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1.
Clinical relevance of aortic stiffness in end-stage renal disease and diabetes: implication for hypertension management.
Yannoutsos, A, Bahous, SA, Safar, ME, Blacher, J
Journal of hypertension. 2018;(6):1237-1246
Abstract
: Evidence suggests that aortic stiffness may antedate and contribute initially to the development of hypertension and cardiovascular risk (CVR). In treated hypertensive patients, both diabetes and end-stage renal disease (ESRD) are comorbid conditions associated with increased aortic stiffness and high CVR. Thus, the pathophysiological relationship between aortic stiffness, blood pressure (BP) and CVR may have clinical implication in the management of hypertension. In patients with diabetes or ESRD, aortic stiffness is a significant predictor of CVR, independently of BP control. The hallmark of accelerated aortic stiffening in these patients associates the presence of vascular calcification, which is considered as a time-dependent process. Aortic stiffness represents a marker of structural but also functional arterial damage associated with increased pressure pulsatility. Carotid-femoral pulse wave velocity (cf-PWV), as a marker of aortic stiffness, may provide a readily available information for the effectiveness of risk reduction strategies. SBP, hyperglycemia and progressive alteration of renal function are considered as determinants of accelerated aortic stiffening. These findings suggest that earlier and intensive treatment of glycemia and BP could be important to limit or even reverse stiffening process. In patients with ESRD, more specific and potentially modifiable kidney disease-related parameters such as phosphocalcic disorders and vitamin K deficiency, appear correlated with aortic calcification and cf-PWV. An important and recent finding is that the magnitude of longitudinal increase in cf-PWV may represent a clinically pertinent surrogate for cardiovascular events. Aortic stiffness may be, thus, considered as an intermediate marker to monitor effectiveness of preventive strategies in these high-risk patients.
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2.
Diabetic retinopathy pathogenesis and the ameliorating effects of melatonin; involvement of autophagy, inflammation and oxidative stress.
Dehdashtian, E, Mehrzadi, S, Yousefi, B, Hosseinzadeh, A, Reiter, RJ, Safa, M, Ghaznavi, H, Naseripour, M
Life sciences. 2018;:20-33
Abstract
Diabetic retinopathy (DR), a microvascular complication of diabetes mellitus (DM), remains as one of the major causes of vision loss worldwide. The release of pro-inflammatory cytokines and the adhesion of leukocytes to retinal capillaries are initial events in DR development. Inflammation, ER stress, oxidative stress and autophagy are major causative factors involved in the pathogenesis of DR. Diabetes associated hyperglycemia leads to mitochondrial electron transport chain dysfunction culminating in a rise in ROS generation. Since mitochondria are the major source of ROS production, oxidative stress induced by mitochondrial dysfunction also contributes to the development of diabetic retinopathy. Autophagy increases in the retina of diabetic patients and is regulated by ER stress, oxidative stress and inflammation-related pathways. Autophagy functions as a double-edged sword in DR. Under mild stress, autophagic activity can lead to cell survival while during severe stress, dysregulated autophagy results in massive cell death and may have a role in initiation and exacerbation of DR. Melatonin and its metabolites play protective roles against inflammation, ER stress and oxidative stress due to their direct free radical scavenger activities and indirect antioxidant activity via the stimulation antioxidant enzymes including glutathione reductase, glutathione peroxidase, superoxide dismutase and catalase. Melatonin also acts as a cell survival agent by modulating autophagy in various cell types and under different conditions through amelioration of oxidative stress, ER stress and inflammation. Herein, we review the possible effects of melatonin on diabetic retinopathy, focusing on its ability to regulate autophagy processes.
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3.
Diabetes and pancreatic neuroendocrine tumours: Which interplays, if any?
Gallo, M, Ruggeri, RM, Muscogiuri, G, Pizza, G, Faggiano, A, Colao, A, ,
Cancer treatment reviews. 2018;:1-9
Abstract
Pancreatic neuroendocrine tumours (PanNETs) represent an uncommon type of pancreatic neoplasm, whose incidence is increasing worldwide. As per exocrine pancreatic cancer, a relationship seems to exist between PanNETs and glycaemic alterations. Diabetes mellitus (DM) or impaired glucose tolerance often occurs in PanNET patients as a consequence of hormonal hypersecretion by the tumour, specifically affecting glucose metabolism, or due to tumour mass effects. On the other hand, pre-existing DM may represent a risk factor for developing PanNETs and is likely to worsen the prognosis of such patients. Moreover, the surgical and/or pharmacological treatment of the tumour itself may impair glucose tolerance, as well as antidiabetic therapies may impact tumour behaviour and patients outcome. Differently from exocrine pancreatic tumours, few data are available for PanNETs as yet on this issue. In the present review, the bidirectional association between glycaemic disorders and PanNETs has been extensively examined, since the co-existence of both diseases in the same individual represents a further challenge for the clinical management of PanNETs.
