Agents In Diabetic Patients Research Articles

Appraisal of guidelines for managing contrast medium in patients with metformin: consensuses, controversies, and gaps.

The current guidelines contain substantial inconsistency regarding the use of metformin concomitantly with contrast media. The objective of this study is to appraise the guidelines and summarize the agreements and differences among recommendations. Our search focused on English language guidelines published between 2018 and 2021. Guidelines for the management of contrast media in patients with continuous metformin were included. Guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Six guidelines out of 1134 fulfilled the inclusion criteria with an AGREE II score of 79.2% (IQR 72.7 to 85.1%). There was good overall quality of the guidelines, with six considered "strongly recommended." CPGs scored poorly in "Clarity of Presentation" and "Applicability," with scores of 75.9% and 76.4%, respectively. The intraclass correlation coefficients were excellent in each domain. There are some guidelines (33.3%) that recommend discontinuation of metformin in patients with an eGFR of < 30mL/min/1.73 m2, while some guidelines (16.7%) suggest the threshold of renal function should be eGFR < 40mL/min/1.73 m2. Most guidelines recommend withdrawing metformin before using contrast agents in diabetic patients with severely impaired kidney function but disagree on the renal function thresholds. Furthermore, the gaps regarding discontinuing metformin with moderate renal impairment (30mL/min/1.73 m2 < eGFR < 60mL/min/1.73 m2) must be considered in future studies. • Guidelines involving metformin and contrast agents are reliable and optimal. • Most guidelines advocate discontinuing metformin before using contrast agents in diabetic patients with advanced renal failure, but there are controversial suggestions regarding kidney function thresholds. • The gaps regarding the time of discontinuation of the metformin with moderate renal impairment (30mL/min/1.73 m2 < eGFR < 60mL/min/1.73 m2) must be considered in the extensive RCT studies.

Ketofol as induction agent in diabetic patients.

Objective: To evaluate the role of ketofol as induction agent in diabetic patients. Study Design: Randomized Control Trial. Setting: Department of Anesthesia, Abwa Medical College, Faisalabad. Period: 01-12-21 to 01-05-22. Material &amp; Methods: Patients after informed consent divided randomly into two groups 25 in each. Group A receiving propofol 1.5 mg/kg and Group B receiving ketofol 1:2 as induction agent. The dose given was 1ml for every 5Kg. Standard 5 parameter monitoring with pulse oximetry, ECG, non invasive BP done starting from preoperative to 2 minutes, 5 minutes and 10 minutes after induction agent given. MAP and HR were monitored. Hemodynamic instability was defined as I) Heart rate &gt;160/min or &lt;50/min. II) MAP&gt;120mmHg or &lt;60 mm Hg. Results: Total 50 patients included in this study. 25 in each group. The results show significant stability in hemodynamics in group B. Conclusion: Ketofol has better hemodynamic stability as induction agent in diabetic patients when used in a 2:1 ratio. This makes it a good choice for this specific patient population.

Phytochemicals of Periploca aphylla Dcne. ameliorated streptozotocin-induced diabetes in rat

BackgroundPeriploca aphylla is used by local population and indigenous medicine practitioners as stomachic, tonic, antitumor, antiulcer, and for treatment of inflammatory disorders. The aim of this study was to evaluate antidiabetic effect of the extract of P. aphylla and to investigate antioxidant and hypolipidemic activity in streptozotocin (STZ)-induced diabetic rats.MethodsThe present research was conducted to evaluate the antihyperglycemic potential of methanol extract of P. aphylla (PAM) and subfractions n-hexane (PAH), chloroform (PAC), ethyl acetate (PAE), n-butanol (PAB), and aqueous (PAA) in glucose-overloaded hyperglycemic Sprague-Dawley rats. Based on the efficacy, PAB (200 mg/kg and 400 mg/kg) was tested for its antidiabetic activity in STZ-induced diabetic rats. Diabetes was induced via intraperitoneal injection of STZ (55 mg/kg) in rat. Blood glucose values were taken weekly. HPLC-DAD analysis of PAB was carried out for the presence of various polyphenols.ResultsHPLC-DAD analysis of PAB recorded the presence of rutin, catechin, caffeic acid, and myricetin. Oral administration of PAB at doses of 200 and 400 mg/kg for 21 days significantly restored (P < 0.01) body weight (%) and relative liver and relative kidney weight of diabetic rats. Diabetic control rats showed significant elevation (P < 0.01) of AST, ALT, ALP, LDH, total cholesterol, triglycerides, LDL, creatinine, total bilirubin, and BUN while reduced (P < 0.01) level of glucose, total protein, albumin, insulin, and HDL in serum. Count of blood cells and hematological parameters were altered in diabetic rats. Further, glutathione peroxidase, catalase, superoxide dismutase, glutathione reductase, and total soluble protein concentration decreased while concentration of thiobarbituric acid reactive substances and percent DNA damages increased (P < 0.01) in liver and renal tissues of diabetic rats. Histopathological damage scores increased in liver and kidney tissues of diabetic rats. Intake of PAB (400 mg/kg) resulted in significant improvement (P < 0.01) of above parameters, and results were comparable to that of standard drug glibenclamide.ConclusionThe result suggests the antihyperglycemic, antioxidant, and anti-inflammatory activities of PAB treatment in STZ-compelled diabetic rat. PAB might be used as new therapeutic agent in diabetic patients to manage diabetes and decrease the complications.

