The effect of guideline revisions on vascular complications of type 2 diabetes

Background: The aim of this study was to investigate the impact of implementation and revision of the ‘Diabetes Mellitus type II’ guideline by the Dutch College of General Practitioners (DCGP) on the prevalence and incidence of macrovascular and microvascular complications. Methods: The DiaGene study is a case-control study ( n = 1886 patients of type 2 diabetes) with extensive, retrospectively collected complication data, as well as prospective follow up of complications. The study incorporates all lines of diabetes care. Cases were divided into categories according to the date of onset of diabetes and publication dates of the DCGP. Logistic regression models were used to investigate the associations between guideline version and complications. To investigate a possible trend between guideline version and complications, the ‘guideline category’ was also used as a continuous variable. All models were adjusted for clinical covariables. Results: The 1999 and 2006 guidelines versions were associated with significantly lower risk of retinopathy than the group that started without a guideline [OR 0.32 (95% CI 0.14–0.72, p = 0.006) and 0.31 (95% CI 0.11–0.91, p = 0.034), respectively]. A significant trend in reduction of peripheral artery disease (PAD) over the guideline versions was found, adjusted for age, sex and diabetes duration (odds ratio (OR) 0.70, 95% CI 0.51-0.97, p trend = 0.029) and for retinopathy in all models (OR = 0.52, 95% CI 0.37-0.73, p trend < 0.001). Conclusions: The introduction of the first diabetes guideline and subsequent revisions have reduced the risk of macrovascular and microvascular complications of type 2 diabetes, most strongly in diabetic retinopathy. This indicates that real-time diabetes care has improved over time.

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Recent Highlights of Research on miRNAs as Early Potential Biomarkers for Cardiovascular Complications of Type 2 Diabetes Mellitus

International Journal of Molecular Sciences ◽

10.3390/ijms22063153 ◽

2021 ◽

Vol 22 (6) ◽

pp. 3153

Author(s):

Agnieszka Bielska ◽

Magdalena Niemira ◽

Adam Kretowski

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Early Stage ◽

Microvascular Complications ◽

Vascular Complications ◽

Diagnostic Methods ◽

Artery Disease ◽

Potential Biomarkers

Type 2 diabetes mellitus (T2DM) and its complications pose a serious threat to the life and health of patients around the world. The most dangerous complications of this disease are vascular complications. Microvascular complications of T2DM include retinopathy, nephropathy, and neuropathy. In turn, macrovascular complications include coronary artery disease, peripheral artery disease, and cerebrovascular disease. The currently used diagnostic methods do not ensure detection of the disease at an early stage, and they also do not predict the risk of developing specific complications. MicroRNAs (miRNAs) are small, endogenous, noncoding molecules that are involved in key processes, such as cell proliferation, differentiation, and apoptosis. Recent research has assigned them an important role as potential biomarkers for detecting complications related to diabetes. We suggest that utilizing miRNAs can be a routine approach for early diagnosis and prognosis of diseases and may enable the development of better therapeutic approaches. In this paper, we conduct a review of the latest reports demonstrating the usefulness of miRNAs as biomarkers in the vascular complications of T2DM.

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Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001413 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001413

Author(s):

Jonathan Yap ◽

Kamalesh Anbalakan ◽

Wan Ting Tay ◽

Daniel Ting ◽

Carol Yim Cheung ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Glycemic Control ◽

Microvascular Complications ◽

Population Based ◽

Cardiovascular Outcomes ◽

Microvascular Complication ◽

The Impact ◽

Hba1c Levels

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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Mean Platelet Volume and Platelet Distribution Width Correlate with Microvascular Complications in Egyptian People with Type 2 Diabetes Mellitus

Current Diabetes Reviews ◽

10.2174/1573399817666210608121024 ◽

2021 ◽

Vol 17 ◽

Author(s):

Mohammed I. Abd El-Ghany ◽

Nahed Abdallah ◽

Waleed Eldars

Keyword(s):

