Plasma Homocysteine and Fibrinogen Levels in Type 2 Diabetics with and without Nocturnal Blood Pressure Fall and Heart Rate Decrease

Wstęp Wpływ podwyższonych stężeń homocysteiny i fibrynogenu na ryzyko wystąpienia chorób układu krążenia jest większy u chorych na cukrzycę typu 2 niż u osób z prawidłową tolerancją glukozy. Chorzy bez spadku ciśnienia tętniczego i zwolnienia akcji serca w godzinach nocnych (tzw. non-dippers) są bardziej narażeni na rozwój powikłań sercowo-naczyniowych. Celem niniejszej pracy była ocena, w jakim stopniu zaburzenia profilu dobowego ciśnienia tętniczego i akcji serca wpływają na stężenie fibrynogenu i homocysteiny w surowicy krwi chorych na cukrzycę typu 2. Materiał i metody Badaniami objęto 87 chorych na cukrzycę typu 2. Oceniano wpływ występowania nefropatii i retinopatii na przebieg profilu dobowego ciśnienia tętniczego i tętna. Na podstawie różnicy dzienno-nocnej podzielono chorych na podgrupę ze spadkiem ciśnienia tętniczego (dippers) i bez jego spadku (non-dippers) w okresie snu. Wyniki Występowanie mikroalbuminurii nie miało wpływu na przebieg profilu dobowego ciśnienia tętniczego i akcji serca. U chorych z retinopatią cukrzycową stwierdzono znamiennie mniejszy spadek ciśnienia tętdaniach niczego w godzinach nocnych. Brak spadku ciśnienia tętniczego w godzinach nocnych wiązał się z wyższym stężeniem homocysteiny. U chorych bez zwolnienia akcji serca w godzinach nocnych zaobserwowano znamiennie wyższe stężenie fibrynogenu. Wnioski Występowanie retinopatii cukrzycowej jest związane ze znamiennie mniejszym spadkiem ciśnienia tętniczego w godzinach nocnych u chorych na cukrzycę typu 2. Brak spadku ciśnienia tętniczego w godzinach nocnych wiąże się z wyższym stężeniem homocysteiny u tych chorych. Zaburzenia profilu dobowego akcji serca u chorych z cukrzycą typu 2 są związane z wyższym stężeniem fibrynogenu.Background The link between high levels of serum homocysteine and fibrinogen and cardiovascular morbidity appears to be much stronger in diabetics than in subjects with normal glucose tolerance. It has been suggested that patients with non-dipping pattern (non-dippers) are at greater risk of target organ damage. The aim of the present study was to evaluate the relationship between blunted diurnal blood pressure and heart rate profile and serum levels of homocysteine and fibrinogen in patients with type 2 diabetes mellitus. Material and methods We studied 87 patients with type 2 diabetes mellitus. We evaluated the impact of retinopathy and nephropathy on diurnal blood pressure and heart rate profile. The patients were grouped according to the presence or lack of nocturnal blood pressure and heart rate decrease. Results Microalbuminuria had no significant effect on diurnal blood pressure profile. Compared to patients without retinopathy, those with this complication had significantly smaller nocturnal blood pressure fall. Non-dipping blood pressure pattern status was linked to higher levels of serum homocysteine. Patients without nocturnal heart rate decrease had significantly greater fibrinogen levels. Conclusions Presence of retinopathy is associated with significantly blunted nocturnal blood pressure fall in type 2 diabetes. Blunted diurnal blood pressure variation in type 2 diabetics is related to higher serum levels of homocysteine. In type 2 diabetics, non-dipping pattern of heart rate profile is linked to higher serum levels of fibrinogen

