Direct Endovascular Revascularization Based on the Angiosome Model Reduces Risk of Major Amputations and Increases Life Expectancy in Type 2 Diabetic Patients with Critical Limb Ischemia and Foot Ulceration

2021 ◽  
Author(s):  
Elisabetta Iacopi ◽  
Alberto Coppelli ◽  
Chiara Goretti ◽  
Irene Bargellini ◽  
Antonello Cicorelli ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Group Versus ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Endovascular Revascularization ◽  
Indirect Revascularization ◽  
Type 2 Diabetic

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.

Adherence to guideline recommended medical therapies in type 2 diabetic patients with chronic critical limb ischemia

2019 ◽  
Vol 158 ◽  
pp. 107898 ◽  
Author(s):  
Elisabetta Iacopi ◽  
Alberto Coppelli ◽  
Nicola Riitano ◽  
Lorenza Abbruzzese ◽  
Letizia Pieruzzi ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Chronic Critical Limb Ischemia ◽  
Medical Therapies ◽  
Type 2 Diabetic

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

Diabetes Care ◽  
2014 ◽  
Vol 37 (5) ◽  
pp. 1410-1417 ◽  
Author(s):  
Gaia Spinetti ◽  
Claudia Specchia ◽  
Orazio Fortunato ◽  
Elena Sangalli ◽  
Giacomo Clerici ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Critical Limb Ischemia ◽  
Mononuclear Cells ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Migratory Activity ◽  
Type 2 Diabetic

scholarly journals MiR-323b-5p acts as a novel diagnostic biomarker for critical limb ischemia in type 2 diabetic patients

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Biao Cheng ◽  
Ju-yi Li ◽  
Xiao-chao Li ◽  
Xiu-fang Wang ◽  
Zhong-jing Wang ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Diagnostic Biomarker ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

scholarly journals Cystatin C: A Strong Marker for Lower Limb Ischemia in Chinese Type 2 Diabetic Patients?

PLoS ONE ◽  
2013 ◽  
Vol 8 (7) ◽  
pp. e66907 ◽  
Author(s):  
Fang Liu ◽  
Jing Shen ◽  
Jun Zhao ◽  
Hui Zeng ◽  
Lianxi Li ◽  
...  
Keyword(s):  
Cystatin C ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Lower Limb Ischemia ◽  
Type 2 Diabetic

scholarly journals Effects of Apolipoprotein E Isoforms in Diabetic Nephropathy of Chinese Type 2 Diabetic Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
YongWei Jiang ◽  
Liang Ma ◽  
ChengWu Han ◽  
Qian Liu ◽  
Xiao Cong ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Genetic Polymorphism ◽  
Apolipoprotein E ◽  
Group Versus ◽  
Allelic Frequency ◽  
Control Group ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Diabetic nephropathy (DN) is one of the major chronic complications of diabetes. Genetic polymorphism of Apolipoprotein E (ApoE) has been proposed to participating in DN. The purpose of the study was to evaluate the relationship between ApoE genetic polymorphism and the presence of DN in Chinese type 2 diabetic patients. We studied 845 diabetic patients who were divided into DN group (n=429) and control group (n=416). ApoE genotype was determined by ApoE genotyping chip and the plasmatic biochemical characterization was performed on all subjects. There were differences (P<0.001) in HbA1c, creatinine, and urinary albumin between the two groups. The ApoEε2 allelic frequency was 7.69% in DN group versus 3.49% in control group (OR = 2.22, 95% CI = 1.41–3.47, andP<0.05), as expected, ApoE E2/E2 and E2/E3 genotype frequency were higher in DN group (13.75% versus 6.49%,P<0.05). The ApoEε4 allelic frequency was 7.93% in DN group versus 11.54% in control group (OR = 0.70, 95% CI = 0.50–0.97, andP<0.05), and DN group presented a lower frequency of ApoE E3/E4 and E4/E4 genotype frequency (14.91% versus 19.96%,P<0.05). These results suggest ApoEε2 allele may be a risk factor; however ApoEε4 allele may play a protective role of DN in Chinese type 2 diabetic patients.

