POSTPRANDIAL HYPERTRIGLYCERIDEMIA AS A RISK FACTOR FOR MACROVASCULAR COMPLICATIONS IN TYPE 2 DIABETES MELLITUS

Diabetes mellitus is a common endocrine disorder characterized by chronic hyperglycemia, and disturbances of carbohydrate, fat and protein metabolism. The prevalence of diabetes has been increasing widely in India and worldwide. Diabetes is a cause of significant mortality and morbidity due to macro and micro vascular complications. Dyslipidemia accompanying type 2 Diabetes plays an important role in pathogenesis of atherosclerotic vascular disease. Post prandial hypertriglyceridemia, irrespective of fasting triglyceride levels, has emerged as a significant risk factor for symptomatic and asymptomatic macro vascular disease It is a case control study, conducted for a period of 1 year from November 2020 to October 2021, on patients visiting the Out-patient department of NRI institute of Medical Sciences, Sangivalasa, Visakhapatnam. The cases and controls were subjected to clinical and biochemical evaluation to detect presence of macro vascular complications. The cases were subjected to a high fat meal, and plasma triglycerides were measured two and four hours after a fat challenge. It was observed that post prandial hypertriglyceridemia correlated better than fasting triglycerides in patients with macro vascular complications. Persistent and significant post prandial hypertriglyceridemia was observed in diabetic patients with macro vascular complications; and can be used as a marker for predicting vascular complications in type 2 Diabetes mellitus.

Hyper-reactive platelets and type 2 diabetes / 中南大学学报(医学版)

Type 2 diabetes mellitus is a progressive process. With the course of the disease progress, microvascular and macrovascular complications always happen. Thrombotic events caused by macrovascular complications, including coronary heart diseases and cerebrovascular diseases, are the main fatal factor for the patients with type 2 diabetes. Endothelial dysfunction, coagulative activation, impaired fibrinolysis, together with hyper-reactive platelets contribute to the diabetic prothrombotic state, which is strongly related to the macrovascular complications. In particular, the hyper-reactive platelets play a fundamental role among them. Type 2 diabetes is characterized by several metabolic dysfunctions such as hyperglycemia, insulin resistance and shortage, oxidative stress, systemic inflammation, obesity, and dyslipidemia. These metabolic dysfunctions work together to promote the formation of hyper-reactive platelets, which are distinctive in type 2 diabetes. The regular antiplatelet drugs, like aspirin, show limited inhibitory effect on them. Hence, studying the mechanism behind the hyper-reactive platelets could provide a brand-new view on the prevention of macrovascular complications and cardiovascular events in type 2 diabetes.

Parámetros clínicos, bioquímicos y metabólicos predictores de complicaciones micro y macrovasculares en diabéticos tipo 2 / Clinical, biochemical and metabolic parameters predictive of micro and macrovascular complications in type 2 diabetics / Parâmetros clínicos, bioquímicos e metabólicos preditivos de complicações micro e macrovasculares em diabéticos tipo 2

RESUMEN Introducción: la diabetes mellitus (DM) es una enfermedad endocrino - metabólica, vascular, crónica, producida por una interacción variable de factores genéticos y ambientales. Actualmente la DM2 es considerada por algunos autores como pandémica, sin la existencia de signos de reducción de las tasas de incidencia. Objetivo: identificar los parámetros clínicos, bioquímicos y metabólicos predictores de complicaciones micro y macrovasculares en personas con diabetes mellitus tipo 2. Método: se realizó un estudio analítico de tipo casos y controles con pacientes ingresados en el Centro de Atención al Diabético de Bayamo (CAD), Granma, desde el año 2010 al 2017, 81 con alguna complicación microvascular, 40 con alguna complicación macrovascular y 162 sin ninguna complicación. Resultados: en el análisis univariado se observó que el tiempo de evolución de la enfermedad y la HTA descontrolada fueron los factores de riesgo para el desarrollo de una complicación microvascular, mientras que a estas se le unieron el tabaquismo y le hipercolesterolemia como factores de riesgo para el desarrollo de complicaciones macrovasculares. Las variables que mostraron una relación independiente con el riesgo de desarrollar alguna complicación microvascular fueron el tiempo de evolución de la enfermedad y la HTA descontrolada, mientras que para el desarrollo de complicaciones macrovasculares fueron el tiempo de evolución de la enfermedad y el tabaquismo. Conclusiones: el tiempo de evolución de la diabetes y la HTA descontrolada y el tiempo de evolución de la enfermedad y el tabaquismo se asocian de forma independiente con la aparición de complicaciones microvasculares y macrovasculates respectivamente.

