Predictors of coronary heart disease and death in NIDDM: The Diabetes Intervention Study experience

Hanefeld, Markolf; Schmechel, H; Schwanebeck, Uta; Lindner, Joachim

doi:10.1007/s001250051425

Cited by 33 publications

(16 citation statements)

References 7 publications

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“…The American Diabetes Association (ADA) suggest that diabetic patients are 2 to 4 times more likely to suffer heart disease or stroke than nondiabetic patients [3,4]. A large, growing body of evidence clearly implicates risk factors associated with hyperglycaemia, hyperlipidaemia and insulin resistance in the development of coronary artery disease and mortality in Type II diabetic patients [5]. The 'hyperinsulinaemia cluster' which includes high BMI, triglycerides and insulin with low HDL cholesterol, was shown to be predictive of death [6].…”

Section: :S 13-s 17]mentioning

confidence: 99%

Assessing the impact of complications on the costs of Type II diabetes

Williams

Gaal²,

Lucioni³

2002

Diabetologia

306

220

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Aimslhypothesis. 'The Cost of Diabetes in EuropeType II (CODE-2) study' provides the first coordinated attempt to assess the total costs of managing people with Type II (non-insulin-dependent) diabetes mellitus in Europe. Type II diabetes is associated with a number of serious long-term complications, which are a major cause of morbidity, hospitalisation and mortality in diabetic patients. Methods. Patients were divided into four broad categories defining their complication status in terms of no complications, one or more microvascular complications, one or more macrovascular complications or one or more of each microvascular and macrovascular complication. The prevalence of complications and associated costs were assessed retrospectively for 6 months.Results. In total, 72% of patients in the CODE-2 study had at least one complication, with 19% having microvascular only, 10% having macrovascular only and 24% of the total having both microvascular and macrovascular complications. Of patients with microvascular complications, 28% had neuropathy, 20% renal damage, 20% retinopathy and 6.5% required treatment far eye complications. Among the patients with macrovascular complications, 18% had periphera1 vascular disease, 17% angina, 12% heart failure and 9% had myocardia1 infarction. Percutaneous trans1uminal coronary angiop1asty, coronary artery bypass graft or stroke occurred in 3%, 4% and 5% of the patients, respective1y. In patients with both microvascu1ar and macrovascular complications, the total cost of management was increased by up to 250% compared to those without complications. Conclusionlinterpretation. Complications have a substantial impact on the costs of managing Type II diabetes. This study has confirmed that the prevention of diabetic complications will not only benefit patients, but potentially reduce overall healthcare expenditure. [Diabetologia (2002) 45:S 13-S 17]

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Section: :S 13-s 17]mentioning

confidence: 99%

Assessing the impact of complications on the costs of Type II diabetes

Williams

Gaal²,

Lucioni³

2002

Diabetologia

306

220

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“…Postprandial hyperglycaemia is a strong and independent risk factor for the development of macrovascular diseases, not only in diabetic patients but also in individuals with impaired glucose tolerance, and even in healthy individuals [1][2][3][4][5]. Although marked postprandial hyperglycaemia is a typical feature of diabetes, it is not necessarily reflected in plasma fructosamine or HbA 1c levels [6][7][8][9]. While it is known that postprandial plasma glucose spikes are important factors in the development of vascular complications and reduced beta cell function in diabetes [8], the underlying cellular and molecular mechanisms are incompletely understood.…”