Vitamin D3 supplementation improves glycemic control in type 2 diabetic patients: Results from an Italian clinical trial

2020 ◽  
pp. 1-10
Author(s):  
Giuseppe Derosa ◽  
Angela D’Angelo ◽  
Chiara Martinotti ◽  
Maria Chiara Valentino ◽  
Sergio Di Matteo ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Metabolic Control ◽  
Vitamin D3 ◽  
Therapy Group ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Abstract. Background: to evaluate the effects of Vitamin D3 on glyco-metabolic control in type 2 diabetic patients with Vitamin D deficiency. Methods: one hundred and seventeen patients were randomized to placebo and 122 patients to Vitamin D3. We evaluated anthropometric parameters, glyco-metabolic control, and parathormone (PTH) value at baseline, after 3, and 6 months. Results: a significant reduction of fasting, and post-prandial glucose was recorded in Vitamin D3 group after 6 months. A significant HbA1c decrease was observed in Vitamin D3 (from 7.6% or 60 mmol/mol to 7.1% or 54 mmol) at 6 months compared to baseline, and to placebo (p < 0.05 for both). At the end of the study period, we noticed a change in the amount in doses of oral or subcutaneous hypoglycemic agents and insulin, respectively. The use of metformin, acarbose, and pioglitazone was significantly lower (p = 0.037, p = 0.048, and p = 0.042, respectively) than at the beginning of the study in the Vitamin D3 therapy group. The units of Lispro, Aspart, and Glargine insulin were lower in the Vitamin D3 group at the end of the study (p = 0.031, p = 0.037, and p = 0.035, respectively) than in the placebo group. Conclusions: in type 2 diabetic patients with Vitamin D deficiency, the restoration of value in the Vitamin D standard has led not only to an improvement in the glyco-metabolic compensation, but also to a reduced posology of some oral hypoglycemic agents and some types of insulin used.

Evaluation of aortic arch calcification in type 2 diabetic patients

VASA ◽  
2005 ◽  
Vol 34 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Papanas ◽  
Symeonidis ◽  
Maltezos ◽  
Giannakis ◽  
Mavridis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Arch ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Insulin Dependence ◽  
Artery Disease ◽  
Type 2 Diabetic ◽  
Aortic Arch Calcification

Background: The purpose of this study is to evaluate the severity of aortic arch calcification among type 2 diabetic patients in association with diabetes duration, diabetic complications, coronary artery disease and presence of cardiovascular risk factors. Patients and methods: This study included 207 type 2 diabetic patients (101 men) with a mean age of 61.5 ± 8.1 years and a mean diabetes duration of 13.9 ± 6.4 years. Aortic arch calcification was assessed by means of posteroanterior chest X-rays. Severity of calcification was graded as follows: grade 0 (no visible calcification), grade 1 (small spots of calcification or single thin calcification of the aortic knob), grade 2 (one or more areas of thick calcification), grade 3 (circular calcification of the aortic knob). Results: Severity of calcification was grade 0 in 84 patients (40.58%), grade 1 in 64 patients (30.92%), grade 2 in 43 patients (20.77%) and grade 3 in 16 patients (7.73%). In simple regression analysis severity of aortic arch calcification was associated with age (p = 0.032), duration of diabetes (p = 0.026), insulin dependence (p = 0.042) and presence of coronary artery disease (p = 0.039), hypertension (p = 0.019), dyslipidaemia (p = 0.029), retinopathy (p = 0.012) and microalbuminuria (p = 0.01). In multiple regression analysis severity of aortic arch calcification was associated with age (p = 0.04), duration of diabetes (p = 0.032) and presence of hypertension (p = 0.024), dyslipidaemia (p = 0.031) and coronary artery disease (p = 0.04), while the association with retinopathy, microalbuminuria and insulin dependence was no longer significant. Conclusions: Severity of aortic arch calcification is associated with age, diabetes duration, diabetic complications (retinopathy, microalbuminuria), coronary artery disease, insulin dependence, and presence of hypertension and dyslipidaemia.

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