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Metamorphopsia Score and Central Visual Field Outcomes in Diabetic Cystoid Macular Edema.
Kalinowska, A, Nowomiejska, K, Brzozowska, A, Maciejewski, R, Rejdak, R
BioMed research international. 2018;:4954532
Abstract
AIM: To detect abnormality of the visual function in naïve patients with cystoid diabetic macular edema (DME) using M-charts, Amsler test, and white on white (W/W) and blue on yellow (B/Y) perimetry. METHODS There were 64 eyes included in the study: 30 eyes with DME, 22 eyes with diabetes without DME, and 12 eyes of normal subjects. Conventional W/W perimetry and B/Y perimetry were performed within the central 10° of the visual field. To assess metamorphopsia, Amsler test and M-charts were used. RESULTS The rate of detection of metamorphopsia was 37% with Amsler test examination and 50% with M-charts. Specificity of both tests was 100%. We found a significant difference between vertical scores of M-charts in all groups, but not in horizontal scores (p < 0.0001). Mean defect (MD) was 8.9 dB and 3.6 dB and loss variance (LV) 4.8 dB and 3.3 dB (p < 0.0001). CONCLUSIONS M-chart is more sensitive than Amsler test method for detection of metamorphopsia. The MD and LV are higher in b/y in comparison to W/W perimetry. B/Y perimetry and M-charts are more sensitive than conventional methods for detecting the visual function loss in cystoid DME.
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5.
Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study.
Schroeder, EB, Chonchol, M, Shetterly, SM, Powers, JD, Adams, JL, Schmittdiel, JA, Nichols, GA, O'Connor, PJ, Steiner, JF
Clinical journal of the American Society of Nephrology : CJASN. 2018;(5):727-734
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Abstract
BACKGROUND AND OBJECTIVES In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown. DESIGN, SETTING PARTICIPANTS, & MEASUREMENTS We used an observational, multicenter cohort of 21,897 individuals with diabetes to compare individuals who added β-blockers, dihydropyridine calcium channel blockers, loop diuretics, or thiazide diuretics to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We examined the hazard of significant kidney events, cardiovascular events, and death using Cox proportional hazard models with propensity score weighting. The composite significant kidney event end point was defined as the first occurrence of a ≥30% decline in eGFR to an eGFR<60 ml/min per 1.73 m2, initiation of dialysis, or kidney transplant. The composite cardiovascular event end point was defined as the first occurrence of hospitalization for acute myocardial infarction, acute coronary syndrome, stroke, or congestive heart failure; coronary artery bypass grafting; or percutaneous coronary intervention, and it was only examined in those free of cardiovascular disease at baseline. RESULTS Over a maximum of 5 years, there were 4707 significant kidney events, 1498 deaths, and 818 cardiovascular events. Compared with thiazide diuretics, hazard ratios for significant kidney events for β-blockers, calcium channel blockers, and loop diuretics were 0.81 (95% confidence interval, 0.74 to 0.89), 0.67 (95% confidence interval, 0.58 to 0.78), and 1.19 (95% confidence interval, 1.00 to 1.41), respectively. Compared with thiazide diuretics, hazard ratios of mortality for β-blockers, calcium channel blockers, and loop diuretics were 1.19 (95% confidence interval, 0.97 to 1.44), 0.73 (95% confidence interval, 0.52 to 1.03), and 1.67 (95% confidence interval, 1.31 to 2.13), respectively. Compared with thiazide diuretics, hazard ratios of cardiovascular events for β-blockers, calcium channel blockers, and loop diuretics compared with thiazide diuretics were 1.65 (95% confidence interval, 1.39 to 1.96), 1.05 (95% confidence interval, 0.80 to 1.39), and 1.55 (95% confidence interval, 1.05 to 2.27), respectively. CONCLUSIONS Compared with thiazide diuretics, calcium channel blockers were associated with a lower risk of significant kidney events and a similar risk of cardiovascular events.
