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Liu W, Zhang G, Nie Z, Guan X, Sun T, Jin X, Li B. Low Concentration of Lipoprotein(a) is an Independent Predictor of Incident Type 2 Diabetes. Horm Metab Res 2024. [PMID: 38772392 DOI: 10.1055/a-2316-9124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
The aim of the study was to assess the association between lipoprotein(a) [Lp(a)] concentration and incident type 2 diabetes. A meta-analysis of qualified studies on the relationship of low levels of Lp(a) concentration with incident type 2 diabetes was conducted. PubMed and Cochrane libraries were searched for randomized controlled trials containing data on events. Seven randomized trials with 227178 subjects were included in this analysis. We found an inverse association of the levels of Lp(a) concentration with risk of type 2 diabetes with approximately 37% lower relative risk in the group with the highest concentration compared with group with the lowest concentration. The current available evidence from prospective studies suggests that there is an inverse association between the levels of Lp(a) concentration and risk of type 2 diabetes, with a higher risk of type 2 diabetes at low levels of Lp(a) concentration. Therefore, we believe that the low levels of Lp(a) concentration is an independent predictor of incident type 2 diabetes.
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Affiliation(s)
- Wenhao Liu
- Cardiology, Zibo Central Hospital, Zibo, China
| | | | - Zifan Nie
- Cardiology, Zibo Central Hospital, Zibo, China
| | - Xiangfeng Guan
- Cardiology, Shandong Second Medical University, Weifang, China
| | - Tingting Sun
- Cardiology, Shandong Second Medical University, Weifang, China
| | - Xiaodong Jin
- Geriatric Medicine, Zibo Central Hospital, Zibo, China
| | - Bo Li
- Cardiology, Zibo Central Hospital, Zibo, China
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Tsamoulis D, Kosmas CE, Rallidis LS. Is inverse association between lipoprotein(a) and diabetes mellitus another paradox in cardiometabolic medicine? Expert Rev Endocrinol Metab 2024; 19:63-70. [PMID: 38078437 DOI: 10.1080/17446651.2023.2293108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The impact of Type II Diabetes mellitus (T2DM) on cardiovascular disease (CVD) is well-established, while lipoprotein(a) [Lp(a)] has recently emerged as a recognized CVD risk factor. The rising prevalence of T2DM resulting from modern lifestyles and the development of specific Lp(a)-lowering agents brought the association between T2DM and Lp(a) in the forefront. AREAS COVERED Despite advancements in T2DM treatment, diabetic patients remain at very-high risk of CVD. Lp(a) may, to some extent, contribute to the persistent CVD risk seen in diabetic patients, and the coexistence of T2DM and elevated Lp(a) levels appears to synergistically amplify overall CVD risk. The relationship between T2DM and Lp(a) is paradoxical. On one hand, high Lp(a) plasma concentrations elevate the risk of diabetic microvascular and macrovascular complications. On the other hand, low Lp(a) plasma concentrations have been linked to an increased risk of developing T2DM. EXPERT OPINION Comprehending the association between T2DM and Lp(a) is critical due to the pivotal roles both entities play in overall CVD risk, as well as the unique aspects of their relationship. The mechanisms underlying the inverse association between T2DM and Lp(a) remain incompletely understood, necessitating further meticulous research.
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Affiliation(s)
- Donatos Tsamoulis
- Second Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece
| | - Constantine E Kosmas
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Loukianos S Rallidis
- Second Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece
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Chen X, Zhang X, Nie Y, Gong Z, Sivaprasad S, Fung AT, Wang Q, Qiu B, Xie R, Wang Y. Circulating level of homocysteine contributes to diabetic retinopathy associated with dysregulated lipid profile and impaired kidney function in patients with type 2 diabetes mellitus. Eye (Lond) 2023; 37:1383-1389. [PMID: 35739242 PMCID: PMC10170092 DOI: 10.1038/s41433-022-02144-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To test the hypothesis that elevated plasma levels of homocysteine (Hcy) and lipoprotein (a) (LPA) contribute to diabetic retinopathy (DR) associated with dysregulated lipid profile, dyslipidaemia, and kidney function. METHODS A total of 83 patients with type 2 diabetes mellitus (T2DM) were enrolled in this prospective case-control study. Patients were categorized into those with no DR (DM), non-proliferative DR (NPDR), and proliferative DR (PDR). Age and sex-matched individuals with no diabetes were included in the control group. Biochemical tests, including fasting blood glucose (FBG), glycated hemoglobin (HbA1c), Hcy, LPA, lipid profile, and urine microalbumin (UMA), were evaluated. RESULTS Hcy was negatively correlated with high-density lipoprotein-cholesterol (HDL-C) (p < 0.05), but positively correlated with [total cholesterol (TC)-HDL-C)/HDL-C] (p < 0.05), low-density lipoprotein cholesterol (LDL-C)/HDL-C (p < 0.05), and UMA (p < 0.05). Traditional risk factors, Hcy, arteriosclerosis-associated plasma indices, and UMA, resulted as the independent risk factors for the occurrence of DM and DR. After controlling for age, sex, duration of DM, and FBG, a multiple ordinal logistic regression model showed that LPA [OR = 2.90, 95% confidence interval (95% CI) 1.16-7.23, p = 0.023)], LDL-C (OR = 4.28, 95% CI 1.24-14.79, p = 0.021), and (TC-HDL-C)/HDL-C (OR = 1.92, 95% CI 1.05-3.53, p = 0.035) were risk factors for DM and DR. CONCLUSIONS Hcy and LPA contributed to DM and DR. Hcy was positively correlated with kidney dysfunction and the ratios of lipid profiles, and negatively with HDL-C, LPA, LDL-C, and (TC-HDL-C)/HDL-C resulted as predictors of the occurrence of DM and severity of DR.