ABSTRACT Introduction: diabetes mellitus (DM) is an endocrine-metabolic, vascular, chronic disease, produced by a variable interaction of genetic and environmental factors. Currently DM2 is considered by some authors as pandemic, without the existence of signs of reduction of incidence rates. Objective: to identify clinical, biochemical and metabolic parameters predictors of micro and macrovascular complications in people with type 2 diabetes mellitus. Method: an analytical case and control study was conducted with patients admitted to the Bayamo Diabetic Care Center (CAD), Granma, from 2010 to 2017, 81 with some microvascular complications, 40 with some macrovascular complications and 162 without any complications. Results: the univariate analysis found that disease progression time and uncontrolled HTA were the risk factors for the development of a microvascular complication, while these were joined by smoking and hypercholesterolemia as risk factors for the development of macrovascular complications. The variables that showed an independent relationship with the risk of developing some microvascular complications were the time of disease evolution and uncontrolled HTA, while for the development of macrovascular complications were the time of disease evolution and smoking. Conclusions: the time of evolution of diabetes and uncontrolled HTA and the time of disease and smoking evolution are independently associated with the emergence of microvascular and macrovasculate complications respectively.

RESUMO Introdução: diabetes mellitus (DM) é uma doença endócrina-metabólica, vascular, crônica, produzida por uma interação variável de fatores genéticos e ambientais. Atualmente o DM2 é considerado por alguns autores como pandemia, sem a existência de sinais de redução das taxas de incidência. Objetivo: identificar preditores de parâmetros clínicos, bioquímicos e metabólicos de complicações micro e macrovasculares em pessoas com diabetes mellitus tipo 2. Método: estudo analítico de caso e controle foi realizado com pacientes internados no Centro de Atendimento Diabético Bayamo (CAD), Granma, de 2010 a 2017, 81 com algumas complicações microvasculares, 40 com algumas complicações macrovasculares e 162 sem complicações. Resultados: a análise univariada constatou que o tempo de progressão da doença e o HTA descontrolado foram os fatores de risco para o desenvolvimento de uma complicação microvascular, enquanto estes foram acompanhados pelo tabagismo e hipercolesterolemia como fatores de risco para o desenvolvimento de complicações macrovasculares. As variáveis que apresentaram relação independente com o risco de desenvolver algumas complicações microvasculares foram o tempo de evolução da doença e HTA descontrolada, enquanto para o desenvolvimento de complicações macrovasculares foi o tempo de evolução da doença e tabagismo. Conclusões: o tempo de evolução do diabetes e do HTA descontrolado e o tempo de evolução da doença e do tabagismo estão independentemente associados ao surgimento de complicações microvasculares e macrovasculadas, respectivamente.

Influencing factors of macrovascular complications in type 2 diabetes mellitus / 第二军医大学学报

The incidence of type 2 diabetes in China is increasing annually, and its chronic complications are very common. Macrovascular complications are the main cause of death in patients with type 2 diabetes mellitus. The pathogenesis of diabetic macrovascular complications is different from that of traditional cardiovascular diseases. It has been found that macrovascular complications of type 2 diabetes are not only related to traditional cardiovascular disease risk factors (age, gender, hypertension, smoking, body mass index, diabetes duration, serum lipid, and glycosylated hemoglobin), but also diabetic microvascular complications, some specific molecular proteins and individual genetic background. This article reviews the clinical factors, molecular proteins and genetic background that affect the incidence of macrovascular complications in type 2 diabetes.

