scholarly journals COVID-19 in Relation to Hyperglycemia and Diabetes Mellitus

2021 ◽  
Vol 8 ◽  
Author(s):  
Hayder M. Al-kuraishy ◽  
Ali I. Al-Gareeb ◽  
M. Alblihed ◽  
Susana G. Guerreiro ◽  
Natália Cruz-Martins ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Receptor Expression ◽  
Final Conclusion ◽  
China National Knowledge Infrastructure ◽  
Angiotensin Converting Enzyme 2 ◽  
Dipeptidyl Peptidase 4 ◽  
Risk Of Death ◽  
Pancreatic Damage ◽  
Increased Risk ◽  
Potential Link

Coronavirus disease 2019 (COVID-19), triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), may lead to extrapulmonary manifestations like diabetes mellitus (DM) and hyperglycemia, both predicting a poor prognosis and an increased risk of death. SARS-CoV-2 infects the pancreas through angiotensin-converting enzyme 2 (ACE2), where it is highly expressed compared to other organs, leading to pancreatic damage with subsequent impairment of insulin secretion and development of hyperglycemia even in non-DM patients. Thus, this review aims to provide an overview of the potential link between COVID-19 and hyperglycemia as a risk factor for DM development in relation to DM pharmacotherapy. For that, a systematic search was done in the database of MEDLINE through Scopus, Web of Science, PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), and Wanfang Data. Data obtained underline that SARS-CoV-2 infection in DM patients is more severe and associated with poor clinical outcomes due to preexistence of comorbidities and inflammation disorders. SARS-CoV-2 infection impairs glucose homeostasis and metabolism in DM and non-DM patients due to cytokine storm (CS) development, downregulation of ACE2, and direct injury of pancreatic β-cells. Therefore, the potent anti-inflammatory effect of diabetic pharmacotherapies such as metformin, pioglitazone, sodium-glucose co-transporter-2 inhibitors (SGLT2Is), and dipeptidyl peptidase-4 (DPP4) inhibitors may mitigate COVID-19 severity. In addition, some antidiabetic agents and also insulin may reduce SARS-CoV-2 infectivity and severity through the modulation of the ACE2 receptor expression. The findings presented here illustrate that insulin therapy might seem as more appropriate than other anti-DM pharmacotherapies in the management of COVID-19 patients with DM due to low risk of uncontrolled hyperglycemia and diabetic ketoacidosis (DKA). From these findings, we could not give the final conclusion about the efficacy of diabetic pharmacotherapy in COVID-19; thus, clinical trial and prospective studies are warranted to confirm this finding and concern.

Impact of Diabetes Mellitus and Insulin Use on Survival After Colorectal Cancer Diagnosis: The Cancer Prevention Study-II Nutrition Cohort

2012 ◽  
Vol 30 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Ahmed N. Dehal ◽  
Christina C. Newton ◽  
Eric J. Jacobs ◽  
Alpa V. Patel ◽  
Susan M. Gapstur ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Colorectal Cancer ◽  
Cancer Prevention ◽  
Cox Proportional Hazards ◽  
Prevention Study ◽  
Men And Women ◽  
Risk Of Death ◽  
Increased Risk ◽  
Specific Mortality ◽  
Insulin Use

