Thrombus and antiplatelet therapy in type 2 diabetes mellitus

SummaryType 2 diabetes mellitus (T2DM) is associated with higher rates of thrombotic complications in patients with coronary artery disease (CAD) despite optimal medical therapy. Thrombus area was measured in T2DM and non-diabetic patients receiving aspirin and clopidogrel 7–10 days after troponin positive Non ST-elevation acute coronary syndrome (NSTE-ACS). Secondly, we assessed response to clopidogrel in naive patients with T2DM and stable CAD in a randomised controlled trial. Thrombus area was measured by Badimon chamber and platelet reactivity by VerifyNow®. In T2DM patients presenting with NSTE-ACS, thrombus area was greater compared to non-diabetic patients (mean ± SD, 20,512 ± 12,567 [n=40] vs. 14,769 ± 8,531 [n=40] μm2/mm, p=0.02) Clopidogrel decreased thrombus area among stable CAD patients with T2DM (mean ± SD, Clopidogrel [n=45]: 13,978 ± 5,502 to 11,192 ± 3,764 μm2/mm vs. placebo [n=45]: 13,959 ± 7,038 to 14,201 ± 6,780 μm2/mm, p<0.001, delta values: clopidogrel vs. placebo, mean ± SD, 2,786 ± 4,561 vs. –249 ± 2,478, p<0.0005). Only 44% of patients with CAD and T2DM responded to clopidogrel as per VerifyNow® (cut-off PRUz value of ≥240). Importantly, no correlation was observed between thrombus area and VerifyNow® values (rho 0.08, p=0.49). Thrombus area values were similar among hypo-responders and good responders to clopidogrel (mean thrombus area ± SD: 12,186 ± 4,294 vs. 10,438 ± 3,401; p=0.17). Type 2 diabetes mellitus is associated with an increased blood thrombogenicity among NSTE-ACS patients on currently recommended medical therapy. Thrombus area was significantly reduced in all stable CAD patients independently of their response to clopidogrel therapy.

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Antidiabetic Effect of Brain-Derived Neurotrophic Factor and Its Association with Inflammation in Type 2 Diabetes Mellitus

Journal of Diabetes Research ◽

10.1155/2017/2823671 ◽

2017 ◽

Vol 2017 ◽

pp. 1-14 ◽

Cited By ~ 33

Author(s):

Ceren Eyileten ◽

Agnieszka Kaplon-Cieslicka ◽

Dagmara Mirowska-Guzel ◽

Lukasz Malek ◽

Marek Postula

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Neurotrophic Factor ◽

Platelet Reactivity ◽

Brain Derived Neurotrophic Factor ◽

Diabetic Patients ◽

Antidiabetic Effect ◽

Coronary Syndrome

Brain-derived neurotrophic factor (BDNF) is a neurotrophin, which plays an important role in the central nervous system, and systemic or peripheral inflammatory conditions, such as acute coronary syndrome and type 2 diabetes mellitus (T2DM). BDNF is also expressed in several nonneuronal tissues, and platelets are the major source of peripheral BDNF. Here, we reviewed the potential role of BDNF in platelet reactivity in T2DM and its association with selected inflammatory and platelet activation mediators. Besides that, we focused on adipocytokines such as leptin, resistin, and adiponectin which are considered to take part in inflammation and both lipid and glucose metabolism in diabetic patients as previous studies showed the relation between adipocytokines and BDNF. We also reviewed the evidences of the antidiabetic effect of BDNF and the association with circulating inflammatory cytokines in T2DM.

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The Level of Ischemic Modified Albumin (IMA) as Risk Marker for Cardio Vascular D isease (CVD) among some diabetic patients (type II) in Khartoum state -Sudan

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v12i4.1354 ◽

2017 ◽

Vol 12 (4) ◽

pp. 231

Author(s):

Sadik I ◽

Yagoub Z ◽

Sayed N ◽

El Nour A ◽

Abide El Hameed M ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Signs And Symptoms ◽

