Smoking and diabetes: dangerous liaisons and confusing relationships

Abstract The combined harmful effects of cigarette smoking and hyperglycemia can accelerate vascular damage in patients with diabetes who smoke, as is well known. Can smoking cause diabetes? What are the effects of smoking on macro and microvascular complications? Now growing evidence indicates that regular smokers are at risk of developing incident diabetes. Since the prevalence rates of smoking in patients with diabetes are relatively similar to those of the general population, it is essential to address the main modifiable risk factor of smoking to prevent the onset of diabetes and delay the development of its complications. Quitting smoking shows clear benefits in terms of reducing or slowing the risk of cardiovascular morbidity and mortality in people with diabetes. Does quitting smoking decrease the incidence of diabetes and its progression? What are the effects of quitting smoking on complications? The current evidence does not seem to unequivocally suggest a positive role for quitting in patients with diabetes. Quitting smoking has also been shown to have a negative impact on body weight, glycemic control and subsequent increased risk of new-onset diabetes. Moreover, its role on microvascular complications of the disease is unclear. What are the current smoking cessation treatments, and which ones are better for patients with diabetes? Stopping smoking may be of value for diabetes prevention and management of the disease and its macrovascular and microvascular complications. Unfortunately, achieving long-lasting abstinence is not easy and novel approaches for managing these patients are needed. This narrative review examines the evidence on the impact of smoking and smoking cessation in patients with diabetes and particularly in type 2 diabetes mellitus and its complications. In addition, management options and potential future directions will be discussed.

Download Full-text

Biological Activity of c-Peptide in Microvascular Complications of Type 1 Diabetes—Time for Translational Studies or Back to the Basics?

International Journal of Molecular Sciences ◽

10.3390/ijms21249723 ◽

2020 ◽

Vol 21 (24) ◽

pp. 9723

Author(s):

Aleksandra Ryk ◽

Aleksandra Łosiewicz ◽

Arkadiusz Michalak ◽

Wojciech Fendler

Keyword(s):

Type 1 Diabetes ◽

Growth Factor ◽

Transforming Growth Factor ◽

Negative Impact ◽

Current Knowledge ◽

Microvascular Complications ◽

C Peptide ◽

Increased Risk ◽

The Impact

People with type 1 diabetes have an increased risk of developing microvascular complications, which have a negative impact on the quality of life and reduce life expectancy. Numerous studies in animals with experimental diabetes show that c-peptide supplementation exerts beneficial effects on diabetes-induced damage in peripheral nerves and kidneys. There is substantial evidence that c-peptide counteracts the detrimental changes caused by hyperglycemia at the cellular level, such as decreased activation of endothelial nitric oxide synthase and sodium potassium ATPase, and increase in formation of pro-inflammatory molecules mediated by nuclear factor kappa-light-chain-enhancer of activated B cells: cytokines, chemokines, cell adhesion molecules, vascular endothelial growth factor, and transforming growth factor beta. However, despite positive results from cell and animal studies, no successful c-peptide replacement therapies have been developed so far. Therefore, it is important to improve our understanding of the impact of c-peptide on the pathophysiology of microvascular complications to develop novel c-peptide-based treatments. This article aims to review current knowledge on the impact of c-peptide on diabetic neuro- and nephropathy and to evaluate its potential therapeutic role.

Download Full-text

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

Interventional Cardiology Review ◽

10.15420/icr.2012.7.1.37 ◽

2012 ◽

Vol 7 (1) ◽

pp. 37

Author(s):

Donald E Cutlip ◽

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Statistical Significance ◽

Bare Metal Stents ◽

Coronary Intervention ◽

Metal Stents ◽

Increased Risk ◽

Percutaneous Coronary ◽

Patients With Diabetes ◽

The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

Download Full-text

Novel Oral Anticoagulants in Peripheral Artery Disease: Current Evidence

Current Pharmaceutical Design ◽

10.2174/1381612825666181226151959 ◽

2019 ◽

Vol 24 (38) ◽

pp. 4511-4515 ◽

Cited By ~ 1

Author(s):