14980 Safety and clinical outcomes of the 1064-nm neodymium-doped yttrium aluminum garnet laser combined with topical antifungal agents for onychomycosis in patients with diabetes mellitus

Background: Onychomycosis affects approximately one third of patients with diabetes. But, treatment failure risk of oral antifungal agents in diabetic patients is high due to poor patient compliance, drug interactions and decreased immune status. The neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has recently been widely used as one of therapeutic options for onychomycosis. However, there have been few studies on clinical outcome of 1064-nm Nd:YAG laser treatment in diabetic patients.

Rapamycin improves renal injury induced by Iodixanol in diabetic rats by deactivating the mTOR/p70S6K signaling pathway

AimsTo study how to effectively prevent or reduce renal injury caused by contrast agents in diabetic patients. Main methodsSprague Dawley (SD) rats were bred with a high-fat diet for eight weeks, then intraperitoneally injected with Streptozotocin (STZ) to prepare the diabetes model. Rats were treated with Iodixanol to prepare a contrast-induced acute kidney injury (CIAKI) model. Moreover, 3-methyladenine (3-MA), an autophagy inhibitor, was administrated to diabetic rats with or without Rapamycin treatment. Serum creatinine (SCr) and blood urea nitrogen (BUN) were examined using Biochemical detector. Kidney injury molecule-1 (KIM-1), N-acetyl-β-D-amino glycosidase (NAG) in urine, inflammatory and oxidative stress factors in serum were determined by ELISA. The expression level of ROS was quantified by immunofluorescence (IF). The protein expressions of Bax, BCl-2, LC3, Beclin1, mTOR and p70S6K in renal tissue were detected by Western blot. Key findingsRapamycin was demonstrated to improve renal injury induced by Iodixanol diabetic rats, decrease the levels of SCr, BUN, KIM-1, NAG, improve renal functions, reduce inflammatory response and oxidative stress injury, down-regulate Bax, while up-regulate BCl-2 and inhibit apoptosis. Moreover, Rapamycin could inhibit the phosphorylation of mTOR/p70S6K pathway-associated proteins, activate autophagy and increase the levels of LC3 and Beclin1. After treatment with 3MA, an inhibitor of mTOR/p70S6K signaling pathway, the protective effects of Rapamycin on CIAKI were weakened. SignificanceRapamycin can alleviate renal injury induced by Iodixanol diabetic rats, and its regulatory mechanisms may be related to the regulation of mTOR/p70S6K signaling pathway and the activating autophagy.

Intravenous contrast agents in diabetic patients taking metformin; an updated review on current concepts

Iodinated contrast agents are routinely used to diagnose a variety of diseases especially malignant tumors. They are crucial for accurate depiction of tumors, monitoring the response to treatment, and assessing possible recurrence of malignant lesions. Unfortunately, there are potential adverse effects associated with their administration. Metformin as an antidiabetic drug is prescribed widely. The drug is usually administered to control type II diabetes mellitus. One of the most important side effects of metformin is the possibility of lactate accumulation and occurrence of metforminassociated lactic acidosis (MALA), which develops under various circumstances including decreased renal function or concurrent use of toxic agents. Since, intravascular injection of iodinated contrast agents for radiologic purposes may result in kidney injury, it is suggested that metformin should be held in diabetic patients with renal failure before administration of contrast media and not to be taken by the patient again till 48 hours after the procedure and assessment of kidney function which should be normal.

