151
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Malone M, Lau NS, White J, Novak A, Xuan W, Iliopoulos J, Crozier J, Dickson HG. The effect of diabetes mellitus on costs and length of stay in patients with peripheral arterial disease undergoing vascular surgery. Eur J Vasc Endovasc Surg 2014; 48:447-51. [PMID: 25116276 DOI: 10.1016/j.ejvs.2014.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/04/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine the impact of diabetes mellitus (DM) and other comorbidities on length of stay (LOS) and costs in patients with peripheral arterial disease (PAD) admitted to a vascular surgical unit. METHODS A retrospective study was conducted between January 2011 and July 2012 at a tertiary referral hospital in Sydney. Demographic, laboratory, and operative data were obtained from the Australasian Vascular Audit database and hospital diagnostic-related group (DRG) reports. Patients with confirmed PAD with or without DM requiring hospital admission for a diagnosis of claudication, rest pain, ulcer/gangrene, and infection that required lower limb surgical intervention were included. Associations between LOS, surgical procedure, and DRG were explored. RESULTS Five hundred and sixty-eight admissions (492 patients) were identified: 292 admissions with PAD and 276 admissions with PAD in conjunction with DM (PADDM). Mean LOS for patients with PAD was 10 ± 13.7 days compared with 15 ± 18.2 days for PADDM (p < .01; 95% confidence interval 2.7-8.0). LOS and costs were greatest in patients with PADDM undergoing major amputation (37 ± 13.7 days; US$42,236; p < .01). Analysis of variance indicated that the best predictors of LOS were the presence of DM, bypass surgery, amputation, chronic kidney disease (CKD) stage V, infection, and emergency admission. Over 18 months, the estimated total inpatient costs associated with lower limb intervention for PAD with and without DM amounted to US$7,598,597. People with DM incurred greater inpatient costs, averaging US$1,912 more per episode of admission and a total of US$528,029 over 18 months. CONCLUSION The impact of diabetes as a comorbid condition in patients with PAD is significant, both clinically and economically. Factors that predict increased LOS in patients with PAD are DM, bypass surgery, amputation, CKD stage V, infection, and emergency admission.
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Affiliation(s)
- M Malone
- High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
| | - N S Lau
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Diabetes and Endocrine Service, Liverpool Hospital, Liverpool, NSW, Australia
| | - J White
- High Risk Foot Service, Liverpool Hospital, Liverpool, NSW 2170, Australia; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - A Novak
- Diabetes Foot Service, Western Health, Victoria, Australia
| | - W Xuan
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - J Iliopoulos
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - J Crozier
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Department of Vascular Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - H G Dickson
- LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia; Ambulatory Care, Liverpool Hospital, Liverpool, NSW, Australia
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152
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Daly B, Arroll B, Sheridan N, Kenealy T, Stewart A, Scragg R. Foot examinations of diabetes patients by primary health care nurses in Auckland, New Zealand. Prim Care Diabetes 2014; 8:139-146. [PMID: 24184120 DOI: 10.1016/j.pcd.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 11/17/2022]
Abstract
AIMS To identify factors associated with patients receiving foot examinations by primary health care nurses. METHODS A cross-sectional survey of 287 randomly sampled primary health care nurses, from a total of 1091 in Auckland, completed a postal self-administered questionnaire and telephone interview. Biographical and diabetes management details were collected for 265 diabetes patients consulted by the nurses on a randomly selected day. RESULTS A response rate of 86% was achieved. Nurses examined patient's feet in 46% of consultations. Controlling for demographic variables, foot examinations were associated with age, odds ratio (1.25, 95% CI 0.57-2.74) for patients aged 51-65 years and >66 years (2.50, 1.08-5.75) compared with those ≤50 years, consultations by district compared with practice nurses (14.23, 95% CI 3.82-53.05), special programme consultations compared with usual follow-up consults (8.81, 95% CI 2.99-25.93) and length of consultation (1.89, 0.72-4.97) for 15-30 min and (4.45, 95% CI 1.48-13.41) >30 min compared with consultations ≤15 min, or for wound care (2.58, 1.01-6.61). CONCLUSIONS Diabetes foot examinations by primary health care nurses varies greatly, and are associated with characteristics of the patient (age, need for wound care) and the consultation (district nurses, diabetes programme and duration).
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Bruce Arroll
- Department of General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | | | - Timothy Kenealy
- Department of General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Alistair Stewart
- Department of Epidemiology & Biostatistics, School of Population Health, University of Auckland, New Zealand
| | - Robert Scragg
- Department of Epidemiology & Biostatistics, School of Population Health, University of Auckland, New Zealand
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153
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Barresi V, Signorelli SS, Musso N, Anzaldi M, Fiore V, Alberghina M, Condorelli DF. ICAM-1 and SRD5A1 gene polymorphisms in symptomatic peripheral artery disease. Vasc Med 2014; 19:175-181. [PMID: 24879712 DOI: 10.1177/1358863x14532705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The genotype distribution of two gene polymorphisms, previously associated with peripheral artery disease (PAD), has been evaluated in a population of diabetic (DPAD) and non-diabetic (NDPAD) patients affected by symptomatic PAD (stages II-IV). A decreased frequency of the AA genotype of rs5498 (ICAM-1) was observed in the PAD subjects compared to controls but this result did not reach statistical significance (p=0.06 by chi-squared test). On the contrary, a significant increase in the frequency of the GG homozygous genotype of rs248793 (SRD5A1) was observed in the PAD patient group in comparison to controls (p=0.01). These data confirm that the GG genotype of rs248793 in the SRD5A1 gene is significantly associated with symptomatic PAD and show a trend towards a stronger association with the non-diabetic status.
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Affiliation(s)
- Vincenza Barresi
- Department of Bio-Medical Sciences, Section of Biochemistry, University of Catania, Catania, Italy
| | | | - Nicolò Musso
- Department of Bio-Medical Sciences, Section of Biochemistry, University of Catania, Catania, Italy
| | | | - Valerio Fiore
- Department of Medicine and Pediatrics, University of Catania, Catania, Italy
| | - Mario Alberghina
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
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154
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Takahara M, Fujiwara Y, Katakami N, Sakamoto F, Kaneto H, Matsuoka TA, Shimomura I. Shared and additional risk factors for decrease of toe-brachial index compared to ankle-brachial index in Japanese patients with diabetes mellitus. Atherosclerosis 2014; 235:76-80. [PMID: 24816041 DOI: 10.1016/j.atherosclerosis.2014.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Some diabetic patients have a low toe-brachial index (TBI) despite their normal ankle-brachial index (ABI). We statistically investigated whether the impact of risk factors on TBI would be different compared to ABI. RESEARCH DESIGN AND METHODS We used a database of 1738 limbs of consecutive 869 Japanese diabetic patients whose ABI and TBI were simultaneously evaluated. We developed a common regression model to ABI and TBI by extending the linear mixed model, and statistically detected the difference in the impact of risk factors between the two indices. RESULTS Sex, smoking, proteinuria, hypertension, and history of stroke and coronary artery disease were common independent risk factors for the decrease of ABI and TBI; their impacts on ABI and TBI were not significantly different. On the other hand, the impact of age, diabetic duration, and body mass index was significantly different between the two indices (all p < 0.05). Age and body mass index were significantly associated with TBI but not with ABI. Diabetic duration had a significant impact both on TBI and ABI, but the impact on TBI was significantly greater than that on ABI (β = -0.144 vs. -0.087; p < 0.05). In the population with normal ABI, patients with these risk factors had a higher prevalence of decreased TBI. CONCLUSIONS The risk factors for the decrease of ABI and TBI were not identical in Japanese diabetic patients. Age, diabetic duration and body mass index were associated with reduced TBI in patients with normal ABI.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871, Japan.