Diabetic Patients ◽

Risk Marker ◽

Characteristic Analysis ◽

Coronary Syndrome ◽

Diagnostic Potential

Background. Recent literature reports show large interest in ischemic modified albumin (IMA) biochemical marker for detection of myocardial injury. Special attention is focused in estimation of IMA test for the diagnosis and evaluation of myocardial ischemia as well as others acute coronary syndrome in emergency patients.Objective : evaluation of ischemia-modified albumin (IMA) in well controlled and uncontrolled patients with type 2 diabetes mellitus and estimation of its connection with cardiovascular disease.Measurement thelevelof IMA asrisk marker forcardio vascular disease (CVD) in diabetic patients that arrivedtoemergency department with signs and symptoms of CVD.Methodology. 140 subjects enrolled in thisstudy ,70 diabetes mellitus patients with signs and symptoms of CVD, and other 70 apparently non diabetic healthy subjects' as controls, , the levels of biomarker IMA was measured as the risk marker ofCVDin controlled and uncontrolleddiabeticpatients with type2,the Diagnostic potential was evaluated by receiver operating characteristic analysis and their relationships were analyzed. This study was donein Shab Hospital, Khartoum.Period from 1st of February 2015 to October 2015.Results: The results showed that CVD were predominant among diabetic female 57 % and peaked at age 75.5 years among 40-75 year old. The IMA was significantly increase in diabetic patients when compare with normal healthy group with cut off value ( 0.97 IU/L ), and there is also significantly increase in IMA level in uncontrolled diabetic patients (Mean ± SD; 14.70 + 10.66) that presented with acute chest pain and havea signs and symptoms of cardiac ischemia when compared with the well-controlled diabetic patients(Mean ± SD; 3.74 + 3.68). controlled and uncontrolled diabetic patients were determined by the level of their HBA1c and comparison with the means of IMA level in their serum.Conclusions: increase IMA level in poor control and long stand diabetic patients could help to identify the higher risk for develop to CVD, and The most common complication such as suffering from local or systemic hypoxic conditions, as acute ischemic stroke, peripheral vascular disease.Keywords: Ischemia, Type 2 diabetes mellitus, cardiovascular disease, Ischemic Modified Albumin

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The importance of three-stage cardiac rehabilitation in patients with acute coronary syndrome and type 2 diabetes mellitus

Medical Council ◽

10.21518/2079-701x-2020-11-12-18 ◽

2020 ◽

pp. 12-18

Author(s):

E. A. Nikitina ◽

E. N. Chicherina ◽

O. S. Elsukova ◽

I. S. Metelev

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Myocardial Revascularization ◽

Diabetic Patients ◽

Coronary Syndrome ◽

Long Term Prognosis

Introduction. Acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) have worse prognosis than those without diabetes. Risk of adverse outcome in this cohort remains high despite the introduction of new methods of invasive treatment of ACS. The use of all-inclusive cardiac rehabilitation (CR) programs allows improving prognosis in patients with ACS and T2DM. Aim. The aim of the study was to evaluate impact of two- or three-stage CR on long-term prognosis in patients with ACS and T2DM. Methods. The study included 251 ACS patients hospitalized in the department of cardiology, of which 120 patients with T2DM. Management of ACS was carried out in accordance with the clinical recommendations of the European Society of Cardiology (2015, 2017). All patients underwent standard laboratory and instrumental examination. We analyzed prognostic parameters (myocardial revascularization, myocardial infarction and mortality) during 12 months of follow-up in diabetic and non-diabetic patients with ACS who underwent two or a three-stage CR. Additionally, the achievement of the combined endpoint, which include at least one of the ACE, was analyzed. Results. Long-term prognosis in ACS patients who underwent three-stage CR in diabetic and non-diabetic groups did not differ significantly. However, the frequency of repeated myocardial revascularization was higher in patients with T2DM in comparison with non-diabetic patients inside the two-stage CR subgroup. Conclusion. Three-stage CR should be recommended in diabetic patients with ACS to improve long-term prognosis.

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Study on the levels of calcitonin gene-related peptide, somatostatin and inflammatory factors in patients with coronary artery disease complicated with type 2 diabetes mellitus

10.21203/rs.3.rs-56283/v1 ◽

2020 ◽

Author(s):