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Affiliation(s)
- Xiaosi Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Xinyuan Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China.
| | - Yao Nie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Zhizhong Gong
- Division of Medical Affairs, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Sobha Sivaprasad
- NIHR Moorfield's Biomedical Research Centre, Moorfield's Eye Hospital, London, UK
| | - Adrian T Fung
- Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Qiyun Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Bingjie Qiu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Rui Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences & School of Basic Medicine Peking Union Medical College, Beijing, China
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Cai D, Hou B, Xie SL. Amino acid analysis as a method of discovering biomarkers for diagnosis of diabetes and its complications. Amino Acids 2023:10.1007/s00726-023-03255-8. [PMID: 37067568 DOI: 10.1007/s00726-023-03255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/21/2023] [Indexed: 04/18/2023]
Abstract
Diabetes mellitus (DM) is a severe chronic diseases with a global prevalence of 9%, leading to poor health and high health care costs, and is a direct cause of millions of deaths each year. The rising epidemic of diabetes and its complications, such as retinal and peripheral nerve disease, is a huge burden globally. A better understanding of the molecular pathways involved in the development and progression of diabetes and its complications can facilitate individualized prevention and treatment. High diabetes mellitus incidence rate is caused mainly by lack of non-invasive and reliable methods for early diagnosis, such as plasma biomarkers. The incidence of diabetes and its complications in the world still grows so it is crucial to develop a new, faster, high specificity and more sensitive diagnostic technologies. With the advancement of analytical techniques, metabolomics can identify and quantify multiple biomarkers simultaneously in a high-throughput manner, and effective biomarkers can greatly improve the efficiency of diabetes and its complications. By providing information on potential metabolic pathways, metabolomics can further define the mechanisms underlying the progression of diabetes and its complications, help identify potential therapeutic targets, and improve the prevention and management of T2D and its complications. The application of amino acid metabolomics in epidemiological studies has identified new biomarkers of diabetes mellitus (DM) and its complications, such as branched-chain amino acids, phenylalanine and arginine metabolites. This study focused on the analysis of metabolic amino acid profiling as a method for identifying biomarkers for the detection and screening of diabetes and its complications. The results presented are all from recent studies, and in all cases analyzed, there were significant changes in the amino acid profile of patients in the experimental group compared to the control group. This study demonstrates the potential of amino acid profiles as a detection method for diabetes and its complications.
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Affiliation(s)
- Dan Cai
- The Affiliated Nanhua Hospital, Department of Hand and Foot Surgery, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Biao Hou
- The Affiliated Nanhua Hospital, Department of Hand and Foot Surgery, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Song Lin Xie
- The Affiliated Nanhua Hospital, Department of Hand and Foot Surgery, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
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Gazzaruso C, Montalcini T, Gallotti P, Ferrulli A, Massa Saluzzo C, Pujia A, Luzi L, Coppola A. Impact of microvascular complications on the outcomes of diabetic foot in type 2 diabetic patients with documented peripheral artery disease. Endocrine 2023; 80:71-78. [PMID: 36565405 DOI: 10.1007/s12020-022-03291-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Microvascular disease (MVD) is associated with amputation linked to peripheral artery disease (PAD) in the general population. No study evaluated the impact of diabetic microvascular complications on the outcomes of vascular diabetic foot ulcers (DFU). The aim of the study was to investigate whether retinopathy, nephropathy, and polyneuropathy can predict the outcomes of DFU in type 2 diabetic patients with PAD. METHODS Three hundred and thirty-one consecutive patients with vascular DFU were enrolled and followed up for 44.1 ± 23.9 months. RESULTS The prevalence of retinopathy was significantly higher in subjects with ulcer persistence (45.2%; p < 0.01), minor amputation (48.9%; p < 0.001), and major amputation (57.9%; p < 0.001) than in healed patients (23.3%), and in non-survivors than in survivors (64.9 versus 20.5%; p < 0.001). The prevalence of nephropathy was significantly greater in subjects with ulcer persistence (83.9%; p < 0.01), minor amputation (86.7%; p < 0.001), and major amputation (94.7%; p < 0.001) than in those with healed DFU (64.4%), and in non-survivors than in survivors (88.3 versus 65.7%; p < 0.001). The prevalence of polyneuropathy was significantly higher in non-survivors than in survivors (76.6 versus 61.0%; p = 0.012). Multivariate analysis showed that absence of retinopathy (OR: 0.451; 95% CI: 0.250-0.815; p < 0.001) and nephropathy (OR: 0.450; 95% CI: 0.212-0.951; p = 0.036) were independently associated with healing. Moreover, retinopathy was a predictor both of minor amputation (OR: 2.291; 95% CI: 1.061-4.949; p = 0.034) and mortality (OR: 5.274; 95% CI: 2.524-11.020; p < 0.001). Polyneuropathy never entered the regression model. CONCLUSIONS Diabetic microvascular complications, in particular retinopathy, may predict the outcomes of vascular DFU. Longitudinal studies should confirm this finding.
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Affiliation(s)
- Carmine Gazzaruso
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy.
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pietro Gallotti
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Anna Ferrulli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
| | | | - Arturo Pujia
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
| | - Adriana Coppola
- Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
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Coppola A, Gallotti P, Montalcini T, Terruzzi I, Pujia A, Luzi L, Gazzaruso C. Association of erectile dysfunction with diabetic foot and its outcomes in type 2 diabetic men. Hormones (Athens) 2023; 22:45-50. [PMID: 36260273 DOI: 10.1007/s42000-022-00407-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Erectile dysfunction (ED) and diabetic foot (DF) are common complications in patients with diabetes. However, the relationship between ED and DF has been little studied. In particular, no study has evaluated whether ED is associated with the outcomes of DF. The aim of this retrospective cohort study was to investigate whether ED is a predictor of the outcomes of DF in a large population of men with DF. METHODS Three hundred and twenty-six consecutive men with type 2 diabetes and a recent and single DF ulcer were recruited and followed up for 41.7 ± 22.7 months. RESULTS Among men with DF, 56.1% had ED (ED group) and 43.9% did not (NO ED group). Wound healing rate was significantly higher in the NO ED than in the ED group (90.2 versus 73.3%; p = 0.0001). Minor amputation rate (13.7 versus 4.8%; p = 0.007) and mortality (25.7 versus 0.7%; p < 0.001) were significantly greater in the ED than in the NO ED group. Among 263 patients with healed ulcers, recurrence rate was significantly higher in the ED than in the NO ED group (51.5 versus 26.3%; p < 0.001). Multivariate analysis showed that the absence of ED was associated with wound healing (OR: 0.459; 95% CI: 0.213-0.993; p = 0.048), while the presence of ED predicted mortality (OR: 22.644; 95% CI: 2.976-34.271; p = 0.002) and DF recurrence (OR: 3.498; 95% CI: 1.882-6.499; p < 0.001). CONCLUSIONS Our data show that among men with DF the prevalence of ED is very high. Moreover, ED may be a strong predictor of wound healing, mortality, and ulcer recurrence.
