OBJECTIVE -Recently, repeated home blood pressure (HBP) measurements in the morning for a long period have been shown to have a stronger predictive power for mortality in patients with hypertension than occasional casual/clinic blood pressure (CBP) measurements. We studied whether HBP in the morning in type 2 diabetic patients is useful for prediction of diabetic complications. RESEARCH DESIGN AND METHODS -The occurrence of diabetic complications (nephropathy, retinopathy, coronary heart disease [CHD], and cerebrovascular disease [CVD])were examined in relation to morning HBP as well as to CBP in 170 type 2 diabetic patients treated with antidiabetic and antihypertensive drugs. Blood pressure was measured at the clinic during the day and at home after awakening in the morning. Clinic hypertension (CH) and morning hypertension (MH) were defined as systolic blood pressure (SBP) Ն130 mmHg and/or diastolic blood pressure (DBP) Ն85 mmHg. The relation of CH and MH to the prevalence of these events was examined.RESULTS -There were no significant differences in the prevalence of nephropathy, retinopathy, CHD, and CVD between the two groups with (n ϭ 131) and without CH (n ϭ 39), whereas the prevalences of these events in the patients with MH (n ϭ 97) were significantly higher (P Ͻ 0.05) than in those without MH (n ϭ 73). The prevalence of nephropathy was highly associated with systolic MH.CONCLUSIONS -Elevations of HBP in the morning in diabetic patients are strongly related to microvascular and macrovascular complications, especially nephropathy. It is concluded that the control of MH may prevent vascular complications in type 2 diabetic patients.

No abstract

No abstract

These results suggest that the diameter and design of the needle play an important role in reducing injection pain and needle anxiety, which is particularly important for insulin initiation.

Background: Study has shown no significant differences in basal and postprandial plasma active glucagon-like peptide-1 (p-active GLP-1) levels following test meal (TM) between complication-and treatment-naïve non-obese Japanese patients with type 2 diabetes (T2DM) and controls. Methods:In non-obese Japanese patients with T2DM (n=23, group 1) and healthy individuals as control (n=13, group 2), blood levels of plasma glucose (PG), serum insulin (s-IRI), serum C-peptide (s-CPR) and p-active GLP-1 like substances (p-active GLP-1-S) were measured 0, 30, and 60 min after TM (520-560 kcal. 23% fat, 60% carbohydrate and 17% protein). HbA1c levels were also measured in the groups. Patients with mean of 9.2 years disease had various complications and treatment with diet, exercise and/or oral medical drugs except incretin-related drugs for hyperglycemia. Results:There was no significant difference in mean of sex, age, or BMI between groups. Means of HbA1c and basal and postprandial PG with area under curve (AUC), and HOMA-R were significantly higher in group 1 than in group 2. Means of HOMA-β and insulinogenic index after ingestion of TM were significantly lower in group 1 than in group 2. However, there were no significant differences in means of basal and postprandial with AUC levels of s-IRI, s-CPR and p-active GLP-1-S levels between groups.

No abstract

Previous cross-sectional studies have demonstrated that blood pressure measurements at home (HBP) in the morning display stronger predictive power for micro- and macrovascular complications in type 1 and 2 diabetic patients than casual/clinic blood pressure (CBP) measurements. This longitudinal study investigated which of these measurements offers stronger predictive power for outcomes over 6 years. At baseline, 400 Japanese patients with type 2 diabetes were classified as hypertensive or normotensive based on HBP and CBP measurements. Mean (+/-SD) survey duration of all patients was 42.1 +/- 20.0 months (range, 3-72 months). Primary and secondary endpoints were death and new, worsened, or improved micro- and macrovascular events, respectively. Differences in outcomes for each endpoint between hypertensive and normotensive patients in each group were analyzed using survival curves from Kaplan-Meier analysis and log-rank testing. Associated risk factors related to outcomes were assessed using Cox proportional hazards modeling. On the basis of HBP, cumulative events of death and new or worsened microvascular diseases were significantly higher in hypertensive patients than in normotensive patients. On the basis of CBP, no significant differences were identified. New or worsened macrovascular events were significantly higher in hypertensive patients than in normotensive patients on the basis of both HBP and CBP. One associated risk factor was morning hypertension. A longitudinal study of type 2 diabetic patients demonstrated that elevated HBP in the morning is predictive of micro- and macrovascular complications.

Previous cross-sectional studies and 6-year longitudinal study have demonstrated that home blood pressure (HBP) measurements upon awakening have a stronger predictive power for death, micro- and macrovascular complications than clinic blood pressure (CBP) measurements in patients with type 2 diabetes (T2DM). This study investigated which of these measurements offers stronger predictive power for outcomes over 10 years. At baseline, 400 Japanese patients with T2DM were classified as having hypertension (HT) or normotension (NT) based on HBP and CBP. The mean survey duration was 95 months. Primary and secondary end-points were death and new or worsened micro- and macrovascular complications, respectively. Differences in outcomes for each end-point between HT and NT patients were analyzed using Kaplan-Meier survival curves and log-rank testing. Associated risk factors were assessed using Cox proportional hazards analysis. Based on HBP, death and micro- and macrovascular complications were significantly higher in patients with HT than with NT at baseline and end-point. Based on CBP, there were no significant differences in incidence of death, micro- or macrovascular complications between patients with HT and NT at baseline and end-point, although a significant difference in incidence of death was observed between the HT and NT groups at end-point. However, the significance was significantly lower in CBP than in HBP. One risk factor associated with micro- and macrovascular complications in patients with HBP was therapy for HT. This 10-year longitudinal study of patients with T2DM demonstrated that elevated HBP upon awakening is predictive of death, and micro- and macrovascular complications.