Type 2 Diabetes ◽

Mean Platelet Volume ◽

Microvascular Complications ◽

Fasting Blood Glucose ◽

Vascular Complications ◽

Platelet Distribution Width ◽

Platelet Volume ◽

Distribution Width ◽

Diabetic Microvascular Complications

Background: Type 2 diabetes is a part of metabolic syndrome associated with a higher risk of vascular complications. Diabetes is characterized by changes in platelet morphology, function, and platelet hyperactivity so, it's considered a prothrombotic condition. Morbidity and mortality in people with type 2 diabetes-related to micro and macrovascular complications. Novel biomarkers are needed to identify and treat people at higher risk. Objective: The main objective of this controlled cross-sectional study was to evaluate Platelet volume indices (PVI) in subjects with type 2 diabetes with and without complications in comparison to subjects without diabetes. Methods: Hundred and thirty-five subjects aged from 35 to 60 years were subdivided into 3 groups. Group A includes 55 subjects with type 2 diabetes with complications. Group B includes 45 subjects with type 2 diabetes without complications. Group C includes 35 normal healthy subjects. Detailed clinical history was taken. Also, PVI, fasting blood glucose (FBG), hemoglobin A1c, and creatinine were obtained. Results: Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet large cell ratio (P-LCR) were significantly higher among subjects with retinopathy, nephropathy, and neuropathy than other subjects with diabetes who didn't develop complications (P<0.001). At cutoff value > 11.9 fL, MPV have diagnostic sensitivity 80% and specificity 97.8%. Whereas PDW >16.9fL has a sensitivity of 74.5% and specificity of 100% for diabetic microvascular complications (retinopathy, nephropathy, and neuropathy). Conclusion: MPV and PDW may be considered as possible biomarkers for the early detection of diabetic microvascular complications.

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THE FAMILY DOCTOR’S ROLE IN ACHIEVING TARGET LEVELS OF TREATMENT IN PATIENTS WITH TYPE 2 DIABETES

PROBLEMS OF ENDOCRINE PATHOLOGY ◽

10.21856/j-pep.2010.2.06 ◽

2020 ◽

Vol 72 (2) ◽

pp. 51-58

Author(s):

О. Korzh ◽

A. Titkova ◽

M. Kochuieva ◽

Yu. Vinnyk ◽

L. A. Ruban ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Microvascular Complications ◽

Vascular Complications ◽

Lifestyle Changes ◽

Treatment Goal ◽

Treatment Goals ◽

Factors Associated ◽

Triple Treatment

The aim of the study was to identify the proportion of patients with type 2 diabetes who were unable toachieve the triple treatment goal for concomitant control of blood glucose level, blood pressure, LDL and modifying factors associated with achieving triple therapy goals. The study included 675 patients with type 2 diabetes,dyslipidemia and hypertension. The analysis was performed using concurrent triple treatment goals with specific levels of HbA1c, LDL and blood pressure as the main result. The questionnaire for patients with dyslipidemiaincluded self-assessment of compliance with prescribed drugs and perceptions related to their understandingand attitude towards lifestyle changes and pharmacological treatment. The results of the analysis of the logistic regression of factors associated with the achievement of triple treatment goals showed that patients whoreceived moderate doses of statins with high intensity were less likely to achieve concurrent treatment of thegoal compared to low intensity. Younger patients were less likely to achieve the triple treatment goal than thoseover 60 years of age. Based on life expectancy, they will be more susceptible to vascular complications due to anearlier onset of the disease and a longer period of time during which these adverse events can develop. Fewerdrugs and a shorter duration of type 2 diabetes were significant factors in the triple control. It was proved thatsimultaneous control of glycemia, hypertension and lipids was achieved in 22.4% of patients, who were affectedby the intensity of statin treatment, the number of diabetic drugs and the presence of concomitant pathology.Thus, the simultaneous achievement of the triple goal is a more comprehensive mitigation measure to reduce therisk of both macro- and microvascular complications

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Glycemic Variability and Vascular Complications in Patients with Type 2 Diabetes Mellitus

Folia Medica ◽

10.1515/folmed-2017-0048 ◽

2017 ◽

Vol 59 (3) ◽

pp. 270-278 ◽

Cited By ~ 11

Author(s):

Martin Caprnda ◽

Dasa Mesarosova ◽

Pablo Fabuel Ortega ◽

Boris Krahulec ◽

Emmanuel Egom ◽

...

Keyword(s):

Diabetes Mellitus ◽

Microvascular Complications ◽

Vascular Complications ◽

Glycemic Variability ◽

Cerebral Stroke ◽

Chronic Hyperglycemia ◽

Type 2 Dm ◽

Artery Disease ◽

Index Value

AbstractBackground:Presence of macro- and microvascular complications in patients with diabetes mellitus (DM) is not only related to chronic hyperglycemia represented by glycated hemoglobin (HbA1c) but also to acute glycemic fluctuations (glycemic variability, GV). The association between GV and DM complications is not completely clear. Aim of our study was to evaluate GV by MAGE index in patients with type 2 DM and to verify association of MAGE index with presence of macro- and microvascular DM complications.Methods:99 patients with type 2 DM were included in the study. Every patient had done big glycemic profile, from which MAGE index was calculated. Anthropometric measurements, evaluation of HbA1c and fasting plasma glucose (FPG) and assessment for macrovascular (coronary artery disease – CAD; peripheral artery disease – PAD; cerebral stroke – CS) and microvascular (diabetic retinopathy – DR; nephropathy – DN; peripheral neuropathy – DPPN) DM complications were done.Results:Average MAGE index value was 5.15 ± 2.88 mmol/l. We found no significant differences in MAGE index values in subgroups according to presence of neither CAD, CS, PAD nor DR, DN, DPPN. MAGE index value significantly positively correlated with FPG (p < 0.01) and HbA1c (p < 0.001) and negatively with weight (p < 0.05).Conclusion:In our study we failed to show association of MAGE index with presence of macrovascular and microvascular complications in patients with type 2 DM. However, this negative result does not necessarily disprove importance of glycemic variability in pathogenesis of diabetic complications.

