Parameters In Diabetic Patients Research Articles

Acarbose Decreases the Rheumatoid Arthritis Risk of Diabetic Patients and Attenuates the Incidence and Severity of Collagen-induced Arthritis in Mice.

Acarbose has been found to decrease some inflammatory parameters in diabetic patients. This study aimed to examine the influence of acarbose on rheumatoid arthritis (RA) risk in diabetes mellitus (DM) patients and on the incidence and severity of collagen-induced arthritis (CIA) in mice. In a nationwide, matched case–control study, we identified 723 incident RA cases and selected 7,230 age-, sex- and RA diagnosis date–matched controls from all newly treated DM patients. We found that use of acarbose at > 16,950 mg per year was associated with a lower RA risk (odds ratio 0.60; 95% CI, 0.41–0.89). In the CIA mouse study, acarbose was orally administered from days -7 to 38 relative to type II collagen (CII) immunization. The results revealed that acarbose at the dose of 500 mg/kg/day attenuated the incidence and severity of arthritis and the expression of proinflammatory cytokines, including TNF-α, IL-6 and IL-17 in the paw tissues. Acarbose further decreased the productions of anti-CII-IgG, IL-17 and IFN-γ by collagen-reactive lymph node cells. This work suggests that the use of acarbose decreased RA risk in DM patients and the incidence of CIA in mice. Acarbose also attenuated the severity of CIA via anti-inflammatory and immunomodulatory effects.

Anterior chamber and refractive parameters in diabetic patients according to metabolic status

PurposeDiabetes Mellitus is associated with changes in refractive parameters. Some aspects already studied were the corneal biomechanics and lens thickness. Although, the discussion about anterior chamber angle and depth is still open.The author objective was to analyze and correlate the anterior chamber depth, lens vault and lens thickness with disease duration and metabolic status.MethodsProspective case‐control study. The anterior chamber and refractive parameters were studied using the Visante OCT and the differences between diabetic patients with metabolic control and disease stability were determined (group 1), without (group 2) and group‐control (3). The metabolic control is based on HbA1c levels. The cut‐off considered was 7%.ResultsA total of 64 patients were evaluated (group 1 – n = 21; group 2 – n = 20; group 3 – n = 23). The mean age was 64.32 ± 7.55 years and approximately 5 years of disease duration. In both groups of diabetic patients we found thicker lens, narrow anterior chamber and higher lens vault compared to control group. There was a difference between diabetic groups exists, but it was not statistically significant.ConclusionsThe anterior chamber angle and lens vault are influenced by the serum glucose levels. Further studies will be necessary to clarify the physiopathology mechanism responsible for the anterior segment modifications.

Anterior chamber and refractive parameters in diabetic patients according to metabolic status

PurposeDiabetes Mellitus is associated with changes in refractive parameters. Some aspects already studied were the corneal biomechanics and lens thickness. Although, the discussion about anterior chamber angle and depth is still open.The author objective was to analyze and correlate the anterior chamber depth, lens vault and lens thickness with disease duration and metabolic status.MethodsProspective case–control study. The anterior chamber and refractive parameters were studied using the Visante OCT and the differences between diabetic patients with metabolic control and disease stability were determined (group 1), without (group 2) and group‐control (3). The metabolic control is based on HbA1c levels. The cut‐off considered was 7%.ResultsA total of 64 patients were evaluated (group 1 – n = 21; group 2 – n = 20; group 3 – n = 23). The mean age was 64.32 ± 7.55 years and approximately 5 years of disease duration. In both groups of diabetic patients we found thicker lens, narrow anterior chamber and higher lens vault compared to control group. There was a difference between diabetic groups exists, but it was not statistically significant.ConclusionsThe anterior chamber angle and lens vault are influenced by the serum glucose levels. Further studies will be necessary to clarify the physiopathology mechanism responsible for the anterior segment modifications.

