Trends in control of cardiovascular risk factors among US adults with type 2 diabetes from 1999 to 2010: Comparison by prevalent cardiovascular disease status

Insulin resistance is characterised by a decreased rate of insulin-mediated glucose uptake and is associated with adverse changes in cardiovascular risk factors, such as high triglyceride levels, low levels of high-density lipoprotein cholesterol, raised blood pressure, obesity and increased levels of plasminogen activator inhibitor 1. The term `insulin resistance syndrome' (IRS) is used to describe the complex of factors associated with insulin resistance that is found in patients both with and without type 2 diabetes. Although the presence of insulin resistance syndrome is generally considered to be a risk factor for cardiovascular disease, there is a lack of definitive evidence for a causal link. Recently, however, a statistical method known as factor analysis has been applied to the cluster of cardiovascular risk factors associated with IRS. This has been able to show that the `insulin resistance factor' (high plasma insulin and glucose levels, body mass index, waist-to-hip ratio and triglyceride levels) predicted coronary heart disease events in elderly non-diabetic men as well as in patients with type 2 diabetes. Therefore, treatment of insulin resistance whether by pharmacological (eg. thiazolidinediones) or nonpharmacological means has the potential to offer both improvements in glycaemic control and in cardiovascular events.

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DECLARE-TIMI 58 trial in the context of EMPA-REG OUTCOME and CANVAS

Diabetes Mellitus ◽

10.14341/dm10289 ◽

2020 ◽

Vol 22 (6) ◽

pp. 592-601

Author(s):

Marina V. Shestakova

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Published Data ◽

Cardiovascular Morbidity And Mortality ◽

Cardiovascular Endpoint

The article discussed results of the DECLARE-TIMI 58 study in the aspects of the previously finished trials (EMPA-REG OUTCOME and CANVAS). All three SGLT2i demonstrated the reduction of the risk of hospitalization for heart failure, as well as the risk of progression chronic kidney disease. At the same time, the patient populations are different. In EMPA-REG OUTCOME almost all the patients had previously diagnosed cardiovascular disease; in CANVAS 44.4% of patients did not have a confirmed cardiovascular disease, but had cardiovascular risk factors, and in DECLARE TIMI 58 there were 59% of such patients. Assessment of the published data suggests that the risk of a combined cardiovascular endpoint, including death from cardiovascular causes, myocardial infarction, and stroke, seems to be most pronounced in patients who already have established cardiovascular disease, and this effect is achieved mainly by reducing cardiovascular mortality. In the population of patients with type 2 diabetes who do not have cardiovascular disease, but who have cardiovascular risk factors, this effect is not detected. Contrary, risk-reduction of hospitalization for CHF and slowing the progression of CKD is manifested both in a population of patients with established cardiovascular disease and in the population of patients with multiple cardiovascular risk factors. In this regard, DECLARE-TIMI 58, as well as previously published data, open up new option for an earlier start of SGLT-2i for primary prevention and/or slowing the progression of nephropathy, reducing the risk of heart failure, and its prevention, as well as reduction of cardiovascular morbidity and mortality in patients with type 2 diabetes, regardless of the presence or absence of cardiovascular pathology in the anamnesis.

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Sex differences in cardiovascular risk factors among people with type two diabetes

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20181074 ◽

2018 ◽

Vol 5 (2) ◽

pp. 384

Author(s):

Gurinder Mohan ◽

Ranjeet Kaur ◽

Heli .

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cvd Risk ◽

High Hba1c ◽

Low Hdl

Background: Type 2 Diabetes Mellitus is associated with various risk factors, which accelerates the development of cardiovascular disease (CVD). The increased relative risk for CVD due to diabetes is greater in women than in men. Aims and objectives of this study were to study the prevalence of cardiovascular risk factors among type 2 diabetes patients and to assess the sex differences in the prevalence of cardiovascular risk factors among type 2 diabetes patients.Methods: A cross-sectional study was performed among the 500 adult (>15 years) patients of type 2 diabetes who attended Department of Medicine, SGRDIMSR, Amritsar and were assessed for the presence of various CVD risk factors and the prevalence of these was compared between both sexes.Results: The most prevalent CVD risk factor among 500 patients of type 2 DM was high HBA1C levels which was present in 67.2% of the study population. It was followed by obesity (which had prevalence of 66.2%), dyslipidaemia (i.e. high triglyceride levels - 64.8% and low HDL levels - 65.6%) and microalbuminuria along with macroalbuminuria (65.4%). Diabetic males had microalbuminuria (along with macroalbuminuria) as the most prevalent CVD risk factor (69.03%), followed by alcohol consumption (63.18%) and abnormal waist circumference (61%). On the other hand, the most prevalent CVD risk factor among female diabetics was high HBA1C (77.4%) followed by obesity (77.0%) and dyslipidaemia-hypertriglyceridemia (75.1%) and low HDL levels (70.5%).Conclusions: Cardiovascular risk factors were highly prevalent among patients with type 2 diabetes attending department of medicine, SGRDIMSR, Amritsar with different risk profiles among diabetic male and females. A gender-sensitive approach is required in planning interventions (counselling and treatment) to reduce the risk of cardiovascular disease in diabetes.

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