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Affiliation(s)
- Adriana Coppola
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Corso Pavia 84, 27029, Vigevano, Italy
| | - Pietro Gallotti
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Corso Pavia 84, 27029, Vigevano, Italy
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Ileana Terruzzi
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Arturo Pujia
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Livio Luzi
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Carmine Gazzaruso
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Corso Pavia 84, 27029, Vigevano, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Coppola A, Montalcini T, Gallotti P, Ferrulli A, Pujia A, Luzi L, Gazzaruso C. A Comprehensive Therapeutic Patient Education May Improve Wound Healing and Reduce Ulcer Recurrence and Mortality in Persons With Type 2 Diabetes. Can J Diabetes 2023; 47:73-77. [PMID: 36154986 DOI: 10.1016/j.jcjd.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/18/2022] [Accepted: 08/12/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The impact of a comprehensive therapeutic patient education (TPE) on the prognosis of diabetic foot ulcer (DFU) has not yet been evaluated in the literature. The purpose of this study was to determine whether TPE is a predictor of outcome in type 2 diabetes patients with DFU. METHODS We evaluated 583 consecutive individuals with a recent and single DFU. They were treated and followed for 42.8±23.3 months. Patients were divided into 2 groups. The TPE group included subjects who had been receiving regular sessions of a comprehensive TPE, including a specific foot care education (FCE), for at least 12 months before DFU occurred (n=129). The non-TPE group comprised the remaining subjects (n=454). All 583 patients received intensive FCE during the treatment period. RESULTS We identified a significantly higher percentage of healed DFUs (96.0% vs 74.9%; p<0.0001) and a lower percentage of major amputations (0.8% vs 4.4%; p=0.0511), minor amputations (1.6% vs 12.3%; p=0.0003), DFU persistence (1.6% vs 8.4%; p=0.0069) and deaths (1.6% vs 21.4%; p<0.0001) in the TPE group than in the non-TPE group. Among 464 patients with healed ulcers, the proportion of subjects with re-ulceration was greater in the non-TPE group than in the TPE group (48.8% vs 6.5%; p<0.0001). Multivariate analysis showed that TPE can predict healing (odds ratio [OR], 4.202; 95% confidence interval [CI], 1.604 to 11.004; p=0.0035) and may significantly reduce DFU recurrence (OR, 0.093; 95% CI, 0.043 to 0.201; p<0.0001) and mortality (OR, 0.096; 95% CI, 0.022 to 0.410; p=0.0016). CONCLUSION A comprehensive TPE may have a positive impact on wound healing, ulcer recurrence and mortality in people with DFU.
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Affiliation(s)
- Adriana Coppola
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pietro Gallotti
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy
| | - Anna Ferrulli
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Arturo Pujia
- Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Livio Luzi
- Department of Endocrinology, IRCCS Multimedica, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Carmine Gazzaruso
- Diabetes and Endocrine-Metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Ulloque-Badaracco JR, Mosquera-Rojas MD, Hernandez-Bustamante EA, Alarcón-Braga EA, Ulloque-Badaracco RR, Al-kassab-Córdova A, Herrera-Añazco P, Benites-Zapata VA, Hernandez AV. Association between Lipid Profile and Apolipoproteins with Risk of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:5450173. [PMID: 36016824 PMCID: PMC9385316 DOI: 10.1155/2022/5450173] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/21/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS Biomarkers are necessary to stratify the risk of diabetic foot ulcers (DFUs). This systematic review and meta-analysis aimed to evaluate the association between the lipid profile and apolipoproteins with the risk of DFU. METHODS A systematic search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science among adult patients. Cohort and case-control studies were included. Random-effects models were used for meta-analyses, and the effects were expressed as odds ratio (OR) and their 95% confidence intervals (CIs). We evaluated publication bias through Egger's test and funnel plot. RESULTS A total of 12 cohort studies and 26 case-control studies were included, with 17076 patients. We found that the higher values of total cholesterol (TC), low-density lipoprotein (LDL), triglycerides, and lipoprotein(a) (Lp(a)) were associated with a higher risk of developing DFU (OR: 1.47, OR: 1.47, OR: 1.5, OR: 1.85, respectively). Otherwise, the lower values of HDL were associated with a higher risk of developing DFU (OR: 0.49). Publication bias was not found for associations between TC, HDL, LDL, or TG and the risk of DFU. CONCLUSIONS The high values of LDL, TC, TG, and Lp(a) and low values of HDL are associated with a higher risk of developing DFU. Furthermore, we did not find a significant association for VLDL, ApoA1, ApoB, and ApoB/ApoA1 ratio.
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Affiliation(s)
- Juan R. Ulloque-Badaracco
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Melany D. Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Enrique A Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Esteban A Alarcón-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | - Percy Herrera-Añazco
- Universidad Privada San Juan Bautista, Lima, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Guías de Práctica Clínica y Evaluaciones de Tecnología Sanitaria, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Mansfield, CT, USA
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Vujčić S, Stefanović T, Zeljković A, Mihajlović M, Vekić J. Biomarkers of dyslipidemia in patients with diabetic foot. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-36296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Diabetic foot (DF) is one of the most severe complications of diabetes that significantly reduces the quality of life and survival of patients. Besides firmly established risk factors, novel data indicate that alterations in lipid metabolism might also be implicated in the development and progression of DF. Diabetic dyslipidemia is characterized by the atherogenic triad, consisting of increased triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL-C) levels and the presence of small, dense low-density lipoprotein (LDL) particles. Accumulating evidence suggests that profound hypertriglyceridemia and HDL-C reduction are common findings in patients with diabetic neuropathy and significantly contribute to an increased risk for DF, amputation and mortality. Small, dense LDL particles play an important role in the development of cardiovascular complications of diabetes, but their clinical importance in patients with DF remains to be established. In this paper, we will discuss the significance of standard and novel lipid biomarker determination in the assessment of the risk for the development and progression of DF.