Levels and correlation between glycated hemoglobin A1c and lipid parameters in diabetic patients recovered from acute myocardial infarction

Introduction. Diabetes mellitus is an important risk factor for coronary artery disease, related to its high prevalence. Risk of developing coronary heart disease in patients with diabetes is 2 to 4 times higher then in non-diabetic patients and correlates with the level of glycated hemoglobin A1c (HbA1c) and severity of dyslipidemia. There is a significant correlation between the level of HbA1c, severity of coronary artery disease and the number of diseased vessels in patients with type 2 diabetes and myocardial infarction Objective. The aim was to determine the level of HbA1c and estimate its correlation with lipid parameters and multivessel coronary artery disease in patients with type 2 diabetes mellitus recovered from myocardial infarction. Method. Study included 42 patients, 24 (57%) men and 18 (43%) women, mean age 65.6 ± 4.6 years, with type 2 diabetes mellitus, recovered from acute myocardial infarction and angiographically confirmed multivessel coronary disease. Levels of HbA1c, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, cholesterol ratio (total cholesterol/HDL) and atherosclerosis index (LDL/HDL) were determined in each patient and correlation between them was examined. Results. The average HbA1c was 8.66 ± 2.21%; total cholesterol 5.55 ± 1.28 mmoll/L; triglycerides 2:51 ± 1.54 mmol/L; LDL 3.32 ± 0.86 mmol/L; HDL 1 06 ± 0.23 mmoll/L; risk factors: total cholesterol/HDL ratio 5.72 ± 2.83; and atherosclerosis index (LDL/HDL) 3.41 ± 1.52. HbA1c shows a positive and statistically significant correlation with the levels of total cholesterol (r = 0.605, p <0.01), triglycerides (r = 0.678, p <0.01), LDL cholesterol (r = 0.375, p <0.01) and a negative highly significant correlation with HDL cholesterol (r = -0.579, p <0.01). There is a positive, statistically significant correlation between HbA1c levels and cholesterol ratio (r = 0.723, p <0.01) and between HbA1c and atherosclerosis index (r = 0.660, p <0.01). Linear regression equation for HbA1c and total cholesterol is y = 0.351x + 2.508, for HbA1c and triglycerides y = 0.471x - 1.572, for HbA1c and LDL cholesterol y = 0.146x + 2.062, for HbA1c and HDL cholesterol y = -1.578 + 0.06x, for HbA1c and cholesterol ratio y = 0.927x - 2.307, for HbA1c and LDL/HDL cholesterol y = 0.455x - 0.529. Conclusion. High levels of HbA1c and statistically significant correlation between HbA1c and lipid parameters in diabetic patients with two vessel and three vessel coronary artery disease recovered from myocardial infarction, indicate that HbA1c level is a significant marker and predictor of dyslipidemia and extensive coronary disease in these patients.

Effects of 6-month sitagliptin treatment on metabolic parameters in diabetic patients taking oral glucocorticoids: a retrospective cohort study.

BackgroundThere are no guidelines for the treatment of diabetes in patients taking glucocorticoids. We studied to understand the effects of 6-month treatment with sitagliptin on metabolic parameters in diabetic patients taking glucocorticoids.MethodsWe retrospectively picked up patients who had been prescribed sitagliptin for 6 months during the continuous prescription of oral glucocorticoids between October 2010 and October 2013 by a chart-based analysis, and compared the data before the sitagliptin treatment with the data at 6 months after the sitagliptin treatment started.ResultsFifteen patients were eligible for the analyses in our study. The plasma glucose and HbA1c levels were significantly reduced by the sitagliptin treatment. Furthermore, body weight significantly decreased. We found a significant and inverse correlation between the change in HbA1c levels and HbA1c levels at baseline. However, there was no significant correlation between the change in HbA1c levels and the daily glucocorticoid dose at baseline.ConclusionsThe present study demonstrated that sitagliptin significantly reduced plasma glucose, HbA1c and body weight. Further, sitagliptin was more effective to improve glycemic control in patients taking glucocorticoids with higher HbA1c levels, independently of the daily glucocorticoid dose.