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Nailfold Capillaroscopy Within and Beyond the Scope of Connective Tissue Diseases.
Lambova, SN, Muller-Ladner, U
Current rheumatology reviews. 2018;(1):12-21
Abstract
Nailfold capillaroscopy is a noninvasive instrumental method for morphological analysis of the nutritive capillaries in the nailfold area. In rheumatology, it is a method of choice among instrumental modalities for differential diagnosis between primary and secondary Raynaud's phenomenon (RP) in systemic rheumatic diseases. RP is a common diagnostic problem in rheumatology. Defining the proper diagnosis is a prerequisite for administration of the appropriate treatment. Thus, nailfold capillaroscopic examination is of crucial importance for the every-day practice of the rheumatologists and is currently gaining increasing attention. The most specific capillaroscopic changes are observed in Systemic Sclerosis (SSc). Due to the high prevalence of the capillaroscopic changes in this clinical entity and their early appearance, they could be used for early and very early diagnosis of the disease. More recently, "scleroderma" type capillaroscopic changes have been defined as diagnostic criterion in the new EULAR/ACR classification criteria for SSc together with the presence of scleroderma-related autoantibodies, RP, telangiectasia and other clinical signs. Capillaroscopic changes in other connective tissue diseases and in different rheumatic-like conditions like those in diabetes mellitus (e.g., diabetic stiff-hand syndrome) and paraneoplastic syndromes associated with microvascular pathology should be interpreted properly in order to obtain precise diagnosis in the shortest possible differential diagnostic process.
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Hypertension with diabetes mellitus complications.
Yamazaki, D, Hitomi, H, Nishiyama, A
Hypertension research : official journal of the Japanese Society of Hypertension. 2018;(3):147-156
Abstract
Chronic diabetic complications are classified as microvascular or macrovascular and contribute to mortality and loss of quality of life. Hyperglycemia plays a critical role in the pathogenesis of microvascular complications, such as diabetic retinopathy, incipient nephropathy, and neuropathy, while atherosclerosis contributes to the pathogenesis of macrovascular complications. Diabetes mellitus and hypertension are frequently present together. Among many microvascular diabetic complications, hypertension plays a predominant role in the progression of diabetic nephropathy by glomerular hyperfiltration. Hypertension also induces atherosclerosis in diabetes. Thus, hypertension is a high-risk factor for both microvascular and macrovascular chronic diabetic complications. In this review, we summarize the current knowledge on the pathophysiological mechanisms of microvascular and macrovascular chronic diabetic complications with particular emphasis on the contribution of hypertension. We also briefly discuss various options available for the treatment of each diabetic complication.
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Association of obesity and diabetes with thyroid nodules.
Buscemi, S, Massenti, FM, Vasto, S, Galvano, F, Buscemi, C, Corleo, D, Barile, AM, Rosafio, G, Rini, N, Giordano, C
Endocrine. 2018;(2):339-347
Abstract
AIM: There are conflicting data concerning the possibility that obesity and diabetes raise the risk of thyroid nodules. The incidence of thyroid nodules is increasing, as is that of obesity and diabetes; therefore, understanding whether these metabolic and nutritional disorders influence nodular thyroid disease is important for organizing prevention strategies. This study investigated the association between thyroid nodules, obesity, diabetes, and dietary habits. MATERIALS AND METHODS A cohort of randomly selected adults (455 males, 746 females; age: 18-90 years) living in Palermo (Italy), a mild iodine deficiency area, was cross-sectionally investigated. Participants underwent high-resolution ultrasonographic evaluation of the thyroid, and answered a food frequency questionnaire. Laboratory blood measurements were obtained in 587 participants. RESULTS AND DISCUSSION Thyroid nodules were detected in 475 (39.5%) participants. The number of thyroid nodules was correlated with age (r = 0.19; P < 0.001), gender (r = 0.08; P = 0.005), and body mass index (r = 0.07; P = 0.02). No significant correlation was observed between the number of nodules and glycated hemoglobin, serum insulin concentrations, and homeostasis model assessment of insulin resistance. Age-adjusted and gender-adjusted prevalence of both overweight/obesity and type 2 diabetes of each group of participants divided according to the number of nodules significantly increased with the number of nodules (P < 0.05 in both cases). The group of participants with nodules exhibited a significantly lower age-adjusted and gender-adjusted habitual intake of milk (P = 0.02). Multivariate regression analysis showed that age, gender, body mass index, diabetes, and habitual consumption of milk were independently correlated with presence of thyroid nodules. CONCLUSION This study seems to indicate that an association exists between obesity, diabetes, and thyroid nodules.