The effect of oral administration of green tea and ginger extracts on blood glucose in diabetic rats.

In recent years,green tea and ginger have become a subject of interest because of their beneficial effects on human health. The aim of the present study was to compare the effect of long term administration of green tea and ginger each alone to the effect of their combination on blood glucose level in streptozotocin-induced diabetic rats. Method: A group of 50 male albino rats was divided into five groups (10 rats each group). The normal control group( NC) administered tap water, other animals were injected by streptozotocin 45mg/Kg body weight intraperitonially to induce diabetes mellitus and then divided into four groups ,diabetic control (DC) without treatment, diabetic group administered green tea extract for four weeks (DGT), diabetic group administered ginger extract for four weeks(DGI), and diabetic group administered mixture of green tea and ginger for four weeks (DGG), then we compare the blood glucose level at 1st,2nd,3rd, and 4th week of experiment. Results:We observed that in groups whose water drink was substituted by green tea and ginger extract, the blood glucose level was significantly( p less than 0.05) reduced as compared to diabetic animals. Importantly, we observed that blood glucose level was near control level when green tea was administered simultaneously with ginger extract.Conclusion: Combination of green tea and ginger may be of great value as hypoglycemic agent in diabetic patients, the synergism of their effect on glucose regulation process is underlying this results.

Exendin-4, a glucagon-like peptide-1 analogue, accelerates diabetic wound healing

BackgroundDiabetes disregulates inflammatory responses and impairs vascular function in wounds. Glucagon-like peptide-1 receptor (Glp-1R) agonists are hypoglycemic agents with pleiotropic vascular protective and anti-inflammatory effects. The therapeutic potential of a Glp-1 analogue in a diabetic rat model of excisional wound injury was investigated. Materials and methodsExcisional wounds were created on the dorsum of streptozotocin-induced diabetic rats, which received placebo or Glp-1 analogue exendin-4 (Ex4; 0.5 μg/kg/d, i.p.) for 2 wk. The final-to-initial wound area ratio was measured for 14 d. Levels of superoxide anions and proinflammatory cytokines in the wound were determined. Angiogenesis was assessed using the Matrigel assay. Expression levels of proangiogenic factors and extracellular matrix proteins were measured. ResultsEx4 restored wound closure in diabetic rats and significantly suppressed the generation of superoxide anions and interleukin-6 in wounds. The number of circulating endothelial progenitor (CD34+/KDR+) cells increased significantly in Ex4-treated diabetic rats, which also showed increased capillary tube formation. Protein levels of vascular endothelial growth factor receptor-2, phosphorylated endothelial nitric oxide synthase, matrix metalloproteinase-2, and transforming growth factor-β were increased in diabetic rats receiving Ex4 therapy. Ex4-enhanced vascularity, dermal regeneration, and epidermal regeneration, while it decreased hemorrhaging and increased the number of proliferative cells in the dermis. ConclusionsEx4 accelerated excisional wound healing in subjects with diabetes. Glp-1R activation attenuates inflammatory response and enhances angiogenesis during the early proliferation phase of wound healing in diabetic subjects, while it enhances transforming growth factor-β/matrix metalloproteinase-mediated regeneration during the maturation phase. These results suggest that Ex4 could be used as a standard hypoglycemic agent in diabetic patients with wound injury.

Posaconazole: an emerging therapeutic option for invasive rhino-orbito-cerebral mucormycosis.

Posaconazole has significant activity against the Mucormycetes. However, data are limited on the clinical efficacy of posaconazole for treating rhino-orbito-cerebral mucormycosis (ROCM). The aim of this study is to assess the efficacy and safety of posaconazole in patients with ROCM. We included 12 consecutive adult patients admitted with ROCM and treated with posaconazole between January 2010 and February 2015. The main outcome of the study was the overall success rate (i.e. either complete or partial response) at the end of treatment. We also assessed serum posaconazole concentrations in a subgroup of patients. Of the 12 patients who received posaconazole, eight patients (66.6%) had complete resolution with median follow-up of 6.5 months (range 2-24 months). Two patients (16.6%) had significant reduction of disease and two (16.6%) had marked residual disease on follow-up. Uncontrolled diabetes was the predisposing factor in all except one patient. One patient developed diarrhoea on posaconazole, which settled without discontinuation of the drug. Posaconazole appears to be a safe and effective antifungal agent in diabetic patients with ROCM, especially in those who have toxicity with polyene therapy.

