Current state-of-the-art antiplatelet and anticoagulation therapy in diabetic patients with coronary artery disease

2021 ◽  
Author(s):  
Johny Nicolas ◽  
Victor Razuk ◽  
Gennaro Giustino ◽  
Roxana Mehran
Keyword(s):  
Diabetes Mellitus ◽  
Complex Disease ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Diabetic Patients ◽  
Current State ◽  
Organ Systems ◽  
Patients With Diabetes ◽  
The Status ◽  
Artery Disease

Diabetes mellitus is a complex disease that leads to long-term damage to various organ systems. Among the numerous cardiovascular disease-related complications, thrombotic events frequently occur in patients with diabetes. Although guidelines exist for treating and preventing most diabetes-related co-morbidities, the evidence on antithrombotic therapy in primary and secondary prevention is limited due to the scarcity of randomized trials dedicated to patients with diabetes mellitus. Most of the available data are derived from studies that only included a small proportion of patients with diabetes. The present review provides an overview of the status of knowledge on antiplatelet and anticoagulation therapy in patients with diabetes, focusing on the risk–benefit balance of these therapies and future treatment strategies.

scholarly journals Atherosclerosis of Coronary and Renal Artery Disease in Diabetes Mellitus

1970 ◽  
Vol 5 (2) ◽  
pp. 63-65
Author(s):  
Neena Islam ◽  
KMHS Sirajul Haque ◽  
Md Abu Siddique ◽  
Bikash Subedi ◽  
Jahanara Arzu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Artery Stenosis ◽  
Diabetic Patients ◽  
Organ Systems ◽  
Artery Disease ◽  
Renal Artery Disease

Atherosclerosis is a systemic disease. Although asymmetries in arterial involvement in atherosclerosis may occur, disease usually proceeds in parallel in various organ systems. From a clinical perspective, knowing the prevalence of renal artery involvement in patients with the evidence of atherosclerosis in other organs is important because this knowledge may be incorporated into diagnostic algorithms. This study was aimed to determine the presence of atherosclerotic renal artery disease in diabetes mellitus with coronary artery disease. A total of 173 coronary artery disease patients were purposively selected for the study .Fasting blood sugar level was estimated. Coronary angiograms were performed by standard percutaneous femoral artery cannulation (Judkins Technique).Selective right and left judkins catheter and hand dye injection were used for opacification of renal arteries. Of the 173 study subjects, 143 (diabetic 73) were male and 22 (diabetic 15) were female. Among the diabetic 15 patients had renal artery stenosis and only 7 patients had renal artery stenosis in the non diabetic group. Strength of link between significant renal artery stenosis were strongly correlated (r=0.233, and p, 0.001). Knowledge on the clinical evolution and on the cardiovascular squeal of atherosclerotic renal disease has made substantial progress in recent years. Atherosclerotic renal artery disease is present in significant proportion of diabetic patients undergoing cardiac catheterization for suspected coronary artery disease in comparisons to their non diabetic counter parts. Keywords : Atherosclerosis; Diabetes mellitis; renal artery stenosis DOI: 10.3329/uhj.v5i2.4556 University Heart Journal Vol.5(2) July 2009 pp.63-65

Revascularization in patients with diabetes mellitus

2018 ◽  
pp. 337-350
Author(s):  
George Kassimis ◽  
Adrian Banning
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Developing Countries ◽  
Diabetic Patients ◽  
Industrialized Countries ◽  
Patients With Diabetes ◽  
The Usa ◽  
Artery Disease ◽  
Worse Prognosis

Coronary artery disease (CAD) is virtually ubiquitous in adults with diabetes mellitus (DM) and it confers a substantially worse prognosis than for non-diabetic patients. There are more than 150 million adults worldwide estimated to have DM, at least half of whom will die from cardiovascular causes. Maturity-onset or type 2 DM accounts for up to 95% of all cases of diabetes and its prevalence has increased by 40% in industrialized countries and almost tripled in developing countries. It has been estimated that the global prevalence of DM among adults will be 7.7% (439 million individuals) in 2025. In the USA, the costs related to DM have been estimated at $174 billion in 2007—$116 billion for direct and $58 billion for indirect medical costs such as disability and work loss—while they are expected to rise to $192 billion by 2020.

