Managing Cardiovascular Risk in Patients with Type 2 Diabetes – Challenges and Opportunities

2010 ◽  
Vol 6 (4) ◽  
pp. 31
Author(s):  
Lars Rydén ◽  
Linda Mellbin ◽  
Klas Malmberg ◽  
◽  
◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Clinical Trial Data ◽  
Oral Glucose ◽  
Lifestyle Modifications ◽  
Oral Glucose Tolerance Testing ◽  
Coronary Death ◽  
Increased Risk ◽  
Challenges And Opportunities ◽  
Patients With Diabetes ◽  
Multifactorial Approach

The prevalence of diabetes and its associated complications, such as cardiovascular disease (CVD), has increased over recent years and is expected to continue to rise dramatically. People with diabetes have a poor prognosis, with a substantially increased risk of coronary heart disease, coronary death, non-fatal myocardial infarction, stroke, and other vascular deaths compared with non-diabetic subjects. Conversely, studies have also shown that many patients with CVD have undiagnosed dysglycaemia and that already impaired glucose tolerance and newly detected diabetes are associated with an impaired prognosis. Thus, screening for such conditions, preferably with oral glucose tolerance testing, should be performed in all patients with CVD. Guidelines advocate a multifactorial approach to the management of prediabetes, diabetes and CVD. This includes lifestyle modifications as well as targets for glycaemic control, blood pressure, lipids, and other cardiometabolic risk factors. Although clinical trial data have demonstrated that target-driven strategies can improve outcomes in patients with diabetes, the implementation and execution of these regimens in clinical practice needs to improve.

scholarly journals Prediabetes as a Therapeutic Target

2011 ◽  
Vol 57 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Omid Rad Pour ◽  
Samuel Dagogo-Jack
Keyword(s):  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Plasma Glucose ◽  
Glucose Concentration ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Plasma Glucose Concentration ◽  
Oral Glucose ◽  
Lifestyle Modifications ◽  
Increased Risk

BACKGROUND The term “prediabetes” is used to describe a condition that involves impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). IGT is defined by a 2-h oral glucose tolerance test plasma glucose concentration >140 mg/dL (7.8 mmol/L) but <200 mg/dL (11.1 mmol/L), and IFG is defined by a fasting plasma glucose concentration ≥100 mg/dL (5.6 mmol/L), but <126 mg/dL (7.0 mmol/L). Studies have shown that people with prediabetes tend to develop type 2 diabetes within 10 years and are at increased risk for cardiovascular disease and death even before the development of diabetes. CONTENT In this minireview we discusses the epidemiology, pathophysiology, and clinical implications of prediabetes. The rationale for therapeutic intervention in people with prediabetes, the goals of intervention, and the specific tools for intervention are presented. Emphasis is placed on data from randomized controlled clinical trials, whenever such data are available. SUMMARY Approximately 57 million Americans have prediabetes and are consequently at risk for cardiometabolic complications. Lifestyle modifications (dietary restriction and exercise) and certain medications can prevent the development of diabetes in persons with prediabetes. Lifestyle intervention also has been demonstrated to decrease cardiovascular disease risk markers, although data on clinical events are lacking.

Abnormal Regulation of Venous Alanine after Glucose Ingestion in Myotonic Dystrophy

1985 ◽  
Vol 68 (2) ◽  
pp. 151-157 ◽  
Author(s):  
Richard T. Moxley ◽  
William Kingston ◽  
Robert C. Griggs
Keyword(s):  
Amino Acids ◽  
Glucose Tolerance ◽  
Myotonic Dystrophy ◽  
Normal Glucose Tolerance ◽  
Oral Glucose ◽  
Oral Glucose Tolerance Testing ◽  
Glucose Ingestion ◽  
Normal Glucose ◽  
Normal Males ◽  
Slight Rise

1. The concentration of amino acids in whole blood was measured before and during standard 5 h oral glucose tolerance testing in six male patients with myotonic dystrophy and five normal males. The plasma levels of insulin and glucose were also determined. 2. From 90 to 240 min after glucose ingestion there was a striking decline in venous alanine concentration in the patients with myotonic dystrophy in contrast to a slight rise in alanine in the normal group. 3. The patients displayed normal glucose tolerance, and there was a sustained fall in the venous concentration of the insulin-sensitive amino acids comparable with that seen in the normal controls. However, the patients showed a threefold increase of plasma insulin after glucose. 4. These data indicate an abnormal regulation of alanine in myotonic dystrophy which may be the result of an alteration in muscle synthesis of this amino acid. This defect in alanine synthesis may be due to a decreased availability of intracellular pyruvate caused by the insulin resistance that exists in these patients.