Purpose To examine the association between type 2 diabetes mellitus (T2DM) and survival among patients with colorectal cancer (CRC) and to evaluate whether this association varies by sex, insulin treatment, and durations of T2DM and insulin use. Patients and Methods This study was conducted among 2,278 men and women diagnosed with nonmetastatic colon or rectal cancer between 1992 and 2007 in the Cancer Prevention Study-II Nutrition Cohort, a prospective study of cancer incidence. In 1992 to 1993, participants completed a detailed, self-administrated questionnaire. Vital status and cause of death were ascertained through the end of 2008. Multivariable-adjusted relative risks (RRs) and 95% CIs were estimated using Cox proportional hazards regression. Results Among the 2,278 men and women with nonmetastatic CRC, there were 842 deaths by the end of follow-up (including 377 deaths from CRC and 152 deaths from cardiovascular disease [CVD]). Among men and women combined, compared with patients without T2DM, patients with CRC and T2DM were at higher risk of all-cause mortality (RR, 1.53; 95% CI, 1.28 to 1.83), CRC-specific mortality (RR, 1.29; 95% CI, 0.98 to 1.70), and CVD-specific mortality (RR, 2.16; 95% CI, 1.44 to 3.24), with no apparent differences by sex or durations of T2DM or insulin use. Insulin use, compared with no T2DM, was associated with increased risk of death from all causes (RR, 1.68; 95% CI, 1.22 to 2.31) and CVD (RR, 3.87; 95% CI, 2.12 to 7.08) but not from CRC (RR, 0.58; 95% CI, 0.28 to 1.19). Conclusion Patients with CRC and T2DM have a higher risk of mortality than patients with CRC who do not have T2DM, especially a higher risk of death from CVD.

scholarly journals A Retrospective Cross Sectional Study of Clinical Characteristics and Prognostic Factors of Covid 19 Patients Admitted to a Gambian Teaching Hospital

2021 ◽  
Author(s):  
Sheikh Omar Bittaye ◽  
Abubacarr Jagne ◽  
Abdoulie Badjan ◽  
Babakunta Fofana ◽  
Ebrima Barrow ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Prognostic Factors ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Health Facility ◽  
Teaching Hospital ◽  
Clinical Characteristics ◽  
Risk Of Death ◽  
Increased Risk ◽  
Lower Level Health Facility

Abstract Background: The first case of Novel coronavirus disease (COVID 19) was diagnosed in The Gambia on the 17th March 2020. We therefore investigate the clinical characteristics and prognostic factors of COVID 19 patients admitted at a Gambian teaching Hospital. Method: Out of 407 suspected COVID 19 patients, 137 (33.7%) tested positive for COVID 19 and were recruited. Clinical features, treatment and outcomes were recorded. Univariate and multivariate logistic regression analyses were used to assess prognostic factors of survival in our patients. Results: The median age of our patients was 60 years (19-100) and 86 (62.8%) were men. Eighty nine (64.9%) patients had co-morbidities, mostly Hypertension 51 (37.2%) and Diabetes Mellitus 47 (34.3%). The most common symptoms were cough 71 (51.8%) and dyspnea 53 (38.7%) and majority of patients presented with SPO ≤ 93% 75 (54.7%). Patients with SPO2 ≤ 93% were older 63.2 vs. 53.1 years (p=0.001), more likely to present with dyspnea (p=0.002), Cough (0.035), higher respiratory rate (p<0.001) and co-morbidities (p=0.009) compared to patients with SPO2>93%. Non survivors were older 63.2 vs 53.1 years (p=0.001), more likely to present with higher respiratory rate (p=0.014), lower oxygen saturation (p=<0.001), to be referred from lower level health facility (p=0.012) and to have Diabetes mellitus (p=0.007) as compared to survivors. Our cumulative mortality is 49 (35.8%) and mortality rate of patients referred from lower level heath facilities was 46 % as compared to 25 % for self referred patients. Multivariate analysis showed increasing odds of mortality independently associated with Age≥ 60 years (odd ratio, 2.87: 95% CI, 1.21 to 6.83, p=0.012), Diabetes mellitus (odd ratio, 3.47: 95% CI, 1.44 to 8.36, p=0.006), oxygen saturation ≤ 93% (odd ratio, 3.18: 95% CI, 1.27 to 7.99, p=0.014) and referral from lower level health facility (odd ratio, 2.87: 95% CI, 1.11 to 6.82, p=0.017).Conclusion: Older patients, patients with Diabetes Mellitus, hypoxemia or patients referred from lower level health facilities are at increased risk of death. In resource limited countries where critical care/emergency medicine resources are limited, our results may help guide the clinical management of patients with severe COVID-19.

scholarly journals Prognostic Value of Troponin Elevation in COVID-19 Hospitalized Patients