| | - Yuko Fujiwara
- Diabetic & Foot Care Center, Division of Nursing, Osaka University Hospital, 2-15, Yamadaoka, Suita City, Osaka 565-0871, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871, Japan
| | - Fumie Sakamoto
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871, Japan
| | - Hideaki Kaneto
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871, Japan
| | - Taka-aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871, Japan
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155
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Analysis of multiple risk factors affecting the result of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes mellitus. J Plast Reconstr Aesthet Surg 2014; 67:624-8. [DOI: 10.1016/j.bjps.2014.01.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 11/22/2022]
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156
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Jung KH, Lee JH, Park JW, Paik JY, Quach CHT, Lee EJ, Lee KH. Annexin V Imaging Detects Diabetes-Accelerated Apoptosis and Monitors the Efficacy of Benfotiamine Treatment in Ischemic Limbs of Mice. Mol Imaging 2014. [DOI: 10.2310/7290.2014.00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kyung-Ho Jung
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Lee
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Won Park
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Young Paik
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cung Hoa Thien Quach
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jeong Lee
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Han Lee
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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157
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Guirro ECDO, Guirro RRDJ, Dibai-Filho AV, Montezuma T, Vaz MMDOLL. Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women. J Phys Ther Sci 2014; 26:553-6. [PMID: 24764632 PMCID: PMC3996420 DOI: 10.1589/jpts.26.553] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/04/2013] [Indexed: 12/25/2022] Open
Abstract
[Purpose] The purpose of this study was to correlate the talocrural range of motion
(ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and
Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary
right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system
disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects
(57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by
using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow
velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also
assessed. [Results] No significant differences were found between the groups by comparing
talocrural ROM and arterial blood velocity. However, a significant association was found
in G2 only between the following variables: plantar flexion and blood flow velocity of the
dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the
popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior
tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a
decrease in the arterial blood flow velocity in diabetic women.
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Affiliation(s)
- Elaine Caldeira de Oliveira Guirro
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Rinaldo Roberto de Jesus Guirro
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Almir Vieira Dibai-Filho
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Thais Montezuma
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Maíta Mara de Oliveira Lima Leite Vaz
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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158
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Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, Da Ros R, De Feo ME, Ferraresi R, Florio F, Gargiulo M, Galzerano G, Gandini R, Giurato L, Graziani L, Mancini L, Manzi M, Modugno P, Setacci C, Uccioli L. Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis 2014; 24:355-369. [PMID: 24486336 DOI: 10.1016/j.numecd.2013.12.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/31/2013] [Accepted: 12/01/2013] [Indexed: 02/07/2023]
Abstract
Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.
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Affiliation(s)
- A Aiello
- P.O. Campobasso - ASReM, Campobasso, Italy
| | - R Anichini
- Servizi di Diabetologia, USL 3, Pistoia, Italy
| | - E Brocco
- Policlinico Abano Terme, Presidio Ospedaliero ULSS 16, Veneto, Italy
| | - C Caravaggi
- Istituto Clinico "Città Studi", Milan, Italy
| | | | - R Cioni
- Dipartimento Radiologia Diagnostica, interventistica e medicina nucleare, Azienda Ospedaliera Universitaria Pisana, Pisa, italy
| | - R Da Ros
- Centro Diabetologico Monfalcone (GO) - Ass2, Gorizia, Italy
| | - M E De Feo
- U.O.S. Diabetologia A.O.R.N. "A. Cardarelli", Naples, Italy
| | - R Ferraresi
- Emodinamica Interventistica Cardiovascolare, Istituto Clinico Città Studi, Milan, Italy
| | - F Florio
- IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - M Gargiulo
- Chirurgia Vascolare, Azienda Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - G Galzerano
- Department of Surgery Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - R Gandini
- Dipartimento Diagnostica per immagini, Imaging molecolare, radioterapia e radiologia interventistica, Policlinico Universitario Tor Vergata, Rome, Italy
| | - L Giurato
- Diabetic Foot Unit, Dept of Internal Medicine, Policlinico Universitario Tor Vergata, Rome, Italy
| | - L Graziani
- Unità Operativa di Cardiologia Invasiva, Istituto Clinico "Città di Brescia", Brescia, Italy
| | - L Mancini
- Istituto Dermatologico Immacolata IRCCS, Rome, Italy
| | - M Manzi
- Radiologia Interventistica, Policlinico Abano Terme, Presidio Ospedaliero ULSS 16, Veneto, Italy
| | - P Modugno
- Dipartimento Malattie Cardiovascolari Fondazione Giovanni Paolo II, Università Cattolica Sacro Cuore, Campobasso, Italy
| | - C Setacci
- Department of Surgery Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - L Uccioli
- Diabetic Foot Unit, Dept of Internal Medicine, Policlinico Universitario Tor Vergata, Rome, Italy.
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159
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Jin QH, Ye WL, Chen HH, He XJ, Li TL, Liu Q, Zhong L, Xu L, Han CM. Levels of brain natriuretic peptide are associated with peripheral arterial disease in subjects with type-2 diabetes mellitus. BMC Endocr Disord 2014; 14:27. [PMID: 24655436 PMCID: PMC3998194 DOI: 10.1186/1472-6823-14-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/17/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The effects of brain natriuretic peptide (BNP) on the risk of cardiovascular disease and atherosclerosis have been studied. However, little information is available regarding peripheral arterial disease (PAD), particularly among subjects with type-2 diabetes mellitus (T2DM). The aim of our study was to assess the potential relationship between BNP levels and PAD among T2DM patients. METHODS The study cohort was 507 T2DM outpatients in which BNP levels were measured. Cross-sectional associations between BNP levels (in tertiles) and PAD were examined. RESULTS Compared withT2DM patients without PAD, BNP levels were markedly higher in patients with PAD (p = 0.001). Correlation analyses showed that the BNP level was negatively correlated with the ankle-brachial index (r = -0.453, p = 0.033). At a cutoff value of 78.2 pg/ml, the BNP level showed a sensitivity of 71.9%, a specificity of 68.1%, and a positive predictive value of 84.3% for a diagnosis of PAD. The area under the receiver-operating characteristic curve increased significantly if BNP levels were incorporated into a predictive model of the potential risk factors for PAD (0.85 vs 0.81, p = 0.029). CONCLUSIONS BNP is a potential and promising biomarker for PAD screening in T2DM patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chun-Mao Han
- Department of Burn, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 JieFang Rd, Hangzhou, Zhejiang 310009, China.
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160
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Abstract
Peripheral arterial disease (PAD) is an atherosclerotic-driven condition that remains underdiagnosed and undertreated. In diabetic patients, PAD begins early, progresses rapidly, and is frequently asymptomatic, making it difficult to diagnose. Strict management of the metabolic instigators and use of screening techniques for PAD in diabetes can facilitate early diagnosis and reduce progression. Exercise is an equally effective treatment option in improving walking distance. Early revascularization must be offered early in suitable patients. Surgical bypass and endovascular revascularization are complementary and the choice of intervention should be applied appropriately by a multidisciplinary vascular team on a selective, patient-specific basis.
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Affiliation(s)
- Janice V Mascarenhas
- Department of Endocrinology, Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-Under-Lyne, Lancashire OL6 9RW, UK; University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Mostafa A Albayati
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Clifford P Shearman
- Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Edward B Jude
- Department of Endocrinology, Tameside Hospital NHS Foundation Trust, Fountain Street, Ashton-Under-Lyne, Lancashire OL6 9RW, UK; University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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161
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Lozano FS, González-Porras JR, March JR, Lobos JM, Carrasco E, Ros E. Diabetes mellitus and intermittent claudication: a cross-sectional study of 920 claudicants. Diabetol Metab Syndr 2014; 6:21. [PMID: 24533798 PMCID: PMC3937005 DOI: 10.1186/1758-5996-6-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 02/06/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) and intermittent claudication (IC) are frequently associated health conditions. Our hypothesis is that the nature, severity and quality of life (QoL) of patients with IC and DM are worse than those of claudicant patients without diabetes. MATERIAL AND METHODS An observational, cross-sectional and multicentre study of 920 patients with IC, divided into two groups: diabetic (n = 477) and non-diabetic (n = 443). For each group, we examined clinical and biological characteristics (including levels of glucose and lipids), the ankle-brachial index (ABI), responses to the Walking Impairment Questionnaire (WIQ) and the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. RESULTS Compared with claudicant patients without diabetes, claudicants with diabetes were older (p < 0.001), more likely to be female (p = 0.006), with a higher BMI (p < 0.001), more likely to have a sedentary lifestyle (p < 0.001) and to be a non-smoker (p < 0.001). Claudicant patients with diabetes also had significantly more cardiovascular risk factors (p < 0.001), more frequent ischaemic cardiopathy (p = 0.023) and chronic renal failure (p = 0.002), and fewer prior ictus events (p = 0.003). No significant differences between groups were found with respect to blood pressure, levels of cholesterol or triglycerides. The mean ABI of diabetic-IC patients was slightly lower than IC patients without diabetes (p = 0.016). All WIQ subdomains scores were significantly lower (p < 0.001), indicating poorer walking ability, in claudicant and diabetic patients with compared with those without diabetes. The mean E5-QD global scores and the mean EQ-5D visual analogue scale in the whole series were 0.58 (SD = 0.21) and 55.04 (SD = 21.30), respectively. Both E5-QD scores were significantly lower, indicating poorer QoL, in claudicant patients with diabetes than claudicant patients without diabetes (p < 0.001). CONCLUSION Patients with IC and DM had more risk cardiovascular factors, cardiovascular conditions, disability and worse haemodynamic status and QoL than claudicant patients without diabetes.