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Gogakos AI, Gogakos T, Kita M, Efstathiadou ZA. Pituitary Dysfunction as a Cause of Cardiovascular Disease. Curr Pharm Des 2021; 26:5573-5583. [PMID: 33155896 DOI: 10.2174/1381612824999201105165351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
The hypothalamic-pituitary axis is responsible for the neuroendocrine control of several organ systems. The anterior pituitary directly affects the functions of the thyroid gland, the adrenal glands, and gonads, and regulates growth and milk production. The posterior hypophysis, through nerve connections with the hypothalamic nuclei, releases vasopressin and oxytocin responsible for water balance and social bonding, sexual reproduction and childbirth, respectively. Pituitary gland hormonal excess or deficiency results in dysregulation of metabolic pathways and mechanisms that are important for the homeostasis of the organism and are associated with increased morbidity and mortality. Cardiovascular (CV) disorders are common in pituitary disease and have a significant impact on survival. Hormonal imbalance is associated with CV complications either through direct effects on the heart structure and function and vasculature or indirectly by altering the metabolic profile. Optimal endocrine control can prevent or reverse CV defects and preserve survival and quality of life. In this review, we discuss the effects of pituitary hormone excess and deficiency on the CV system. Specifically, we assess the impact of Somatotroph, Corticotroph, Gonadotroph, and Lactotroph anterior pituitary axes on the CV system. The effect of posterior pituitary function on the CV system is also explored.
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Affiliation(s)
- Apostolos I Gogakos
- Department of Endocrinology, "Hippokration" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Tasos Gogakos
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Marina Kita
- Department of Endocrinology, "Hippokration" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Zoe A Efstathiadou
- Department of Endocrinology, "Hippokration" General Hospital of Thessaloniki, Thessaloniki, Greece
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11
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Muzurović E, Kraljević I, Solak M, Dragnić S, Mikhailidis DP. Homocysteine and diabetes: Role in macrovascular and microvascular complications. J Diabetes Complications 2021; 35:107834. [PMID: 33419630 DOI: 10.1016/j.jdiacomp.2020.107834] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 01/12/2023]
Abstract
Diabetes mellitus (DM) can lead to the development of macro- and microvascular complications. Homocysteine (Hcy) may play a role in the development of cardiovascular (CV) diseases (CVDs). The role of Hcy in the development of the vascular complications associated with DM is not clearly defined. Despite a strong initial assumption regarding the importance of Hcy in DM and its complications, over time "enthusiasm has waned" because several studies showed unconvincing and occasionally contradictory results. A universal conclusion is not easy to draw given the diversity of studies (e.g. number of patients, design, folic acid and vitamin B status, ethnic differences, genetic background). For some complications, most results encourages further investigation. Impaired renal function is a major independent determinant of high total Hcy (tHcy) levels. However, the role of hyperhomocysteinaemia (HHcy) in the development of diabetic kidney disease (DKD) has yet to be determined. Hcy-lowering therapies can significantly decrease Hcy levels but their effects on CVD risk reduction are conflicting. Further studies are needed to determine the influence of Hcy-lowering therapy on CVD risk reduction, especially in patients with DM.
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Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Ljubljanska bb, 81000 Podgorica, Montenegro.
| | - Ivana Kraljević
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirsala Solak
- Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Siniša Dragnić
- Department of Cardiology, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Ljubljanska bb, 81000 Podgorica, Montenegro
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG, UK
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12
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Gazzaruso C, Gallotti P, Pujia A, Montalcini T, Giustina A, Coppola A. Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study. Endocrine 2021; 71:59-68. [PMID: 32712853 DOI: 10.1007/s12020-020-02431-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Predictors of outcome of diabetic foot ulcer (DFU) are important to improve the management of patients. Aim of the study was to find these predictors in type 2 diabetic patients with DFU. METHODS We recruited 583 patients. They were followed-up by a multidisciplinary team. A holistic and conservative approach was used and all risk factors and co-morbidities were aggressively treated. RESULTS During the follow-up period, 79.6% of patients healed in a mean time of 7.6 ± 3.8 months, 6.9% showed DFU persistence, 9.9% had minor amputations, and 3.6% experienced major amputation. Seventeen percent of the patients died. Among patients who healed, 37.1% of them showed DFU recurrence. Impairment of renal function was associated to DFU persistence, amputation, and mortality. Previous cardiovascular disease predicted DFU persistence, DFU recurrence, and mortality. Lower BMI predicted DFU persistence and mortality. Osteomyelitis was a predictor of amputation and death. Markers of peripheral artery disease (PAD) predicted minor amputation and DFU recurrence. Our study shows a relatively low incidence of complications of DFU. CONCLUSIONS Some predictors of outcome of DFU were confirmed and new predictors, like BMI and markers of PAD, were found. Our new findings suggest future strategies for nutrition support and revascularization. In addition, a holistic and conservative approach may improve the prognosis.
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Affiliation(s)
- Carmine Gazzaruso
- Diabetes and Endocrine, Metabolic and Vascular Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia 84, 27029, Vigevano, Italy.
| | - Pietro Gallotti
- Diabetes and Endocrine, Metabolic and Vascular Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia 84, 27029, Vigevano, Italy
| | - Arturo Pujia
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Germaneto, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Germaneto, Catanzaro, Italy
| | - Andrea Giustina
- Unit and Chair of Endocrinology, IRCCS Ospedale San Raffaele and University Vita e Salute, Milan, Italy
| | - Adriana Coppola
- Diabetes and Endocrine, Metabolic and Vascular Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia 84, 27029, Vigevano, Italy
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13
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Dai J, Yu M, Chen H, Chai Y. Association Between Serum 25-OH-Vitamin D and Diabetic Foot Ulcer in Patients With Type 2 Diabetes. Front Nutr 2020; 7:109. [PMID: 32984392 PMCID: PMC7493196 DOI: 10.3389/fnut.2020.00109] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Vitamin D deficiency has been associated with an increased risk in several diabetic complications. We aimed to evaluate the association between vitamin D and diabetic foot ulcer (DFU) in patients with type 2 diabetes. Methods: Fifty one patients were included in the study and divided into two groups for study of vitamin D, cholesterol, and triglycerides in blood serum on DFU. The association between vitamin D and DFU was measured by binary logistic regression analysis. The cut point of vitamin D for DFU was assessed by the receiver operating characteristic curve. Results: Levels of 25-OH-vitamin D were lower in patients with DFU than in DM group (P < 0.0001). The AUC of 25-OH-vitamin D was 0.8254 and had an optimal cut point value (13.68 ng/ml) for the identification of DFU, with a sensitivity of 90% and a specificity of 66.67% in all patients. Multivariate logistic regression analysis indicated that the significant risk factors included 25-OH-vitamin D level (P = 0.001, OR = 0.618) and HDL-C level (P = 0.038, OR = 0.012). Conclusion: Low serum 25-OH-vitamin D level was associated with DFU. This indication was more specific than cholesterol and triglycerides levels.