Treatment of hyperglycaemia in newly diagnosed diabetic patients is associated with a reduction in oxidative stress and improvement in β‐cell function

There exist several reports demonstrating enhancement in oxidative stress in diabetic patients; however, serial and comprehensive measurement of oxidative stress parameters in newly diagnosed diabetic patients is not yet reported. We measured the oxidative stress parameters in diabetic patients serially from the time of diagnosis and after starting treatment to study their association with glycaemia, insulin resistance and β-cell function. Fifty-four newly diagnosed diabetic patients were studied at diagnosis and 4 and 8 weeks after initiating anti-hyperglycaemic treatment. Oxidative stress parameters included activity of antioxidant enzymes, concentration of antioxidant molecules and damage markers. Oxidative stress score was computed as a collective measure of oxidative stress to interpret total oxidative stress state. Association of changing glucose levels with changing oxidative stress parameters over 8 weeks and association of oxidative stress score with insulin resistance and β-cell function was analysed by homeostasis model assessment (HOMA-IR and HOMA-β, respectively). Eight weeks of treatment improved HbA1C from 9.8 ± 2.1 to 7.7 ± 1.0%. There was a significant increase in oxidative stress in diabetic patients [23.8 (95% CI 20.0, 27.6)] compared with non-diabetic subjects [-1.2 (-3.4, 0.9)] (p < 0.001). Non-diabetic subjects showed a stable status over 8 weeks. Improvement in hyperglycaemia in diabetic patients was associated with an improvement in oxidative stress parameters irrespective of the anti-diabetic treatment received. Oxidative stress score fell after 8 weeks and was significantly associated with an improvement in HOMA-β (standardized β = -0.38, p < 0.01) but not with HOMA-IR. Controlling hyperglycaemia in diabetic patients alleviates oxidative stress within 8 weeks of treatment, and improvement in oxidative stress parameters was related to an improved β-cell function.

Effect of Exercise Training on Left Ventricular Remodeling in Diabetic Patients with Diastolic Dysfunction: Rationale and Design

INTRODUCTIONThis study will examine the effects of combined aerobic and resistance training on left ventricular remodeling in diabetic patients with diastolic dysfunction. This is the first randomized controlled trial to look for effects of combined strength training and aerobic exercise on myocardial function as well as other clinical, functional, or psychological parameters in diabetic patients with isolated diastolic dysfunction, and will provide important insights into the potential management strategies for heart failure with preserved ejection fraction.METHODS AND ANALYSISThis is a prospective, randomized controlled investigator initiated single center trial. Diabetic patients with LV diastolic dysfunction suitable for exercise training intervention will be randomized to three months of a supervised combination of aerobic and strength training exercises, or supervised light stretching (control arm). Pre and post intervention assessment will include stress echocardiography, peak aerobic power with 12-lead ECG, dual-energy X-ray absorptiometry, muscle strength, the capacity to perform activities of daily living (ADLs), and questionnaires to assess self-perceived quality of life and symptoms of depression. The primary endpoint is to compare any change in tissue Doppler-derived LV systolic and early diastolic velocities.ETHICS AND DISSEMINATIONThe current trial protocol has been approved by the Human Research Ethics Committee of Austin Health and the University of Melbourne, Melbourne. The study will be performed in accordance with the Declaration of Helsinki. The investigator, regardless of the outcome, will publish the results of the study.TRIAL REGISTRATIONAustralian New Zealand Clinical Trials Registry: ACTRN12610000943044.

Vitamin D deficiency, serum leptin and osteoprotegerin levels in older diabetic patients: an input to new research avenues