A. Koutsoumpelis ◽

C. Argyriou ◽

K.M. Tasopoulou ◽

E.I. Georgakarakos ◽

G.S. Georgiadis

Keyword(s):

Peripheral Artery Disease ◽

Oral Anticoagulants ◽

Novel Oral Anticoagulants ◽

Current Evidence ◽

Peripheral Artery ◽

Cardiac Events ◽

Traditional Therapy ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Artery Disease

Background: Peripheral artery disease is a common manifestation of systemic atherosclerosis which strongly correlates to cardiovascular morbidity and mortality. In addition, the progression of peripheral artery disease leads to an increased risk of limb loss. In order to reduce these events, the benchmark of treatment and research over the last years has been the antiplatelet therapy which aims at inhibition of platelet aggregation. Over the last years, new studies combining antiplatelet agents in different therapeutic schemes have been proven efficacious. Unfortunately, patients remain still at high risk of CV events. Novel Oral Anticoagulants have been introduced as alternatives to warfarin, in the prevention and treatment of venous thromboembolism. The rationale of using medication which acts on platelet activation and the coagulation pathway of thrombosis has led investigators to examine the role of Noac's in preventing CV events in patients with peripheral artery disease, stable or unstable. Methods: The aim of this study is to review the current evidence with respect to recently published studies concerning the use of Novel anticoagulants in peripheral artery disease. Results: The Compass trial has shown that a combination of rivaroxaban with traditional therapy may produce promising results in reducing amputation rates, stroke, cardiac events, and mortality, however, there are still safety issues with bleeding requiring acute care. The ePAD study has provided us with insight concerning safety and efficacy after peripheral angioplasty or stenting and actually the need for further research. The Voyager Pad study, following the steps of Compass, is studying the effect and safety of the addition of rivaroxaban to traditional therapy in the highest risk population aka patients undergoing peripheral revascularization. The evidence concerning patients with concomitant atrial fibrillation appears to be insufficient, however, recent guidelines propose the use of novel oral anticoagulants. Conclusion: For the time being, novel oral anticoagulants in combination with aspirin may provide an alternative treatment in PAD, however, it is deemed necessary to identify patient subgroups who will benefit the most.

Download Full-text

Impact of the COVID-19 Pandemic on the Patient’s Decision about Bariatric Surgery: Results of a National Survey

Medicina ◽

10.3390/medicina57080756 ◽

2021 ◽

Vol 57 (8) ◽

pp. 756

Author(s):

Maciej Walędziak ◽

Anna Różańska-Walędziak ◽

Paweł Bartnik ◽

Joanna Kacperczyk-Bartnik ◽

Andrzej Kwiatkowski ◽

...

Keyword(s):

Bariatric Surgery ◽

Online Survey ◽

Negative Impact ◽

Weight Loss Surgery ◽

General Information ◽

Open Questions ◽

Increased Risk ◽

Bariatric Patients ◽

The Moment ◽

The Impact

Background: the COVID-19 pandemic and the implemented restrictions have changed the functioning of healthcare systems worldwide. The purpose of the study was to evaluate the impact of the present epidemiological situation on patients’ decisions about undergoing weight loss surgery. Methods: data were collected from 906 bariatric patients by the means of a national online survey, the majority of whom were women (87.9%). The survey started on 9 April 2020 and was open until 28 April 2020. The questionnaire included multiple choice and open questions, divided into three chapters: general information about the patient, life during the COVID-19 pandemic, and bariatric care during the COVID-19 pandemic. Results: despite the pandemic and the associated risk of COVID-19 infection, 443 responders (48.9%) would have decided to undergo bariatric surgery. Awareness of the negative impact of obesity on the course of COVID-19 illness had only marginable impact on patients’ decision-making (76.6% vs. 75.3%; p < 0.80). Contact with COVID-19 prior to the survey had a negative impact on the willingness to undergo bariatric surgery (3.0% vs. 4.4%; p < 0.55). There was a positive correlation between the BMI and preference for bariatric surgery in the time of the pandemic (37.4 ± 9.0 vs. 34.9 ± 8.7; p < 0.001). Conclusions: the level of awareness about the advantages of operative treatment of obesity is high among bariatric patients. The majority of patients awaiting bariatric surgery at the moment of the survey were positive about undergoing bariatric surgery despite the increased risk of a serious course of COVID-19 infection. Therefore, a large proportion of patients was determined to have bariatric treatment even during the pandemic, being aware of the increased risk of worse pace of COVID-19 disease in case of obesity and related diseases.