Synthesis, anti-hyperglycaemic activity, and in-silico studies of N-substituted 5-(furan-2-ylmethylene)thiazolidine-2,4-dione derivatives

Thiazolidinedione derivatives have been used as anti-hyperglycemic agents in diabetic patients since last decade. In the present study, a series of N-substituted-5-(furan-2-ylmethylene)thiazolidine-2,4-dione derivatives were synthesized and characterized by 1H-NMR, 13C-NMR and mass spectra. The introduction of the alkyl/haloalkyl moiety onto the amidic nitrogen of the thiazolidine-2,4-dione ring was intended to enhance the anti-hyperglycaemic activity, which was further tested in vivo by using alloxan-induced diabetic laca mice. Molecular docking simulation studies further helped in understanding the nature of the interactions and the binding mode of ligands inside the active site of the protein tyrosine phosphatase 1B enzyme, which negatively regulates the insulin signaling pathway. The compounds were screened for in-vivo anti-hyperglycaemic activity in which compounds 9 and 10 have exhibited significant decreases in blood glucose level comparable to that of pioglitazone.

Oleuropein activated AMPK and induced insulin sensitivity in C2C12 muscle cells

AimsOleuropein has been recognized as an important medicinal compound because of its various biological properties, including anti-cancer, antidiabetic and anti-atherosclerotic activities. Here, we evaluate the antioxidant activity as well as the mechanism of the hypoglycemic effects of oleuropein in C2C12 cells and we establish the mechanism underlying these effects. Main methodsTo perform this study, C2C12 cells viability was analyzed via MTT assay and the antioxidant activity was investigated by ROS and TBARS assays. Also, the effect of oleuropein on AMPK and PI3 kinase signaling pathways was evaluated. Key findingsTreatment with oleuropein was able to protect cells against H2O2 induced stress in cells. On the other hand, the molecular bases of its actions have been scarcely understood. Oleuropein significantly enhanced glucose consumption and the phosphorylation of AMPK (AMP-activated protein kinase/ACC (acetyl-CoA carboxylase)) and MAPKs (mitogen-activated protein kinases), but not PI3 kinase (Phosphatidylinositol 3-kinase)/Akt. However, the co-treatment of oleuropein and insulin improved the insulin sensitivity via insulin-dependent (PI3 kinase/Akt) and insulin independent (AMPK/ACC) pathways. These results could be confirmed from the findings of GLUT4 translocation which was strongly enhanced in the case of oleuropein. SignificanceOur results provide important insights for the possible mechanism of action of oleuropein as a therapeutic agent in diabetic patients.

Antiplatelet Agents in Diabetic Patients: Clinical Advances and Remaining Questions

Patients with diabetes mellitus (DM) are at significantly greater risk for major cardiovascular events (MACE) than non-DM patients. Primary and secondary prevention of cardiovascular disease (CVD) involves a multifactorial approach that aims to treat the cluster of risk factors associated with this condition including blood disorders and clinical features, such as hyperglycaemia, dyslipidemia, hypercoagulation, obesity and hypertension. Platelet activation and aggregability play a key role in the genesis of arterial thrombus secondary to plaque rupture. For patients in secondary prevention, inhibition of platelet function is crucial to significantly decrease the rate of MACE. Inhibiting plaque rupture would therefore prevent platelet aggregation. For patients with DM presenting with an acute coronary syndrome (ACS), a dual antiplatelet therapy with antagonism of COX1 and P2Y12 is central to their treatment, especially in the setting of percutaneous coronary intervention (PCI) and stenting. Large randomized trials have demonstrated that platelet inhibition with the P2Y12 antagonist clopidogrel, is associated with a better short and long-term prognosis after an acute coronary syndrome. Despite the clinical benefits of clopidogrel in patients with ACS, it has limitations in urgent and early PCI due to its slow onset of action, large interindividual variability and drug-drug interactions resulting in inconsistent drug response with reduced efficacy, especially in patients with diabetes. Therefore, newer drugs with a rapid onset of action, and a more potent and predictable effect have been developed. Prasugrel and ticagrelor have demonstrated net clinical benefit over clopidogrel in two major randomized trials, including a large number of diabetic patients, in patients presenting with non-ST elevation ACS (NSTE-ACS) and ST-elevation ACS (STE-ACS) revascularized by PCI. The aim of this review is to provide an overview of aspirin, P2Y12 receptor antagonists, and Glycoprotein (GP) IIb-IIIa inhibitors in the management of diabetic patients, with a focus on perspectives in optimal and appropriate agent selection and timing of treatment in both primary and secondary prevention.