scholarly journals Patients With Type 2 Diabetes: Anesthetic Management in the Ambulatory Setting. Part 1: Pathophysiology and Associated Disease States

2016 ◽  
Vol 63 (4) ◽  
pp. 208-215 ◽  
Author(s):  
Bryant W. Cornelius
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Anesthetic Management ◽  
Multiple Organ ◽  
Ambulatory Setting ◽  
Diabetic Patients ◽  
Ambulatory Anesthesia ◽  
Disease States ◽  
Organ Systems ◽  
Patients With Diabetes

The increasing prevalence of diabetes mellitus in the general population has many implications for the ambulatory anesthesia provider. Complications, particularly associated with poor glycemic control, can affect multiple organ systems and jeopardize the safety of any planned anesthetic. It is essential that anesthesiologists and sedation providers have in-depth knowledge of the pathophysiology of diabetes mellitus and the comorbid conditions that commonly accompany it. Anesthesiologists and sedation providers must also understand certain surgical and anesthetic considerations when planning an effective and safe anesthetic for diabetic patients. This is a 2-part series concerning perioperative glycemic control for patients with diabetes mellitus. Part 1 will focus on the physiology of diabetes and its associated disease states. Part 2 will address the pharmacology associated with the wide variety of medications used to treat the disorder and the most recent guidelines for blood glucose management in ambulatory surgical patients.

scholarly journals Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Montserrat Dòria ◽  
Verónica Rosado ◽  
Linda Roxana Pacheco ◽  
Marta Hernández ◽  
Àngels Betriu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Foot Ulceration ◽  
Patients With Diabetes ◽  
Artery Disease

Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain.Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression.Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p=0.004andp=0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p=0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations.Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

Features of diabetes mellitus in very elderly patients

2019 ◽  
Vol 1 (9) ◽  
pp. 13-19
Author(s):  
S. V. Topolyanskaya ◽  
T. M. Kolontai ◽  
O. N. Vaculenko ◽  
L. I. Dvoretski
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Very Elderly ◽  
Younger Patients ◽  
Patients With Diabetes ◽  
Artery Disease

Modern concepts about features of diabetes mellitus in very elderly patients are described in the article. Special attention to the therapeutic methods of management of very elderly patients with diabetes mellitus has been devoted. The results of diabetes mellitus study in patients with coronary artery disease older than 75 years in comparison with younger patients are presented.

Management of the Asymptomatic Diabetic Patient with Evidence of Ischaemia

2010 ◽  
Vol 6 (1) ◽  
pp. 62
Author(s):  
Dimitrios Bliagos ◽  
Ajay J Kirtane ◽  
Jeffrey W Moses ◽  
◽  
◽  
...  
Keyword(s):  
Coronary Artery ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Ageing Population ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Asymptomatic Diabetic Patient ◽  
Artery Disease

In the US, a total of 23.6 million people have diabetes, representing 7.8% of the population, and the prevalence of diabetes is on the rise due to an increasingly sedentary lifestyle, increasing obesity and an ageing population. Coronary artery disease is the leading cause of death in patients with diabetes, despite a reduction in cardiovascular events over the last 50 years, due in part to better medical therapy. Asymptomatic diabetic patients with evidence of ischaemia on stress testing have higher cardiac mortality; increasing amounts of ischaemia are associated with higher mortality rates. Revascularisation of high-risk patients, or those with significant ischaemia, has the potential to improve outcomes in this patient population. The choice of which revascularisation strategy to choose – either percutaneous coronary intervention (PCI) or coronary artery bypass grafting – should be carefully individualised, and must always be implemented against the background of optimal medical therapy.

scholarly journals A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus

2019 ◽  
Vol 9 (9) ◽  
pp. 98 ◽  
Author(s):  
Kisokanth G. ◽  
Indrakumar J. ◽  
Prathapan S. ◽  
Joseph J. ◽  
Ilankoon I.M.P.S.
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Management Education ◽  
Self Management ◽  
Rank Test ◽  
Diabetic Patients ◽  
Effective Measure ◽  
Before And After ◽  
Patients With Diabetes ◽  
Preliminary Study