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Declining trends of diabetic nephropathy, retinopathy and neuropathy with improving diabetes care indicators in Japanese patients with type 2 and type 1 diabetes (JDDM 46)

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2018-000521 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000521 ◽

Cited By ~ 13

Author(s):

Hiroki Yokoyama ◽

Shin-ichi Araki ◽

Koichi Kawai ◽

Katsuya Yamazaki ◽

Osamu Tomonaga ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 1 Diabetes ◽

Kidney Disease ◽

Diabetes Care ◽

Microvascular Complications ◽

Treatment Target ◽

Younger Patients

ObjectiveWe examined changes in prevalence of diabetic microvascular/macrovascular complications and diabetes care indicators for adults in Japan with type 2 and type 1 diabetes over one decade.Research design and methodsTwo independent cohorts were recruited with the same inclusion criteria in 2004 (cohort 1: 3319 with type 2 and 286 with type 1 diabetes) and in 2014 (cohort 2: 3932 with type 2 and 308 with type 1 diabetes). Prevalence of complications and care indicators including achieving treatment targets for glycemia, blood pressure, lipid control, body mass index (BMI), and smoking were compared. In addition, patients in cohort 1 were re-examined in 2014 and their data were compared with the baseline data of each cohort.ResultsIn type 2 diabetes, the prevalence of nephropathy, retinopathy, neuropathy, chronic kidney disease, current smoking and stroke significantly decreased, with improvements in achieving treatment target rates in cohort 2 two as compared with cohort 1. In type 1 diabetes, the prevalence of nephropathy, retinopathy, chronic kidney disease, and hemoglobin A1Cvalues significantly decreased. Decreases in prevalence of microvascular complications in type 2 diabetes were similarly found in each age-matched and sex-matched group, whereas younger patients exhibited marked increase in BMI and lower treatment target achieving rates compared with elderly patients. Regarding normoalbuminuric renal impairment, only a slight increase in the prevalence was observed both in type 2 and type 1 diabetes. In cohort 1, re-examined in 2014, care indicators were significantly improved from 2004, while complications increased with getting 10 years older.ConclusionsWe observed declining trends of diabetic microvascular complications with improvement in diabetes care indicators in type 2 and type 1 diabetes. Younger patients with type 2 diabetes exhibited marked increase in BMI and lower rates of achieving treatment targets compared with elderly patients, which remains a concern.

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Association of serum Cyr61 levels with peripheral arterial disease in subjects with type 2 diabetes

10.21203/rs.3.rs-62840/v2 ◽

2020 ◽

Author(s):

Feng Bin ◽

Guidong Xu ◽

Kangyun Sun ◽

Kaipeng Duan ◽

Bimin Shi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Logistic Regression ◽

Arterial Disease ◽

Logistic Regression Models ◽

Patients With Diabetes ◽

Clinically Significant ◽

Artery Disease ◽

Peripheral Arterial ◽

Fontaine Classification

Abstract Background: The prevalence of peripheral artery disease (PAD) is obviously increased in patients with diabetes. Existing evidence shows that cysteine-rich angiogenic inducer 61 (Cyr61), a 40-kD secreted protein, plays important roles in regulating cellular physiological processes. Recent studies have demonstrated a significant correlation between serum Cyr61 and atherosclerosis. However, the relationship between Cyr61 levels and PAD in patients with type 2 diabetes (T2DM) remains obscure.Methods:. Data from a total of 306 subjects with T2DM were cross-sectionally analysed. The extent of PAD was determined by using the Fontaine classification, which defines four stages. We measured serum Cyr61 concentrations by ELISA in subjects with and without PAD at Fontaine’s stage II, III, or IV. Logistic regression models were used to examine the independent association of Cyr61 with PAD.Results: Out of the 306 subjects enrolled, 150 were free from PAD, while 156 had clinically significant PAD. In subjects with PAD, the prevalences of Fontaine classification stages II, III and IV were 48.7%, 32.1%, and 19.2%, respectively. Patients with more advanced PAD had significantly higher Cyr61 (P for trend < 0.001). The prevalence of PAD on the basis of severity increased with increasing Cyr61 quartiles (all P values for trends < 0.001), and the severity of PAD was positively correlated with Cyr61 quartiles (r = 0.227, P = 0.006). The association of Cyr61 levels with PAD remained after adjusting for major risk factors in a logistic regression analysis.Conclusions: Our results demonstrated that Cyr61 was significantly increased in PAD patients with T2DM and that Cyr61 levels were positively associated with disease severity. Cyr61 could be a promising biomarker and further studies are needed to assess its clinical utility.

