex-smoker with history of diagnosed pulmonary interstitial fibrosis. He had Coronary angiography in another hospital on May 2008 showing a left main lesion 60%, Left anterior descending lesion 90%, circumflex lesion 80% and Right coronary lesion 70%, three weeks later an acute on top of chronic deterioration in renal chemistry was observed for which conservative treatment was chosen.
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PMID:Cholesterol crystal embolization in a Saudi patient after cardiac surgery--a case report. 2080 69

A patient with abdominal obesity, type 2 diabetes, arterial hypertension and dyslipidaemia is exposed to a high risk of coronary artery disease, congestive heart failure and/or renal insufficiency. The management of such a patient requires different medications, which should be prescribed by taking into account both (relative and absolute) indications and contra-indications to improve overall prognosis. The present clinical case report illustrates the therapeutic reasoning leading to an appropriate pharmacological polytherapy, combined with life-style changes.
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PMID:[A patient with cardiovascular risk factors and comorbidities: integration of indications and contra-indications in pharmacotherapy]. 2085 8


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