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1.
Diabetes Care ; 37(2): 516-20, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24041680

ABSTRACT

OBJECTIVE: In patients with type 2 diabetes and cardiovascular diseases (CVDs), intensive treatment with insulin and/or sulfonylurea (SU) may be associated with excessive increased risk of hypoglycemic episodes. To evaluate the risk of critical arrhythmias related to glycemic variability, we carried out an observational study in type 2 diabetes patients with CVD. RESEARCH DESIGN AND METHODS: Thirty patients with type 2 diabetes and documented CVD who had been treated with insulin and/or SU underwent 5 days of monitoring with a continuous glucose measurement system along with parallel electrocardiogram recording for monitoring of ventricular arrhythmias. Twelve age-matched patients with documented CVD who received treatment with metformin and/or dipeptidyl peptidase-4 inhibitor served as the control group. Patients were receiving stable treatment, and were instructed to notice symptoms of arrhythmias and hypoglycemia, respectively. RESULTS: We observed a high incidence of asymptomatic severe episodes of hypoglycemia (<3.1 mmol/L) in patients receiving treatment with insulin and/or SU, whereas severe hypoglycemia did not develop in any of the control subjects. Patients with severe hypoglycemia (n = 12) had a higher number of severe ventricular arrhythmias (patients with versus without severe hypoglycemia, respectively: ventricular couplets 41.7 ± 81.8 vs. 5.5 ± 16.7; ventricular tachycardia 1.0 ± 1.9 vs. 0.1 ± 0.3). No direct correlation could be found among different variables of glucose profile, corrected QT interval, and ventricular arrhythmias. CONCLUSIONS: Our results suggest that severe episodes of hypoglycemia are associated with an increased risk of severe ventricular arrhythmias.


Subject(s)
Arrhythmias, Cardiac/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Hypoglycemia/epidemiology , Adult , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/drug therapy , Female , Humans , Incidence , Insulin/therapeutic use , Male , Middle Aged
2.
J Periodontol ; 84(5): 614-23, 2013 May.
Article in English | MEDLINE | ID: mdl-22769439

ABSTRACT

BACKGROUND: The association between periodontitis and systemic diseases, including cardiovascular diseases and diabetes mellitus (DM), has been recognized repeatedly. Paraoxonase-1 (PON-1) is involved in the prevention of atherosclerosis, and decreased enzyme activity in patients with DM has been shown. The aim of this study is to investigate a possible correlation between decreased PON-1 activity and the association between impaired glucose metabolism or DM and periodontitis. METHODS: PON-1 phenotype distribution and enzyme activities were characterized by measuring the hydrolysis of phenylacetate and paraoxon in serum samples of 87 patients with type 2 DM and 46 patients with pre-DM showing impaired fasting plasma glucose and/or impaired oral glucose tolerance. The control group comprised 64 individuals with normal fasting plasma glucose and normal glucose tolerance. Altogether, 154 study participants were available for complete clinical periodontal examination. RESULTS: No difference in periodontitis prevalence existed between the study groups. However, patients with DM had an increased risk of suffering from generalized periodontitis (adjusted odds ratio = 4.05; 95% confidence interval = 1.24 to 13.18; P = 0.02), and their PON-1 activity was reduced compared to controls. In contrast, patients with pre-DM showed neither an increased periodontitis risk nor an impaired paraoxonase status. PON-1 was not associated directly with periodontitis. Nevertheless, concerning patients with DM, poor oral hygiene, male sex, and PON-1 phenotype were found to be significant predictors for periodontitis extent. CONCLUSIONS: Type 2 DM, but not a prediabetic state, increases the risk of generalized periodontitis. PON-1 status in patients with type 2 DM may contribute to this association.


Subject(s)
Aryldialkylphosphatase/deficiency , Chronic Periodontitis/complications , Chronic Periodontitis/enzymology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/enzymology , Prediabetic State/enzymology , Aged , Analysis of Variance , Aryldialkylphosphatase/blood , Aryldialkylphosphatase/metabolism , C-Reactive Protein/analysis , Carboxylic Ester Hydrolases/metabolism , Case-Control Studies , Female , Glucose/metabolism , Glucose Tolerance Test , Glycated Hemoglobin/metabolism , Humans , Male , Middle Aged , Oxidative Stress , Prediabetic State/complications , Regression Analysis , Risk Factors , Sex Factors , Statistics, Nonparametric
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