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Affiliation(s)
- Francisco S Lozano
- Hospital Universitario de Salamanca e IBSAL, Salamanca, Spain
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Salamanca, Universidad de Salamanca, Paseo de San Vicente s/n, Salamanca, 37007, Spain
| | | | | | | | | | - Eduardo Ros
- Hospital Universitario San Cecilio, Granada, Spain
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162
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Association of total white cell count with mortality and major adverse events in patients with peripheral arterial disease: a systematic review. Eur J Vasc Endovasc Surg 2014; 47:422-32. [PMID: 24485842 DOI: 10.1016/j.ejvs.2013.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/19/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Peripheral arterial disease (PAD) is principally caused by atherosclerosis, an established inflammatory disease. Total white cell count (TWCC) is a marker of inflammation and has been associated with outcomes for patients with inflammatory diseases. The aim of this systematic review was to assess the association of TWCC with mortality and major adverse events (MAEs) in PAD patients. METHODS Studies investigating the association of TWCC with outcome in patients with PAD were identified by a literature search using the Medline and Cochrane databases. To be eligible for inclusion, studies needed to investigate the association of TWCC with mortality or a composite endpoint that included mortality in patients with PAD. Studies were excluded when the primary focus was carotid artery disease, aortic aneurysmal disease, intracranial vascular disease, or rheumatoid arthritis and treatment with chemotherapy or transplantation of stem cells. Secondary searching of reference lists and relevant reviews was performed. RESULTS Ten studies including 8,490 patients with PAD met the inclusion criteria. All studies investigated more than 100 patients with four studies assessing more than 1,000 patients. Study quality varied with well-established risk factors of outcome such as age, smoking, diabetes, and the ankle brachial index being adjusted for inconsistently. The study populations were also disparate. Few studies reported relative risk and 95% confidence intervals for the association of TWCC with mortality or MAE. TWCC was positively and significantly associated with death alone in four of five studies investigating 3,387 patients. TWCC was positively and significantly associated with MAE in five of six studies investigating a total of 6,846 patients. CONCLUSIONS Current evidence suggests a positive association of TWCC with mortality and MAEs in patients with PAD. Further well-designed prospective studies are required with high-quality analysis and more complete reporting of outcomes.
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163
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Dokun AO, Chen L, Lanjewar SS, Lye RJ, Annex BH. Glycaemic control improves perfusion recovery and VEGFR2 protein expression in diabetic mice following experimental PAD. Cardiovasc Res 2014; 101:364-72. [PMID: 24385342 DOI: 10.1093/cvr/cvt342] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Diabetes mellitus (DM) is associated with poor clinical outcomes in humans with peripheral arterial disease (PAD) and in pre-clinical models of PAD, but the effects of glycaemic control are poorly understood. We investigated the effect of glycaemic control on experimental PAD in mice with Type 1 DM and explored the effects of hyperglycaemia on vascular endothelial growth factor receptor 2 (VEGFR2) expression in ischaemia. METHODS AND RESULTS Hind limb ischaemia was induced in non-diabetic, untreated Type 1 DM, and treated Type 1 DM mice. We assessed perfusion recovery, capillary density, VEGFR2 levels, and VEGFR2 ubiquitination in ischaemic hind limbs. We found that untreated Type 1 DM mice showed impaired perfusion recovery, lower hind limb capillary density 5 weeks post-ischaemia, and lower VEGFR2 protein in Day 3 post-ischaemic hind limbs when compared with non-DM controls. Treated Type 1 DM mice had perfusion recovery, capillary density, and VEGFR2 protein levels comparable with that of non-diabetic mice at the same time points. Treatment with anti-VEGFR2 antibody negated that the improved perfusion recovery displayed by treated Type 1 DM mice. In ischaemic Type 1 DM hind limbs and endothelial cells exposed to simulated ischaemia, high glucose impaired VEGFR2 expression and was associated with increased VEGFR2 ubiquitination. Inhibition of the ubiquitin-proteasome complex restored normal endothelial VEGFR2 expression in simulated ischaemia. CONCLUSION Hyperglycaemia in Type 1 DM impairs VEGFR2 protein expression in ischaemic hind limbs, likely due to increased ubiquitination and degradation by the proteasome complex. Glycaemic control allows normal levels of VEGFR2 in ischaemia and improved perfusion recovery.
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Affiliation(s)
- Ayotunde O Dokun
- Division of Endocrinology, University of Virginia School of Medicine, Charlottesville, VA 22901, USA
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164
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Gili M, Orsello A, Gallo S, Brizzi MF. Diabetes-associated macrovascular complications: cell-based therapy a new tool? Endocrine 2013; 44:557-75. [PMID: 23543434 DOI: 10.1007/s12020-013-9936-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/20/2013] [Indexed: 01/01/2023]
Abstract
Diabetes mellitus and its ongoing macrovascular complications represent one of the major health problems around the world. Rise in obesity and population ages correlate with the increased incidence of diabetes. This highlights the need for novel approaches to prevent and treat this pandemic. The discovery of a reservoir of stem/progenitors in bone marrow and in mesenchymal tissue has attracted interest of both biologists and clinicians. A number of preclinical and clinical trials were developed to explore their potential clinical impact, as target or vehicle, in different clinical settings, including diabetes complications. Currently, bone marrow, peripheral blood, mesenchymal, and adipose tissues have been used as stem/progenitor cell sources. However, evidences have been provided that both bone marrow and circulating progenitor cells are dysfunctional in diabetes. These observations along with the growing advantages in genetic manipulation have spurred researchers to exploit ex vivo manipulated cells to overcome these hurdles. In this article, we provide an overview of data relevant to stem-progenitors potential clinical application in revascularization and/or vascular repair. Moreover, the hurdles at using progenitor cells in diabetic patients will be also discussed.
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Affiliation(s)
- Maddalena Gili
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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165
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Althouse AD, Abbott JD, Sutton-Tyrrell K, Forker AD, Lombardero MS, Buitrón LV, Pena-Sing I, Tardif JC, Brooks MM. Favorable effects of insulin sensitizers pertinent to peripheral arterial disease in type 2 diabetes: results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Diabetes Care 2013; 36:3269-75. [PMID: 23735723 PMCID: PMC3781574 DOI: 10.2337/dc12-2265] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this manuscript was to report the risk of incident peripheral arterial disease (PAD) in a large randomized clinical trial that enrolled participants with stable coronary artery disease and type 2 diabetes and compare the risk between assigned treatment arms. RESEARCH DESIGN AND METHODS The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial randomly assigned participants to insulin sensitization (IS) therapy versus insulin-providing (IP) therapy for glycemic control. Results showed similar 5-year mortality in the two glycemic treatment arms. In secondary analyses reported here, we examine the effects of treatment assignment on the incidence of PAD. A total of 1,479 BARI 2D participants with normal ankle-brachial index (ABI) (0.91-1.30) were eligible for analysis. The following PAD-related outcomes are evaluated in this article: new low ABI≤0.9, a lower-extremity revascularization, lower-extremity amputation, and a composite of the three outcomes. RESULTS During an average 4.6 years of follow-up, 303 participants experienced one or more of the outcomes listed above. Incidence of the composite outcome was significantly lower among participants assigned to IS therapy than those assigned to IP therapy (16.9 vs. 24.1%; P<0.001). The difference was significant in time-to-event analysis (hazard ratio 0.66 [95% CI 0.51-0.83], P<0.001) and remained significant after adjustment for in-trial HbA1c (0.76 [0.59-0.96], P=0.02). CONCLUSIONS In participants with type 2 diabetes who are free from PAD, a glycemic control strategy of insulin sensitization may be the preferred therapeutic strategy to reduce the incidence of PAD and subsequent outcomes.
