scholarly journals Ankle-Brachial Index Is Independently Associated With Cardiovascular Outcomes and Foot Ulcers in Asian Patients With Type 2 Diabetes Mellitus

2021 ◽  
Vol 12 ◽  
Author(s):  
Ming-Chi Yang ◽  
Yu-Yao Huang ◽  
Sheng-Hwu Hsieh ◽  
Jui-Hung Sun ◽  
Chih-Ching Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Ankle Brachial Index ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Type 2 Dm

Background and AimsThe ankle-brachial index (ABI) is an efficient tool for objectively documenting the presence of lower-extremity peripheral arterial disease (PAD). The predictive factors of cardiovascular events and diabetic foot ulcer were not clear from the ABI examination in Taiwanese patients with type 2 diabetes mellitus (DM).MethodsWe enrolled 482 patients with type 2 DM who regularly visited the outpatient department of Chang Gung Memorial Hospital and received ABI as well as brachial-ankle pulse wave velocity (ba-PWV) examinations from 2010 to 2017. Age, gender, PAD symptoms, comorbidities, family history of chronic diseases, lifestyle (smoking, alcohol consumption, and exercise), height, weight, waist circumference, monofilament testing and foot ulcer status were studied.ResultsThere were 104 (22%) patients (mean age, 67.8 years) with the ABI <1.0. These patients with low ABI (ABI<1.0) had a significantly older age (p=0.001), higher delta PWV (p<0.001), higher rates of stroke (p=0.007), myocardial infarction (p=0.016), and foot ulcer (p=0.039). In a multivariable analysis model, the adjusted odds ratio (aOR) for myocardial infarction, stroke, and foot ulcers associated with low ABI were 1.219 (0.397-3.743, p=0.729), 1.204 (0.556-2.610, p=0.638), and 2.712 (1.199-6.133, p=0.017), respectively. The patients with low PWV (PWV<1400 cm/s) were significantly younger (p<0.001) and had a lower rate of hypertension (p<0.001), and higher percentages of stroke (p=0.027) and dialysis (p=0.041) family history.ConclusionsLow ABI was associated with cardiovascular events and diabetic foot ulcer independently in patients with type 2 DM.

scholarly journals Asymmetric dimethylarginine – a marker of repeated cardiovascular events in patients with comorbid pathology

2021 ◽  
Vol 25 (4) ◽  
pp. 567-571
Author(s):  
D. A. Feldman
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Acute Myocardial Infarction ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Asymmetric Dimethylarginine ◽  
Type 2 Dm

Annotation. Today, diseases of the cardiovascular system retain their leading position among the incidence in the world. The presence of comorbid pathology in the form of type 2 diabetes mellitus (DM) significantly complicates the course of these diseases, worsening its prognosis. The aim of the study: to analyze the prognostic value of asymmetric dimethylarginine (ADMA) as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes for 6 months of follow-up. 120 patients were examined: group 1 – patients with acute myocardial infarction (AMI) in combination with type 2 diabetes mellitus (n=70), group 2 - patients with isolated AMI (n=50). The control group included 20 practically healthy individuals. All patients underwent general clinical and instrumental examinations, on the first day of AMI the level of ADMA was determined using a commercial test system "Human Asymmetrical Dimethylarginine ELISA". Statistical processing of the obtained data was performed using the software package StatSoft Inc, USA – "Statistica 6.0". The analysis of the average level of ADMA showed a significantly higher value of this indicator in patients with AMI in combination with type 2 DM than in patients without concomitant type 2 DM 2.57 times (1.57±0.11 μmol / l and 0.61±0.06 μmol / l, respectively), (p<0,05. ADMA level >1,72 μmol / l in patients with AMI in combination with type 2 DM and >0,69 μmol / l in patients with AMI without concomitant type 2 DM was identified as a predictor of recurrent acute myocardial infarction within 6 months of follow-up. Thus, the level of ADMA was higher in the presence of comorbid pathology in the form of type 2 DM in patients with AMI, reflecting endothelial dysfunction combining disease. It is advisable to further study this indicator of endothelial dysfunction as a predictor of the adverse course of AMI in combination with concomitant type 2 DM.