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Affiliation(s)
- Jiezhi Dai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Min Yu
- Department of Vascular Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yimin Chai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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14
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Coppola A, Gallotti P, Choussos D, Pujia A, Montalcini T, Gazzaruso C. Association between clitoral tissue perfusion and female sexual dysfunction in healthy women of reproductive age: a pilot study. Int J Impot Res 2019; 32:221-225. [DOI: 10.1038/s41443-019-0155-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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15
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An J, Yu H, Gao Z, Yang W, Li J, Nie X, Wang X, An G. Predictive value of the ratio of homocysteine to serum albumin concentrations in the recurrence of diabetic foot ulcer. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00744-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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16
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Zubair M, Ahmad J. Transcutaneous oxygen pressure (TcPO 2) and ulcer outcome in diabetic patients: Is there any correlation? Diabetes Metab Syndr 2019; 13:953-958. [PMID: 31336550 DOI: 10.1016/j.dsx.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Due to poor blood circulation, the prevalence of foot ulcer is extensively reported among diabetic patients. Diabetic neuropathy is the critical factor of diabetes that can affect the nerves. OBJECTIVE To examine the outcomes and correlation between TcPO2 and ulcer outcomes among diabetic patients. MATERIAL AND METHODS A prospective cohort design has been employed to compare and correlate TcPO2 group with ulcer outcomes. A total of 192 patients were enrolled, who underwent diagnosis for ulcer outcome. Descriptive analysis and Pearson Correlation were used for data analysis via SPSS version 20. RESULTS The prevalence of minor amputation among diabetic patients in 25-40 mmHg 75 (85.22%) and >40 mmhG 73 (84.88%) group is reported for ulcer outcome. Mostly diabetic patients were healed with intact skin (male = 36, female = 73), and improved ulcer healing (male = 23, female = 43). Correlation between ulcer size (p = .016), ABI (p = .044), TBI (p = .000), Adiponectin (p = .009), HbA1c (p = .033), and S. creatinine (p = .025) was significant with TcpO2 group. CONCLUSIONS The study concluded that there is a positive and significant correlation between TcPO2 group and ulcer outcome. There is a positive association between TcPO2 baseline and degree of ulcer healing with intact skin.
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Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia.
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India
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17
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Coppola A, Montalcini T, Gallotti P, Luzi L, Pujia A, Giustina A, Gazzaruso C. Transmucosal oxygen tension of the clitoris: a new parameter for future investigations of the sexual, metabolic, and cardiovascular health of women. Endocrine 2019; 63:177-181. [PMID: 30302662 DOI: 10.1007/s12020-018-1782-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/01/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Several studies suggested that abnormalities in tissue perfusion of external genitalia and vagina can lead to female sexual dysfunctions (FSDs) and can be associated to metabolic and cardiovascular risk factors. However, there are some technical difficulties in assessing these abnormalities. The measurement of oxygen partial pressure is a noninvasive method to measure oxygen partial pressure (pO2) at the skin surface to assess tissue perfusion. The aim of this study was to evaluate whether transmucosal oxygen tension (TmPO2) can be measured at the mucosal surface of clitoris and whether the measurements are reliable. METHODS TmPO2 was measured in six young healthy women by using a device to measure transcutaneous pO2 on the skin and by choosing a small sensor, usually used for newborns. The identical procedure for the detection of pO2 at the skin surface was used. RESULTS The mean value of TmPO2 was 42.3 mmHg (range: 24.1-53.4 mmHg). All the trend curves of the TmPO2 showed the same behavior: after a stabilization time, there was a stable pO2 (plateau phase) that corresponds to the TmPO2 of the clitoris. These curves had a similar trend to those recorded at the skin surface. CONCLUSIONS TmPO2 can be easily measured at the mucosal surface of clitoris. Large epidemiological studies in healthy and unhealthy women and in women with FSD are needed to establish both the normal range of TmPO2 and the meaning that different values of TmPO2 can have on sexual and general health of the women.
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Affiliation(s)
- A Coppola
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - T Montalcini
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - P Gallotti
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy
| | - L Luzi
- Department of Biomedical Sciences for Health, University of Milan, 20100, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, 20097, San Donato Milanese, Italy
| | - A Pujia
- Nutrition Unit, Department of Clinical and Experimental Medicine, University Magna Grecia, Catanzaro, Italy
| | - A Giustina
- Chair of Endocrinology, San Raffaele Vita-Salute University, Milan, Italy
| | - C Gazzaruso
- Diabetes and Endocrine and Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), 27029, Vigevano, Italy.
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18
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Coppola A, Luzi L, Montalcini T, Giustina A, Gazzaruso C. Role of structured individual patient education in the prevention of vascular complications in newly diagnosed type 2 diabetes: the INdividual Therapeutic Education in Newly Diagnosed type 2 diabetes (INTEND) randomized controlled trial. Endocrine 2018; 60:46-49. [PMID: 28936586 DOI: 10.1007/s12020-017-1427-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/11/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Recent studies showed that a structured patient therapeutic education (PTE) may decrease both mortality and the development of diabetes complications. Nevertheless, no data are available in the literature on the impact of individual PTE on the complications in newly diagnosed type 2 diabetic patients. Aim of the present randomized controlled trial is to evaluate the impact of individual PTE on the occurrence of macrovascular complications in newly diagnosed type 2 diabetic patients when compared to usual care (UC) and group PTE. DESIGN AND METHODS Six hundred newly diagnosed type 2 diabetic patients will be enrolled. The patients will be randomly assigned to one of these three groups: individual PTE, group PTE and UC. A comprehensive and complete PTE will be delivered to all the patients: PTE will include eleven themes. Primary composite endpoint of the study is occurrence of vascular complications, including cardiovascular death, non fatal coronary disease, non fatal stroke, peripheral artery disease. Secondary endpoints are: foot ulcers, amputations, sexual dysfunction, quality of life, microvascular complications, bone health, intensification of diabetes and hypertension therapy. RESULTS AND CONCLUSIONS The present trial can give precious information on the features for the most effective PTE.