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166
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Dubský M, Jirkovská A, Bem R, Fejfarová V, Skibová J, Schaper NC, Lipsky BA. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup. Int Wound J 2013; 10:555-61. [PMID: 22712631 PMCID: PMC7950559 DOI: 10.1111/j.1742-481x.2012.01022.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Few studies have examined factors associated with diabetic foot ulcer (DFU) recurrence. Using data from patients enrolled in the prospective Eurodiale DFU study, we investigated the frequency of and risk factors for DFU recurrence after healing during a 3-year follow-up period. At our site, 93 Eurodiale-enrolled patients had a healed DFU. Among these, 14 were not alive; of the remaining 79 patients we enrolled 73 in this study. On entry to the Eurodiale study, we assessed demographic factors (age, sex and distance from hospital); diabetes-related factors [duration, and glycated haemoglobin (HbA1c) levels]; comorbidities (obesity, renal failure, smoking and alcohol abuse) and DFU-related factors [peripheral arterial disease, ulcer infection, C-reactive protein (CRP) and; foot deformities]. During the 3-year follow-up period, a DFU had recurred in 42 patients (57.5%). By stepwise logistic regression of findings at initial DFU presentation, the significant independent predictors for recurrence were plantar ulcer location [odds ratio (OR) 8.62, 95% confidence interval (CI) 2.2-33.2]; presence of osteomyelitis (OR 5.17, 95% CI 1.4-18.7); HbA1c > 7.5% ([DCCT], OR 4.07, 95% CI 1.1-15.6) and CRP > 5 mg/l (OR 4.27, 95% CI 1.2-15.7). In these patients with a healed DFU, the majority had a recurrence of DFU during a 3-year follow-up period, despite intensive foot care. The findings at diagnosis of the initial DFU were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) and define those at high risk for recurrence, but may be amenable to targeted interventions.
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Affiliation(s)
- Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands General Medical Service, VA Puget Sound Health Care System, Department of Medicine, University of Washington, Seattle, WA, USA
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167
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Barone Gibbs B, Dobrosielski DA, Althouse AD, Stewart KJ. The effect of exercise training on ankle-brachial index in type 2 diabetes. Atherosclerosis 2013; 230:125-30. [PMID: 23958264 PMCID: PMC3775271 DOI: 10.1016/j.atherosclerosis.2013.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/24/2013] [Accepted: 07/02/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Though being physically active has associated with a healthier ankle-brachial index (ABI) in observational studies, ABI usually does not change with exercise training in patients with peripheral artery disease (PAD). Less is known about the effect of exercise training on ABI in patients without PAD but at high risk due to the presence of type 2 diabetes (T2DM). METHODS Participants (n = 140) with uncomplicated T2DM, and without known cardiovascular disease or PAD, aged 40-65 years, were randomized to supervised aerobic and resistance training 3 times per week for 6 months or to a usual care control group. ABI was measured before and after the intervention. RESULTS Baseline ABI was 1.02 ± 0.02 in exercisers and 1.03 ± 0.01 in controls (p = 0.57). At 6 months, exercisers vs. controls improved ABI by 0.04 ± 0.02 vs. -0.03 ± 0.02 (p = 0.001). This change was driven by an increase in ankle pressures (p < 0.01) with no change in brachial pressures (p = 0.747). In subgroup analysis, ABI increased in exercisers vs. controls among those with baseline ABI <1.0 (0.14 ± 0.03 vs. 0.02 ± 0.02, p = 0.004), but not in those with a baseline ABI ≥1.0 (p = 0.085). The prevalence of ABI between 1.0 and 1.3 increased from 63% to 78% in exercisers and decreased from 62% to 53% in controls. Increased ABI correlated with decreased HbA1c, systolic and diastolic blood pressure, but the effect of exercise on ABI change remained significant after adjustment for these changes (β = 0.061, p = 0.004). CONCLUSION These data suggest a possible role for exercise training in the prevention or delay of PAD in T2DM, particularly among those starting with an ABI <1.0. Clinicaltrials.gov Registry Number: NCT00212303.
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Affiliation(s)
- Bethany Barone Gibbs
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh, PA
| | | | | | - Kerry J. Stewart
- Johns Hopkins University School of Medicine, Division of Cardiology
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168
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Dang Y, Xia Y, Li Y, Yu DCW. Anemia and type 2 diabetes mellitus associated with peripheral arterial disease progression in Chinese male patients. Clin Biochem 2013; 46:1673-7. [PMID: 23892184 DOI: 10.1016/j.clinbiochem.2013.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Peripheral arterial disease (PAD) is a chronic occlusive disease mainly occurred in elderly adults. Arteriosclerosis obliterans (ASO) mainly occurring from small or medium sized arteries of the lower extremities is one of the most common causes of PAD. The gender-related differences of circulating risk factors in diabetic patients with ASO in China remain unknown. The aim of this study is to investigate the gender-related differences in the pattern of several potential risk factors between male and female patients with ASO and type 2 diabetes mellitus (T2D). DESIGN AND METHODS Clinical profiles and risk factors were analyzed in 323 Chinese patients with ASO and 112 patients were confirmed with T2D. Severities of limb ischemia were staged according to Fontaine classification. RESULTS The significant inverse correlation was seen between the increased age and hemoglobin. The significant positive correlation was seen between the increased age, urea and creatinine both in the non-diabetic and diabetic male patients. The expression levels of hemoglobin significantly correlate with the classification of Fontaine clinical symptoms in Chinese male patients with T2D/ASO. CONCLUSION The study is the first report indicating that the gender-related differences of circulating risk factors are associated with T2D patients with ASO in China. Anemia in Chinese male patients with T2D/ASO may play an important role in peripheral arterial disease progression.
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Affiliation(s)
- Yiping Dang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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169
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Dubsky M, Jirkovska A, Bem R, Fejfarova V, Pagacova L, Sixta B, Varga M, Langkramer S, Sykova E, Jude EB. Both autologous bone marrow mononuclear cell and peripheral blood progenitor cell therapies similarly improve ischaemia in patients with diabetic foot in comparison with control treatment. Diabetes Metab Res Rev 2013; 29:369-76. [PMID: 23390092 DOI: 10.1002/dmrr.2399] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of our study was to compare the effect of bone marrow mononuclear cell and peripheral blood progenitor cell therapies in patients with diabetic foot disease and critical limb ischaemia unresponsive to revascularization with conservative therapy. METHODS Twenty-eight patients with diabetic foot disease (17 treated by bone marrow cells and 11 by peripheral blood cell) were included into an active group and 22 patients into a control group without cell treatment. Transcutaneous oxygen pressure and rate of major amputation, as the main outcome measures, were compared between bone marrow cells, peripheral blood cell and control groups over 6 months; both cell therapy methods were also compared by the characteristics of cell suspensions. Possible adverse events were evaluated by changes of serum levels of angiogenic cytokines and retinal fundoscopic examination. RESULTS The transcutaneous oxygen pressure increased significantly (p < 0.05) compared with baseline in both active groups after 6 months, with no significant differences between bone marrow cells and peripheral blood cell groups; however, no change of transcutaneous oxygen pressure in the control group was observed. The rate of major amputation by 6 months was significantly lower in the active cell therapy group compared with that in the control group (11.1% vs. 50%, p = 0.0032), with no difference between bone marrow cells and peripheral blood cell. A number of injected CD34+ cells and serum levels of angiogenic cytokines after treatment did not significantly differ between bone marrow cells and peripheral blood cell. CONCLUSIONS Our study showed a superior benefit of bone marrow cells and peripheral blood cell treatments of critical limb ischaemia in patients with diabetic foot disease when compared with conservative therapy. There was no difference between both cell therapy groups, and no patient demonstrated signs of systemic vasculogenesis.
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Affiliation(s)
- M Dubsky
- Diabetes Centre, Prague, Czech Republic; First Medical Faculty, Charles University, Prague, Czech Republic.