The aim of this study was to assess the effects of single oral bolus of 300,000IU Vitamin D3 on serum levels and on bone and metabolic parameters in diabetic patients. This study is a Phase IV, randomized, double-blind, placebo-controlled, monocenter clinical trial. Thirty patients, 60years or older, with type 2 diabetes mellitus, and diabetic foot complications, were enrolled and monitored for 24weeks: 14 were treated with Vitamin D3 and 16 with placebo. Parameters including glucose, adiponectin, leptin, osteoprotegerin (OPG), 25-hydroxyvitamin D [25(OH)D], beta-CrossLaps, osteocalcin, bone-specific isoenzyme of alkaline phosphatase, tumor necrosis factor-α and parathyroid hormone were measured at screening and baseline and 12 and 24weeks after treatment. Analysis of covariance was used to compare treatment groups. Analysis of the data detected a significant increase in 25(OH)D serum levels both at 12 and 24weeks with respect to baseline values only in the treated patients. Significant variations with respect to baseline values were noted in OPG (P=0.0085) and in leptin (P=0.0442) levels: these were lower in the placebo group at week 24 but higher in the treated group. Vitamin D3 supplementation significantly increased serum leptin and OPG levels. Further, large-scale clinical trials are warranted to confirm these results.

Diabetes mellitus does not affect the efficacy and safety of intravesical onabotulinumtoxina injection in patients with refractory detrusor overactivity

To investigate the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with diabetes mellitus (DM) and refractory detrusor overactivity (DO). Forty-eight type 2 DM patients with refractory DO received intravesical 100 U onabotulinumtoxinA injection. Another 48 age-matched patients were randomly selected from a non-diabetic group as controls. Video-urodynamic studies were performed at baseline and were repeated 3 months after treatment. The treatment outcomes were graded on the basis of changes in the Patient's Perception of Bladder Condition (PPBC) and a PPBC decrease of 2 or more points was considered successful. Treatment-related adverse events including acute urinary retention, large post-voiding residual (PVR) volumes, straining to void, urinary tract infection, hematuria, and general weakness were recorded. The mean ages of the diabetic and non-diabetic patients were 73.1 ± 8.8 and 72.0 ± 9.3 (P = 0.552), respectively. The changes of urodynamic parameters were comparable between the two groups. Similar successful results were noted at the 6-month follow-up (DM, 56% vs. non-DM, 61%, P = 0.128). Diabetic patients had a significantly greater incidence of large PVR volumes (DM, 60.4% vs. non-DM, 33.3%; P = 0.007) and general weakness (DM, 10.4% vs. non-DM, 0%; P = 0.03) after treatment. Baseline urodynamic parameters in diabetic patients did not predict the occurrence of adverse events. No major complication was noted in either group. Intravesical onabotulinumtoxinA injection is a safe and effective treatment for DM patients with refractory DO. Patients with DM should be informed of the increased risk of large PVR before initiation of treatment.

Pulmonary function tests in type 2 diabetes mellitus and their association with glycemic control and duration of the disease.

Background:Pulmonary complications of diabetes mellitus (DM) have been poorly characterized. Some authors have reported normal pulmonary functions and even concluded that spirometry is not at all necessary in diabetic patients. Some studies have shown abnormal respiratory parameters in patients of DM. Moreover, the duration of DM and glycemic control have varied impact on the pulmonary functions.Aims and Objectives:The study was undertaken to analyze the pulmonary function parameters in diabetic patients and compare them with age and gender matched healthy subjects. We correlated forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) in diabetic patients with duration of the disease and glycosylated hemoglobin (HbA1c).Materials and Methods:Pulmonary function tests (PFTs) were recorded in 60 type 2 diabetic male patients and 60 normal healthy male controls aged 40-60 years by using Helios 702 spirometer. The PFTs recorded were - FVC, FEV1, FEV1/FVC, FEF25, FEF50, FEF75, FEF25–75, FEF0.2–1.2, and peak expiratory flow rate (PEFR). HbA1c of all the patients was estimated by ion exchange resin method, which is a very standard method of estimation. PFTs of diabetic patients and controls were compared by applying Student′s unpaired t test. Associations between FVC and FEV1 and HbA1c and duration of illness in diabetic patients were analyzed by applying Pearson′s coefficient.Results:The PFTs were significantly decreased in diabetic patients compared with the healthy controls except FEV1/FVC. There was no correlation found between FVC and FEV1 and duration of illness as well as HbA1c.Conclusion:DM being a systemic disease, which also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues, reduced pulmonary elastic recoil and inflammatory changes in lungs. We found glycemic levels and duration of disease are probably not the major determinants of lung pathology, which requires further research.