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ASSOCIATION OF HYPOTHYROIDISM WITH MICROVASCULAR COMPLICATIONS AMONG PATIENTS OF TYPE-2 DIABETES MELLITUS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i12.2341 ◽

2021 ◽

Vol 5 (12) ◽

Author(s):

Krishan Kumar Meena ◽

Praveen Sharma ◽

Swati Srivastava ◽

Uma Kumari Meena

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Microvascular Complications ◽

Vascular Complications ◽

Vascular Complication ◽

Cross Sectional ◽

Type 2 Dm ◽

Hypothyroid Patients

Introduction: Diabetes mellitus (DM) is common metabolic disorder leading to various complications including micro-vascular complication. Diabetes and thyroid dysfunction can result in abnormalities of one another, as both are strongly implicated in cellular metabolism. Aim of study was to establish any association between hypothyroidism and micro-vascular complications in patients of type 2 DM. Material and Methods: This Hospital based Cross sectional analytical Study was included 80 Euthyroid and 80 hypothyroid patients of type 2 DM. These patients were subjected to fundus examination (for retinopathy), urine for spot albumin and creatinine ratio and routine microscopy (for nephropathy), clinical examination and NCV (for neuropathy). Results: Age of patients ranged from 30 – 80 years. Most patients had duration of Diabetes > 5 years. Diabetic retinopathy was found in 15% Euthyroid and 37.5% Hypothyroid diabetics (p=0.002). Neuropathy was more in Hypothyroid (35%) as compared to Euthyroid (12.5%) patients (p=0.003). Prevalence of Nephropathy was also significantly more (p=0.011) in Hypothyroids (60%) as compared to Euthyroid (38.75%). Conclusion: Significant association was found between hypothyroidism and micro vascular complications in type 2 Diabetes mellitus. Screening of diabetics for thyroid functions is essential to reduce morbidity. Keywords: Diabetes, thyroid, retinopathy, neuropathy, nephropathy

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The impact of bariatric surgery on incident microvascular complications in patients with type 2 diabetes: A matched controlled population-based retrospective cohort study

10.2337/figshare.13075748.v1 ◽

2020 ◽

Author(s):

Pushpa Singh ◽

Nicola Adderley ◽

Anuradhaa Subramanian ◽

Krishna Gokhale ◽

Rishi Singhal ◽

...

Keyword(s):

Type 2 Diabetes ◽

Bariatric Surgery ◽

Cohort Study ◽

Microvascular Complications ◽

Population Based ◽

Type2 Diabetes ◽

Foot Disease ◽

The Impact ◽

Surgical Group

Aim: To assess the impact of bariatric surgery (BS) on incident microvascular complications [diabetes-related foot disease (DFD), sight threatening diabetic retinopathy (STDR), chronic kidney disease (CKD)] in patients with type 2 diabetes and obesity. Methods: <a>A retrospective matched, controlled population-based cohort study of adults with type 2 diabetes between 1/1/1990 and 31/1/2018 using </a><a>IQVIA Medical Research Data (IMRD), </a>a database of primary care electronic records. <a>Each patient with type2 diabetes who subsequently had BS (surgical) was matched on index date with up to 2 patients with type 2 diabetes did not have BS (non-surgical) within the same general practice by age, sex, pre-index body mass index and diabetes duration</a>. Results: 1126 surgical and 2219 non-surgical participants were included. In the study population, 2261 (68%) were women; Mean (SD) age was 49.87 (9.3) vs 50.12 (9.3) years and BMI was 46.76 (7.96) kg/m2 vs 46.14 (7.49) kg/m2 in surgical vs non-surgical group respectively. In surgical group, 22.1%, 22.7%, 52.2% and 1.1% patients had gastric band, sleeve gastrectomy, gastric bypass & duodenal switch respectively. Over median (IQR) follow-up was 3.9 years (1.8-6.4), BS was associated with reduction in incident combined microvascular complications (adjusted HR 0.63, 95% CI 0.51 to 0.78, p<0.001), DFD (0.61, 0.50 to 0.75, p<0.001), STDR (0.66, 0.44 to 1.00, p<0.001), CKD (0.63, 0.51 to 0.78, p<0.001). Analysis based on the type of surgery showed that all types of surgery were associated with favourable impact on the incident of composite microvascular complications, greatest reduction RYGB. Conclusions: BS was associated with a significant reduction in incident diabetes-related microvascular complications.

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