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170
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Mancera-Romero J, Sánchez-Chaparro MA, Rioja J, Ariza MJ, Olivecrona G, González-Santos P, Valdivielso P. Fasting apolipoprotein B48 is a marker for peripheral arterial disease in type 2 diabetes. Acta Diabetol 2013; 50:383-9. [PMID: 23053881 DOI: 10.1007/s00592-012-0434-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/23/2012] [Indexed: 02/06/2023]
Abstract
An earlier study showed that fasting and postprandial concentrations of apolipoprotein B48 were raised in patients with type 2 diabetes (DM2) and peripheral arterial disease (PAD) as compared with persons without DM2 or persons with DM2 but not PAD. The aim of this study was to confirm the association of PAD and B48 in a larger group of patients with DM2 and the relation of B48 with the preheparin lipoprotein lipase (LPL) mass. We studied 456 patients with DM2. PAD was defined as an ankle-brachial index (ABI) <0.9. Apolipoprotein B48 was quantified by ELISA. Apo B48 was significantly higher in the group with an ABI <0.9 than the groups with ABI of 0.9-1.3 and >1.3 (10.7 ± 6.28 vs. 9.24 ± 5.5 vs. 9.17 ± 8.8 mg/L, ANOVA test, p < 0.05). B48 was independently associated with an ABI <0.9 (OR 1.053; 95 % CI, 1.013-1.094; p < 0.05), together with smoking and duration of diabetes. The preheparin LPL mass was similar in the patients with and without PAD. In conclusion, we confirmed that fasting B48 is an independent marker of PAD in patients with DM2, unrelated to the preheparin LPL mass, statin therapy or glucose lowering treatment.
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Affiliation(s)
- J Mancera-Romero
- Centro de Salud Ciudad Jardín, Servicio Andaluz de Salud, Málaga, Spain
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171
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Beckman JA, Paneni F, Cosentino F, Creager MA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. Eur Heart J 2013; 34:2444-52. [DOI: 10.1093/eurheartj/eht142] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Takahara M, Kaneto H, Katakami N, Iida O, Matsuoka TA, Shimomura I. Effect of sarpogrelate treatment on the prognosis after endovascular therapy for critical limb ischemia. Heart Vessels 2013; 29:563-7. [PMID: 23494607 PMCID: PMC4085500 DOI: 10.1007/s00380-013-0334-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/22/2013] [Indexed: 11/25/2022]
Abstract
5-Hydroxytryptamine type 2 antagonists are used to treat symptomatic peripheral arterial disease. However, it remains unknown as to whether the administration of sarpogrelate, a 5-hydroxytryptamine type 2 antagonist, improves the prognosis after endovascular therapy for critical limb ischemia (CLI). We performed a retrospective analysis using a database of 386 Japanese patients undergoing endovascular therapy for CLI. Sixty-seven patients were treated with sarpogrelate, and we compared their prognosis with that of an equal number of background-matched controls extracted from the population. The primary end point was the first event of either major amputation or death from any cause, and amputation-free survival was evaluated. The follow-up period was 21 ± 18 months (mean ± standard deviation), and 58 end points were observed. Patients treated with sarpogrelate had a significantly higher amputation-free survival rate than their matched controls (P = 0.036). The hazard ratio for the end point and its 95 % confidence interval was 0.57 (0.34–0.97). These results suggest that sarpogrelate treatment is associated with a favorable prognostic outcome in CLI patients undergoing endovascular therapy. Future prospective studies are required to investigate whether sarpogrelate treatment would improve the prognosis of CLI patients.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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173
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Moosa SR, Bakri FG, Khammash MR, Jaddou HY, Shatnawi NJ, Ajlouni KM. Peripheral arterial disease in diabetic Jordanian patients and the agreement between ankle brachial index and toe brachial index. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1474651412475098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aims to screen patients with type 2 diabetes mellitus for peripheral arterial disease (PAD) and to determine the agreement between ankle brachial index (ABI) and toe brachial index (TBI). A total of 182 diabetic patients at 40 years of age or older were assessed using both ABI and TBI. Mean age was 60.5 (SD ±8.1) years. PAD was present in 28.9% and 5.4% of patients according to TBI and ABI definitions respectively. The prevalence of high ABI (ABI > 1.3) was 16.5%. The agreement between TBI and ABI results was fair. Current smoking was associated with low ABI whereas age was inversely associated with TBI. We strongly suggest using both the ABI and TBI as screening tests for PAD because the agreement between these tests was fair, they complement each other in most instances and they detect PAD at different anatomical levels.
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Affiliation(s)
- Sameh R Moosa
- The National Center for Diabetes Endocrinology and Genetics, Amman, Jordan
| | | | | | | | | | - Kamel M Ajlouni
- The National Center for Diabetes Endocrinology and Genetics, Amman, Jordan
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174
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Georgakarakos E, Papanas N, Papadaki E, Georgiadis GS, Maltezos E, Lazarides MK. Endovascular treatment of critical ischemia in the diabetic foot: new thresholds, new anatomies. Angiology 2012; 64:583-91. [PMID: 23129734 DOI: 10.1177/0003319712465172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review discusses the role of endovascular treatment in diabetic patients with critical limb ischemia (CLI). Angioplasty of the femoropopliteal region achieves similar technical success and limb salvage rates in diabetic and nondiabetic patients. Angioplasty in as many as possible tibial vessels is accompanied by more complete and faster ulcer healing as well as better limb salvage rates compared to isolated tibial angioplasty. Targeted revascularization of a specific vessel responsible for the perfusion of a specific ulcerated area is a promising new approach: it replaces revascularization of the angiographically easiest-to-access tibial vessel, even if this is not directly responsible for the perfusion of the ulcerated area, by revascularization of area-specific vascular territories. In conclusion, the endovascular approach shows very high efficacy in ulcer healing for diabetic patients with CLI. Larger prospective studies are now needed to estimate the long-term results of this approach.
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175
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Abstract
Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12 to 15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50% to 1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking approximately five times per week, at a significant intensity that requires frequent rest periods, are most significant. Preclinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, and mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a lifestyle pattern that includes enhanced physical activity prior to the advance of PAD limitations is the most desirable and beneficial.
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Affiliation(s)
- Tara L Haas
- Angiogenesis Research Group, Muscle Health Research Centre, Faculty of Health, York University, Toronto, Ontario, Canada
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176
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Takahara M, Kaneto H, Iida O, Katakami N, Matsuoka TA, Ikeda M, Shimomura I. Association of diabetes and hemodialysis with ankle pressure and ankle-brachial index in Japanese patients with critical limb ischemia. Diabetes Care 2012; 35:2000-4. [PMID: 22723344 PMCID: PMC3447830 DOI: 10.2337/dc11-1636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 04/25/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI). RESEARCH DESIGN AND METHODS We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI. RESULTS Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level. CONCLUSIONS Diabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideaki Kaneto
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Iida
- Cardiovascular Division, Kansai Rosai Hospital, Hyogo, Japan
| | - Naoto Katakami
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taka-aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ikeda
- Cardiovascular Division, Kansai Rosai Hospital, Hyogo, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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177
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Hoe J, Koh WP, Jin A, Sum CF, Lim SC, Tavintharan S. Predictors of decrease in ankle-brachial index among patients with diabetes mellitus. Diabet Med 2012; 29:e304-7. [PMID: 22587456 DOI: 10.1111/j.1464-5491.2012.03705.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Screening for peripheral arterial disease, a complication among patients with diabetes, is performed by periodic assessment of ankle-brachial index. We aimed to study the degree of ankle-brachial index change over time and factors associated with significant change. METHOD We assessed difference between two ankle-brachial index measurements over time in a consecutive series of 82 patients with Type 2 diabetes. All patients had ankle-brachial index > 0.9 but ≤ 1.3 for the first measurement, and significant ankle-brachial index decrease was defined as a decrease of > 0.1 in the follow-up measurement compared with the baseline. RESULTS The mean follow-up duration was 27.6 (median 30.0) months. Significant ankle-brachial index decrease was seen in 20.7% of patients, including 5% with follow-up ankle-brachial index of ≤ 0.9, consistent with the diagnosis of peripheral arterial disease. After adjusting for age and gender, higher baseline HbA(1c) and serum creatinine levels, increase in follow-up serum LDL cholesterol levels compared with baseline and history of retinopathy were predictors of significant ankle-brachial index decrease. CONCLUSIONS Our study suggests that, within two years, one in five patients with diabetes and a normal ankle-brachial index may have significant progression of peripheral arterial disease. Annual ankle-brachial index assessment and better control of hyperlipidaemia may thus be required for at-risk patients with poor glycaemic control, renal impairment and retinopathy.