Intravitreal pegaptanib sodium (Macugen®) for treatment of diabetic macular oedema: a morphologic and functional study

To study whether morphologic (foveal thickness, FT) variations of clinically significant macular oedema (CMO) in patients suffering from diabetes following intravitreal pegaptanib sodium (IVP) injection were associated with functional [macular sensitivity (MS) and colour discrimination (CD)] changes. A longitudinal, interventional, non-randomized study was performed. FT was assessed by optical coherence tomography (OCT), MS by microperimetry, best-corrected visual acuity (BCVA) by early treatment diabetic retinopathy study charts (ETDRS) and CD by Farnswoth-Munsell test. The treatment protocol consisted of three consecutive injections (0.3 mg/0.05 ml; baseline, week 6 and week 12). Follow-up checks were scheduled at 18, 24, 36 and 48 weeks, after injections. Thirty eyes of 30 patients with clinically significant CMO were included for analysis. After IVP a significant decrease of FT occurred with a mean reduction from baseline of 56.9% (P= 0.0001). An improvement of functional parameters was recorded in all patients (BCVA from 18.2 ± 8.5 letters to 25.5 ± 8.4 letters, P < 0.005, MS from 8.6 ± 2.16 dB to 10.6 ± 2.61 dB, P < 0.001, colour analysis from 376.1 ± 125.6 TES to 116 ± 34.6 TES, P= 0.0001). A statistically significant correlation between FT and BCVA as well as MS and CD was also found. Neither ocular nor systemic adverse events were reported. Intravitreal pegaptanib significantly reduced FT, with a concomitant improvement of MS and CD. This association emphasizes the efficacy of IVP in the treatment of CMO.

Correlation between Metabolic Control and Periodontal Parameters in Diabetic Patients

Background and aims. Recent reports suggest that some of the risk factors for periodontal disease are similar to those of certain systemic diseases, and that periodontal disease itself may be a risk factor for some systemic diseases. Therefore, the present study investigated the association of markers of metabolic control and systemic inflammation in diabetics with the extent and severity of periodontal disease; in addition, the relative cardiovascular risk was evaluated in such patients. Materials and methods. A total of 50 known diabetic subjects participated in the study. Periodontal examination included a full-mouth assessment for bleeding on probing using sulcus bleeding index (SBI) and probing depths (PD). Blood analyses were carried out for glycosylated hemoglobin, (HbA1c), C-reactive protein (CRP) and lipid profile. Results. Periodontal disease severity, in terms of SBI scores and PD, was found to be associated with inadequate glycemic control as measured by HbA1c. Similarly, increased probing depths were associated with increased CRP levels, total choles-terol, low-density lipoproteins, and triglycerides (Pl0.05). Conclusion. The results suggest that patients with poorer glycemic control are at increased risk for periodontitis with an associated risk for cardiovascular disease.

Six-channel ECG-based pulse wave velocity for assessing whole-body arterial stiffness

Background. Despite the proposal of different means of non-invasive arterial stiffness assessment, none offers simultaneous information on whole-body peripheral arterial condition. We investigated the validity of applying a six-channel electrocardiogram-based pulse wave velocity (ECG-PWV) measurement system for this purpose. Methods. The study consisted of two parts. Part One enrolled hypertensive (Group 1, n = 32) and normal (Group 2, n = 32) subjects, whereas Part Two recruited diabetic (Group 3, n = 50) and normal (Group 4, n = 50) subjects. To validate the application of ECG-PWV in assessing peripheral arterial stiffness in different parts of body, ECG-PWV data were compared with three other parameters including the cardio-ankle vascular index (CAVI), pulse wave velocity–digital volume pulse (PWV-DVP) and intima-media thickness (IMT). Results. ECG-PWV in healthy subjects in Part One correlated significantly with CAVI and PWV-DVP (p < 0.05), whereas ECG-PWV and CAVI were significantly different between the hypertensive and normal subjects. Moreover, comparison of IMT and ECG-PWV from different sites showed significant correlation only between IMT and ECG-PWV from earlobe (r = 0.495, p = 0.004). No significant association, however, was noted between IMT and CAVI. For Part Two, significant differences existed between diabetic and normal subjects in body weight, waist circumference, level of HbA1c, fasting blood sugar, serum creatinine and ECG-PWV from the foot. However, no significant difference was noted in PWV-DVP between two groups. Conclusions. Six-channel ECG-PWV measurement system showed remarkable correlation with IMT in hypertensive subjects and with key anthropometric and biochemical parameters in diabetic patients, suggesting its validity in assessing whole-body arterial stiffness in subjects with peripheral arterial diseases within 10 min.