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Affiliation(s)
- Adriana Coppola
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Metabolism Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, Nutrition Unit, University Magna Grecia, Catanzaro, Italy
| | - Andrea Giustina
- Chair of Endocrinology San Raffaele Vita-Salute University, Milan, Italy
| | - Carmine Gazzaruso
- Diabetes and endocrine and metabolic diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.) Clinical Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.
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19
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Rahimi M, Vinciguerra M, Daghighi M, Özcan B, Akbarkhanzadeh V, Sheedfar F, Amini M, Mazza T, Pazienza V, Motazacker MM, Mahmoudi M, De Rooij FWM, Sijbrands E, Peppelenbosch MP, Rezaee F. Age-related obesity and type 2 diabetes dysregulate neuronal associated genes and proteins in humans. Oncotarget 2016; 6:29818-32. [PMID: 26337083 PMCID: PMC4745765 DOI: 10.18632/oncotarget.4904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 08/07/2015] [Indexed: 12/29/2022] Open
Abstract
Despite numerous developed drugs based on glucose metabolism interventions for treatment of age-related diseases such as diabetes neuropathies (DNs), DNs are still increasing in patients with type 1 or type 2 diabetes (T1D, T2D). We aimed to identify novel candidates in adipose tissue (AT) and pancreas with T2D for targeting to develop new drugs for DNs therapy. AT-T2D displayed 15 (e.g. SYT4 up-regulated and VGF down-regulated) and pancreas-T2D showed 10 (e.g. BAG3 up-regulated, VAV3 and APOA1 down-regulated) highly differentially expressed genes with neuronal functions as compared to control tissues. ELISA was blindly performed to measure proteins of 5 most differentially expressed genes in 41 human subjects. SYT4 protein was upregulated, VAV3 and APOA1 were down-regulated, and BAG3 remained unchanged in 1- Obese and 2- Obese-T2D without insulin, VGF protein was higher in these two groups as well as in group 3- Obese-T2D receiving insulin than 4-lean subjects. Interaction networks analysis of these 5 genes showed several metabolic pathways (e.g. lipid metabolism and insulin signaling). Pancreas is a novel site for APOA1 synthesis. VGF is synthesized in AT and could be considered as good diagnostic, and even prognostic, marker for age-induced diseases obesity and T2D. This study provides new targets for rational drugs development for the therapy of age-related DNs.
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Affiliation(s)
- Mehran Rahimi
- Faculty of Medical Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Manlio Vinciguerra
- Institute for Liver and Digestive Health, Division of Medicine, University College London (UCL), London, UK.,Gastroenterology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mojtaba Daghighi
- Department of Biomedical Engineering, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Behiye Özcan
- Department of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Fareeba Sheedfar
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marzyeh Amini
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tommaso Mazza
- Bioinformatics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Valerio Pazienza
- Gastroenterology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahdi M Motazacker
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Morteza Mahmoudi
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States.,Department of Nanotechnology and Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Felix W M De Rooij
- Department of Cardiovascular Genetics, Metabolism, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eric Sijbrands
- Department of Cardiovascular Genetics, Metabolism, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - Farhad Rezaee
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands.,Department of Cell Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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20
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Gazzaruso C, Fodaro M, Coppola A. Structured therapeutic education in diabetes: is it time to re-write the chapter on the prevention of diabetic complications? Endocrine 2016; 53:347-9. [PMID: 27048357 DOI: 10.1007/s12020-016-0947-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/29/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Carmine Gazzaruso
- Diabetes and Endocrine-metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia, 84, 27029, Vigevano, Italy.
| | - Mariangela Fodaro
- Diabetes and Endocrine-metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia, 84, 27029, Vigevano, Italy
| | - Adriana Coppola
- Diabetes and Endocrine-metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" (Hospital Group San Donato), Corso Pavia, 84, 27029, Vigevano, Italy
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21
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Coppola A, Sasso L, Bagnasco A, Giustina A, Gazzaruso C. The role of patient education in the prevention and management of type 2 diabetes: an overview. Endocrine 2016; 53:18-27. [PMID: 26494579 DOI: 10.1007/s12020-015-0775-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/10/2015] [Indexed: 12/25/2022]
Abstract
The management of type 2 diabetes mellitus includes ability and empowerment of the patient to change lifestyle, maintain an adequate diet and physical activity, manage the disease, and follow a specific program of periodic medical checks and education sessions. In addition, the patient should be able to correctly identify and adequately solve problems related to the disease and actively collaborate with the healthcare system. To obtain these goals, therapeutic patient education (TPE) is now considered a crucial element not only in the treatment but also in the prevention of type 2 diabetes. Several trials showed that TPE is able to improve clinical, lifestyle, and psycho-social outcomes. Nevertheless, studies have not clarified the ideal characteristics of a comprehensive patient education program in clinical practice. Other work is needed to answer open questions regarding the type of PTE (individual or group education), themes, frequency and number of education sessions, contact time between educator and patient, background of educators, use of new technologies, and barriers to self-management. The present review discusses these points on the basis of the most recent data of the literature.
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Affiliation(s)
- Adriana Coppola
- Diabetes and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" Vigevano, Corso Pavia, 84, 27029, Vigevano, Italy.
