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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Type 2 diabetes currently accounts for over 100 billion dollars in annual healthcare expenditure in the United States and 28% of the national (Medicare) healthcare budget for elderly Americans. In our inner-city hospital, 20% of all 950 beds are occupied by patients with diabetes; and 28-38% of patients receiving cardiac care in Coronary Care Units, catheterization laboratories or cardiovascular surgery, have diabetes as an underlying disorder. Both computer modelling and controlled clinical trials suggest that intensive therapy of diabetes can reduce significantly the morbidity and costs associated with this increasingly common disorder. Early detection of carbohydrate intolerance holds great promise for preventing the onset, progression and complications of Type 2 diabetes. To date our efforts have been futile, with 20% of newly diagnosed Type 2 diabetic patients already complicated by retinopathy and 14% complicated by peripheral vascular disease. It is now clear that high-risk individuals can be identified, and intervention trials are underway to test the hypothesis that Type 2 diabetes (and its attendant cardiovascular risks) can be prevented. The Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP NIDDM) in Canada and Europe has randomized 1200 individuals with impaired glucose tolerance (IGT) into a three-year trial to prevent disease progression. The Diabetes Prevention Program (DPP) in the US has randomized almost 3000 individuals with IGT into a six-year, three-arm study testing the efficacy of intensive lifestyle and pharmacological therapy in disease progression. Together, these studies should provide a public health model for the recognition of high-risk individuals and interventions to stem the epidemic of Type 2 diabetes. For those patients suffering with Type 2 diabetes already, pancreas transplantation remains an extreme intervention with the potential for 'curing' diabetes. Although applied usually to patients with Type 1 diabetes, experience is accumulating of transplantation in Type 2 diabetic patients with end-stage renal disease. Outcomes for these individuals are as good as for Type 1 diabetes. Islet-cell transplants, in fact, have been more successful in Type 2 diabetes compared with Type 1. Improved islet-cell availability, better immunosuppression, and the possibility of antigen masking make this technology a major hope for the future.
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PMID:Type 2 diabetes mellitus: the grand overview. 986 84

The importance of type 2 diabetes is due to its high prevalence, the difficulties in achieving optimal glucose control (financial, time, quality of life) and the high frequency of chronic microvascular and macrovascular complications that add very significantly to the morbidity, mortality and overall cost of the disease. Numerous risk factors have been identified that predict the future onset of type 2 diabetes in individuals and an early stage of the disease (impaired glucose tolerance) can often be identified. Insulin resistance is central to the pathogenesis and is initially compensated by an increased insulin secretion. Over time, insulin secretion progressively fails and diabetes appears. Several approaches have been proposed for the prevention of diabetes. Lifestyle changes (nutritional therapy and physical activity) have been shown to reduce the frequency of diabetes in small studies and are being assessed in the NIH-funded Diabetes Prevention Trial. Metformin, which reduces insulin resistance and hyperinsulinaemia, is being assessed in this same trial. Acarbose, which has been shown to reduce post-prandial insulin secretion and improve insulin resistance, is being assessed in the STOP-NIDDM trial. The ACE inhibitor ramipril has been shown in the HOPE study to reduce the appearance of diabetes by one third when given to patients with vascular disorders and this class of agents has been shown to improve insulin resistance. Another very promising approach is the use of thiazolidinediones (rosiglitazone, pioglitazone) to improve the insulin resistance and possibly preserve the beta cells by reducing the need for increased insulin secretion. These lifestyle changes and medications have been shown to be safe in the treatment of type 2 diabetes. There is a high probability that one of these approaches will be effective in delaying or preventing type 2 diabetes, and prevention may become a clinical reality in the near future.
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PMID:Prevention of type 2 diabetes. 1196 30