2020 ◽  
Vol 9 (12) ◽  
pp. 4078
Author(s):  
Elena-Mihaela Cordeanu ◽  
Nicolas Duthil ◽  
Francois Severac ◽  
Hélène Lambach ◽  
Jonathan Tousch ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Missing Values ◽  
University Hospital ◽  
Troponin Elevation ◽  
Angiotensin Converting Enzyme 2 ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
The Impact ◽  
Observation Period

(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) penetrates the respiratory epithelium through angiotensin-converting enzyme-2 (ACE2) binding. Myocardial and endothelial expression of ACE2 could account for the growing body of reported evidence of myocardial injury in severe forms of Human Coronavirus Disease 2019 (COVID-19). We aimed to provide insight into the impact of troponin (hsTnI) elevation on SARS-CoV-2 outcomes in patients hospitalized for COVID-19. (2) Methods: This was a retrospective analysis of hospitalized adult patients with the SARS-CoV-2 infection admitted to a university hospital in France. The observation period ended at hospital discharge. (3) Results: During the study period, 772 adult, symptomatic COVID-19 patients were hospitalized for more than 24 h in our institution, of whom 375 had a hsTnI measurement and were included in this analysis. The median age was 66 (55–74) years, and there were 67% of men. Overall, 205 (55%) patients were placed under mechanical ventilation and 90 (24%) died. A rise in hsTnI was noted in 34% of the cohort, whereas only three patients had acute coronary syndrome (ACS) and one case of myocarditis. Death occurred more frequently in patients with hsTnI elevation (HR 3.95, 95% CI 2.69–5.71). In the multivariate regression model, a rise in hsTnI was independently associated with mortality (OR 3.12, 95% CI 1.49–6.65) as well as age ≥ 65 years old (OR 3.17, 95% CI 1.45–7.18) and CRP ≥ 100 mg/L (OR 3.62, 95% CI 1.12–13.98). After performing a sensitivity analysis for the missing values of hsTnI, troponin elevation remained independently and significantly associated with death (OR 3.84, 95% CI 1.78–8.28). (4) Conclusion: Our study showed a four-fold increased risk of death in the case of a rise in hsTnI, underlining the prognostic value of troponin assessment in the COVID-19 context.

scholarly journals Coronavirus Infections and Type 2 Diabetes—Shared Pathways with Therapeutic Implications

2020 ◽  
Vol 41 (3) ◽  
pp. 457-470 ◽  
Author(s):  
Daniel J Drucker
Keyword(s):  
Type 2 Diabetes ◽  
Viral Infections ◽  
Biological Activities ◽  
Angiotensin Converting Enzyme 2 ◽  
Dipeptidyl Peptidase 4 ◽  
Therapeutic Implications ◽  
Increased Risk ◽  
Coronavirus Infection ◽  
Coronavirus Infections

Abstract Abstract Individuals with diabetes are at increased risk for bacterial, mycotic, parasitic, and viral infections. The severe acute respiratory syndrome (SARS)-CoV-2 (also referred to as COVID-19) coronavirus pandemic highlights the importance of understanding shared disease pathophysiology potentially informing therapeutic choices in individuals with type 2 diabetes (T2D). Two coronavirus receptor proteins, angiotensin-converting enzyme 2 (ACE2) and dipeptidyl peptidase-4 (DPP4) are also established transducers of metabolic signals and pathways regulating inflammation, renal and cardiovascular physiology, and glucose homeostasis. Moreover, glucose-lowering agents such as the DPP4 inhibitors, widely used in subjects with T2D, are known to modify the biological activities of multiple immunomodulatory substrates. Here, we review the basic and clinical science spanning the intersections of diabetes, coronavirus infections, ACE2, and DPP4 biology, highlighting clinical relevance and evolving areas of uncertainty underlying the pathophysiology and treatment of T2D in the context of coronavirus infection.

scholarly journals Role of incretin based therapies in the treatment of diabetic kidney disease