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Affiliation(s)
- J Hoe
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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178
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Bényi Z, Nagy G, Nyirati G, Szentpétery L, Vallus G. A diabetic patient with asymptomatic multiple arterial disease. Orv Hetil 2012; 153:1475-9. [DOI: 10.1556/oh.2012.29460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors present the case of a 73-year-old diabetic woman who was referred to hospital because of the suspicion of lower limb peripheral arterial stenosis. During evaluations signs of the subclavian artery occlusion were found. In addition to diabetes, the patient had several risk factors revealed by medical history. Subclavian artery occlusion was solved by angiography guided stenting, and angiography also showed the presence of abnormalities in renal arteries. This case draws the attention to the importance of screening old diabetic patients for arterial stenosis and the importance of accurate risk factor assessment. Orv. Hetil., 2012, 153, 1475–1479.
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Affiliation(s)
- Zoltán Bényi
- Bajai Szent Rókus Kórház II. Belgyógyászat Baja Rókus u. 10. 6500
| | - György Nagy
- Bajai Szent Rókus Kórház II. Belgyógyászat Baja Rókus u. 10. 6500
| | - Gábor Nyirati
- Bajai Szent Rókus Kórház II. Belgyógyászat Baja Rókus u. 10. 6500
| | | | - Gábor Vallus
- MH Honvédkórház Általános és Érsebészeti Osztály Budapest
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179
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Campbell PT, Newton CC, Patel AV, Jacobs EJ, Gapstur SM. Diabetes and cause-specific mortality in a prospective cohort of one million U.S. adults. Diabetes Care 2012; 35:1835-44. [PMID: 22699290 PMCID: PMC3425000 DOI: 10.2337/dc12-0002] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a major predictor of death from heart disease and stroke; its impact on nonvascular mortality, including specific cancers, is less understood. We examined the association of diabetes with cause-specific mortality, including deaths from specific cancers. RESEARCH DESIGN AND METHODS A prospective cohort of 1,053,831 U.S. adults, without cancer at baseline, enrolled in the Cancer Prevention Study-II in 1982 and was followed for mortality until December 2008. At baseline, participants completed a self-administered questionnaire that included information on diabetes, smoking, physical activity, height, and weight. Multivariable-adjusted relative risks (RRs) (95% CI) were estimated using Cox proportional hazards regression. RESULTS During 26 years of follow-up, 243,051 men and 222,109 women died. In multivariable models that controlled for age, BMI, and other variables, diabetes was associated with higher risk of all-cause mortality (women RR 1.90 [95% CI 1.87-1.93]; men 1.73 [1.70-1.75]). Among women, diabetes was associated with higher risk of death from cancers of the liver (1.40 [1.05-1.86]), pancreas (1.31 [1.14-1.51]), endometrium (1.33 [1.08-1.65]), colon (1.18 [1.04-1.33]), and breast (1.16 [1.03-1.29]). Among men, diabetes was associated with risk of death from cancers of the breast (4.20 [2.20-8.04]), liver (2.26 [1.89-2.70]), oral cavity and pharynx (1.44 [1.07-1.94]), pancreas (1.40 [1.23-1.59]), bladder (1.22 [1.01-1.47]), colon (1.15 [1.03-1.29]), and (inversely) prostate (0.88 [0.79-0.97]). Diabetes was also associated with higher risks of death involving the circulatory system, respiratory system, digestive system, genitourinary system, and external causes/accidental deaths. CONCLUSIONS Diabetes is associated with higher risk of death for many diseases, including several specific forms of cancer.
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180
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Amer MS, Alsadany MA, Tolba MF, Omar OH. Quality of life in elderly diabetic patients with peripheral arterial disease. Geriatr Gerontol Int 2012; 13:443-50. [PMID: 22934536 DOI: 10.1111/j.1447-0594.2012.00928.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study the impact of peripheral arterial disease (PAD) on quality of life and functional status in Egyptian elderly diabetic patients. METHODS This case-control study included 90 non-demented patients aged 60 years and older. Quality of life assessment was carried out using the Short Form 36 health survey (SF-36), Arterial duplex for diagnosis of peripheral arterial disease; Mini-Mental State Examination, Geriatric Depression Scale, Activity of Daily Living and Instrumental Activity of Daily Living were used. RESULTS SF-36 domains (except emotional well-being) were significantly affected in diabetic patients with PAD compared with the diabetic patients without PAD. Most of functional assessment items were significantly affected in diabetic patients with PAD compared with diabetic patients without PAD. Increasing PAD severity and presence of PAD symptoms had a significant negative impact on SF-36 scores. Among diabetic complications in PAD patients, cardiovascular disease or stroke significantly affected quality of life. CONCLUSION PAD significantly affects quality of life and functional status in elderly diabetic patients.
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Affiliation(s)
- Moatassem S Amer
- Geriatric Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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181
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Inercia e incumplimiento a partes iguales. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/s1889-1837(12)70004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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182
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Lapice E, Cipriano P, Patti L, Romano G, Vaccaro O, Rivellese AA. Fasting apolipoprotein B48 is associated with asymptomatic peripheral arterial disease in type 2 diabetic subjects: a case-control study. Atherosclerosis 2012; 223:504-6. [PMID: 22762727 DOI: 10.1016/j.atherosclerosis.2012.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/28/2012] [Accepted: 05/31/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test whether there is an association between fasting ApoB48 level, a marker of the residual presence of intestinally derived TRLs lipoproteins, thought to be highly atherogenic, and peripheral artery disease (PAD) in type 2 diabetic patients independent of fasting plasma lipids. METHODS We studied 87 patients with type 2 diabetes: 34 with asymptomatic PAD (ankle/brachial index < 0.9) and 53 without PAD matched on age (±2 years), gender and BMI (±2 kg/m(2)). The plasma fasting ApoB48 was measured by ELISA. RESULTS Patients with PAD had significantly higher ApoB48 levels (1.529 ± 1.253 vs 1.095 ± 0.667 μg/ml p = 0.04) than those without PAD independent of major confounders, such as duration of diabetes, smoking status, HbA1c, systolic blood pressure and fasting plasma lipids. CONCLUSIONS Fasting ApoB48 was independently associated with asymptomatic PAD in patients with type 2 diabetes.
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Affiliation(s)
- Emanuela Lapice
- Department of Clinical and Experimental Medicine, University of Naples Federico II, Via S Pansini 5, 80131 Napoli, Italy.
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183
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What the radiologist needs to know about the diabetic patient. Insights Imaging 2012; 2:193-203. [PMID: 22347947 PMCID: PMC3259362 DOI: 10.1007/s13244-011-0068-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 11/16/2010] [Accepted: 01/13/2011] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is recognised as a major health problem. Ninety-nine percent of diabetics suffer from type 2 DM and 10% from type 1 and other types of DM. The number of diabetic patients worldwide is expected to reach 380 millions over the next 15 years. The duration of diabetes is an important factor in the pathogenesis of complications, but other factors frequently coexisting with type 2 DM, such as hypertension, obesity and dyslipidaemia, also contribute to the development of diabetic angiopathy. Microvascular complications include retinopathy, nephropathy and neuropathy. Macroangiopathy mainly affects coronary arteries, carotid arteries and arteries of the lower extremities. Eighty percent of deaths in the diabetic population result from cardiovascular incidents. DM is considered an equivalent of coronary heart disease (CHD). Stroke and peripheral artery disease (PAD) are other main manifestations of diabetic macroangiopathy. Diabetic cardiomyopathy (DC) represents another chronic complication that occurs independently of CHD and hypertension. The greater susceptibility of diabetic patients to infections completes the spectrum of the main consequences of DM. The serious complications of DM make it essential for physicians to be aware of the screening guidelines, allowing for earlier patient diagnosis and treatment.