Recent trials have helped to clarify indications for the initial pharmacological therapy of hypertension. Both the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and World Health Organization-international Society of Hypertension (WHO-ISH) recommendations should be revised. The more recent trials indicate that: (1) diuretics and beta-blockers appear to be as effective in reducing overall morbidity/ mortality as other agents (Swedish Trial in Old Patients with Hypertension [STOP-2], United Kingdom Prospective Diabetes Study [UKPDS], Intervention as a Goal in Hypertension Treatment [INSIGHT], Nordic diltiazem [NORDIL]); (2) the use of an a-blocker results in more cardiovascular events, especially congestive heart failure, when compared with a diuretic (Antihypertensive Therapy and Lipid Lowering Heart Attack Trial [ALLHAT]); (3)the use of an angiotensin-converting enzyme (ACE) inhibitor results in fewer myocardial infarctions and episodes of heart failure than calcium channel blockers in the elderly and in diabetic patients (Fosinopril vs. Amlodipine Cardiovascular Events Randomized Trial [FACET], Appropriate Blood Pressure Control in Diabetes [ABCD], STOP-2) - other data (Captopril Prevention Project [CAPPP]) suggest that the use of an ACE inhibitor is preferred in diabetic patients; (4) overall cardiovascular events are similar with calcium channel blockers compared with a diuretic - however, there are fewer strokes with non-dihydropyridine calcium channel blockers (NORDIL) and a trend towards an increase in heart failure and myocardial infarctions with either a dihydropyridine or non-dihydropyridine calcium channel blockers compared with a diuretic (INSIGHT, NORDIL); (5) angiotensin receptor blockers (ARBs) will decrease proteinuria and slow progression of renal disease in type 2 diabetic patients when compared with regimens that do not include an ARB or an ACE inhibitor (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan [RENAAL], Irbesartan Type II Diabetic Nephropathy Trial [IDNT], Irbesartan Type II Diabetes with Microalbuminuria [IRMA Il]). The debate over initial therapy may be moot. High-risk hypertensive patients should probably be treated initially with combination therapy, one of which should be a diuretic. The use of diuretics and beta-blockers as well as ACE-inhibitors alone or with a diuretic should be considered as initial therapy (a change from JNCVI). Alpha-blockers should be reserved for special situations, i.e. prostatic hypertrophy (in contrast to WHO-ISH recommendations). An ACE-inhibitor or ARB, usually along with a diuretic, can be considered as preferred therapy in hypertensive diabetic patients. Some data suggest equal or greater reduction in strokes with a calcium channel blocker than other medications.
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PMID:Current recommendations for the treatment of hypertension: are they still valid? 1199 97

In recent years postchallenge or postprandial hyperglycaemia has been found to be an independent risk factor for cardiovascular comorbidities and all-cause mortality in impaired glucose tolerance (IGT) and type 2 diabetes. With the database of the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) study, it was also shown that atherosclerosis as measured by intima-media thickness of the common carotid arteries was associated with 2-hour postchallenge glucose level when HbA1c was normal. Taken together there are now comprehensive and consistent data from pathophysiological as well as epidemiological studies that excessive post-load glucose excursions have acute and chronic harmful effects on the endothelium and vessel wall. This is supported by four outcome studies that included control of postprandial glucose to prevent cardiovascular disease: Diabetes Intervention Study (DIS), Kumamoto study, DIGAMI study, and STOP-NIDDM trial. Therefore, in addition to HbA1c and fasting blood glucose, postprandial glucose monitoring should be an integral part of treatment to prevent acute and chronic complications.
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PMID:Postprandial hyperglycaemia: noxious effects on the vessel wall. 1216 6