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Diabetic Complications and Insight into Antidiabetic Potentialities of Ethno- Medicinal Plants: A Review.
Bilal, M, Iqbal, MS, Shah, SB, Rasheed, T, Iqbal, HMN
Recent patents on inflammation & allergy drug discovery. 2018;(1):7-23
Abstract
BACKGROUND The naturally inspired treatment options for several disease conditions and human-health related disorders such as diabetes mellitus have gained considerable research interest. In this context, naturally occurring plants and herbs with medicinal functionalities have gained special place than ever before in the current medicinal world. OBJECTIVE The objective of this review is to extend the current knowledge in the clinical field related to the diabetic complications. A special focus has also been given to the anti-diabetic potentialities of ethnomedicinal plants. METHOD Herein, we reviewed and compiled salient information from the authentic bibliographic databases including PubMed, Scopus, Elsevier, Springer, Bentham Science and other scientific databases. The patents were searched and reviewed from http://www.freepatentsonline.com. RESULTS Diabetes mellitus is a group of metabolic disorders associated with the endocrine system that resulted in hyperglycemic conditions. Metabolic disorders can cause many complications such as neuropathy, retinopathy, nephropathy, ischemic heart disease, stroke, and microangiopathy. Traditional botanical therapies have been used around the world to treat diabetes. Among several medications and different medicines, various herbs are known to cure and control diabetes; also have no side effects. History has shown that medicinal plants have long been used for traditional healing around the world to treat diabetes. More than 800 plants around the world are shown by ethnobotanical information as traditional remedies for the treatment of diabetes. Several parts of these plants have been evaluated and appreciated for hypoglycemic activity. Medicinal plants have been found to be more effective than conventional drug compounds with no/fewer side effects and relatively inexpensive. In this review paper, we have reviewed plants with anti-diabetic and related beneficial medicinal effects. CONCLUSION This review may be helpful for researchers, diabetic patient and decision makers in the field of ethnobotanical sciences. These efforts may also provide treatment to everyone and focus on the role of traditional novel medicine plants that have anti-diabetic abilities.
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Prevalence Of Diabetic Complications In Newly Diagnosed Type 2 Diabetes Patients In Pakistan: Findings From National Registry.
Uddin, F, Ali, B, Junaid, N
Journal of Ayub Medical College, Abbottabad : JAMC. 2018;(4):S652-S658
Abstract
BACKGROUND This study was conducted to assess the prevalence of micro- and macrovascular complications in patients with newly diagnosed type 2 diabetes (T2DM) in Pakistan. METHODS In this multicentre, observational, cross-sectional disease registry, patients (aged ≥18 years) who were diagnosed at enrolment with T2DM, defined by fasting blood glucose (FBG) ≥126 mg/dL and/or glycated haemoglobin (HbA1c) ≥6.5%, were enrolled. Microvascular complications were ascertained by objective examination while macrovascular complications were identified from patients' medical history. Descriptive statistics were used for data analysis. RESULTS Data from 891 patients were analysed in the study. Mean [±standard deviation (SD)] HbA1c, FBG, and random blood glucose were 9.9% (±2.2%), 193.4 (±74.0) mg/dL, and 294.3 (±72.7) mg/dL, respectively. Obesity (n=689, 77.3%) and familial history of diabetes (n=575, 64.3%) were the most common risk factors for T2DM. Overall prevalence of micro- and macrovascular complications was 68.6% [n=611, 95% confidence interval (CI): 65.4-71.5] and 9.0% (n=80, 95% CI: 7.3-11.0), respectively. Neuropathy, nephropathy, and retinopathy were reported in 59.6% (95% CI: 56.3-62.8), 24.4% (95% CI: 21.6-27.2), and 15.9% (95% CI: 13.7-18.5) of the patients, respectively. Oral antidiabetic agents and insulin were prescribed to 839 (94.2%) and 140 (15.7%) patients, respectively. All study patients received education on T2DM management, mostly from the investigators, and also from diabetes educators and nurses. CONCLUSION The prevalence of micro- and macrovascular complications of T2DM is high, indicating a delay in diagnosis of disease. In order to counter the burden of diabetic complications, optimum strategies for screening of the general population are required.