Download Full-text

Abstract 5857: Low Operative Mortality with implantation of a Continuous Flow LVAD and Impact of Concurrent Cardiac Procedures

Circulation ◽

10.1161/circ.118.suppl_18.s_1017 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jay D Pal ◽

Charles T Klodell ◽

Ranjit John ◽

Francis Pagani ◽

Joseph G Rogers ◽

...

Keyword(s):

Aortic Valve ◽

Continuous Flow ◽

Operative Mortality ◽

Negative Impact ◽

Venous Pressure ◽

Heartmate Ii ◽

Cardiac Procedures ◽

Increased Risk ◽

The Impact ◽

Tricuspid Repair

Objective: Our goal was to determine the operative mortality of isolated implantation of the HeartMate II continuous flow LVAD and the impact of additional concurrent cardiac procedures on patient outcomes. Methods: In a multicenter trial, 279 patients at 33 clinical sites underwent implantation of the HeartMate II continuous flow LVAD as a bridge to transplantation from March 2005 to March 2007. HeartMate II implantation (HM II) was the only procedure required in 172 patients while 80 patients required concurrent cardiac procedures in conjunction with LVAD implantation (HM II+CCP). Results: Preoperative characteristics were similar, but central venous pressure (14.5 vs 11.6 mmHg) was greater for patients requiring concurrent cardiac procedures, suggesting worse right heart dysfunction. Mean cardiopulmonary bypass times increased from 97 to 120 minutes when a concurrent cardiac procedure was performed (p<0.001). Length of stay slightly increased from 23 to 26 days (p=0.17). Overall 30- and 180-day mortality was 5.8% and 13.3% for the HM II group, and 11.3% and 20.0% for the HM II+CCP group. Concurrent valvular procedures increased the risk to 8.5% and 19.1%. Patients who underwent an aortic valve replacement with cardioplegic arrest had a 30-day mortality of 25%, higher than for isolated concurrent mitral (0%) or tricuspid repair (3.3%). Other cardiac procedures were associated with a 30-day mortality of 27.8%. Survival at 180 days was 87% for HMII alone and 80% for HMII+CCP. Conclusion: There is a low 5.8% operative mortality for patients requiring uncomplicated HeartMate II implantation, with no apparent increased risk for concurrent PFO closure, mitral or tricuspid repair. However, concurrent aortic valve and other cardiac procedures are associated with a significantly decreased survival. The increased risk of these procedures must be balanced against the negative impact of uncorrected aortic insufficiency during VAD support.

Download Full-text

Inflammation and thrombosis in diabetes

Thrombosis and Haemostasis ◽

10.1160/ths10-11-0739 ◽

2011 ◽

Vol 105 (S 06) ◽

pp. S43-S54 ◽

Cited By ~ 70

Author(s):

Katharina Hess ◽

Peter Grant

Keyword(s):

Plaque Rupture ◽

Thrombus Formation ◽

Atherosclerotic Lesion ◽

Coagulation Factors ◽

Fibrin Clot ◽

Thrombotic Risk ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Patients With Diabetes ◽