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Andrea Giustina
- Chair of Endocrinology, A.O. Spedali Civili, University of Brescia, Brescia, Italy
| | - Carmine Gazzaruso
- Diabetes and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute "Beato Matteo" Vigevano, Corso Pavia, 84, 27029, Vigevano, Italy
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22
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Wu W, Guan Y, Xu K, Fu XJ, Lei XF, Lei LJ, Zhang ZQ, Cheng Y, Li YQ. Plasma Homocysteine Levels Predict the Risk of Acute Cerebral Infarction in Patients with Carotid Artery Lesions. Mol Neurobiol 2015; 53:2510-7. [DOI: 10.1007/s12035-015-9226-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/21/2015] [Indexed: 01/17/2023]
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Papanas N, Ziegler D. New vistas in the diagnosis of diabetic polyneuropathy. Endocrine 2014; 47:690-8. [PMID: 24839196 DOI: 10.1007/s12020-014-0285-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/02/2014] [Indexed: 01/01/2023]
Abstract
New modalities are now available to improve the diagnosis of diabetic polyneuropathy (DPN). The present review discusses the progress achieved in this area. First, the minimal diagnostic criteria have been better clarified. Moreover, there are now new bedside tests available, such as the indicator test Neuropad, NeuroQuick, Ipswich Touch Test (IpTT), Vibratip, NC-stat(®)/DPNCheck™ for automated nerve conduction study (NCS), tactile circumferential discriminator, steel ball-bearing, and SUDOSCAN(®), while more sophisticated modalities include skin biopsy and corneal confocal microscopy (CCM). Some tests can be used as screening tools, including primary care setting (Neuropad, IpTT, Vibratip, automated NCS), while others are more suitable for research, including evaluation of DPN in prospective studies (CCM, skin biopsy). Importantly, there is some evidence of earlier DPN diagnosis with the aid of some tests (Neuropad, skin biopsy, CCM). Further advantages provided by different tests are educational value and self-examination. Thus far, the potential of these tests has not been fully utilised. In particular, they have not been validated against standardised clinical examination scores in terms of predicting foot ulcers and amputations. Hence, it now remains to investigate the potential benefits from the widespread use of these tests for earlier and easier diagnosis of DPN in the everyday clinic.
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Affiliation(s)
- Nikolaos Papanas
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
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24
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Huang Y, Wang H. Diabetic foot in a patient with polydactyly. Endocrine 2014; 47:338-9. [PMID: 24510627 DOI: 10.1007/s12020-013-0156-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/20/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Yuxin Huang
- Department of Endocrinology, Shanghai Huadong Hospital Affiliated to Fudan University, Shanghai, China,
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25
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Xiang L, Xiang G, Zhang J, Yue L, Zhao L. Contrast agent suppresses endothelium-dependent arterial dilation after digital subtraction angiography procedure in patients with diabetic foot. Endocrine 2014; 46:505-11. [PMID: 24272602 DOI: 10.1007/s12020-013-0095-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/19/2013] [Indexed: 01/21/2023]
Abstract
Recent studies showed that contrast agents can induce renal injury. Thus, the present study was designed to assess whether the contrast agents used during digital subtraction angiography (DSA) procedure can damage endothelium. Fow-mediated endothelium-dependent vasodilation (FMD) was measured at baseline, 1, 3, and 7 days after DSA in 198 subjects with diabetic foot. We also measured the levels of thiobarbituric acid-reactive substances (TBARS) and von Willebrand factor (vWF), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP). Compared with baseline (3.60 ± 0.47 %), FMD at 1 day decreased (2.74 ± 0.47 %), and increased significantly from 1 to 3 days (p < 0.01), and returned to baseline level at 7 days after DSA. The plasma TBARS increased at 1 day and decreased from 1 to 3 days (p < 0.01), and returned to baseline level at 7 days after DSA. CRP, IL-6, and TNF-α had similar changes before and after DSA procedure. FMD was significantly correlated to vWF, IL-6, TNF-α, CRP, and TBARS (p < 0.01). A negative correlation between contrast volume and FMD, positive correlation between contrast volume and vWF, TBARS, CRP, IL-6 at 1 or 3 days after DSA exist in diabetic group (p < 0.05). Contrast medium suppresses FMD, probably through an increased production of oxygen-derived free radicals and inflammation although adequate hydration was given in type 2 diabetes. Therefore, an effective prophylaxis should allow to prevent this complication.
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Affiliation(s)
- Lin Xiang
- Department of Endocrinology, Wuhan General Hospital of Guangzhou Command, Wuluo Road 627, Wuhan, 430070, Hubei, People's Republic of China,
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Pei E, Li J, Lu C, Xu J, Tang T, Ye M, Zhang X, Li M. Effects of lipids and lipoproteins on diabetic foot in people with type 2 diabetes mellitus: a meta-analysis. J Diabetes Complications 2014; 28:559-64. [PMID: 24849711 DOI: 10.1016/j.jdiacomp.2014.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND To conduct a meta-analysis of case-control studies to determine the effects of lipids and lipoproteins on morbidity of diabetic foot in adults with type 2 diabetes. METHODS We searched the PubMed and EMBASE to identify eligible studies. The Newcastle-Ottawa Quality Assessment Scale was used to determine the quality of selected studies. We assessed the strength of associations using standardized mean differences with 95% confidence intervals. RESULTS A total of 4 articles were found. Decreased HDL-cholesterol had a significant association with diabetic foot susceptibility in fixed-effects model, but no significant associations were found between diabetic foot and LDL-cholesterol, TC or TG levels. CONCLUSIONS Our results suggested that decreased HDL-cholesterol was associated with diabetic foot, so possible measures to prevent diabetic foot should include targeting increases in HDL-cholesterol.
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Affiliation(s)
- Erli Pei
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China; Institute of Medical Intervention Engineering, Tongji University, North Zhongshan Road, Shanghai, China
| | - Jue Li
- Heart, Lung and Blood Vessel Center, Tongji University School of Medicine, Siping Road, Shanghai, China
| | - Chenhui Lu
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China
| | - Jichong Xu
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China
| | - Tao Tang
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China
| | - Meng Ye
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China
| | - Xiaoping Zhang
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China; Heart, Lung and Blood Vessel Center, Tongji University School of Medicine, Siping Road, Shanghai, China.
| | - Maoquan Li
- Department of Interventional Radiology, Shanghai Tenth People's Hospital, Tongji University, No. 301, Yanchang Road, Shanghai, China; Heart, Lung and Blood Vessel Center, Tongji University School of Medicine, Siping Road, Shanghai, China.
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Moura Neto A, Zantut-Wittmann DE, Fernandes TD, Nery M, Parisi MCR. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. Endocrine 2013; 44:119-24. [PMID: 23124278 DOI: 10.1007/s12020-012-9829-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/23/2012] [Indexed: 12/20/2022]
Abstract
Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p < 0.001). Predictors of amputation were male gender (p < 0.001; OR = 3.44 95 % CI = 1.81-6.56) and neuro-ischemic diabetic foot (p < 0.049; OR = 4.6; 95 % CI = 1.01-20.9). The predictors for diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.