scholarly journals Effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events in patients with Type 2 diabetes mellitus with or without established cardiovascular disease: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 41 (35) ◽  
pp. 3346-3358 ◽  
Author(s):  
Fabio Marsico ◽  
Stefania Paolillo ◽  
Paola Gargiulo ◽  
Dario Bruzzese ◽  
Simona Dell’Aversana ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Receptor Agonists ◽  
Type 2 Dm ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Abstract Aims  Glucose-lowering, glucagon-like peptide-1 (GLP-1) receptor agonists reduce incidence of major cardiovascular (CV) events in patients with Type 2 diabetes mellitus (DM). However, randomized clinical trials reported inconsistent effects on myocardial infarction (MI) and stroke, and limited data in DM patients without established CV disease (CVD). Very recently, new relevant evidence was available from additional CV outcome trials (CVOTs) that also included large subgroups of patients with DM without established CVD. Thus, the aim of this meta-analysis was to investigate the effects of GLP-1 receptor agonists on major CV events and safety in DM patients with and without established CVD. Methods and results  In this trial-level meta-analysis, we analysed data from randomized placebo-controlled CVOTs assessing efficacy and safety of GLP-1 receptor agonists in adult patients with Type 2 DM. We searched PubMed, Embase, Cochrane, ISI Web of Science, SCOPUS, and clinicaltrial.gov databases for eligible trials. Of 360 articles identified and screened for eligibility, seven CVOTs were included, with an overall of 56 004 patients included. The difference in efficacy with respect to the major adverse cardiovascular events (MACE) primary endpoint (including CV mortality, non-fatal MI, and non-fatal stroke) between patients with established CVD and patients with CV risk factors only was not significant [pooled interaction effect, expressed as ratio of hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.85–1.34]. In the analysis of the whole population of DM patients, GLP-1 receptor agonists showed a significant 12% reduction in the hazard of the three-point MACE composite endpoint (HR 0.88, 95% CI 0.80–0.96) and a significant reduction in the risk of CV mortality (HR 0.88, 95% CI 0.79–0.98), all-cause mortality (HR 0.89, 95% CI 0.81–0.97), fatal and non-fatal stroke (HR 0.84, 95% CI 0.76–0.94), and heart failure (HF) hospitalization (HR 0.92, 95% CI 0.86–0.97). No significant effect was observed for fatal and non-fatal MI (HR 0.91, 95% CI 0.82–1.02), although in a sensitivity analysis, based on a less conservative statistical approach, the pooled HR become statistically significant (HR 0.91, 95% CI 0.83–1.00; P = 0.039). No excess of hypoglycaemia, pancreatitis, and pancreatic cancer was observed between GLP-1 receptor agonists and placebo. Conclusion  Glucagon-like peptide-1 receptor agonists significantly reduce MACE, CV and total mortality stroke, and hospitalization for HF, with a trend for reduction of MI, in patients with Type 2 DM with and without established CVD.

Meta-Anaylsis: Gender and the Risk of Lower Extremity Amputation in Patients with Type 2 Diabetes Mellitus and Foot Ulcer

2020 ◽  
Author(s):  
Anissa Eka Septiani ◽  
◽  
Bhisma Murti ◽  
Setyo Sri Rahardjo ◽  
Hanung Prasetya ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lower Extremity ◽  
Foot Ulcer ◽  
Lower Extremity Amputation ◽  
Limb Amputation ◽  
Type 2 Dm ◽  
Extremity Amputation

ABSTRACT Background: Diabetes is an independent predictor of limb amputation (versus revascularization) for the treatment of critical limb ischemia. Much of the cost related to diabetes results from macrovascular and microvascular complications, such as myocardial infarctions, end-stage renal disease, and lower extremity amputations (LEAs). This study aimed to examine the associations between gender and the risk of lower extremity amputation in patients with type 2 diabetes mellitus and foot ulcer. Subjects and Method: A meta-analysis and systematic review was conducted by collected published articles from Pubmed, Scopus, Google Scholar, and Springer Link databases. Lower limb amputation, lower extremity amputation, diabetic foot, and diabetic ulcer keywords were used to collect the articles. The inclusion criteria were full text, cohort study, and reporting adjusted odds ratio. The selected articles were analyzed by PRISMA flow chart and revman 5.3. Results: 9 articles were reported that male increased the risk of lower extremity amputation in type 2 DM patients (aOR= 1.60; 95% CI= 1.32 to 1.94; p<0.001). Conclusion: Male increases the risk of lower extremity amputation in type 2 DM patients. Keywords: lower extremity amputation, type 2 diabetes mellitus, foot ulcer Correspondence: Anissa Eka Septiani. Masters Program in Public Heath, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: 089514646458. DOI: https://doi.org/10.26911/the7thicph.01.37

scholarly journals Comparison Pai-1 Level in Type 2 Diabetes Mellitus with and Without Diabetic Foot Ulcer

2018 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Alfi Dewi Sholat ◽  
Dairion Gatot ◽  
Savina Handayani ◽  
Andri Iskandar Mardia ◽  
Santi Syafril
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Significant Difference ◽  
Pai 1

In type 2 diabetes mellitus, there are changes in hemostasis components, including overexpression of PAI-1. By these facts, the authors are interested in conducting the study of PAI-1 level in diabetic patients with and without foot ulcer. Methods: The sample of this research was collected cross-sectionally on 20 type 2 diabetic patients with foot ulcer and 20 without foot ulcer. Blood samples were taken to measure serum PAI-1 level, complete blood count and hemostasis screening test. Results: Statistical analysis showed there are significant differences in hemoglobin, trombosit, Fibrinogen and D-dimer levels in the ulcer and non-ulcer groups but no significant difference in PAI-1 level. Conclusions: No higher PAI – 1 level were found in diabetic foot ulcer group than those without diabetic foot ulcer. There was no significant difference between PAI-1 level and grade of diabetic foot ulcer.