Inflammatory State

SummaryPatients with diabetes mellitus are at increased risk of cardiovascular morbidity and mortality. Atherothrombosis, defined as atherosclerotic lesion disruption with superimposed thrombus formation, is the most common cause of death among these patients. Following plaque rupture, adherence of platelets is followed by local activation of coagulation, the formation of a cross-linked fibrin clot and the development of an occlusive platelet rich fibrin mesh. Patients with diabetes exhibit a thrombotic risk clustering which is composed of hyper-reactive platelets, up regulation of pro-thrombotic markers and suppression of fibrinolysis. These changes are mainly mediated by the presence of insulin resistance and dysglycaemia and an increased inflammatory state which directly affects platelet function, coagulation factors and clot structure. This prothrombotic state is related to increased cardiovascular risk and may account for the reduced response to antithrombotic therapeutic approaches, underpinning the need for adequate antithrombotic therapy in patients with diabetes to reduce their cardiovascular mortality.

Download Full-text

Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽

10.1515/med-2018-0048 ◽

2018 ◽

Vol 13 (1) ◽

pp. 304-323 ◽

Cited By ~ 3

Author(s):

Hernando Vargas-Uricoechea ◽

Manuel Felipe Cáceres-Acosta

Keyword(s):

Blood Pressure ◽

Cardiovascular Events ◽

Angiotensin Receptor Blockers ◽

Pharmacological Therapy ◽

Current Evidence ◽

Diabetic Patients ◽

Channel Blockers ◽

Converting Enzyme Inhibitors ◽

Patients With Diabetes ◽

The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

Download Full-text

How important is the relative balance of fat and carbohydrate as sources of energy in relation to health?

Proceedings of The Nutrition Society ◽

10.1017/s0029665115004188 ◽

2015 ◽

Vol 75 (2) ◽

pp. 147-153 ◽

Cited By ~ 7

Author(s):

Thomas A. B. Sanders

Keyword(s):

Controlled Trial ◽

Dietary Guidelines ◽

Partial Replacement ◽

Current Evidence ◽

Added Sugar ◽

Increased Risk ◽

Total Fat ◽

Randomised Controlled ◽

Refined Carbohydrates ◽

The Impact

Both the intake of fat, especially saturated trans fatty acids, and refined carbohydrates, particularly sugar, have been linked to increased risk of obesity, diabetes and CVD. Dietary guidelines are generally similar throughout the world, restrict both intake of SFA and added sugar to no more than 10 and 35 % energy for total fat and recommend 50 % energy from carbohydrates being derived from unrefined cereals, tubers, fruit and vegetables. Current evidence favours partial replacement of SFA with PUFA with regard to risk of CVD. The translation of these macronutrient targets into food-based dietary guidelines is more complex because some high-fat foods play an important part in meeting nutrient requirements as well as influencing the risk of chronic disease. Some of the recent controversies surrounding the significance of sugar and the type of fat in the diet are discussed. Finally, data from a recently published randomised controlled trial are presented to show the impact of following current dietary guidelines on cardiovascular risk and nutrient intake compared with a traditional UK diet.

Download Full-text

A Patient-Centered PaTH to Address Diabetes: Protocol for a Study on the Impact of Obesity Counseling

JMIR Research Protocols ◽

10.2196/12054 ◽

2019 ◽

Vol 8 (4) ◽

pp. e12054 ◽

Cited By ~ 2

Author(s):

Jennifer L Kraschnewski ◽

Lan Kong ◽

Erica Francis ◽

Hsin-Chieh Yeh ◽

Cindy Bryce ◽

...

Keyword(s):