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184
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Yu X, Yu GR, Chen YX, Liu XC. The Characteristics and Clinical Significance of Plantar Pressure Distribution in Patients with Diabetic Toe Deformity: A Dynamic Plantar Pressure Analysis. J Int Med Res 2011; 39:2352-9. [PMID: 22289554 DOI: 10.1177/147323001103900635] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study evaluated plantar pressure distribution and its clinical significance in patients with diabetic foot toe deformities. Patients with diabetic claw or hammer toe deformities (patient group; n = 30) and healthy subjects without toe deformities (control group; n = 30) were recruited into the study. Plantar pressures in different regions of the foot were measured using the F-scan® in-shoe plantar pressure dynamic analysis system. Peak pressures in the hallux and first to fifth metatarsal heads were significantly higher in the patient group compared with the control group. In the midfoot there was no significant difference between the two groups. Hindfoot peak plantar pressures were significantly lower in the patient group compared with the control group. The results indicated that toe deformities in patients with diabetes increased forefoot plantar pressures to abnormally high levels. If plantar pressure is regularly monitored in patients with diabetic foot, toe deformities might be detected earlier and ulceration prevented.
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Affiliation(s)
- X Yu
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, China
| | - G-R Yu
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, China
| | - Y-X Chen
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, China
| | - X-C Liu
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, China
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185
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Jalil A, Barlaan PI, Fung BKK, Ip JWY. HAND INFECTION IN DIABETIC PATIENTS. ACTA ACUST UNITED AC 2011; 16:307-12. [PMID: 22072465 DOI: 10.1142/s021881041100559x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 03/19/2011] [Accepted: 03/22/2011] [Indexed: 12/14/2022]
Abstract
The diabetic hand infection is less reported in the literature. Therefore, it is easily ignored and underestimated resulting in increased morbidity among the diabetic population. Diabetic hand is a rapid in progression, extensive and severe tissue destruction. We analyze the clinical course and outcome of hand infection in diabetic patients. We reviewed all the admissions with hand infection from January 2006–April 2010. Thirty-seven patients were found with associated diabetes mellitus. The demographic data, culture report, number of operations and management, hospital stay and outcome-like amputation were recorded. The average age was 62 years. Pain and swelling were the chief complaints. The cause of infection was varied. The infection was superficial in 13 and deep in 24 patients. Forty-one percent of culture report revealed polymicrobial organism. The increased length of hospital stay, reoperations and amputation were associated with deep infection and polymicrobial organism. Prompt medical and surgical attentions are the most important factors. A proper glycemic control, elevation of the affected extremity, thorough and adequate surgical debridement and appropriate antibiotics are the important considerations when dealing with diabetic hand infection.
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Affiliation(s)
- Amir Jalil
- Department of Orthopaedics and Traumatology, Hong Kong University, Division of Hand and Foot Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong S.A.R., China
| | - Philip Ian Barlaan
- Department of Orthopaedics and Traumatology, Hong Kong University, Division of Hand and Foot Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong S.A.R., China
| | - Boris Kwok Keung Fung
- Department of Orthopaedics and Traumatology, Hong Kong University, Division of Hand and Foot Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong S.A.R., China
| | - Josephine Wing-Yuk Ip
- Department of Orthopaedics and Traumatology, Hong Kong University, Division of Hand and Foot Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong S.A.R., China
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186
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Voulgari C, Katsilambros N, Tentolouris N. Smoking cessation predicts amelioration of microalbuminuria in newly diagnosed type 2 diabetes mellitus: a 1-year prospective study. Metabolism 2011; 60:1456-64. [PMID: 21489578 DOI: 10.1016/j.metabol.2011.02.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 02/27/2011] [Accepted: 02/28/2011] [Indexed: 01/28/2023]
Abstract
The objective of the study was to assess the effect of smoking cessation on microalbuminuria in subjects with newly diagnosed type 2 diabetes mellitus (DM). From 500 smokers newly diagnosed with type 2 DM and microalbuminuria, only 193 (96 men/97 women; age, 56.4 ± 7.8 years) agreed to participate and were educated on smoking cessation, diet, and exercise. Pharmacological interventions were not different among the studied groups. All subjects were contacted by phone monthly with emphasis on smoking cessation. Anthropometric, biochemical parameters and urine specimens were obtained at baseline and at 12-month follow-up. Microalbuminuria was defined as an albumin to creatinine ratio of 30 to 299.9 μg/mg creatinine. Ankle brachial pressure index was determined by ultrasound. A total of 120 (62.2%) subjects quit smoking. Prevalence of microalbuminuria was reduced at 1 year to 72.6% in the subjects who quit smoking and to 22.5% in those who continued smoking (P = .015). Multivariate logistic regression analysis demonstrated that independently associated with the reduction in albumin to creatinine ratio (84.8 vs 28.7 μg/mg creatinine) were amelioration of glycemic control (P < .001), blood pressure (P = .02), dyslipidemia (P = .02), and insulin resistance (P = .05). Smoking cessation also reduced the prevalence of peripheral vascular disease (P = .03) and neuropathy (P = .04). From the pharmacological and lifestyle interventions, smoking cessation had the highest and an independent contribution to the reduction of microalbuminuria (P < .001). Smoking cessation in newly diagnosed type 2 DM patients is associated with amelioration of metabolic parameters, blood pressure, and the reduction of microalbuminuria. Stricter counseling about the importance of quitting smoking upon type 2 DM diagnosis is necessary to protect against the development of diabetic nephropathy and vascular complications.
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Affiliation(s)
- Christina Voulgari
- First Propaedeutic Department of Internal Medicine, Laiko General Hospital, Athens University Medical School, Athens 11362, Greece.
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187
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Faglia E. Characteristics of peripheral arterial disease and its relevance to the diabetic population. INT J LOW EXTR WOUND 2011; 10:152-66. [PMID: 21856972 DOI: 10.1177/1534734611417352] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral arterial disease (PAD) is very frequent in diabetics, and it increases with age. Foot examination contributes poorly to diagnosis of PAD. The ankle-brachial index (ABI) measurement is considered the most accurate noninvasive diagnostic method when evaluating PAD: ABI evaluation is recommended in all diabetics aged >50 years. Many diabetic patients with PAD have a concomitant sensitive neuropathy: as a consequence, perception of ischemic pain is remarkably reduced or completely blocked. The result is that the prevalence of claudication in the diabetic population with PAD is lower than the prevalence of critical limb ischemia (CLI) in this population. CLI is a major risk factor for lower extremity amputation without revascularization. Ankle and toe pressures and oxygen tension at the foot are the noninvasive diagnostic parameters of CLI though the medial artery calcification inhibits accurate determination of the ankle and toe pressures, especially when a forefoot ulcer is present. In diabetics, the anatomical localization is mainly distal; arterial wall calcification is frequently observed and occlusion occurs more frequently than stenosis. Such anatomical features, along with the difficulties in the diagnostic approach, account for the fundamental role of CLI as the main prognostic indicator for major amputation. PAD is an expression of systemic atherosclerotic disease. Prognosis of patients with PAD is related to the presence and extent of underlying coronary artery disease (CAD) but also to the severity of PAD: in particular, patients in whom revascularization is not feasible have the highest mortality rate.
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Affiliation(s)
- Ezio Faglia
- Diabetic Foot Centre, IRCCS MultiMedica, Milan, Italy.
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188
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Seaman ME, Peirce SM, Kelly K. Rapid analysis of vessel elements (RAVE): a tool for studying physiologic, pathologic and tumor angiogenesis. PLoS One 2011; 6:e20807. [PMID: 21694777 PMCID: PMC3111429 DOI: 10.1371/journal.pone.0020807] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 05/10/2011] [Indexed: 11/26/2022] Open
Abstract
Quantification of microvascular network structure is important in a myriad of emerging research fields including microvessel remodeling in response to ischemia and drug therapy, tumor angiogenesis, and retinopathy. To mitigate analyst-specific variation in measurements and to ensure that measurements represent actual changes in vessel network structure and morphology, a reliable and automatic tool for quantifying microvascular network architecture is needed. Moreover, an analysis tool capable of acquiring and processing large data sets will facilitate advanced computational analysis and simulation of microvascular growth and remodeling processes and enable more high throughput discovery. To this end, we have produced an automatic and rapid vessel detection and quantification system using a MATLAB graphical user interface (GUI) that vastly reduces time spent on analysis and greatly increases repeatability. Analysis yields numerical measures of vessel volume fraction, vessel length density, fractal dimension (a measure of tortuosity), and radii of murine vascular networks. Because our GUI is open sourced to all, it can be easily modified to measure parameters such as percent coverage of non-endothelial cells, number of loops in a vascular bed, amount of perfusion and two-dimensional branch angle. Importantly, the GUI is compatible with standard fluorescent staining and imaging protocols, but also has utility analyzing brightfield vascular images, obtained, for example, in dorsal skinfold chambers. A manually measured image can be typically completed in 20 minutes to 1 hour. In stark comparison, using our GUI, image analysis time is reduced to around 1 minute. This drastic reduction in analysis time coupled with increased repeatability makes this tool valuable for all vessel research especially those requiring rapid and reproducible results, such as anti-angiogenic drug screening.