Complications of Diabetes Mellitus: Prevention in Type 2 Diabetes Mellitus

@#Type 2 Diabetes Mellitus is a complex disorder which has many associated comorbidities besides hyperglycaemia. Micro and macrovascular complications develop as a result of poor risk factor control and contribute to the disability, reduced quality of life and reduced life expectancy associated with the disease. Intensive glucose control and, more importantly, comprehensive care involving treatment of all modifiable cardiovascular risk factors over a sustained period decreases the risk of morbidity and mortality especially in people newly diagnosed with Type 2 Diabetes Mellitus. The need to recognise subgroups of people with diabetes with increased risks of complications and the importance of individualised treatment are also discussed. Early intensive treatment and control of risk factors provides the opportunity for greatest accrual of benefit over the longer term.

Effect of sex hormone levels on macrovascular complications in community-dwelling male patients with diabetes mellitus in Shanghai / 中华内分泌代谢杂志

Objective We aimed to investigate whether sex hormone levels including total testosterone, estradiol, estradiol/total testosterone, and dehydroepiandrosterone ( DHEA ) were associated with macrovascular complications among Shanghai community-dwelling diabetic men. Methods Relying on the Environmental Pollutant Exposure and Metabolic Diseases in Shanghai (METAL) study (ChiCTR1800017573, www.chictr.org.cn), 2147 male diabetic participants were recruited from 10 communities. Carotid plaques and common carotid artery ( CCA) diameters were detected by carotid ultrasound. Cardiovascular disease ( CVD) was defined as a self-reported diagnosis of CVD, including coronary heart disease, myocardial infarction, or stroke. Results ( 1) The prevalence of CVD in this study was 36. 0％, and patients with CVD had higher rates of hypertension and dyslipidemia than those without CVD. ( 2) After controlling for multiple factors, serum DHEA levels were negatively correlated with the prevalence of CVD while estradiol levels were positively correlated with both the prevalences of CVD and carotid plaque, estradiol/total testosterone ratio was also positively correlated with the prevalence of CVD. ( 3) In subgroup with unilateral/bilateral CCA plaque, and after controlling for multiple factors, total serum testosterone was negatively associated with the mean CCA diameter. Conclusion The incidence of macrovascular complications was lower in male diabetic patients with higher serum total testosterone and DHEA levels and lower estradiol levels, suggesting that sex hormone levels may be a window for the diagnosis and treatment of diabetic macrovascular complications.

Analysis of risk factors of thyroid nodules in patients with type 2 diabetes in the community / 上海交通大学学报（医学版）

Objective • To evaluate the prevalence, risk factors and the effects of macrovascular complications on the onset of thyroid nodules in patients with type 2 diabetes mellitus (T2DM) in the community. Methods • A total of 711 outpatients with T2DM from March 2015 to December 2017 in Community Family Doctor Outpatient Department and Department of Endocrinology and Metabolism of Fengxian District Central Hospital were selected. Anthropometric data and clinical test data were collected. Patients were divided into two groups based on the results of thyroid ultrasound. The Logistic regression analysis was used to analyze the risk factors for thyroid nodules in T2DM patients, such as age, sex, body mass index, glycolipid metabolism index, pancreatic function index, and thyroid function index. Furthermore, the effect of macrovascular disease on the onset of thyroid nodules was analyzed. Results • Of the 711 patients with T2DM, 438 (61.60%) had thyroid nodules, including 231 males (55.13% of the male population) and 207 females (70.89% of the female population). Comparison of anthropometry data, glycolipid metabolism index, pancreatic function index, and thyroid function index in groups with and without thyroid nodules revealed that there was a statistically significant difference in gender, age, duration of T2DM, 2-hour post-meal plasma glucose, total cholesterol, triglyceride, low density lipoprotein-cholesterol, free triiodothyronine, and thyroid peroxidase antibody between the two groups (P0.05). Conclusion • This study found that females, seniors, reduction of 2-hour post-meal plasma glucose, low density lipoprotein-cholesterol, and thyroglobulin antibody levels were the risk factors of thyroid nodules in T2DM patients in the community. There is no certain correlation between macrovascular complications and the occurrence of thyroid nodules in T2DM.