&amp;nbsp;Diabetes mellitus and comorbid depression: improvement of both diseases with milnacipran. A replication study (results of the Austrian Major Depression Diabetes Mellitus study group)

Comorbid depression is common in patients with type 2 diabetes mellitus and is associated with greater mortality risk and a higher incidence of diabetic complications and decreased quality of life. In an earlier pilot study, we found that treatment with the serotonin norepinephrine reuptake inhibitor antidepressant, milnacipran, significantly improved metabolic parameters in diabetic patients with comorbid depression who had an antidepressant response. We sought to replicate these results in a larger cohort (n = 135). Patients received milnacipran and metformin for 6 months and metabolic parameters and depressive symptoms were measured at baseline and after 3 and 6 months. At the end of the study, 72.6% of patients had an antidepressant response (≥50% reduction of baseline Beck Depression Inventory score). Overall, there was significant improvement in the metabolic and anthropometric parameters measured. The number of patients with glycated hemoglobin > 8% (>63.9 mmol/mol), an indicator of poor metabolic control requiring intensive therapeutic intervention, decreased from 31.9% at baseline to 11.9% during the study. As found in the pilot study, levels of total cholesterol and triglycerides were only significantly decreased in antidepressant responders. Body weight was significantly reduced in both responders and nonresponders but the effect size was significantly greater in the responder group. In contrast to the pilot study, fasting blood glucose and glycated hemoglobin were significantly decreased to a similar extent in both antidepressant-responders and nonresponders. The present study thus replicates some of the original findings. The main difference between the present and the pilot study is that in the larger cohort significant reductions in fasting blood glucose and glycated hemoglobin were found in all patients irrespective of whether or not they responded to antidepressant treatment. The present data underline the importance of diagnosis and treatment of comorbid depression in patients with type 2 diabetes mellitus with milnacipran.

Validity and reliability of accelerometer-based gait assessment in patients with diabetes on challenging surfaces.

Walking on irregular terrain influences gait of diabetic patients. We investigate the test-retest reliability and construct validity of gait measured with the DynaPort MiniMod under single and dual task conditions in diabetic patients walking on irregular terrain to identify the measurement error (precision) and minimal clinical detectable change. 29 patients with Type 2 diabetes were measured once, and 25 repeated the measurement within 7 days. Patients walked on a therapy garden walkway. Differences between three groups of diabetics with various levels of lower extremity neuropathy were analyzed with planned contrasts. ICC was excellent for intervisit measurements with ICC's >0.824. Bland and Altman Plots, SEM, and SDD showed precise values, distributed around zero for both test conditions. A significant effect of grouping on step length performance hints at possible construct validity of the device. Good reliability of DynaPort MiniMod measurements on a therapy garden walkway and an indication for discriminatory capability suggests that DynaPort MiniMod could facilitate the study of gait in diabetic patients in conditions close to real-life situations. Good reliability, small measurement error, and values of minimal clinical detectable change recommend the further utilization of DynaPort MiniMod for the evaluation of gait parameters in diabetic patients.