Refractory rheumatoid factor positive polyarthritis in a female adolescent already suffering from type 1 diabetes mellitus and Hashimoto’s thyroiditis successfully treated with etanercept

Type 1 diabetes mellitus may be associated with many autoimmune diseases with the common autoimmune pathogenesis. We describe the case of a girl suffering from Type 1 diabetes mellitus and autoimmune Hashimoto's thyroiditis since the childhood and, due to the onset of Juvenile Idiopathic Arthritis during adolescence, for three years practiced therapy with an anti-TNF drug, etanercept . Currently her inflammatory markers are normal, arthritis is inactive and diabetes is well controlled. During the treatment with anti-TNF drug we observed a significative reduction of insulin dose, probably due to an increased tissue sensitivity secondary to the suppression of the activity of TNF-alpha. Several clinical trials that have evaluated the effect of immunomodulatory agents in diabetic patients, especially in those with recent onset of disease, were already performed but further studies of longer duration on a larger population are needed to assess the role of biologic drugs and immunotherapy in this group of patients.

Antioxidation and antiglycation of Fagopyrum tataricum ethanol extract.

Fagopyrum tataricum is used for the treatment of type 2 diabetes mellitus in Taiwan. The aim of this study was to evaluate the inhibitory effects of 75% ethanol extract of buckwheat (EEB) and rutin on carbohydrate-metabolized enzymes, including α-amylase and α-glucosidase, which are related to hyperglycemia. The rutin dosage (40μg/mL) was equivalent to that of EEB (200μg/mL). In addition, the antioxidant and antiglycation activities of EEB and rutin were investigated. Results showed that both EEB and rutin exerted free radical (DPPH and ABTS) scavenging activity. They also attenuated protein glycation to lower the generation of advanced glycation end-products (AGEs) through the suppression of fructosamine and α-dicarbonyl compounds. Moreover, EEB and rutin also inhibited α-amylase and α-glucosidase activity. Taken together, these findings suggest that EEB and rutin may reduce oxidative stress, AGEs formation, and carbohydrate-metabolized enzymes hence EEB may use as protection agent in diabetic patients.

Saffron (Crocus sativus L.) increases glucose uptake and insulin sensitivity in muscle cells via multipathway mechanisms

Saffron (Crocus sativus Linn.) has been an important subject of research in the past two decades because of its various biological properties, including anti-cancer, anti-inflammatory, and anti-atherosclerotic activities. On the other hand, the molecular bases of its actions have been scarcely understood. Here, we elucidated the mechanism of the hypoglycemic actions of saffron through investigating its signaling pathways associated with glucose metabolism in C2C12 skeletal muscle cells. Saffron strongly enhanced glucose uptake and the phosphorylation of AMPK (AMP-activated protein kinase)/ACC (acetyl-CoA carboxylase) and MAPKs (mitogen-activated protein kinases), but not PI 3-kinase (Phosphatidylinositol 3-kinase)/Akt. Interestingly, the co-treatment of saffron and insulin further improved the insulin sensitivity via both insulin-independent (AMPK/ACC and MAPKs) and insulin-dependent (PI 3-kinase/Akt and mTOR) pathways. It also suggested that there is a crosstalk between the two signaling pathways of glucose metabolism in skeletal muscle cells. These results could be confirmed from the findings of GLUT4 translocation. Taken together, AMPK plays a major role in the effects of saffron on glucose uptake and insulin sensitivity in skeletal muscle cells. Our study provides important insights for the possible mechanism of action of saffron and its potential as a therapeutic agent in diabetic patients.