2018 ◽  
Vol 21 (5) ◽  
pp. 395-398 ◽  
Author(s):  
Paola Fioretto ◽  
Andrea Frascati
Keyword(s):  
Diabetes Mellitus ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Diabetic Kidney ◽  
Dipeptidyl Peptidase 4 ◽  
The Metabolic Syndrome ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
Glucagon Like Peptide 1 ◽  
Stage Renal Disease

Diabetic kidney disease (DKD), a serious microvascular complication of diabetes mellitus is a leading cause of end-stage renal disease and is associated with an increased risk of cardiovascular morbidity and mortality. Despite advancements in blood glucose and blood pressure (BP) control, ~20% to 40% of patients with diabetes mellitus develop DKD. Intensive glycaemic and BP control positively influence decline in estimated glomerular filtration rate and albuminuria, thereby delaying the onset and progression of diabetic nephropathy. Incretin based therapies namely glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used glucose lowering agents and have shown favorable renal outcomes in DKD. This article discusses the extra-glycaemic properties of incretin based therapies and their renoprotective effects on components of the metabolic syndrome, including obesity, hypertension and dyslipidaemia; reduction in oxidative stress and inflammation; and increase in natriuresis.

Lumbosacral Radiculoplexus Neuropathy: Neurological Outcomes and Survival in a Population-based Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011799
Author(s):  
Marcus V. Pinto ◽  
Peng-Soon Ng ◽  
Benjamin M. Howe ◽  
Prabin Thapa ◽  
Ruple S. Laughlin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Survival Data ◽  
Population Based ◽  
Clinical Findings ◽  
Neurological Outcomes ◽  
Risk Of Death ◽  
Increased Risk ◽  
Impairment Score ◽  
Inflammatory Neuropathies ◽  
Artery Disease

Objective:To determine whether community Lumbosacral Radiculoplexus Neuropathy (LRPN) patients have milder neuropathy than referral patients, we characterize the outcomes and survival of population-based compared to referral-based LRPN cohorts .Background:Previously, we found that the incidence of LRPN is 4.16/100,000/year, a frequency greater than other inflammatory neuropathies. The survival of LRPN is uncharacterized.Materials/Methods:62 episodes in 59 LRPN patients were identified over 16 years (2000-2015). Clinical findings were compared to previous referral-based LRPN cohorts. Survival data were compared to age-gender matched controls.Results:At LRPN diagnosis, median age was 70 years, median neuropathy impairment score (NIS) 22 points, 92% had pain, 95% weakness, 23% were wheelchair-bound and median modified Rankin scale (mRS) was 3 (1-4). At last follow-up, median NIS improved to 17 points (p<0.001) with 56% having ≥4 points improvement, 16% were wheelchair-bound, and median mRS was 2. Compared to referral-based LRPN cohorts, community LRPN had less impairment, less bilateral disease (37% vs 92%) and less wheelchair usage (23% vs 49%). LRPN survival was 86% at 5 years and 55% at 10 years. Compared to age-gender matched controls, LRPN patients had 76% increased risk of death (p=0.016). In multivariate analysis, diabetes mellitus, age, stroke, chronic kidney disease, peripheral artery disease, and coronary artery disease were significant mortality risk factors but LRPN was not.Conclusions:LRPN is a painful, paralytic, asymmetric, monophasic, sometimes bilateral pan-plexopathy that improves over time but leaves patients with impairment. Although having LRPN increases mortality, this increase is probably due to comorbidities (diabetes mellitus) rather than LRPN itself.

scholarly journals Dipeptidyl Peptidase 4: A New Link between Diabetes Mellitus and Atherosclerosis?