RETRACTED: Acarbose on insulin resistance after an oral fat load: a double-blind, placebo controlled study

We evaluated the effects of acarbose on insulin resistance parameters in diabetic patients before and after a standardized oral fat load (OFL). Patients were assigned to take acarbose 50 mg three times a day or placebo; after the first month, acarbose was titrated to 100 mg three times a day. We evaluated body mass index, glycemic control, fasting plasma insulin (FPI), post-prandial plasma insulin (PPI), homeostasis model assessment insulin resistance index (HOMA-IR), blood pressure, lipid profile, retinol binding protein-4 (RBP-4), adiponectin (ADN), tumor necrosis factor-α and resistin (r). Furthermore, at the baseline and at the end of the study, all patients underwent an OFL and an euglycemic hyperinsulinemic clamp. We observed that acarbose was better than placebo in improving glycemic control and HOMA-IR and that it was also more effective in improving lipid profile, RBP-4 and ADN. Regarding FPI, PPI and r, we did not obtain any significant differences between the two groups. During the second OFL, performed after 7 months of therapy with acarbose, we observed a significant decrease of blood glucose, lipid profile and all insulin resistance parameters peaks compared with the OFL administered at baseline with acarbose, but not with placebo. Acarbose was more effective than placebo in improving glycemic and lipid profile and in reducing the post-OFL peaks of the various parameters including the insulin resistance biomarkers.

Effects of Treatment With Risedronate and Alfacalcidol on Progression of Atherosclerosis in Postmenopausal Women With Type 2 Diabetes Mellitus Accompanied With Osteoporosis

IntroductionAccumulating evidence suggests that osteoporosis and cardiovascular disease have epidemiologic similarities. This study investigated the effects of treatment with risedronate and alfacalcidol on parameters of atherosclerosis in postmenopausal women with type 2 diabetes accompanied with osteoporosis. MethodsThirteen Japanese type 2 diabetes postmenopausal women with newly diagnosed osteoporosis (osteoporosis group) and 13 age- and weight-matched diabetic women with normal bone mineral density (control group) were enrolled in this 1-year prospective study. Risedronate (2.5mg/d) and alfacalcidol (1μg/d) were given to the osteoporosis group for a year. We measured parameters of atherosclerosis, such as ultrasonographically evaluated plaque score (PS) and abdominal aortic calcification score (AACS) calibrated by x-ray. ResultsPatients with osteoporosis had significantly higher PS and AACS than control [mean (range)—PS: 11.85 (0.00–27.50) versus 4.90 (0.00–10.90), P=0.02 and AACS: 4.0 (0.0–14.0) versus 1.0 (0.0–7.0), P=0.01]. After 1-year treatment, PS and AACS in the osteoporosis group were not statistically changed, whereas both parameters in the control group were significantly increased (P=0.01 and P=0.03, respectively). When percent changes in these parameters were compared between 2 groups, they were significantly different at any time points (at least P < 0.05). ConclusionsAtherosclerosis parameters in diabetic patients with osteoporosis were higher than those in patients without it. Combination therapy of risedronate with alfacalcidol might protect against progressive atherosclerosis.

Effects of combination of sibutramine and l-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients

The aim of the study was to evaluate the effects of 12-month treatment with sibutramine plus l-carnitine compared with sibutramine alone on body weight, glycemic control, insulin resistance, and inflammatory state in type 2 diabetes mellitus patients. Two hundred fifty-four patients with uncontrolled type 2 diabetes mellitus (glycated hemoglobin [HbA 1c] >8.0%) in therapy with different oral hypoglycemic agents or insulin were enrolled in this study and randomized to take sibutramine 10 mg plus l-carnitine 2 g or sibutramine 10 mg in monotherapy. We evaluated at baseline and after 3, 6, 9, and 12 months these parameters: body weight, body mass index, HbA 1c, fasting plasma glucose, postprandial plasma glucose, fasting plasma insulin, homeostasis model assessment of insulin resistance index, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, tumor necrosis factor– α, adiponectin, vaspin, and high-sensitivity C-reactive protein. Sibutramine plus l-carnitine gave a faster improvement of fasting plasma glucose, postprandial plasma glucose, lipid profile, leptin, tumor necrosis factor– α, and high-sensitivity C-reactive protein compared with sibutramine alone. Furthermore, there was a better improvement of body weight, HbA 1c, fasting plasma insulin, homeostasis model assessment of insulin resistance index, vaspin, and adiponectin with sibutramine plus l-carnitine compared with sibutramine alone. Sibutramine plus l-carnitine gave a better and faster improvement of all the analyzed parameters compared with sibutramine alone without giving any severe adverse effect.