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Affiliation(s)
- Marc E. Seaman
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States of America
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Shayn M. Peirce
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States of America
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Kimberly Kelly
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States of America
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail:
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189
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Management of patients hospitalized for diabetic foot infection: Results of the French OPIDIA study. DIABETES & METABOLISM 2011; 37:208-15. [DOI: 10.1016/j.diabet.2010.10.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 09/28/2010] [Accepted: 10/01/2010] [Indexed: 11/19/2022]
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190
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Abstract
Atherosclerotic occlusion of vessels outside of the heart is commonly referred to as peripheral arterial disease (PAD). The lower extremity is the most common site of PAD and its development is associated with the same risk factors involved in general atherosclerosis. However, there is emerging evidence that other risk factors may play a key role in the development of PAD. Over the past decade polymorphism in a number of genes has been shown to contribute to the risk of developing PAD. These genes can be classified into proartherosclerosis or proatherothrombosis based on the known gene function. Moreover, they can be categorized as "novel" polymorphism when the function of the genes is not known or when the specific gene within an associated genetic locus is not known. It is intriguing that not only are gene polymorphisms associated with PAD being identified, but more recently studies are now finding gene polymorphisms that may be important in development of this syndrome only in the contest of certain environmental factors such as diabetes. Currently how these gene-environment interactions contribute to the pathogenesis of PAD is poorly understood but will likely play a critical role in future understanding of this complex disease.
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Affiliation(s)
- Arabindra B. Katwal
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Ayotunde O. Dokun
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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191
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Sahakyan K, Klein BEK, Lee KE, Myers CE, Klein R. The 25-year cumulative incidence of lower extremity amputations in people with type 1 diabetes. Diabetes Care 2011; 34:649-51. [PMID: 21273496 PMCID: PMC3041199 DOI: 10.2337/dc10-1712] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the 25-year cumulative incidence of lower-extremity amputation (LEA) in people with type 1 diabetes. RESEARCH DESIGN AND METHODS Cumulative incidence of LEA was ascertained in Wisconsin Epidemiologic Study of Diabetic Retinopathy participants (n = 943) using the Kaplan-Meier approach accounting for competing risk of death. Relationships of baseline characteristics with incidence of LEA were explored using a proportional hazards approach with discrete linear regression modeling. RESULTS The overall 25-year incidence of LEA was 10.1%. In multivariate analyses (results reported as odds ratio; 95% CI), being male (3.90; 2.29-6.65), heavy smoking (2.07; 1.11-3.85), having hypertension (3.36; 1.91-5.93), diabetic retinopathy (2.62; 1.13-6.09), neuropathy (1.68; 1.02-2.76), and higher HbA(1c) (per 1% 1.40; 1.24-1.58) were independently associated with the incidence of LEA. CONCLUSIONS Our results show a high 25-year incidence of LEA and suggest that glycemic control and blood pressure control and preventing heavy smoking may result in reduction in its incidence.
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Affiliation(s)
- Karine Sahakyan
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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192
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Pattillo CB, Bir SC, Branch BG, Greber E, Shen X, Pardue S, Patel RP, Kevil CG. Dipyridamole reverses peripheral ischemia and induces angiogenesis in the Db/Db diabetic mouse hind-limb model by decreasing oxidative stress. Free Radic Biol Med 2011; 50:262-9. [PMID: 21070849 PMCID: PMC4413947 DOI: 10.1016/j.freeradbiomed.2010.10.714] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/23/2010] [Accepted: 10/28/2010] [Indexed: 11/28/2022]
Abstract
Dipyridamole anti-platelet therapy has previously been suggested to ameliorate chronic tissue ischemia in healthy animals. However, it is not known if dipyridamole therapy represents a viable approach to alleviating chronic peripheral tissue ischemia associated with type 2 diabetes. Here we examine the hypothesis that dipyridamole treatment restores reperfusion of chronic hind-limb ischemia in the murine B6.BKS-Lepr(db/db) diabetic model. Dipyridamole therapy quickly rectified ischemic hind-limb blood flow to near preligation levels within 3 days of the start of therapy. Restoration of ischemic tissue blood flow was associated with increased vascular density and endothelial cell proliferation observed only in ischemic limbs. Dipyridamole significantly increased total nitric oxide metabolite levels in tissue, which were not associated with changes in endothelial NO synthase expression or phosphorylation. Interestingly, dipyridamole therapy significantly decreased ischemic tissue superoxide and protein carbonyl levels, identifying a dominant antioxidant mechanistic response. Dipyridamole therapy also moderately reduced diabetic hyperglycemia and attenuated development of dyslipidemia over time. Together, these data reveal that dipyridamole therapy is an effective modality for the treatment of chronic tissue ischemia during diabetes and highlights the importance of dipyridamole antioxidant activity in restoring tissue NO bioavailability during diabetes.
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Affiliation(s)
| | - Shyamal C. Bir
- Department of Pathology, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Billy G. Branch
- Department of Pathology, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Eric Greber
- Department of Pathology, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Xinggui Shen
- Department of Pathology, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Sibile Pardue
- Department of Pathology, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Rakesh P. Patel
- Department of Pathology and Center for Free Radical Biology, University of Alabama-Birmingham, Birmingham, Alabama
| | - Christopher G. Kevil
- Department of Pathology, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana
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193
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In vitro effect of aspartame in angiogenesis induction. Toxicol In Vitro 2010; 25:286-93. [PMID: 20837131 DOI: 10.1016/j.tiv.2010.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 08/30/2010] [Accepted: 09/02/2010] [Indexed: 11/23/2022]
Abstract
Aspartame (APM) is the most widely used artificial sweetener and is added to a wide variety of foods, beverages, drugs, and hygiene products. In vitro and in vivo tests have reported contradictory data about APM genotoxicity. We evaluated the angiogenic effect of APM in an in vitro model using blood vessel development assay (Angio-Kit), cultured endothelial cells and fibroblasts. The release of IL-6, VEGF-A, and their soluble receptors sIL-R6 and sVEGFR-2 were determined over time in the conditioned medium of the Angio-Kit system, endothelial cells and cell lines with fibroblast properties after APM treatment. Reactive oxygen species (ROS) formation, cell viability, and stimulation of the extracellular signal-regulated kinases (erk1/2) and protein p38 were also evaluated. Exposure to APM induced blood vessel formation. ROS production was observed in endothelial cells after APM treatment, which was associated with a slight cell cytotoxicity. Neither intracellular ROS formation nor cell death was observed in fibroblasts. APM increases the levels of inflammatory mediator IL-6, VEGF and their soluble receptors released from endothelial cells into the medium. APM treatment induces VEGF-pathway activation by erk1/2 and p38 phosphorylation. APM at low doses is an angiogenic agent that induces regenerative cytokine production leading to the activation of MAPKs and resulting in the formation of new blood vessels.
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194
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Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. ACTA ACUST UNITED AC 2005. [PMID: 16291066 DOI: 10.1016/j.mpmed.2010.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes in the next 20 years. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-up is indicated for these patients. When assessing the economic effects of diabetic foot disease, it is important to remember that rates of recurrence of foot ulcers are very high, being greater than 50% after 3 years. Costing should therefore include not only the immediate ulcer episode, but also social services, home care, and subsequent ulcer episodes. A broader view of total resource use should include some estimate of quality of life and the final outcome. An integrated care approach with regular screening and education of patients at risk requires low expenditure and has the potential to reduce the cost of health care.
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