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Affiliation(s)
- Arnaldo Moura Neto
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil
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Gazzaruso C, Coppola A, Falcone C, Luppi C, Montalcini T, Baffero E, Gallotti P, Pujia A, Solerte SB, Pelissero G, Giustina A. Transcutaneous oxygen tension as a potential predictor of cardiovascular events in type 2 diabetes: comparison with ankle-brachial index. Diabetes Care 2013; 36:1720-5. [PMID: 23404303 PMCID: PMC3661826 DOI: 10.2337/dc12-1401] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Transcutaneous oxygen tension (TcPO2) measures tissue perfusion and is important in the management of peripheral artery disease (PAD). Ankle brachial index (ABI) is used for the diagnosis of PAD and represents a predictor of major adverse cardiovascular events (MACE), even if in diabetes its diagnostic and predictive value seems to be reduced. No study has evaluated TcPO2 as a predictor of cardiovascular events. Aim of this longitudinal study was to assess whether TcPO2 is better than ABI at predicting MACE in type 2 diabetic patients. RESEARCH DESIGN AND METHODS Among 361 consecutive patients with apparently uncomplicated diabetes, 67 MACE occurred during a follow-up period of 45.8 ± 23.2 months. RESULTS The percentage of both subjects with low ABI (≤ 0.9) and subjects with low TcPO2 (≤ 46 mmHg as measured by a receiver operating characteristic curve) was significantly (<0.001) greater among patients with than among those without MACEs (ABI 64.2 vs. 40.8; TcPO2 58.2 vs. 34%). The Kaplan-Meier method showed that both low ABI (Mantel log-rank test, 4.087; P = 0.043) and low TcPO2 (Mantel log-rank test, 33.748; P > 0.0001) were associated with a higher rate of MACEs. Cox regression analysis showed that low TcPO2 (hazard ratio 1.78 [95% CI 1.44-2.23]; P < 0.001) was a significant predictor of MACE, while ABI did not enter the model. CONCLUSIONS This longitudinal study showed that TcPO2 may be a potential predictor of MACE among patients with uncomplicated type 2 diabetes and that its predictive value seems to be greater than that of ABI.
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Affiliation(s)
- Carmine Gazzaruso
- Internal Medicine, Diabetes, Vascular and Endocrine-Metabolic Diseases Unit and the Centre for Applied Clinical Research, Clinical Institute Beato Matteo, Vigevano, Italy.
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Gazzaruso C, Coppola A, Collaviti S, Saluzzo CM, Furlani F, Gallotti P, Clerissi J, Solerte BS, Giustina A. Percutaneous transluminal angioplasty for critical limb ischemia in very elderly diabetic patients. Aging Clin Exp Res 2013; 25:225-8. [PMID: 23739911 DOI: 10.1007/s40520-013-0033-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
Abstract
In diabetic subjects, new less invasive therapies for critical limb ischemia (CLI) are available to obtain limb salvage. One of these is the percutaneous transluminal angioplasty (PTA), a minor surgical intervention which allows obtaining an effective revascularization, avoiding the traditional major surgery and its post-operative complications. Our case report regards a 94-year-old woman with CLI due to critical obstruction (stage IV according to Leriche's classification) of superficial femoral and popliteal arteries and infrapopliteal arteries that should have been treated by the left limb amputation considering her age, severe co-morbidities, and poor compliance. Instead of this quite common approach, our team treated the patient with PTA. This led to very good outcomes, above all in terms of pain control. PTA is able to avoid major surgery, lower intra and post-operative risks, reduce length of hospital stay, and preserve functional autonomy. Therefore, this procedure should be taken into account also for frail very elderly diabetic patients with peripheral artery disease (PAD).
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Abstract
It is increasingly apparent that not only is a cure for the current worldwide diabetes epidemic required, but also for its major complications, affecting both small and large blood vessels. These complications occur in the majority of individuals with both type 1 and type 2 diabetes. Among the most prevalent microvascular complications are kidney disease, blindness, and amputations, with current therapies only slowing disease progression. Impaired kidney function, exhibited as a reduced glomerular filtration rate, is also a major risk factor for macrovascular complications, such as heart attacks and strokes. There have been a large number of new therapies tested in clinical trials for diabetic complications, with, in general, rather disappointing results. Indeed, it remains to be fully defined as to which pathways in diabetic complications are essentially protective rather than pathological, in terms of their effects on the underlying disease process. Furthermore, seemingly independent pathways are also showing significant interactions with each other to exacerbate pathology. Interestingly, some of these pathways may not only play key roles in complications but also in the development of diabetes per se. This review aims to comprehensively discuss the well validated, as well as putative mechanisms involved in the development of diabetic complications. In addition, new fields of research, which warrant further investigation as potential therapeutic targets of the future, will be highlighted.
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Affiliation(s)
- Josephine M Forbes
- Diabetes Division, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Baradaran A. Lipoprotein(a), type 2 diabetes and nephropathy; the mystery continues. J Nephropathol 2012; 1:126-9. [PMID: 24475402 DOI: 10.5812/nephropathol.8107] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 05/18/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Azar Baradaran
- Department of Clinical Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
Every 30 s, a lower limb is amputated due to diabetes. Of all amputations in diabetic patients 85% are preceded by a foot ulcer which subsequently deteriorates to a severe infection or gangrene. There is a complexity of factors related to healing of foot ulcers including strategies for treatment of decreased perfusion, oedema, pain, infection, metabolic disturbances, malnutrition, non-weight bearing, wound treatment, foot surgery, and management of intercurrent disease. Patients with diabetic foot ulcer and decreased perfusion do often not have rest pain or claudication and as a consequence non-invasive vascular testing is recommended for early recognition of ulcers in need of revascularisation to achieve healing. A diabetic foot infection is a potentially limb-threatening condition. Infection is diagnosed by the presence or increased rate of signs inflammation. Often these signs are less marked than expected. Imaging studies can diagnose or better define deep, soft tissue purulent collections and are frequently needed to detect pathological findings in bone. The initial antimicrobial treatment as well as duration of treatment is empiric. There is a substantial delay in wound healing in diabetic foot ulcer which has been related to various abnormalities. Several new treatments related to these abnormalities have been explored in wound healing with various successes. An essential part of the strategy to achieve healing is an effective offloading. Many interventions with advanced wound management have failed due to not recognizing the need for effective offloading. A multidisciplinary approach to wounds and foot ulcer has been successfully implemented in different centres with a substantial decrease in amputation rate.
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Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Skåne (SUS), 205 02, Malmö, Sweden.
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