Potential benefit of (-)-epigallocatechin-3-gallate for macrovascular complications in diabetes

Vascular problems are the most common complications in diabetes. Substantial evidence from epidemiological and pathophysiological studies show that hyperglycemia is a major risk factor for macrovascular complications in patients with diabetes. (-)-Epigallocatechin-3-gallate (EGCG), the major catechin derived from green tea, is known to exert a variety of cardiovascular beneficial effects. The protective effects of EGCG in diabetes are also evident. However, whether EGCG is beneficial against macrovascular complications that occur in diabetes remains unknown. Our previous studies demonstrated that treatment of EGCG inhibits high glucose-induced vascular smooth muscle cell proliferation and suppresses high glucose-mediated vascular inflammation in human umbilical vein endothelial cells. Therefore, we hypothesize that EGCG might be an effective potential candidate to reduce the macrovascular complications in diabetes.

Relationship between type 2 diabetes mellitus and serum stromal cell derived factor 1 levels / 实用医学杂志

Objective To explore the relationship between type 2 diabetes mellitus(T2DM)and serum stromal cell derived factor-1(SDF-1)levels. Methods A community-based epidemiological field study for T2DM patients and non-T2DM subjects was conducted in Beijing,China. Every subject underwent physical examinations, biochemical tests of stromal cell derived factor 1 and so on,and completed a standardized questionnaire. A total of 756 subjects were recruited in our analysis ,including 267 T2DM patients and 489 non-T2DM subjects ,T2DM patients were further divided into 81 simple T2DM patients and 186 macrovascular complication patients on the basis of the status of macrovascular complication. The correlation between serum SDF-1 levels and T2DM was analyzed. Results Compared with non-T2DM group,the level of SDF-1 in T2DM group was higher(P=0.019). The level of SDF-1 in simple T2DM group was also higher than macrovascular complication group(P=0.044). In the multi-ple linear regression analysis,after adjustment for age,gender,smoking,drinking,dyslipidemia,hypertension and BMI,SDF-1 level in simple T2DM group was higher than macrovascular complication group(P = 0.049), still. Conclusions Simple T2DM patients had a higher serum SDF-1 level than T2DM patients with macrovascular complications as well as those who did not suffer T2DM,suggesting that the stromal cell derived factor-1 may play a certain role in the development of T2DM and macrovascular complications.

Relationship between type 2 diabetes mellitus and serum stromal cell derived factor 1 levels / 实用医学杂志

Objective To explore the relationship between type 2 diabetes mellitus(T2DM)and serum stromal cell derived factor-1(SDF-1)levels. Methods A community-based epidemiological field study for T2DM patients and non-T2DM subjects was conducted in Beijing,China. Every subject underwent physical examinations, biochemical tests of stromal cell derived factor 1 and so on,and completed a standardized questionnaire. A total of 756 subjects were recruited in our analysis ,including 267 T2DM patients and 489 non-T2DM subjects ,T2DM patients were further divided into 81 simple T2DM patients and 186 macrovascular complication patients on the basis of the status of macrovascular complication. The correlation between serum SDF-1 levels and T2DM was analyzed. Results Compared with non-T2DM group,the level of SDF-1 in T2DM group was higher(P=0.019). The level of SDF-1 in simple T2DM group was also higher than macrovascular complication group(P=0.044). In the multi-ple linear regression analysis,after adjustment for age,gender,smoking,drinking,dyslipidemia,hypertension and BMI,SDF-1 level in simple T2DM group was higher than macrovascular complication group(P = 0.049), still. Conclusions Simple T2DM patients had a higher serum SDF-1 level than T2DM patients with macrovascular complications as well as those who did not suffer T2DM,suggesting that the stromal cell derived factor-1 may play a certain role in the development of T2DM and macrovascular complications.