Projekt utworzenia sieci ośrodków diabetologicznych w województwie pomorskim

Wstęp. Cukrzyca stanowi ważny problem zdrowotny i ekonomiczny w Polsce. W województwie pomorskim choruje na nią około 110 tysięcy osób powyżej 18. roku życia. Co czwarty pacjent spośród nich jest nieświadomy posiadania choroby. Szacuje się, że liczba osób chorych na cukrzycę w Polsce i na Pomorzu będzie szybko wzrastać ze względu na coraz większą zapadalność oraz starzenie się społeczeństwa. Głównym celem niniejszego artykułu jest przedstawienie optymalnego dla województwa pomorskiego modelu sieci ośrodków diabetologicznych. Jego głównym założeniem ma być redukcja liczby hospitalizacji chorych z cukrzycą oraz zdecydowana poprawa opieki ambulatoryjnej. Materiał i metody. Oceniono dane dotyczące hospitalizacji osób z rozpoznaną cukrzycą w całym województwie pomorskim, uzyskane z bazy Pomorskiego Oddziału NFZ oraz dane osób hospitalizowanych z powodu cukrzycy w Uniwersyteckim Centrum Klinicznym w Gdańsku (szpitalu dysponującym jedynym oddziałem diabetologicznym w województwie). Następnie odniesiono się do aktualnych zaleceń towarzystw naukowych i wskazano wady obecnego systemu leczenia osób chorujących na cukrzycę. Ostatecznie zapro­ponowano model sieci ośrodków diabetologicznych dla województwa pomorskiego. Wyniki. Wyniki przedstawiono osobno dla opieki szpitalnej i ambulatoryjnej. Zaproponowano sieć 4 szpitali dla opieki całodobowej, zwracając uwagę na potrzeby finansowe, sprzętowe oraz wymagany personel. W opiece ambulatoryjnej zaproponowano szereg rozwiązań, zwłaszcza dotyczących opieki nad osobami młodymi z cukrzycą typu 1, kobietami ciężarnymi oraz pacjentami z zespołem stopy cukrzycowej.Introduction. Diabetes is an important health and economical problem in Poland. Pomorskie Region has a population of about 110.000 adult diabetics. Every fourth of them is unaware of having the disease. It is estimated that the number of people with diabetes in Poland will rapidly increase due to population aging. Aim. The aim of this article is to describe the optimal model of diabetes centers network in Pomorskie to reduce the number of hospitalizations of patients with diabetes and to improve outpatient care. Material and methods. Data of hospital care of diabetics in Pomorskie from National Health Service and from the University Clinical Centre in Gdansk was evaluated and compared to the current guidelines. Then defects of current healthcare on diabetics was indicated. Finally, the model of diabetes centers network in Pomorskie was proposed. Results. Results are presented separately for hospital and outpatient care. The network of four hospitals was proposed depending of the financial needs, required equipment and staff. In outpatient care several solutions was suggested, e.g. healthcare for young people with type 1 diabetes, pregnant women and patients with diabetic foot syndrome

Efficacy and Safety of Lacosamide in Painful Diabetic Neuropathy

OBJECTIVE: To evaluate efficacy and safety of lacosamide compared with placebo in painful diabetic polyneuropathy. RESEARCH DESIGN AND METHODS: Diabetic patients with at least moderate neuropathic pain were randomized to placebo or lacosamide 400 (in a slow or standard titration) or 600 mg/day over 6-week titration and 12-week maintenance periods. Primary efficacy criterion was intra-individual change in average daily Numeric Pain Rating Scale score from baseline to the last 4 weeks. RESULTS: For the primary end point, pain reduction was numerically but not statistically greater with lacosamide compared with placebo (400 mg/day, P = 0.12; 600 mg/day, P = 0.18). Both doses were significantly more effective compared with placebo over the titration (P = 0.03, P = 0.006), maintenance (P = 0.01, P = 0.005), and entire treatment periods (P = 0.03, P = 0.02). Safety profiles between titration schemes were similar. CONCLUSIONS: Lacosamide reduced neuropathic pain and was well tolerated in diabetic patients, but the primary efficacy criterion was not met, possibly due to an increased placebo response over the last 4 weeks.status: publishe

Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro-and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials

Background. A recent clinical trial showed harmful renal effects with the combined use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) in people with diabetes or vascular disease. We examined the benefits and risks of these agents in people with albuminuria and one or more cardiovascular risk factors.Methods. MEDLINE, EMBASE and Renal Health Library were searched for trials comparing ACEI, ARB or their combination with placebo or with one another in people with albuminuria and one or more cardiovascular risk factor.Results. Eighty-five trials (21 708 patients) were included. There was no significant reduction in the risk of all-cause mortality or fatal cardiac-cerebrovascular outcomes with ACEI versus placebo, ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. There was a significant reduction in the risk of nonfatal cardiovascular events with ACEI versus placebo but not with ARB versus placebo, ACEI versus ARB or with combined therapy with ACEI + ARB versus monotherapy. Development of end-stage kidney disease and progression of microalbuminuria to macroalbuminuria were reduced significantly with ACEI versus placebo and ARB versus placebo but not with combined therapy with ACEI + ARB versus monotherapy.Conclusions. ACEI and ARB exert independent renal and nonfatal cardiovascular benefits while their effects on mortality and fatal cardiovascular disease are uncertain. There is a lack of evidence to support the use of combination therapy. A comparative clinical trial with ACE, ARB and its combination in people with albuminuria and a cardiovascular risk factor is warranted

Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO) : an open randomised controlled trial

Background: As type 2 diabetes mellitus progresses, oral hypoglycaemic agents often fail to maintain blood glucose control and insulin is needed. We investigated whether the addition of once-daily insulin glargine is non-inferior to three-times daily prandial insulin lispro in overall glycaemic control in adults with inadequately controlled type 2 diabetes mellitus taking oral hypoglycaemic agents. Methods: In the 44-week, parallel, open study that was undertaken in 69 study sites across Europe and Australia, 418 patients with type 2 diabetes mellitus that was inadequately controlled by oral hypoglycaemic agents were randomly assigned to either insulin glargine taken once daily at the same time every day or to insulin lispro administered three times per day. The primary objective was to compare the change in haemoglobin A1c from baseline to endpoint (week 44) between the two regimens. Randomisation was done with a central randomisation service. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00311818. Findings: 205 patients were randomly assigned to insulin glargine and 210 to insulin lispro. Mean haemoglobin A1c decrease in the insulin glargine group was -1·7% (from 8·7% [SD 1·0] to 7·0% [0·7]) and -1·9% in the insulin lispro group (from 8·7% [1·0] to 6·8% [0·9]), which was within the predefined limit of 0·4% for non-inferiority (difference=0·157; 95% Cl -0·008 to 0·322). 106 (57%) patients reached haemoglobin A1c of 7% or less in the glargine group and 131 (69%) in the lispro group. In the glargine group, the fall in mean fasting blood glucose (-4·3 [SD 2·3] mmol/L vs -1·8 [2·3] mmol/L; p<0·0001) and nocturnal blood glucose (-3·3 [2·8] mmol/L vs -2·6 [2·9] mmol/L; p=0·0041) was better than it was in the insulin lispro group, whereas insulin lispro better controlled postprandial blood glucose throughout the day (p<0·0001). The incidence of hypoglycaemic events was less with insulin glargine than with lispro (5·2 [95% CI 1·9-8·9] vs 24·0 [21-28] events per patient per year; p<0·0001). Respective mean weight gains were 3·01 (SD 4·33) kg and 3·54 (4·48) kg. The improvement of treatment satisfaction was greater for insulin glargine than for insulin lispro (mean difference 3·13; 95% CI 2·04-4·22). Interpretation: A therapeutic regimen involving the addition of either basal or prandial insulin analogue is equally effective in lowering haemoglobin A1c. We conclude that insulin glargine provides a simple and effective option that is more satisfactory to patients than is lispro for early initiation of insulin therapy, since it was associated with a lower risk of hypoglycaemia, fewer injections, less blood glucose self monitoring, and greater patient satisfaction than was insulin lispro. Funding: Sanofi-Aventis