Type 2 diabetes mellitus is a major health problem associated with excess morbidity and mortality. As the prevalence of this metabolic disorder is rapidly increasing and current treatment fails to stabilise the disease in most patients, prevention should be considered as a key objective in the near future. People who develop type 2 diabetes pass through a phase of impaired glucose tolerance (IGT). Defects in the action and/or secretion of insulin are the two major abnormalities leading to development of glucose intolerance. Any intervention in the impaired glucose tolerance phase that reduces resistance to insulin or protects the beta-cells, or both, should prevent or delay progression to diabetes.Acarbose, miglitol and voglibose act by competitively inhibiting the alpha-glucosidases, a group of key intestinal enzymes involved in the digestion of carbohydrates. They decrease both postprandial hyperglycaemia and hyperinsulinaemia, and thereby may improve sensitivity to insulin and release the stress on beta-cells. These compounds do not induce hypoglycaemia and have a good safety profile, although gastrointestinal adverse effects may limit long-term compliance to therapy. The recent placebo-controlled prospective STOP-noninsulin-dependent diabetes mellitus (STOP-NIDDM) trial demonstrated that acarbose 100mg three times daily reduces the risk of developing type 2 diabetes in patients with IGT (relative risk reduction of 25% after a mean follow-up of 3.3 years). The 6-year Early Diabetes Intervention Trial (EDIT), comparing the effect of acarbose 50mg three times daily to that of metformin, showed a trend to a positive effect of acarbose compared with placebo, in a mid-term 3-year analysis, which should be confirmed in the final analysis. To our knowledge, no such prevention intervention trials have been or are currently being performed with miglitol or voglibose. In conclusion, because of its absence of toxicity and its particular mechanism of action on gastrointestinal tract and indirect consequences on both insulin action and beta-cell function, acarbose may be used to prevent type 2 diabetes. If the ongoing EDIT trial confirms the positive results of the recent STOP-NIDDM trial, acarbose could be used, either as an alternative or in addition to changes in lifestyle, to delay development of diabetes in patients with IGT. However, the best dosage of acarbose for this specific indication remains to be specified, especially when all three important parameters, efficacy, tolerance and cost, are taken into consideration.
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PMID:Is there a role for alpha-glucosidase inhibitors in the prevention of type 2 diabetes mellitus? 1269 98

Patients with type 2 diabetes mellitus are associated with insulin resistance and/or impaired insulin secretion. Previous observations indicate that Japanese patients with type 2 diabetes tend to have impaired insulin response after glycemic load more often than Caucasian counterparts. Recently it has been reported that hyperglycemia after glucose load is itself a risk factor for the development of cardiovascular complications in the absence of elevated fasting plasma glucose. Recent observations on the association of post-challenge or post-prandial hyperglycemia with cardiovascular events suggest that lowering post-prandial plasma glucose may protect patients from developing cardiovascular diseases. Results of STOP-NIDDM trial suggest that nateglinide, which attenuates post-prandial glycemic surge in type 2 diabetes, may also be helpful for the protection against cardiovascular events. Nateglinide exerts its effects shortly after its administration and the effects continue for only about 3 hours. The patients receiving this agent rarely gain weight and develop hypoglycemia. This agent exerts hypoglycemic effects additively with alpha-gulucosidase inhibitors or metformin.
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PMID:[Nateglinide and mitiglinide]. 1287 90

Four prospective randomised long-term studies have been recently completed and published (Diabetes Prevention Study, Diabetes Prevention Program, STOP-NIDDM trial, XENDOS Study). Both of them clearly demonstrate the possibility to delay and/or prevent the onset of type 2 diabetes in at high-risk subjects with impaired glucose tolerance, through changes in lifestyle (dietary intervention, weight reduction, increased physical activity) or drug treatment (metformin, acarbose, orlistat). These studies are reviewed and practical implications of their results are discussed.
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PMID:[Is it possible to prevent type 2 diabetes?]. 1291 58