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Wellington Santana da Silva Júnior ◽  
Amélio Fernando de Godoy-Matos ◽  
Luiz Guilherme Kraemer-Aguiar
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Function ◽  
Dipeptidyl Peptidase ◽  
Noncommunicable Diseases ◽  
Atherosclerotic Cardiovascular Disease ◽  
Dipeptidyl Peptidase 4 ◽  
Increased Risk ◽  
Increase Insulin Secretion

Type 2 diabetes mellitus (T2DM) has become one of the most prevalent noncommunicable diseases in the past years. It is undoubtedly associated with atherosclerosis and increased risk for cardiovascular diseases. Incretins, which are intestinal peptides secreted during digestion, are able to increase insulin secretion and its impaired function and/or secretion is involved in the pathophysiology of T2DM. Dipeptidyl peptidase 4 (DPP4) is an ubiquitous enzyme that regulates incretins and consequently is related to the pathophysiology of T2DM. DPP4 is mainly secreted by endothelial cells and acts as a regulatory protease for cytokines, chemokines, and neuropeptides involved in inflammation, immunity, and vascular function. In T2DM, the activity of DPP4 seems to be increased and there are a growing number ofin vitroandin vivostudies suggesting that this enzyme could be a new link between T2DM and atherosclerosis. Gliptins are a new class of pharmaceutical agents that acts by inhibiting DPP4. Thus, it is expected that gliptin represents a new pharmacological approach not only for reducing glycemic levels in T2DM, but also for the prevention and treatment of atherosclerotic cardiovascular disease in diabetic subjects. We aimed to review the evidences that reinforce the associations between DPP4, atherosclerosis, and T2DM.

scholarly journals Semaglutide for the Treatment of Type 2 Diabetes Mellitus

2018 ◽  
Vol 34 (6) ◽  
pp. 281-289
Author(s):  
Kaitlin E. Miles ◽  
Jessica L. Kerr
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
English Language ◽  
Common Adverse Event ◽  
Pharmacologic Therapy ◽  
Phase 3 ◽  
Risk Of Death ◽  
Increased Risk

Objective: To detail studies investigating the efficacy/safety of semaglutide as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in the treatment of type 2 diabetes mellitus. Data Sources: A literature search in MEDLINE and ClinicalTrials.gov (January 2013 to May 2018) using the terms semaglutide, SUSTAIN, oral, and PIONEER resulted in 10 published articles and 14 ongoing/unpublished articles. Study Selection and Data Extraction: All English language phase 2 and 3 clinical trials evaluating efficacy/safety of semaglutide were included. Data Synthesis: In 9 phase 3, multicenter SUSTAIN trials, the efficacy and safety of semaglutide have been compared with placebo and other pharmacologic therapy for diabetes (PTD). In these trials, semaglutide resulted in lower hemoglobin A1c (HbA1c; approximately −1.5%) and weight reductions (approximately −4.5 kg) as comparable with dulaglutide for HbA1c lowering (approximately −1.5%). Semaglutide also has cardiovascular (CV) outcomes data that show significant reduction in risk of death from CV causes, nonfatal myocardial infarction, or nonfatal stroke (hazard ratio = 0.74; 95% confidence interval = 0.58-0.95). A safety finding that emerged from the CV outcomes trial was an association of semaglutide treatment with an increased risk of retinopathy complications in patients with preexisting diabetic retinopathy. Phase 3 trial data assessing semaglutide oral formulation have shown similar HbA1c (approximately −1.5% for 14 mg dose) and body weight (approximately −4.1 kg for 14 mg dose) reductions as compared with placebo. Across these studies, semaglutide was generally well tolerated with the most common adverse event reported as gastrointestinal side effects as seen in all GLP-1 RAs. Conclusions: These results suggest that semaglutide may have a place in therapy as a GLP-1 RA add-on therapy with higher weight loss as compared with other GLP-1 RAs and PTD and CV benefit.

scholarly journals Relevance of self-control of blood glucose in the aspect of prevention of cardiovascular complications in patients with diabetes mellitus

2021 ◽  
pp. 104-109
Author(s):  
D. I. Trukhan
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Blood Glucose ◽  
Cardiovascular Diseases ◽  
Glycemic Control ◽  
Complications Of Diabetes ◽  
Glucose Levels ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patients With Diabetes