Lipid management in Diabetes Mellitus: A Singapore Perspective

Patients with Diabetes Mellitus (DM) have increased risk of atherosclerosis and up to half die during the first myocardial infarction. Primary prevention of cardiovascular disease (CVD) should be a major goal in the management of DM patients. DM patients with the highest risk (established CVD or chronic kidney disease) should have aggressive lipid-lowering therapy. Statin therapy should be the first line of therapy for all DM patients with elevated LDL-C. Ezetimibe can be added if LDL-C target is not reached at maximally tolerated statin dose. Fibrates can be used in DM patients with TG of >4.5 mmol/l (400 mg/dl). The adverse effects from lipid-lowering therapy are low while the benefits of intervention are well proven and significant.

Microvascular and macrovascular complications in young-onset type 2 diabetes in a tertiary health institution in Malaysia in comparison with type 1 diabetes patients / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To compare the rate of diabetes complications in young-onset type 2 diabetes (T2DM) with type 1 diabetes (T1DM) patients and to examine the relationship between diabetes complications with clinical and metabolic parameters.<br /><strong>METHODOLOGY:</strong> This is a retrospective,comparative study based on electronic medical records review. Young-onset T2DM patients defined as those with disease onset before the age of 40 and T1DM patients were included. Data was collected on demographic and clinical parameters, cardiovascular risks factors, macrovascular and microvascular complications.<br /><strong>RESULTS:</strong> There were 194 young-onset T2DM and 45 T1DM subjects. Despite similar glycemic profile, more subjects in the T2DM group hadunfavourable cardiovascular risk factors and developedmacro- or microvascular complications than the T1DM group (22 vs. 0%, p< 0.001for macrovascular, 68 vs. 40%, p< 0.001 for microvascular). Afteradjustment ofthe confounders, young-onset T2DM remained an independent predictor for both macrovascular and microvascular complications in the overall cohort (HR= 2.635, p= 0.022).<br /><strong>CONCLUSION:</strong> Young-onset T2DM appeared to be a more aggressive disease compared to T1DM. An aggressive approach should be adopted in treating young-onset T2DM to optimise the cardiovascular risk factors and glycemic control to prevent premature mortality and morbidity.</p>

Clinical Implications of Glucose Variability: Chronic Complications of Diabetes

Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

Macrovascular and Microvascular Complications in Newly Diagnosed Type 2 Diabetes Mellitus.

Objectives: To study the prevalence and clinical profile of microvascular and macrovascular complications in newly diagnosed type 2 diabetes mellitus patients in and around Bellary, Karnataka. Study design: The study was an observational cross-sectional study of 100 newly detected type 2 diabetics attending Dept. of Medicine (outpatient/inpatient), VIMS combined hospitals, Bellary, from October 2012 to June 2013 (9 months) who matched the inclusion criteria. Material and methods: Cases were screened for vascular complications as per ADA criteria, data tabulated and analyzed. Statistical analysis: SPSS software package was used for analysis. Statistical significance was defined as a p value <0.05. Results: The mean age of presentation was 54.05 ± 13.24 with male:female ratio of 1.6:1. The prevalence of diabetic retinopathy, nephropathy, neuropathy, cardiovascular, cerebrovascular and peripheral vascular disease was 20%, 37%, 16%, 26%, 8% and 11%, respectively; retinopathy, nephropathy and coronary artery disease screening being significant (p < 0.05). Conclusion: There was a significant correlation between prevalence of diabetes and increased waist circumference and body mass index. There was high prevalence of coronary artery disease, nephropathy and retinopathy in South Indian population at diagnosis. Screening for all cases of diabetes at diagnosis for complications is recommended.