Chenyang Zhang ◽

Lifang Ye ◽

Qinggang Zhang ◽

Yingxiang Song ◽

Lihong Wang

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Inflammatory Factors ◽

Control Group ◽

Diabetic Patients ◽

Independent Risk Factors ◽

Stable Cad

Abstract BackgroundTo evaluate the level and correlation of serum neuropeptide cakiNnin gene-elated peptide (CORP), somatostatin (SS) and inflammatory factors (CRP, TNF-o, MCP-1 and sICAM-1) in patients with coronary atherosclerotic heart disease (CAD) complicated with type 2 diabetes mellitus (DM), to explore the mechanism of diabetic patients prone to complicated CAD.MethodsPatients were divided into three groups according to corcmary angiography results and whether there was a history of type 2 diabetes: control group (no CAD or DM; n 58), CAD group (stable CAD without DM; n 68) and DM+CAD group (stable CAD+DM; n =66). The age, sex ratio and body mass index (BMI) of the three groups were balanced, and the indexes of serum CORP, SS and inflammatory factors (CRP, TNE-a, IL-113, MCP-1 and sICAM-1) were measured by ELASA method. The relationship between serum CORP, SS and inflammatory factors (CRP, TNE-¢,11,-1), MCP-1 and sICAM-1) were analyzed by Spearman correlation analysis, and the risk factors f CAD were analysed by binary logistic regression model.ResultsThere were significant differences between neuropeptides (CORP, SS) and inflammatory factors (CRP, TNT', IL-I, MCP-1 and sICAM-1) in the th©© groups. Compared with the control group and the CAD group, CGRP and SS were decreased (P < 0.05), and inflammatory factors were significantly increased (P < 0.05) in the DMTCAD group. CGRP and SS were negatively correlated with inflammatory factors. Logistic regression model showed that CORP, SS, 11-10 and MCP-1 were independent risk factors for CAD (P <0.05). ConclusionCompared with the control group and the CAD group, patients in the DMTCAD group had less CGRP and SS but more inflammatory factors. Moreover, the inflammabry factors were negatively correlated with neuropeptides, and neuropeptides and some inflammatory factors are independent risk factors for CAD. This suggests that the TRPV1 injury in the sensory nerve endings and the reduction of neuropeptides release in type 2 diabetic patients may increase the risk of CAD. The mechanism may include that these neuropeptides may inhibit the inflammatory response to some extend

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Metformin and Exercise; the Effects of Metformin in the Body Building to Minimize the Effects of the Use of Anabolics: Case Report for a Randomized Controlled Trial

Archives of Health Science ◽

10.31829/2641-7456/ahs2020-4(1)-118 ◽

2020 ◽

pp. 1-9

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Fatty Acids ◽

Type 2 Diabetes Mellitus ◽

Controlled Trial ◽

The Body ◽

Diabetic Patients ◽

Insulin Levels ◽

Oral Antidiabetic

Metformin is an oral antidiabetic used in the treatment of type 2 diabetes mellitus. More precisely, it belongs to the class of biguanides, Metformin is used in the treatment of type 2 diabetes mellitus both as monotherapy and in combination therapy with other oral antidiabetic agents or with insulin, when dietary interventions and exercise are not sufficient to control the disease. When used in overweight diabetic patients, metformin also causes a decrease in the complications of diabetes and its use has been associated with stabilization and, albeit modest, loss of body weight.In type 2 diabetes mellitus (called also DM2 and in the past 'adult diabetes' or 'food') the insulin produced by the pancreas is unable to fully exert its action so that the body even produces it in excess, with the result on the one hand of making increasing weight and on the other hand progressively depleting the pancreas, is unable to meet the body's needs. It is as if the body were resisting the action of insulin. Metformin reduces insulin resistance. It is taken by mouth and is the only drug useful in all stages of type 2 diabetes. It also helps improve the balance of fats and, to a limited extent, blood pressure. Metformin alone has important effects on blood sugar. Accompanied by physical exercise, weight loss and possibly other medications, it is often an effective therapy. It does not cause hypoglycemia, helps not to gain weight or even reduces it. The main feature of Metformin is to interact strongly with AMPK by regulating its expression. In fact, its down regulation leads to consuming ATP, synthesizing cholesterol and fatty acids and consuming glucose: a situation in which insulin levels are quite high (therefore energy abundance).On the contrary, its up regulation leads to the creation of ATP, consuming more fatty acids for energy purposes and it is a metabolic situation similar to caloric restriction in which insulin levels are kept low (therefore energy scarcity). Metformin by upregulating AMPK has therefore shown to have a somewhat transversal therapeutic use in the treatment of metabolic dysfunctions.

