Follow-up of Glycemic Control and Cardiovascular Outcomes in Type 2 Diabetes

IntroductionDiabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.Research design and methodsThis was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.ResultsA total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).ConclusionDiabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.

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Intensive glycemic control fails to improve indices of vascular dysfunction in patients with type 2 diabetes; results at 6-12 months follow-up

Endocrine Abstracts ◽

10.1530/endoabs.37.ep486 ◽

2015 ◽

Author(s):

Sofia Antoniou ◽

Katerina Naka ◽

Aris Bechlioulis ◽

Lampros Michalis ◽

Agathocles Tsatsoulis ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Vascular Dysfunction ◽

Intensive Glycemic Control

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Influence of glycemic control on survival of zygomatic implants in relation with type-2 diabetes mellitus: 10 years’ follow-up results

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-20-00261 ◽

2020 ◽

Author(s):

Saad Alresayes ◽

Modhi AlDeeb ◽

Nawwaf AlHamoudi ◽

Fawad Javed ◽

Fahim Vohra ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Edentulous Patient ◽

Zygomatic Bone ◽

Zygomatic Implants ◽

Hba1c Levels

It is hypothesized that under optimal glycemic control (GC), there is no difference in the survival of implants placed in the zygomatic bone of edentulous patient with and without type-2 diabetes mellitus (T2DM). Purpose: The aim was to assess the influence of GC on survival of implants placed in the zygomatic bone of edentulous patient with and without T2DM at 10-years’ follow-up. Twenty patients with T2DM (10 with poorly- and 10 with well-controlled T2DM) and 12 patients without T2DM were included. Hemoglobin A1c (HbA1c) levels were recorded and demographic data was collected from all participants. Peri-implant inflammatory parameters (plaque index [PI], probing depth [PD], crestal bone loss [BL] and gingival index [GI]) were measured in all patients. Group comparisons were done and P-values, which were less than 0.01 were indicative of statistical significance. Twenty and 12 male patients with and without T2DM, respectively were included. Among patients with T2DM, 10 and 10 individuals had poorly- and well-controlled T2DM, respectively. The mean HbA1c levels were significantly higher in patients with poorly- (9.2 ± 0.7%) compared with well-controlled T2DM (4.8 ± 0.3%) (P<0.01) and non-diabetic individuals (4.6 ± 0.3%) (P<0.01). The crestal BL on the mesial (P<0.01) and distal (P<0.01) surfaces, PD (P<0.01), PI (P<0.01), and GI (P<0.01) were significantly higher around all zygoma implants placed in patients with poorly-controlled T2DM compared with patients with well-controlled T2DM and patients without T2DM. These clinicoradiographic parameters were comparable around zygoma implants placed in patient with well-controlled T2DM and in subjects without T2DM. Optimal glycemic control is essential for the long-term stability of zygomatic plants in patients with T2DM.

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Association between Macronutrient Intake Pattern, Glycemic Status and Use of Antidiabetic Drugs among Type 2 Diabetes Patients

The Indian Journal of Nutrition and Dietetics ◽

10.21048/ijnd.2019.56.4.23726 ◽

2019 ◽

Vol 56 (4) ◽

pp. 412

Author(s):

Martil Chacko ◽

Khyrunnisa Begum

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Dual Therapy ◽

Serum Glucose ◽

Macronutrient Intake ◽

Glycemic Status ◽

Good Glycemic Control ◽

Diabetes Patients

The study was aimed to assess the macronutrient intake pattern and its association to glycemic status and drug intake pattern of type 2 diabetes patients. Forty five subjects (25 males and 20 females) aged between 30 and 60 years, diagnosed with diabetes for less than 3 years were enrolled into the study. Based on Oral Anti-Diabetic drugs (OAD) treatment, they were grouped as those on mono-therapy (GpI, n=21) and dual therapy (GpII, n=25). Information about drugs profile, macronutrient intake (3 days diet recall reported as % equivalent of energy) and serum glucose profile were obtained at baseline and a 6th month follow up. Mean CHO, protein and fat intakes were 65.4±4.84, 12.6±1.26 and 22.0±4.7 % of total energy at baseline and remained essentially similar at 6th month. Patients who had controlled glycemic status (HbA1C ≤ 7 %) consumed 63.4±2.70 % CHO which was significantly (P<0.05) lower than those with not-controlled glycemic status (HbA1C >7 %) during both the assessment periods. Also, mean protein intake was higher and fat intake was lower among patients with good glycemic control. Significantly a higher proportion of (P<0.05) patients consuming CHO > 65 % were on dual therapy. A diet with lower carbohydrates and fat but high protein exerted good glycemic control. Number of OADs and their dosages were significantly associated to CHO intakes. Since Indian diets are predominantly carbohydrate rich, it calls for a careful management of diet among Type 2 diabetes patients

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