This study was aimed to assess the effectiveness of diabetes self-management education (DSME) in the improvement of glycemic control among patients with type 2 Diabetes Mellitus (T2DM) in Batticaloa District, Sri Lanka. The study was a prospective interventional study and conducted as a preliminary study at medical clinic, Base hospital, Kaluwanchikudy, Batticaloa. Thirty patients with T2DM were included based on inclusion and exclusion criteria. A structured individual diabetes self-management education for 10 hours (one hour per week) was delivered to diabetic patients by the trained Nurse Health Educator. Glycosylate hemoglobin (HbA1c) was assessed as a main outcome measure and Fasting Blood Sugar (FBS), Body Mass Index (BMI) of each patient were also measured and recorded before and after the intervention. The respondent rate was 96.7% (n = 29). Majority of them were females (n = 25, 86.2%). A Wilcoxon signed rank test showed that DSME had a statistically significant reduction in HbA1c [8.60 (IQR 2.60) vs. 7.40 (IQR 2.10), p = .000] and FBS level [159.00 (IQR 77.50) vs. 134.00 (IQR 40.50), p = .002] at 3 months of intervention. The mean BMI at baseline was higher compared to 3 months of intervention [24.88 (SD ± 3.06) vs. 24.19 (SD ± 2.79)] which was statistically significant (p = .000). Majority of participants (n = 22, 75.9%) had improved their HbA1c level by ≥ 0.5% in 3 months. The diabetes self-management education is an effective measure in improving glycemic control and other clinical parameters among patients with T2DM. Thus, DSME needs to be implemented among clinic patients with T2DM for the better outcome and the preventions of complications.

scholarly journals When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

2021 ◽  
Vol 7 (4) ◽  
pp. 298
Author(s):  
Teny M. John ◽  
Ceena N. Jacob ◽  
Dimitrios P. Kontoyiannis
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Clinical Features ◽  
The Other ◽  
Diabetic Patients ◽  
Epidemiological Factors ◽  
Uncontrolled Diabetes ◽  
Diagnostic Certainty ◽  
Patients With Diabetes ◽  
Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

scholarly journals Diabetes Mellitus—A Risk Factor for Unfavourable Outcome in COVID-19 Patients—The Experience of an Infectious Diseases Regional Hospital

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 788
Author(s):  
Egidia Miftode ◽  
Larisa Miftode ◽  
Ioana Coman ◽  
Cristian Prepeliuc ◽  
Maria Obreja ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Inflammatory Responses ◽  
Scientific Data ◽  
Risk Category ◽  
Diabetic Patients ◽  
Direct Effects ◽  
Unfavourable Outcome ◽  
Strong Connection ◽  
Risk Of Death ◽  
Patients With Diabetes

Early research into the implications concerning the evolution of the infection caused by the new coronavirus in people with glucose metabolism dysfunction, in this case diabetics, shows that severe forms of the disease predominate in this risk category. Moreover, it seems that even in patients with normal glycaemic status, COVID-19 may predispose to the development of hyperglycaemia which modulates immune mechanisms and inflammatory responses, with direct effects on morbidity and mortality. Thus, taking into account these scientific data, as well as the increased frequency of diabetes in the general population, we aimed to assess the risk of an unfavourable outcome of diabetic patients, which is in a strong connection with the presence and severity of pulmonary disease such as interstitial pneumonia/bronchopneumonia, as well as the effectiveness of Tocilizumab administration. The results of our study indicate a three-fold higher risk of death in patients with diabetes and COVID-19 (RR = 3.03; IC95%: 2.37–3.86; p = 0.001),compared to nondiabetic patients, and the risk of developing severe forms of acute respiratory failure was 1.5 times higher in the first studied category. In conclusion, we can say that the diabetic diagnosed with SARS-CoV-2 infection is more predisposed to immunological and organic dysfunctions that may ultimately result in death, and treatment with monoclonal anti-IL-6 antibodies was more effective in diabetic patients than non-diabetics (p < 0.05). The effectiveness of Tocilizumab was significant in both studied groups, but diabetic patients responded better to this therapy compared to non-diabetes-mellitus (DM) ones (76.7% vs. 35% p = 0.001).

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