scholarly journals Pattern of Glucose Tolerance among Patients with Peripheral Spondyloarthritis

2020 ◽  
Vol 5 (9) ◽  
pp. 773-777
Author(s):  
A T M Tanveer Hasan ◽  
Al-Mamun .
Keyword(s):  
Diabetes Mellitus ◽  
General Population ◽  
Glucose Tolerance ◽  
Inflammatory Diseases ◽  
Age Groups ◽  
Oral Glucose ◽  
Increased Risk ◽  
Significant Difference ◽  
Study Population ◽  
Peripheral Spondyloarthritis

Peripheral spondyloarthritis is a variant of spondyloarthritis which usually has a chronic course. There is an increased risk of cardiovascular diseases among patients with chronic inflammatory diseases in general. Coexisting diabetes mellitus can potentially add to the risk. The objective of this study was to determine the frequency of glucose intolerance in patients with spondyloarthritis The study was conducted among 35 participants with peripheral spondyloarthritis who visited the Department of Rheumatology, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh from September, 2018 to January, 2020. The participants underwent either oral glucose tolerance test or estimation of HbA1C. The mean age of participants was 43.96 years. The majority (80%) of them were young to muddle-aged (≤40 years). 22.9% of the participants were prediabetic. Diabetes mellitus was found to be present in 37.1% of the participants. There was no significant difference between the study population and the general population in terms of frequency of prediabetes. But the frequency of diabetes in the study population was higher than that in the general population. There was no significant difference between males and females with regard to the frequencies of prediabetes and DM. Moreover, there was no significant difference in the frequencies of prediabetes and DM between young and middle-aged to elderly population. Considering the greater burden of DM among patients with peripheral spondyloarthritis across all age groups, routine screening for DM may be indicated in these individuals.

Trajectories of oral glucose tolerance testing in cystic fibrosis

2020 ◽  
Author(s):  
Monal Patel ◽  
Courtney McCracken ◽  
Tanicia Daley ◽  
Arlene Stecenko ◽  
Rachel Linnemann
Keyword(s):  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Oral Glucose Tolerance Testing ◽  
Tolerance Testing

scholarly journals A Clinic-based Approach to Diagnosis and Management of Prediabetes in High-risk Children and Adolescents

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Chelsea Lawson ◽  
S Naseeruddin Ahmed ◽  
Cassandra Brady ◽  
Ashley H Shoemaker
Keyword(s):  
High Risk ◽  
Glucose Tolerance ◽  
Best Practice ◽  
Fasting Glucose ◽  
Retrospective Chart Review ◽  
Normal Glucose Tolerance ◽  
Oral Glucose ◽  
Oral Glucose Tolerance Testing ◽  
Normal Glucose

Abstract Background Type 2 diabetes (T2D) in youth is increasing in prevalence. Diabetes screening is recommended for at-risk youth but best-practice strategies for management of pediatric prediabetes are unknown. This study leverages a pediatric prediabetes clinic to assess identification of high-risk patients, the rate of clinic follow-up and progression to T2D in youth over time. Methods Retrospective chart review of children referred to a single center for evaluation of prediabetes over a 3-year period. Measurements included hemoglobin A1c (HbA1C) and oral glucose tolerance testing. Patients were classified as normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or T2D based on 2019 American Diabetes Association criteria. Patients classified as IGT/T2D were prescribed metformin. Results Of the 254 patients included; 25.6% had IGT and 6.7% had T2D. The IGT/T2D groups were older and more obese than the NGT group. There was a moderate correlation between HbA1C and fasting glucose (r = 0.59, P < 0.001); HbA1C and 2-hour glucose (r = 0.63, P < 0.001). Over the 3-year study, 52 of 82 patients with IGT/T2D (63%) returned for follow-up. Four patients regained NGT; 3 of those had isolated impaired fasting glucose (100 to 102 mg/dL). Three patients (4.6%) progressed from IGT to T2D over an average of 13 ± 6.2 months. In those patients, body mass index had increased 1.7 ± 2.3 kg/m2 from baseline. Conclusions A pediatric prediabetes clinic may allow for identification of high-risk youth but lost to follow-up rates are high. Continued weight gain is a risk factor for progression to T2D and effective weight management programs are needed.

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