Migratory Activity of Circulating Mononuclear Cells Is Associated With Cardiovascular Mortality in Type 2 Diabetic Patients With Critical Limb Ischemia

Background: We evaluated whether direct or indirect endovascular revascularization, based on angiosome model (AM), affects outcomes in type 2 diabetes (T2DM) and critical limb ischemia (CLI). Methods: From 2010 to 2015, 603 T2DM were admitted for CLI and submitted to endovascular revascularization. Among these, 314 (52%) underwent a direct and 123 (20%) an indirect revascularization, depending on whether the flow to the artery directly feeding the site of ulceration, according to the AM, whereas 166 patients (28%) were judged not revascularizable. Outcomes were: healing (HR), major amputation (MA) and mortality rates (MR), respectively. Results: An overall HR of 62.5% was observed: patients who did not receive PTA presented a HR of 58.4% (p< 0.02 vs revascularized patients). An higher HR was observed in the direct group versus indirect one (82.4% vs 50.4%. p<0.001). MA rate was significantly higher in indirect group than in direct one (9.2% vs 3.2%. p<0.05). MR was 21.6% and higher in indirect revascularization (24% vs 14% in direct group. p<0.05). Conclusions: Our data show that direct revascularization of arteries supplying the diabetic foot ulcers site by means of AM is associated with higher healing rate and lower risk of amputation and death as compared to indirect procedure. These results support use of AM in T2DM with CLI.

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The protective role of metformin in autophagic status in peripheral blood mononuclear cells of type 2 diabetic patients

Cell Biology International ◽

10.1002/cbin.11355 ◽

2020 ◽

Author(s):

Debalina Bhattacharya ◽

Moumita Dutta ◽

Mainak Mukhopadhyay ◽

Maitree Bhattacharyya ◽

Subhankar Chowdhury ◽

...

Keyword(s):

Peripheral Blood Mononuclear Cells ◽

Mononuclear Cells ◽

Protective Role ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Peripheral Blood Mononuclear ◽

Blood Mononuclear Cells ◽

Type 2 Diabetic

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Abstract 3781: A Reduction in Urinary Albumin Excretion is Associated with a Decrease in 10-year Cardiovascular Mortality in Hypertensive Type 2 Diabetic Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_860 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Raymond Estacio ◽

Joseph Coll ◽

Rita Dale ◽

Becki Bucher-Bartelson ◽

Mori J Krantz

Keyword(s):

Cardiovascular Mortality ◽

Urinary Albumin Excretion ◽

Urinary Albumin ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Albumin Excretion ◽

Type 2 Diabetic ◽

Overt Albuminuria

Urinary albumin excretion (UAE) is one of the strongest predictors of both adverse renal and cardiovascular outcomes in patients with type 2 diabetes. Although measurement of UAE is widely recommended, there is little available data to suggest that reducing UAE translates into a reduction in cardiovascular mortality. We assessed whether an early reduction in UAE is associated with improved long-term cardiovascular mortality in hypertensive type 2 diabetic patients with normo, micro, or overt albuminuria at baseline. The study is a 10-year longitudinal analysis of a prospective, randomized study- the Appropriate Blood Pressure Control in Diabetes (ABCD) trial including 393 type 2 diabetic patients with hypertension. We evaluated the association between the change in UAE from baseline to 1-year with the incidence of all cause and cardiovascular mortality over a ten year period. Our results revealed that a reduction in log UAE achieved at one-year was one of the strongest predictors of reduced cardiovascular mortality in a multivariable model that adjusted for multiple cardiovascular risk factors (HR1.42, 95% CI 1.06 – 1.92). This association was at all levels of UAE, normo, micro and overt albuminuria. In conclusion, an early reduction in UAE even at the normoalbuminuria level is associated with improvements in long-term cardiovascular mortality. Our data support current guideline recommendations to screen for UAE in all type 2 diabetic patients, but also suggest that serial UAE measurements after initiation of therapy may have clinical value. Prospective studies addressing this approach to care are needed prior to widespread adoption in practice.

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Effect of metabolic control on the in vitro proliferation of peripheral blood mononuclear cells in type 1 and type 2 diabetic patients

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000400009 ◽

2006 ◽

Vol 124 (4) ◽

pp. 219-222 ◽

Cited By ~ 5

Author(s):

Maria Cristina Foss-Freitas ◽

Norma Tiraboschi Foss ◽

Eduardo Antonio Donadi ◽

Milton Cesar Foss

Keyword(s):

Metabolic Control ◽

Mononuclear Cells ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

In Vitro Proliferation ◽

Peripheral Blood Mononuclear ◽

Type 2 Diabetic

CONTEXT AND OBJECTIVE: Diabetes mellitus is a clinical syndrome that frequently leads to the development of chronic complications and high susceptibility to infections. It is probably due to defective immunological defense, which may be related to metabolic control of the disease. The aim of this study was to evaluate the effect of metabolic control on immune-cell behavior in type 1 and type 2 diabetic patients. For this, the in vitro proliferation of peripheral blood mononuclear cells (PBMC) was analyzed in patients with inadequate and adequate metabolic control. DESIGN AND SETTING: Experimental/laboratory study at a university hospital. METHODS: Eleven type 1 and thirteen type 2 diabetic patients were studied, together with 21 healthy individuals divided in two groups (11/10), who were matched by sex and age with those diabetic patients. PBMC cultures stimulated with concanavalin-A (Con-A) were used to measure ³H-thymidine incorporation after 72 hours of cell culturing. For patients with inadequate metabolic control, culturing was performed on the first day of patient hospitalization and again after intensive treatment to achieve adequate control. RESULTS: The proliferation index for Con-A-stimulated cultures from type 1 diabetic patients was significantly greater than that for cultures from healthy individuals and type 2 diabetic patients, independent of metabolic control. A negative correlation between the proliferation cell index and body mass index and serum C-reactive protein levels was also observed. CONCLUSION: The increase in the proliferation capacity of type 1 diabetic T lymphocytes was probably not caused by hyperglycemia and/or insulinopenia related to inadequate metabolic control.

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