C[omicron]mbined cataract surgery with anti‐VEFG agents in patients with quiescent proliferative diabetic retinopathy with no macular edema

AbstractPurpose The study of visual acuity and the course of diabetic retinopathy after combined cataract surgery and injection of ANTI‐VEGF agents in diabetic patients with quiescent proliferative diabetic retinopathy without macular edema.Methods The study included 22 patients with quiescent proliferative diabetic retinopathy with no macular edema aged 62‐75 years of both sexes (15 men and 7 women). The preoperative visual acuity was of 1/10 to 4/10 and the time monitoring the patients after cataract surgery was 18 months.Results The visual acuity improved in all patients and follow up of 18 months showed that only one patient developed macular edema after 6 months who was treated with subsequent monthly infusions of Anti‐VEGF (4.5%). At a percentage of 72.7% (16 patients), visual acuity improved and at a rate of 22.8% (5 patients), visual acuity remained unchangedConclusion The combination of cataract surgery and Anti‐VEGF helps in the greater improvement of visual acuity and of proliferative diabetic retinopathy.

The effects of atorvastatin and rosuvastatin on oxidative stress in diabetic patients

Aim Diabetes is associated with abnormalities in lipid profile and increased oxidative stress. Statins are preferred agents in diabetic patients due to their antioxidant and LDL-C lowering effects. This study is designed to compare the effects of atorvastatin and rosuvastatin on low density lipoprotein cholesterol (LDL-C), lipid hydroperoxide (LOOH), total oxidant status (TOS) and total antioxidant capacity (TAC) in diabetic patients with hyperlipidemia. Materials and methods Sixty two patients who have type 2 diabetes mellitus with serum LDL levels more than 100 mg/dL were randomly assigned to receive atorvastatin 20 mg ( n = 31) or rosuvastatin 10 mg ( n = 31). Blood tests were performed at the beginning of the study and after three months. Results There were no statistically significant differences in the pre- and after treatment levels of the LDL-C between groups. TAC values were increased in both groups and statistically significant in the former group ( p = 0.007). There was no diferrence between the change percentages ((after treatment TAC − pretreatment TAC) / pretreatment level) of TAC between two treatment groups. The effects of two drugs on the other oxidative parameters were not significantly different. Conclusion Both atorvastatin and rosuvastatin may be helpful in reducing increased oxidative stress in diabetic patients with hyperlipidemia.

Therapeutic Options for Diabetic Foot Infections

Foot complications are common in diabetic patients; foot ulcers are among the more serious consequences. These ulcers frequently become infected, and if not treated promptly and appropriately, diabetic foot infections can lead to septic gangrene and amputation. Foot infections may be classified as mild, moderate, or severe; this largely determines the approach to therapy. Staphylococcus aureus is the most common pathogen in these infections, and the increasing incidence of methicillin-resistant S aureus during the past two decades has further complicated antibiotic treatment. Chronic infections are often polymicrobial. Physiologic changes, and local and systemic inflammation, can affect the plasma and tissue pharmacokinetics of antimicrobial agents in diabetic patients, leading to impaired target-site penetration. Knowledge of the serum and tissue concentrations of antibiotics in diabetic patients is, therefore, important for choosing the optimal drug and dose. This article reviews the commonly used therapeutic options for treatment, including many newer antibiotics developed to target multidrug-resistant gram-positive bacteria, and includes available data relating specifically to the tissue penetration of these agents.

Diabetes and acute coronary syndromes

Diabetic patients with acute coronary syndromes (ACSs) are at a high risk for subsequent cardiovascular events but derive, at the same time, greater benefit from evidence-based therapy than non-diabetic individuals. State-of-the-art anti-thrombotic therapy includes a triple anti-platelet combination - aspirin, clopidogrel and glycoprotein (GP) IIb/IIIa receptor inhibitors - and unfractionated heparin or enoxaparin. For low- or medium-risk individuals, a treatment based on aspirin, clopidogrel and bivalirudin is a valuable alternative. Prasugrel, a new and more potent inhibitor of the platelet P2Y(12) receptor, has to be regarded as the most promising anti-thrombotic agent for diabetic patients with ACS. This agent may replace clopidogrel - and possibly GP IIb/IIIa inhibitors - in the future. In addition to aggressive anti-thrombotic therapy, diabetic patients should undergo systematic early invasive angiography if presenting with non-ST-segment elevation ACS, and immediate percutaneous coronary intervention if presenting with ST-segment elevation myocardial infarction. Indeed, the benefit derived from these strategies appears to be more pronounced in the diabetic population than in non-diabetic individuals. Despite the benefit, multiple surveys have demonstrated that, in the setting of ACS, diabetic patients receive evidence-based therapy less frequently than non-diabetic counterparts.

Is aspirin effective in diabetic patients? No

Is aspirin effective in diabetic patients? No