Effect of Strict Glycemic Control in Patients With Diabetes Mellitus on Frequency of Macrovascular Events

Singh, Amita; Donnino, Robert; Weintraub, Howard; Schwartzbard, Arthur

doi:10.1016/j.amjcard.2013.05.044

Cited by 23 publications

(19 citation statements)

References 50 publications

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“…The main challenge in the treatment of diabetes is represented by the prevention of microvascular and macrovascular complications in order to reduce morbidity, mortality, disability and costs [96]. For many years, a strict glycemic control has been considered the most important method to achieve sustained reduction in the occurrence of diabetic complications, even if recent intervention trials have given questionable results for macrovascular complications, especially when very tight diabetes control was pursued.…”

Section: Abnormalities Of Gh/igf-1 Axis In Diabetes Mellitus: Clinicamentioning

confidence: 99%

“…Intervention trials have shown that the closer HbA1c is to normal values, the better is the prevention of the microvascular complications. Even if the reduction of HbA1c to 7 % has been seen associated with a reduction in the development of macrovascular complications, an additional reduction in these complications was not achieved with a tighter glycemic control [96]. This suggests that other mechanisms and biomarkers should be taken into account in the prevention of macrovascular complications.…”

Section: Abnormalities Of Gh/igf-1 Axis In Diabetes Mellitus: Clinicamentioning

confidence: 99%

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Insulin and GH–IGF-I axis: endocrine pacer or endocrine disruptor?

et al. 2014

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Growth hormone/insulin-like growth factor (IGF) axis may play a role in maintaining glucose homeostasis in synergism with insulin. IGF-1 can directly stimulate glucose transport into the muscle through either IGF-1 or insulin/IGF-1 hybrid receptors. In severely decompensated diabetes including diabetic ketoacidosis, plasma levels of IGF-1 are low and insulin delivery into the portal system is required to normalize IGF-1 synthesis and bioavailability. Normalization of serum IGF-1 correlated with the improvement of glucose homeostasis during insulin therapy providing evidence for the use of IGF-1 as biomarker of metabolic control in diabetes. Taking apart the inherent mitogenic discussion, diabetes treatment using insulins with high affinity for the IGF-1 receptor may act as an endocrine pacer exerting a cardioprotective effect by restoring the right level of IGF-1 in bloodstream and target tissues, whereas insulins with low affinity for the IGF-1 receptor may lack this positive effect. An excessive and indirect stimulation of IGF-1 receptor due to sustained and chronic hyperinsulinemia over the therapeutic level required to overtake acute/chronic insulin resistance may act as endocrine disruptor as it may possibly increase the cardiovascular risk in the short and medium term and mitogenic/proliferative action in the long term. In conclusion, normal IGF-1 may be hypothesized to be a good marker of appropriate insulin treatment of the subject with diabetes and may integrate and make more robust the message coming from HbA1c in terms of prediction of cardiovascular risk.

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Section: Abnormalities Of Gh/igf-1 Axis In Diabetes Mellitus: Clinicamentioning

confidence: 99%

Section: Abnormalities Of Gh/igf-1 Axis In Diabetes Mellitus: Clinicamentioning

confidence: 99%

Insulin and GH–IGF-I axis: endocrine pacer or endocrine disruptor?

et al. 2014

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“…[4] Numerous studies indicate that better glycemic control, determined by glycosylated hemoglobin A1c (Hb A1c), reduces the risk of microvascular and macrovascular complications. [5][6][7][8][9] Precision and knowledge with carbohydrate counting (CC), as well as health literacy is associated with lower A1c values. [9][10][11][12][13][14][15] Studies, mostly from primary care settings, have shown low knowledge about diabetes and general health, contribute to poorer diabetic outcomes.…”

Section: Introductionmentioning

confidence: 99%

Carbohydrate knowledge in diabetic emergency department patients at an academic institution

Dalawari

Sprowls

Moran

et al. 2017

JHA

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Background: Diabetes Mellitus (DM) affects 12.3% of the U.S. population and is responsible for $245 billion in annual costs. Knowledge about their disease is an important part of patients' self-management. Objective: The objective of this study was to describe the baseline level of knowledge of patients with diabetes in this emergency department (ED), including behaviors related to healthy eating such as carbohydrate counting (CC). Methods: This was a cross sectional interview survey conducted at an academic tertiary center. An 8-item survey was developed to assess areas of diabetes self-care and carbohydrate knowledge. Trained research assistants approached all medically stable, non-pregnant ED patients with a past medical history of diabetes for participation. Descriptive statistics and ANOVA analysis were used. Results: Of the 115 patients approached, 98 were willing to participate; 54% were using insulin and 68% were female. The average age was 55 (SD +/-14) years and diagnosed for an average of 12 (SD +/-10) years. Fifty three percent did not check their morning blood sugar. Only 20% could accurately state the target hemoglobin A1c. While 48% of participants could relate the importance of carbohydrates to blood sugar, only 5% could state the number of grams of carbohydrates in a slice of bread. Only 1 participant correctly answered all 4 of the carbohydrate questions. Higher education and more visits with a nutritionist were associated with carbohydrate knowledge. Conclusions: Carbohydrate knowledge among this ED population was poor. Opportunities exist for patient education.

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“…Secondary prevention after a cardiovascular event (CVE) is well-accepted, but the value of statin therapy in low risk patients and the possibly increased risk of diabetes manifestation with potent statins remain a matter of debate [9,10]. The benefits and possible harms of strict glycemic control in diabetic patients [11] and the so-called obesity paradoxon with a more favourable prognosis for certain diseases in the case of overweight or mild obesity are especially discussed in elderly [12].…”

Section: Introductionmentioning

confidence: 99%