Section: Introductionmentioning

confidence: 99%

Rapid ‘glycaemic swings’ induce nitrosative stress, activate poly(ADP-ribose) polymerase and impair endothelial function in a rat model of diabetes mellitus

et al. 2009

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Aim/hypothesis Postpandrial hyperglycaemia is a significant risk factor for the development of macrovascular diseases. There is no clear agreement in the field whether these alterations result from hyperglycaemic episodes or from exaggerated alterations ('glycaemic swings') in blood glucose. We compared the effect of stable high glucose with a model of poorly maintained insulin-controlled diabetes (on average lower glucose, but with large glycaemic swings) on the development of endothelial dysfunction in rats. Methods Intermediate-or long-acting insulin was used to reduce mean blood glucose levels. One group of animals had stable low glucose levels, while animals in the other group exhibited rapid changes ('swings') in their blood glucose concentration. Acetylcholine-induced endothelium-dependent vascular relaxation of the thoracic aorta was measured. Immunohistochemistry, western blot analysis and flow cytometry were used to determine nitrotyrosine formation and poly(ADP-ribose) accumulation in the aorta, in circulating leucocytes and in bone marrow cells. Results Steady normalisation of blood glucose levels (a model of well-controlled diabetes) protected against the development of endothelial dysfunction, poly(ADP-ribose) polymerase (PARP) activation and nitrotyrosine production. However, impairment of endothelium-dependent relaxation was found in the animals undergoing glycaemic swings, even though the fructosamine levels in these animals were lower than in the untreated diabetic rats. This was associated with elevated PARP activation in the aorta and in bone marrow cells that was similar to or even more pronounced than that seen in the untreated diabetic animals. Conclusions/interpretation Large glycaemic swings exert deleterious cardiovascular effects in diabetes mellitus, in part via enhanced activation of the PARP pathway.

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“…Cardiovascular disease is the principal cause of morbidity and premature mortality in people with Type 2 diabetes [1]. The prevalence of the cardiovascular risk factors that comprise the insulin resistance syndrome is increased in Type 2 diabetes [2].…”

Section: Introductionmentioning

confidence: 99%

Heritability estimates for beta cell function and features of the insulin resistance syndrome in UK families with an increased susceptibility to Type 2 diabetes

et al. 2004

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Aims/hypothesis. The aim of this study was to measure the heritability estimates for metabolic traits and the features of the insulin resistance syndrome in families with an increased genetic susceptibility to Type 2 diabetes. Methods. A total of 811 non-diabetic relatives from 278 pedigrees of northern European extraction in which there was a sib-pair with Type 2 diabetes were recruited and studied at the six Diabetes UK Warren Type 2 diabetes centres. Heritability estimates were calculated, allowing for key covariates (age, sex, BMI and recruitment centre). Values greater than 0.10 were considered statistically significant in comparison to zero. Results. Fasting glucose concentration and homeostasis model assessment of pancreatic beta cell function (HOMA %B) had the highest heritability estimates of 0.72 and 0.78 respectively. Heritability estimates for the features of the insulin resistance syndrome (BMI, WHR, systolic and diastolic blood pressure, serum lipids and homeostasis model assessment of insulin sensitivity [HOMA %S]) were also high. The heritability estimate for fasting glucose was markedly higher in the present study (0.77 vs 0.21 adjusted for age and sex; p<0.001) than in a comparable study of families from the same background population but with no increased susceptibility to diabetes. However, the estimates for the features of the insulin resistance syndrome were similar in the two studies. Conclusions/interpretation. In families with a high risk of Type 2 diabetes, the heritability estimates for fasting glucose, pancreatic beta cell function and the features of the insulin resistance syndrome were all high. The higher heritability estimate for pancreatic beta cell function suggests that this resource may be most effective when investigating genetic susceptibility to beta cell dysfunction.Keywords Heritability · Quantitative traits · Risk of Type 2 diabetes · Insulin resistance syndrome · Genetic susceptibility

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Predictors of coronary heart disease and death in NIDDM: The Diabetes Intervention Study experience

Cited by 33 publications

References 7 publications

Assessing the impact of complications on the costs of Type II diabetes

Assessing the impact of complications on the costs of Type II diabetes

Rapid ‘glycaemic swings’ induce nitrosative stress, activate poly(ADP-ribose) polymerase and impair endothelial function in a rat model of diabetes mellitus

Heritability estimates for beta cell function and features of the insulin resistance syndrome in UK families with an increased susceptibility to Type 2 diabetes

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