There is a clear link between diabetes and cardiovascular disease. It is known that cardiovascular diseases in patients with diabetes mellitus occur 2–5 times more often than in people without diabetes. It is cardiovascular outcomes that are the main cause of death in patients with diabetes mellitus in both men and women. Diabetes mellitus has a high risk of coronary heart disease, myocardial infarction, arterial hypertension and acute cerebrovascular accident, and patients with diabetes mellitus may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Various rhythm disturbances are much more common in diabetes mellitus, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. The leading factor in the development of vascular complications of diabetes mellitus is hyperglycemia. In addition, early glycemic disorders - impaired glucose tolerance or impaired fasting glycemia - make a significant contribution to the increased risk of macrovascular complications. Improving glycemic control leads to a significant reduction in the risk of late macro- and microvascular complications of diabetes mellitus. Glycated hemoglobin is the gold standard for monitoring glycemic control, but it does not provide complete information on daily and intraday changes in glucose levels. Regular self-monitoring of glucose levels is important in the prevention of cardiovascular diseases in patients with diabetes mellitus. In addition, during the COVID-19 pandemic, all consensus documents and recommendations for the management of patients with diabetes indicate the need for regular monitoring of glucose levels. An important aspect of the technical impact on patients’ adherence to selfcontrol and diabetes therapy is the presence of a convenient communicative connection between the patient and the doctor, in particular, the possibility of contact remotely via a computer and a mobile phone. In conclusion, the possibilities of the new model of the line of blood glucose meters are considered.

Abstract 1245: The Mortality Rate from Cardiovascular Disease is more than Five Times Higher in Individuals with Diabetes Mellitus who have the Hp 2–2 Genotype as Compared to Individuals with Diabetes Mellitus who do not have the Hp 2–2 Genotype

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Uzi Milman ◽  
Shany Blum ◽  
Chen Shapira ◽  
Andrew Levy
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Treatment Strategies ◽  
Total Mortality ◽  
Fold Increase ◽  
High Risk Population ◽  
Risk Of Death ◽  
Health Care Clinics ◽  
Increased Risk

Objective: To determine if the Haptoglobin (Hp) genotype can predict the risk of death from cardiovascular disease in individuals with Diabetes Mellitus (DM) in a prospective community based longitudinal study. Background: The Hp gene is polymorphic in man with two classes of alleles denoted 1 and 2. Retrospective analysis of 5 longitudinal studies has demonstrated that the Hp genotype is a major determinant of the risk of incident CVD in DM individuals. Specifically, individuals with the Hp 2–2 genotype and DM were found to have a 2–5 fold increased risk of CVD as compared to Hp 1–1 or Hp 2–1 DM individuals. Method: 2241 individuals with DM ≥55 years of age from 47 primary health care clinics were Hp genotyped and followed prospectively for three years for incident myocardial infarction, stroke and death (all cause and cardiovascular). All aspects of the medical care of individuals in the cohort were left to the discretion of the patient’s physician. Results: The cohort consisted of 708 individuals with the Hp 2–2 genotype and 1533 individuals with the Hp 1–1 or 2–1 genotype. At baseline there were no significant differences between individuals with and without the Hp 2–2 genotype in their DM characteristics (HbA1c, duration) or in the prevalence of cardiovascular disease (25% in both groups). During the nearly 3 year period of follow up total mortality was increased in individuals with the Hp 2–2 genotype (2.5% vs 1.8%, HR 0.68, CI 0.35–1.25, p=0.2 by log rank). These differences in overall mortality were the result of a greater than 5 fold increase in CV death in Hp 2–2 individuals (1.1% vs 0.2%, HR 0.15, CI 0.038 – 0.44, p=0.001 by log rank). The incidence of non fatal MI was increased by over 50% in the Hp 2–2 group (3.9% vs. 2.5%, p=0.068). These differences were unaffected by adjustment for DM characteristics and conventional cardiovascular risk factors. Conclusions. DM individuals with the Hp 2–2 genotype are at a dramatically increased risk of death due to cardiovascular disease. Pharmacogenomic treatment strategies targeted to this high risk population may provide considerable public health and economic benefit.

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