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Association of Major Dietary Patterns with General and Abdominal Obesity in Iranian Patients with Type 2 Diabetes Mellitus

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000233 ◽

2015 ◽

Vol 85 (3-4) ◽

pp. 145-155 ◽

Cited By ~ 9

Author(s):

Marjan Ghane Basiri ◽

Gity Sotoudeh ◽

Mahmood Djalali ◽

Mohammad Reza Eshraghian ◽

Neda Noorshahi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Abdominal Obesity ◽

Dietary Patterns ◽

Dietary Pattern ◽

Diabetic Patients ◽

General Obesity ◽

Healthy Dietary Pattern

Abstract. Background: The aim of this study was to identify dietary patterns associated with general and abdominal obesity in type 2 diabetic patients. Methods: We included 728 patients (35 - 65 years) with type 2 diabetes mellitus in this cross-sectional study. The usual dietary intake of individuals over 1 year was collected using a validated semi-quantitative food frequency questionnaire. Weight, height, and waist circumference were measured according to standard protocol. Results: The two major dietary patterns identified by factor analysis were healthy and unhealthy dietary patterns. After adjustment for potential confounders, subjects in the highest quintile of the healthy dietary pattern scores had a lower odds ratio for the general obesity when compared to the lowest quintile (OR = 0.45, 95 % CI = 0.26 - 0.79, P for trend = 0.02), while patients in the highest quintile of the unhealthy dietary pattern scores had greater odds for the general obesity (OR = 3.2, 95 % CI = 1.8 - 5.9, P for trend < 0.001). There were no significant associations between major dietary patterns and abdominal obesity, even after adjusting for confounding factors. Conclusion: This study shows that in patients with type 2 diabetes mellitus, a healthy dietary pattern is inversely associated and an unhealthy dietary pattern is directly associated with general obesity.

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ESTIMATION OF SERUM FERRITIN LEVELS IN TYPE 2 DIABETIC PATIENTS AND ITS RELATION WITH HbA1C LEVEL.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i8.456 ◽

2019 ◽

Vol 3 (8) ◽

Author(s):

Shah Namrata Vinubhai ◽

Pardeep Agarwal ◽

Bushra Fiza ◽

Ramkishan Jat

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Blood Sugar ◽

Serum Ferritin ◽

Inflammatory Marker ◽

Control Group ◽

Diabetic Patients ◽

Positive Correlation

Background: Serum ferritin is known as an index for body iron stores also as an inflammatory marker and it is influenced by several disease. We were looking for a correlation between HbA1c and S. Ferritin in type 2 DM. Methodology: The present study a total of 150 participants were enrolled of which 100 were confirmed cases of Type 2 Diabetes Mellitus and rest 50 age and sex matched healthy subjects constituted the control group. All were screened for HbA1c, Fasting blood sugar, Post prandial blood sugar and S.Ferritin. Results: A highly significant variation and positive correlation was observed with respect to S.Ferritin and HbA1c levels. Mean S.Ferritin was high in the subgroup with poor glycemic control. Conclusion: The fasting, post prandial sugar levels, HbA1c and S.Ferritin were significantly higher in the diabetic subjects. This study shows a positive correlation between HbA1c and S. Ferritin levels. So we can conclude that in diabetic patients S. Ferritin may serve as an independent marker of poor glycemic and metabolic control. Keywords: Serum ferritin, Type 2 Diabetes Mellitus, HbA1c.

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A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors

Nutrients ◽

10.3390/nu13010183 ◽

2021 ◽

Vol 13 (1) ◽

pp. 183

Author(s):

Anna Izzo ◽

Elena Massimino ◽

Gabriele Riccardi ◽

Giuseppe Della Pepa

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Elderly Population ◽

The Elderly ◽

Narrative Review ◽

Macrovascular Complications ◽

Diabetic Patients ◽

Age Related

Type 2 diabetes mellitus (T2DM) represents a major health burden for the elderly population, affecting approximately 25% of people over the age of 65 years. This percentage is expected to increase dramatically in the next decades in relation to the increased longevity of the population observed in recent years. Beyond microvascular and macrovascular complications, sarcopenia has been described as a new diabetes complication in the elderly population. Increasing attention has been paid by researchers and clinicians to this age-related condition—characterized by loss of skeletal muscle mass together with the loss of muscle power and function—in individuals with T2DM; this is due to the heavy impact that sarcopenia may have on physical and psychosocial health of diabetic patients, thus affecting their quality of life. The aim of this narrative review is to provide an update on: (1) the risk of sarcopenia in individuals with T2DM, and (2) its association with relevant features of patients with T2DM such as age, gender, body mass index, disease duration, glycemic control, presence of microvascular or macrovascular complications, nutritional status, and glucose-lowering drugs. From a clinical point of view, it is necessary to improve the ability of physicians and dietitians to recognize early sarcopenia and its risk factors in patients with T2DM in order to make appropriate therapeutic approaches able to prevent and treat this condition.

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