Weight Loss ◽

Health System ◽

Diabetes Incidence ◽

Patient Centered ◽

Diabetes Outcomes ◽

Increased Risk ◽

Patients With Diabetes ◽

Penn State ◽

Service Coverage ◽

The Impact

Background Overweight and obesity are America’s number one health concern. The prevalence of obesity in the United States is greater than 36%, a rate that has doubled since 1970. As the second most preventable cause of death, obesity is a risk factor for diabetes, cardiovascular disease, stroke, and cancer, all major causes of death. Primary care clinics may be an ideal setting for weight control interventions to help manage and prevent diabetes. For this reason, the Centers for Medicare and Medicaid Services (CMS) implemented a health care procedure coding system code for intensive behavioral therapy (IBT) for obesity within primary care in 2012 to facilitate payment for addressing obesity, which was followed by broader coverage by most insurers for IBT for adults in 2013. However, the impact of this coverage on patient-centered outcomes is largely unknown. Objective The overarching goal of this study is to understand the comparative effectiveness of obesity counseling as covered by CMS and other insurers in improving weight loss for adults either with or at increased risk for type 2 diabetes. Methods This study leverages the novel infrastructure of the Patient-Centered Outcomes Research Institute–funded PaTH Clinical Data Research Network. The PaTH network is comprised of Geisinger Health System, Johns Hopkins University, Johns Hopkins Health System, Lewis Katz School of Medicine at Temple University, Temple Health System, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, University of Pittsburgh, UPMC and UPMC Health Plan, and the University of Utah. Electronic health record (EHR) data will originate from the 6 PaTH health systems. Specifically, we will (1) evaluate the impact of broader preventive service coverage for obesity screening and counseling on weight loss, diabetes incidence, and diabetes outcomes in patients with diabetes or at increased risk for diabetes (defined by body mass index [BMI] ≥25). We will determine how the annual probability of receiving obesity and/or nutritional counseling changed pre- and postpolicy across all insurers in a cohort of patients with diabetes and at high risk for diabetes. We will (2) compare patient weight loss and diabetes-related outcomes among those who receive obesity screening and counseling with those who do not, following implementation of preventive service coverage. We will examine postpolicy impact of obesity screening and counseling in a cohort of patients with diabetes and at increased risk for diabetes. Specific outcomes to be examined include weight loss, diabetes incidence, and diabetes outcomes. Exploratory outcomes will include patient-reported outcomes. Furthermore, we will determine patient characteristics, including demographics, and practice characteristics, including provider type. Results Our PCORI-funded study is underway. To date, we have obtained our second data extraction from the PaTH CDRN and are performing data editing and cleaning. Next steps include analysis of early policy change. Conclusions Given patients who are overweight are at highest risk for diabetes, improved weight management services could prevent diabetes and its negative health outcomes. Comparing weight and diabetes outcomes in 3 states using EHRs and claims data before and after this policy was implemented using the PaTH Network will allow important insight into policy effectiveness. International Registered Report Identifier (IRRID) DERR1-10.2196/12054

Download Full-text

Effect of Antidiabetic Treatment on Bone

Physiological Research ◽

10.33549/physiolres.934297 ◽

2019 ◽

pp. S107-S120 ◽

Cited By ~ 1

Author(s):

J. JACKULIAK ◽

M. KUŽMA ◽

J. PAYER

Keyword(s):

Diabetes Mellitus ◽

Bone Fractures ◽

Negative Impact ◽

Osteoporotic Fractures ◽

Antidiabetic Drugs ◽

Mineral Density ◽

Skeletal Health ◽

Antidiabetic Treatment ◽

Increased Risk ◽

Patients With Diabetes

Patients with diabetes mellitus are at an increased risk of bone fractures. Several groups of effective antidiabetic drugs are available, which are very often given in combination. The effects of these medications on bone metabolism and fracture risk must not be neglected. Commonly used antidiabetic drugs might have a positive, neutral or negative impact on skeletal health. Increased risk of fracture has been identified with use of thiazolidinediones, most definitively in women. Also treatment with sulfonylureas can have adverse effects on bone. One consequence of these findings has been greater attention to fracture outcomes in trails of new diabetes medication (incretins and SGLT-2 inhibitors). The effect of insulin on bone is discussed and the risk of fractures in patients using insulin seems to be unrelated to insulin as itself. The aim of the review is to summarize effects of antidiabetic treatment on bone – bone mineral density, fractures and bone turnover markers. The authors also try to recommend a strategy how to treat patients with diabetes mellitus regarding the risk of osteoporotic fractures. In this review the problem of how to treat osteoporosis in patient with diabetes is also discussed.

Download Full-text