Diabetes mellitus type 2 develops worldwide in the dimensions of an epidemic disease. In order to reduce the personal burden of patients and the enormous costs for the health system, which are mainly due to diabetes complications, diabetes prevention is urgently needed. Regarding pathophysiology, type 2 diabetes develops on the basis of insulin resistance, together with increasing reduction of insulin secretion. This leads to postprandial blood glucose peaks (Impaired Glucose Tolerance, IGT), which furthermore increase insulin resistance (metabolic resistance) and decrease insulin secretion, finally resulting in manifestation of diabetes mellitus. Therefore it is a logical way of diabetes prevention, to treat postprandial blood glucose peaks in the early stadium of IGT. The STOP-NIDDM trial showed conclusively that acarbose reduces postprandial hyperglycemia and diabetes incidence for 36% in comparison to placebo in a group of IGT patients. At the same time the incidence of normal glucose tolerance increased significantly for 30%. The NNT ("number needed to treat") for acarbose to avoid one case of diabetes manifestation in patients with IGT, is eleven patients in 3.3 years. The preventive effect of acarbose is independent of age, gender or weight of the patients. So acarbose has the potential to reduce postprandial hyperglycemia, which is the driving force for diabetes, and thus can prevent diabetes mellitus type 2.
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PMID:[Postprandial blood glucose as the driving force in pathogenesis of type 2 diabetes]. 1469 35

An impaired glucose tolerance results in a significantly increased cardiovascular risk. In view of the dramatically increasing population with non-insulin-dependent diabetes mellitus, metabolic syndrome and impaired glucose tolerance, new therapeutic options are urgently required. In the past, studies of an intensified diabetes therapy generally did not reveal a relevant effect on the incidence of macrovascular complications. Consequently, the phrase of the "glucose paradoxon" was coined. The STOP-NIDDM study (study to prevent non-insulin-dependent diabetes mellitus) for the first time showed a reduction of cardiovascular events by 49% in patients with impaired glucose tolerance treated with acarbose compared with placebo. Furthermore, a retrospective metaanalysis of seven placebo-controlled long-term-studies of acarbose in patients with non-insulin-dependent diabetes mellitus showed a reduction of cardiovascular events by 41% (p = 0.0017). In summary, there is good evidence from placebo-controlled studies of a significant reduction of cardiovascular risk by acarbose in patients with impaired glucose tolerance or non-insulin-dependent diabetes mellitus.
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PMID:[Does targeted therapy of type 2 diabetes prevent cardiovascular incidents?]. 1469 36

Type 2 diabetes mellitus is a major health problem associated with excess morbidity and mortality. Defects in the action and/or secretion of insulin are the two major abnormalities leading to development of glucose intolerance. Any intervention in the impaired glucose tolerance phase that reduces resistance to insulin or protects the beta-cells, or both, should prevent or delay progression to diabetes. The natural history of type 2 diabetes includes a preceding period of impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) which provides an opportunity for targeted intervention within large communities. As the prevalence of this metabolic disorder is rapidly increasing and current treatment fails to stabilise the disease in most patients, prevention should be considered as a key objective in the near future. Lifestyle intervention studies have consistently shown that quite modest changes can reduce the progression from IGT to diabetes by 50-60%. The Diabetes Prevention Program (DPP) randomised trial has shown that a combined program of weight loss, improvement of diet and increase of physical exercise lowers the risk for development of type 2 diabetes by 58% compared with placebo. It may, however, not be possible to translate these successful findings to larger cohorts or maintain the lifestyle changes longer term. This has lead to consideration of pharmacotherapy. Benefits have been found for metformin, acarbose and troglitazone. Treatment with metformin was less effective than lifestyle modifications, resulting in an average reduction of risk for development of type 2 diabetes by 31% compared with placebo. Similarly, acarbose in the STOP-NIDDM trial reduced the risk of developing type 2 diabetes in patients with IGT by 25%. Remarkably, cardiovascular event rates, in particular myocardial infarction, were significantly reduced when acarbose was used instead of placebo in subjects with glucose intolerance. The ACE inhibitors captopril (CAPPP) or ramipril (HOPE) and the Angiotensin-II receptor antagonist losartan (LIFE) have been shown to reduce the appearance of diabetes by one third when given to patients with hypertension. Since many hypertensive patients are insulin-resistant and have an increased risk in developing type 2 diabetes, the protective effect of these classes of antihypertensive drugs might be explained by their antiinsulin-resistance effects.
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PMID:[Progress in the prevention of type 2 diabetes]. 1474 78


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