NPWT: a gate of hope for patients with diabetic foot ulcers

2019 ◽  
Vol 28 (12) ◽  
pp. S6-S9
Author(s):  
Kazem Hajimohammadi ◽  
Khadijeh Makhdoomi ◽  
Roghayeh Esmaili Zabihi ◽  
Naser Parizad
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Irrigation ◽  
History Of

Non-healing diabetic foot ulcers are a common and costly complication of type 2 diabetes and can result in lower extremity amputation. This case study concerns a 51-year-old man with a 17-year history of uncontrolled type 2 diabetes. He had developed a deep ulcer to the calcaneus of his left foot, which was 12x7 cm in size and infected with multi-drug-resistant Staphylococcus aureus. He was admitted to hospital for the non-healing diabetic foot ulcer and uncontrollable fever and was a candidate for amputation. He was treated with wound irrigation and debridement as well as negative-pressure wound therapy and antibiotic treatment. This strategy was effective and the wound size reduced progressively. The patient recovered well. Medical and wound care teams who deal with non-healing diabetic foot ulcers can benefit from a strategy of combination therapy.

scholarly journals Prevalence and Risk Factors of Peripheral Arterial Disease in type 2 Diabets Mellitus in Yogyakarta, Indonesia

2021 ◽  
Vol 7 (2) ◽  
pp. 5
Author(s):  
Muhamad Taufik Ismail ◽  
Hariadi Hariawan ◽  
Firman Fauzan Arief Lutfie ◽  
Dhite Bayu Nugroho ◽  
Vina Yanti Susanti ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Risk Factor ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Type 2 Dm ◽  
Peripheral Arterial

Aim: Diabetes mellitus increases the risk of peripheral artery disease (PAD) 2 times. PAD is diagnosed by ABI (Ankle Brachial Index). PAD increases mortality and morbidity of patient with Diabetes Mellitus (DM) Type 2. This study aims to determine the prevalence and risk factors of PAD in the population of type 2 diabetes mellitus (DM) in Yogyakarta, Indonesia.   Methods: This study was a community-based descriptive and analytic observational study that examines the prevalence and risk factors of PAD in type 2 diabetes mellitus. Diagnosis of PAD was detected by ABI examination using VaSera VS-1500N. All patients with type 2 diabetes mellitus in Yogyakarta who meet the inclusion criteria will be enrolled in this study. The research subjects were taken in multi-stage, cluster-random sampling in Yogyakarta. The patient will undergo an interview of demographic data which were assessed by one assessor.  Data from interviews and ABI examinations were analysed statistically.   Results: Two hundred and fifty-six (256) patients with type 2 DM consisted of 188 patients (73.4%) women and 68 patients (26.6%) men. Prevalence of PAD diagnosed by abnormal ABI was found in 41 (16%) of 256 patients. Subjects with age more than 67 years old was significantly associated with PAD occurrence (P=0,001) in type 2 DM population.   Conclusion: The prevalence of PAD was 16% of 256 type 2 DM patients. Age more than 67 years old was the strong risk factor of PAD in type 2 DM.   Key words: Ankle Brachial Index, Peripheral Arterial Disease, Diabetes mellitus, Prevalence, Risk Factor

scholarly journals Glucagon-like peptide-1 (GLP-1) receptor agonists and cardiovascular events in patients with type 2 diabetes mellitus: A meta-analysis of double-blind, randomized, placebo-controlled clinical trials

2019 ◽  
Author(s):  
Jing Qin ◽  
Li Song
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Double Blind ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Fatal Myocardial Infarction

Abstract Background The cardiovascular effects of glucagon-like peptide-1 (GLP-1) receptor agonists are still controversial in the treatment of type 2 diabetes mellitus (T2DM) patients. The purpose of this study was to evaluate the risk of cardiovascular events of GLP-1 (albiglutide, exenatide, liraglutide and semaglutide) receptor agonists in T2DM patients.Methods PubMed and Embase were searched to find relevant randomized controlled trials (RCTs) from inception to June 2019 that evaluated the effect of GLP-1 receptor agonists on cardiovascular events in patients with T2DM. The T2DM patients of all the eligible trials received either GLP-1 therapy or placebo, and the cardiovascular outcomes included death from cardiovascular causes, fatal or non-fatal myocardial infarction and fatal or non-fatal stroke.Results We included 4 multinational double-blind randomized placebo-control trials that included a total of 36852 T2DM patients. The results indicated that GLP-1 receptor agonists reduced the risk of death from cardiovascular causes (RR: 0.86; 95% CI: 0.78–0.96; P = 0.005), fatal or non-fatal myocardial infarction (RR: 0.85; 95% CI: 0.74–0.98; P = 0.03) and fatal or non-fatal stroke (RR: 0.84; 95% CI: 0.75–0.95; P = 0.007) compared with the placebo controls.Conclusion We concluded that GLP-1 receptor agonist therapy had a protective cardiovascular effect compared with the placebo in the treatment of T2DM patients in trials with cardiovascular outcomes.

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