Asymmetrical dimethylarginine (ADMA) and nitric oxide as potential cardiovascular risk factors in type 2 diabetes mellitus.

Hyperglycemia affects biochemical parameters and influences the progression of coronary heart disease and mortality rates in diabetic patients. L-arginine is the substrate used by NO synthase to produce the vasodilator NO. However, in patients with type 2 diabetes mellitus (T2DM), there is an increase in serum levels of methylated L-arginines, such as ADMA, which is a recently identified potent cardiovascular risk factor. The aim of this study was designed to determine both risk factors (ADMA and NO) in type 2 diabetic patients with and without cardiovascular disease and to evaluate whether there is an association between ADMA and glycosylated hemoglobin (HbA1c) on the one hand and nitric oxide on the other hand. The study included 3 groups of subjects; Group I (Control group); comprising 20 healthy subjects; the mean age 48 ± 1.6 years; Group II: 20 diabetic patients without cardiovascular complications; the mean age 51.0 ± 1.96 years and Group III; 20 diabetic patients with evidence of cardiovascular complications; the mean age 54.0 ± 2.1 years. Fasting and postprandial serum glucose, HbA1c, lipid profile (total cholesterol, triacylglycerol, HDL-c and LDL-c), ADMA and serum NO metabolite level, were determined. Serum glucose (fasting and postprandial), HbA1c and ADMA levels showed significant increase in diabetic patients type 2 with and without cardiovascular complications compared to healthy normal control. Total cholesterol, triacylglycerol and LDL-c manifested significant elevations, while HDL-c level showed insignificant change in both groups in compared to non diabetic healthy subjects. Serum NO metabolite level was significantly reduced in the both diabetic patient groups compared with controls. No correlation between ADMA level and studied parameters in diabetic patients without evidence of cardiovascular complications, whereas in cardiovascular complications group, the ADMA level was positively correlated with both postprandial serum glucose and HbA1c, but there was a negative correlation between ADMA levels and NO. Also, NO was negatively correlated with postprandial serum glucose and HbA1c. In conclusion, ADMA and NO may serve as predictors for future cardiovascular events in type 2 diabetic patients. So, early diagnosis and good glycemic control are more effective in reducing the cardiovascular complications. Key words: Type 2 diabetes, cardiovascular disease, ADMA, nitric oxide.

Gait alterations of diabetic patients while walking on different surfaces

Patients with diabetes have been shown to suffer from increased fall risk. However, authors disagree as to whether only diabetic patients with neuropathy, or also those without neuropathy, present gait alterations. Existing studies evaluate gait indoors, i.e. in specialized gait laboratories. This study evaluates gait parameters in diabetic patients under various real life conditions and compares them to those recorded for healthy controls. Methods We conducted a clinical observation study. Forty-five subjects’ gait was assessed on three different surfaces (tar, grass and stones) with a Physilog ® system (BioAGM, CH), consisting of accelerometers and gyroscopes. Temporal and spatial gait parameters as well as stride-to-stride variability of 30 patients with type 2 diabetes, 15 with and 15 without neuropathy were compared to 15 healthy controls. The three groups were comparable for age, height and body weight ( p > 0.05). Results Diabetic patients’ gait parameters differed significantly from those of healthy controls. Post hoc analysis revealed a significant difference between healthy individuals and patients with neuropathy, and between healthy individuals and patients without neuropathy. No difference was observed between patients with and without neuropathy. The highest surface effect was found in patients with diabetic neuropathy, followed by patients without neuropathy and healthy controls. Conclusions Walking in real life conditions revealed gait difficulties in patients with type 2 diabetes before neuropathy was clinically detectable. Clinicians should be aware that diabetic individuals’ gait capacity decreases and fall risk increases at an early stage of the disease.