Direct Medical Costs for Patients with Type 2 Diabetes and Related Complications: A Prospective Cohort Study Based on the Korean National Diabetes Program

We analyzed the direct medical costs for Korean patients with type 2 diabetes according to the type of complications and the number of microvascular complications. We analyzed costs for type 2 diabetes and associated complications in 3,125 patients. These data were obtained from the Korean National Diabetes Program (KNDP), a large, ongoing, prospective cohort study that began in 2005. The cost data were prospectively collected, using an electronic database, for the KNDP cohort at six hospitals. The costs were analyzed according to complications for 1 yr from enrollment in the study. Among 3,125 patients, 918 patients had no vascular complications; 1,883 had microvascular complications only; 51 had macrovascular complications only; and 273 had both complications. The annual direct medical costs for a patient with only macrovascular, only microvascular, or both macrovascular and microvascular complications were 2.7, 1.5, and 2.0 times higher than the medical costs of patients without complications. Annual direct medical costs per patient increased with the number of microvascular complications in patients without macrovascular complications. The economic costs for type 2 diabetes are attributable largely to the management of microvascular and macrovascular complications. Proper management of diabetes and prevention of related complications are important for reducing medical costs.

Correlation between serum adiponectin level and macrovascular complications in type 2 diabetes patients / 中国综合临床

Objective To understand the serum adiponectin levels in normal subjects and type 2 diabetes patients with macrovascular complications, to investigate the correlation between adipnectin and macrovascular complications in type 2 diabetes patients. Methods One hundred and two normal subjects, 116 type 2 diabetes patients and 123 type 2 diabetic patients with macrovascular complications were recruited in the current study. The serum adiponectin levels among three groups were compared, and the factors affecting the serum adiponectin were investigated. Results ①The serum adiponectin level was significantly lower in type 2 diabetic patients (8. 62 ± 2. 97) mg/L than that in normal subjects (10. 03 ± 4.41) mg/L, and was the lowest in type 2 diabetic patients with macrovascular complications(6. 17 ± 2. 55) mg/L(P < 0.05). ②Serum adiponetin level was negatively correlated with BMI,WHR,HOMA-IR,fasting insulin level, HbAlC and TG(r = -0.492, -0. 581, -0. 813, -0. 754, -0.619, -0.387, P<0.05). ③In a general multivariate regression, HOMA-IR fasting insulin and HbAlc.were negatively correlated with serum adipnectin level (r = - 0. 828, - 0. 769, - 0. 631, P < 0. 01). Conclusions The serum adiponectin level in type 2 diabetic patients is significantly decreased and even more in type 2 diabetic patients with macrovascular complications. These results suggest that lower serum adiponectin level is related to macrovascular complications in type 2 diabetic patients and maybe plays an important role in atherosclerosis in type 2 diabetic patients.

Study of correlation of serum adiponectin with type 2 diabetes and its macrovascular complications / 中国糖尿病杂志

Objective To explore the correlation of adipnectin with T2DM and its macrovascular complications. Methods The levels of serum adiponectin, plasma glucose, serum lipids, and fasting insulin were measured in normal subjects, type 2 diabetic patients and type 2 diabetic patients with macrovascular complications. Results (1) The serum adiponectin level was significantly lower in type 2 diabetic patients than in normal subjects, and was the lowest in type 2 diabetic patients with macrovascular complications. (2) Serum adiponetin level was negatively correlated with BMI,HOMA-IR, HbA_1c,TG and fasting insulin level. Conclusions The results suggest that lower serum adiponectin level may be related to macrovascular complications in type 2 diabetic patients.

Diabetes control- the legacy of a memory

Achieving and maintaining good glycaemic control remains an important goal in the management of this common and prevalent disorder. Recent evidence from important megatrials, ACCORD, ADVANCE, VADT, UKPDS-10 year follow-up as well as the STENO-2 follow-up study, have cleared doubts concerning the benefits of targeting good glycaemic control. For the first time, we have the reassurance that macrovascular benefits can be realised from good glycaemic control. The legacy effect of prior good glucose control from the UKPDS-10 year follow-up, reinforces the results seen from the DCCT-EDIC (for Type 1 diabetes). The Intervention Phase of the UKPDS revealed benefits for reduction of microvascular complications, while it was only at the end of the Post-Trial Monitoring Phase where significant improvements in both micro and macrovascular outcomes were seen. The other three Trials assessing the effect of glycaemic control on cardiovascular outcomes, although largely negative for CV benefit, give valuable insight towards appropriate patient characteristics for which aggressive glucose control can and should be instituted. Individualising glycaemic targets, which has been the approach that many clinicians have been practising, has received new impetus albeit with clearer details. Getting to glycaemic goal early in the course of T2DM and Doing to Safely (Avoiding hypoglycaemia) are the key ingredients to successful management. The legacy of the memory of initial good metabolic/glycaemic control is investment in good health with benefits of reductions in both micro and more importantly, macrovascular disease, years later. Multifactorial interventions that include blood pressure, lipid lowering in addition to glucose control in these individuals with the Metabolic Syndrome result in more immediate beneficial additive effects on cardiovascular outcomes.

