Plasma triglycerides and LDL cholesterol are related in a parabolic fashion in the general population and patients with Type 2 diabetes mellitus: long-term follow-up results from the Hoorn study

Abstract. The development of microalbuminuria in individuals with type 2 diabetes mellitus is associated with a 10-fold increase in the risk of progression to overt nephropathy and eventual end-stage renal failure. The present study reports long-term (up to 8 yr) follow-up of 43 Pima Indians with type 2 diabetes detected on screening to have microalbuminuria. The natural history of albuminuria in these individuals included progression to overt proteinuria (urinary albumin excretion ≥ 300 mg/d) in half of the participants by 7 yr of follow-up. The size selectivity of the glomerular barrier was also investigated using dextran sieving and pore theory. Whereas a comparison group of macroalbuminuric Pima Indians had an excess of large pores that served as a macromolecular “shunt,” individuals with microalbuminuria had a shunt size no different from long-term diabetic, normoalbuminuric control subjects. An abrupt transition from little or no relationship to a highly significant and positive relationship between increasing albuminuria and shunt size occurred at an albumin-to-creatinine ratio of approximately 3000 mg/g. Shunt size in macroalbuminuric individuals correlated with the extent of foot process broadening. Podocyte foot processes in microalbuminuric participants were not different from those in control subjects. In conclusion, although microalbuminuria in type 2 diabetic Pima Indians often heralds progressive glomerular injury, it is not the result of defects in the size permselectivity of the glomerular barrier but rather of changes in either glomerular charge selectivity or tubular handling of filtered proteins or of a combination of these two factors.

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Stroke Risk among Patients with Type 2 Diabetes Mellitus in Zhejiang: A Population-Based Prospective Study in China

International Journal of Endocrinology ◽

10.1155/2016/6380620 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Lihua Guo ◽

Min Yu ◽

Jieming Zhong ◽

Haibin Wu ◽

Jin Pan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

General Population ◽

Stroke Risk ◽

Population Based ◽

Stroke Subtypes ◽

The Relationship

Objective. This study aimed to explore the incidence of stroke and stroke subtypes among patients with type 2 diabetes mellitus (T2DM) based on the long-term surveillance data in Zhejiang, China, during 2007 to 2013.Materials and Methods. During January 1, 2007, and December 31, 2013, a total of 327,268 T2DM and 307,984 stroke patients were registered on Diabetes and Stroke Surveillance System, respectively. Stroke subtypes were classified according to standard definitions of subarachnoid hemorrhage, intracerebral hemorrhage, and ischemic stroke. The incidence of stroke and stroke subtypes was calculated by standardized incidence ratio (SIRs) with 95% confidence intervals (CIs) compared with general population.Results. The incidence of stroke and stroke subtypes among patients with T2DM was significantly higher than in general population. Stroke risk was found significantly increased with an SIR of 3.87 (95% CI 3.76–3.99) and 3.38 (95% CI 3.27–3.48) in females and males, respectively. The excess risk of stroke was mainly attributable to the significantly higher risk of cerebral infarctions with the risk for T2DM being four times that for general population.Conclusions. The relationship between stroke and T2DM was strong, especially in female. The incidence of stroke and stroke subtypes among patients with T2DM was up to 3-fold higher than in general population in Zhejiang province, especially the subtype of cerebral infarctions.

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Preventive pharmacotherapy of type 2 diabetes mellitus in patients with early carbohydrate metabolism disorders: long-term efficacy and clinical outcomes

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2020.014 ◽

2020 ◽

Author(s):

V.V. Boeva ◽

A.N. Zavyalov

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Carbohydrate Metabolism ◽

Lifestyle Modification ◽

Term Therapy ◽

Medication Therapy

Prevention of type 2 diabetes mellitus (T2DM) in prediabetic patients is a pressing concern due to its increasing prevalence. The aim of this study was to evaluate the efficacy of preventive pharmacotherapy in delaying progression of incident impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) to T2DM. The participants of the study (1,136 subjects) found healthy by a regular annual checkup underwent repeat screening for T2DM. Blood samples were processed following the guidelines for good preanalytical sample preparation. Patents with incident IGT/IFG were prescribed medication therapy with metformin or/and acarbose. The rate of IGT/IFG conversion to T2DM was evaluated in years 3 and 10 of observation. Carbohydrate metabolism disorders were detected in 18.5% (n = 210) of the re-screened patients: 5.0% had T2DM, 5.5% had IGT, 8.0% had IFG. Patients with incident T2DM were prescribed blood sugar lowering therapy and they were excluded from further analysis. Patients with IGT/IFG (n = 151) were given recommendations on lifestyle modification and prescribed metformin (77%) or a combination of metformin and acarbose (23%). Three years after the start of observation, the rate of conversion to T2DM was 6.8% in patients undergoing monotherapy with metformin and 11.4% in patients undergoing combination therapy with metformin and acarbose. After the active follow-up phase was over, the majority of the patients (n = 85) decided to discontinue preventive therapy without consulting their physicians. Ten years after the active follow-up phase, the rate of NGT/IFG conversion to T2DM was 38.8% in patients who had discontinued their treatment and 0% in patients still taking metformin (p < 0.01). Long-term therapy with metformin prevented progression to T2DM in the long run in 83.3% (p < 0.05).

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Long Term Evaluation of Intensive Insulin Therapy in Patients with Type 2 Diabetes Mellitus

Series of Endocrinology, Diabetes and Metabolism ◽

10.54178/jsedmv2i3002 ◽

2021 ◽

Vol 2 (3) ◽

pp. 88-94

Author(s):

Leilani B Mercado-Asis ◽

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycemic Control ◽

Insulin Therapy ◽

Intensive Insulin Therapy ◽

Demographic Data

Background: This study aimed to determine long-term effect of intensive insulin therapy on prevention, progression, and development of chronic diabetes complications, both micro and macrovascular events. This study also aimed to evaluate long-term sustainability of glycemic control of patients on intensive insulin treatment. Methods: A retrospective review of adult type 2 diabetes mellitus (T2DM) patients on intensive insulin therapy for ≥7 years. Demographic data, co-morbidities, body mass index (BMI), hemoglobin A1c (HbA1c), hospitalization were collated. Majority received intensive insulin therapy with combination of premixed 70/30 given two times a day and fast short acting analogue given premeal three times a day, with the addition of glargine or degludec once a day in some. Results: Among 76 patients, 62% were males and 38% were females. Mean age at diagnosis and last visit were 53 and 65 years, respectively. At time of diagnosis, patient had the following co-morbidities: hypertension (32%), dyslipidemia (13%), non-dialyzable chronic kidney disease (CKD) (4%), thyroid disease (1%), pulmonary tuberculosis (1%). In terms of long-term complications, event rates during follow up period are as follows: 0.001 per person-year for acute coronary event; 0.002 per person-year for CKD needing dialysis, 0.009 per person-year for cerebrovascular accident. There were no blindness and amputation observed. There is a statistical difference between HbA1c levels at time of diagnosis (8.53 ± 1.86) and last follow up (7.83 ± 1.71) (P = 0.00). After a median follow up of 12 years (7–22 years), glycemic control was sustained with an HbA1c of ≤7% and ≤8% in 32% and 45% of patients, respectively. Conclusion: With intensive insulin therapy, micro and macrovascular complications can be prevented significantly. Long-term sustainability of glycemic control was also achieved.

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