Doença cardiovascular no diabetes melito tipo 1: [revisão] / Cardiovascular disease in type 1 diabetes mellitus: [review]

O risco de doença arterial coronariana (DAC) nos pacientes com diabetes melito tipo 1 (DM1) é conhecido desde o final dos anos 1970, sendo atualmente a principal causa de mortalidade na população adulta com diabetes tipo 1 de longa duração. A patogênese do processo aterosclerótico nesta doença ainda é obscura, acreditando-se que a hiperglicemia desenvolva aí um papel importante, entretanto vários estudos epidemiológicos mostraram que a associação entre doença coronariana e glicemia, em pacientes com DM1 seja fraca. Dados recentes do estudo DCCT/EDIC mostram que o grupo que recebeu tratamento insulínico intensificado durante o DCCT desenvolveu graus menores de aterosclerose, relacionado aos valores reduzidos de HbA1c durante a fase ativa do estudo, com melhor proteção nos pacientes mais jovens e com menor duração da doença. Há também evidências de que os benefícios são maiores nos pacientes sem nefropatia quando comparados aos com doença renal. Outros fatores de risco importante para o desenvolvimento de DAC em pacientes com DM1 são os mesmos descritos para DM2, incluindo os componentes da síndrome metabólica e marcadores de resistência insulínica. Sugere-se que pacientes com DM1 devam ter o melhor controle glicêmico possível, desde o início da sua doença acrescido de vigilância e tratamento rígido dos fatores de riscos clássicos para DAC, principalmente naqueles com história familiar de DM2.

The association between type 1 diabetes and coronary heart disease has become very clear since the late 1970. It has been demonstrated that there is an important increased risk in morbidity and mortality caused by coronary artery disease in young adults with type 1 diabetes compared with the non diabetic population. The underlying pathogeneses is still poorly understood. While the role of glycemic control in the development of microvascular disease complication is well established its role in CVD in patients with DM1 remains unclear with epidemiologic studies reporting conflicting data. Recent findings from the DCCT/EDIC showed that prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced level of HbA1c during the DCCT. The improvement of glycemic control itself appeared to be particularly effective in younger patients with shorter duration of the disease. Other analyses suggested the glycemia may have a stronger effect on CAD in patients without than in those with albuminúria. Other major determinants of coronary artery disease are the components of metabolic syndrome and the surrogate measure of insulin resistence: eGDR. It is proposed that patients with DM1 should have aggressive medical therapy, risk factor modification and careful monitoring not only of his blood sugar but also of the other processes involved in the atherosclerotic process, mostly the ones with family history of type 2 diabetes.

Association of serum adiponectin and resistin with type 2 diabetes mellitus and its macrovascular complications / 中华内分泌代谢杂志

The concentration of serum adiponectin [(2.51±1.42)mg/L] was lower in the group of patients with type 2 diabetes mellitus as compared with that in normal controlgroup [(5.26±0.78)mg/L ,P＜0.01]. The concentration of serum adiponectin was lower in the diabetics with macrovascular complications (MVC) [(1.38±0.77)mg/L] as compared with those without macrovascular complication [(3.66±0.91)mg/L]. The concentration of serum resistin was higher in the diabetic group as compared with that in control group[(7.07±1.11 vs 6.09±0.47)μg/L, P＜0.01]. It was also higher in patients with MVC [(7.96±0.65)μg/L] compared with those without MVC [(6.10±0.43)μgL, P＜0.01].