ASSOCIATED FACTORS OF EJECTION FRACTION IN INSULIN-TREATED PATIENTS WITH TYPE 2 DIABETES
|
|
- Eunice Sparks
- 8 years ago
- Views:
Transcription
1 Rev. Med. Chir. Soc. Med. Nat., Iaşi 204 vol. 8, no. 4 INTERNAL MEDICINE - PEDIATRICS ORIGINAL PAPERS ASSOCIATED FACTORS OF EJECTION FRACTION IN INSULIN-TREATED PATIENTS WITH TYPE 2 DIABETES Gina Botnariu *, A. O. Petriş, O. R. Petriş 2, Alina D. Popa 2, Irina Iuliana Costache University of Medicine and Pharmacy Grigore T. Popa - Iași Faculty of Medicine. Department of Medical Specialties (I) 2. Department of Preventive Medicine and Interdisciplinarity *Corresponding author. ginabotnariu66@gmail.com ASSOCIATED FACTORS OF EJECTION FRACTION IN INSULIN-TREATED PA- TIENTS WITH TYPE 2 DIABETES (Abstract). Aim of the study: to evaluate the relation between ejection fraction (EF), diabetes characteristics and cardiovascular risk factors. Material and methods: We carried out a cross-sectional study in 7 patients with insulintreated type 2 diabetes hospitalized at the Sf. Spiridon Emergency Clinical Hospital, Iasi. All patients were evaluated for asymptomatic organ damage and cardiovascular risk factors of hypertension and diabetes metabolic control. Global ejection fraction (EF) was evaluated through 2-D echocardiography. Results and discussion: In the studied group the ejection fraction had significant negative correlations with the duration of the disease (p=0.007) and the presence of microalbuminuria (p=0.00). There were some differences between the categories realized by grouping the patients according to the presence of hypertension and/or previous myocardial infarction. In patients without personal history of cardiovasc ular disease EF was correlated only with LDLc levels. In the hypertensive patients without myoca r- dial infarction it was correlated with diabetes duration, Hb Ac and LDLc. In those patients with both conditions, EF had significant correlations with Hb Ac and microalbuminuria. Conclusions: These results emphasized that the determinants associated with heart failure in patients with type 2, insulin-treated diabetes, differ according to the presence of high blood pressure and myocardial infarction. Keywords: ARTERIAL ESSENTIAL HYPERTEN- SION, DIABETES MELLITUS, HEART FAILURE Metabolic syndrome is a frequent association in hypertensive patients because insulin resistance is the main trigger of metabolic abnormalities and is related to lifestyle characteristics (). High blood pressure is associated with primary lifestyle risk factors, and induces a large range of injuries in cardiovascular and renal system since the earliest stages (, 2, 3, 4). Metabolic syndrome is acknowledged as the clustering of risk factors (obesity, insulin resistance, dyslipidemia and hypertension) associated with the subsequent development of cardiovascular disease and type 2 diabetes (8, 9, 0,, 2). The metabolic syndrome is a known risk factor for cardiovascular morbidity and mortality (, 2); moreover, some of the antihypertensive drugs, such as beta-blockers and diuretics, have metabolic side effects that could inter- 946
2 Associated factors of ejection fraction in insulin-treated patients with type 2 diabetes fere and worsen the preexistent anomalies (5, 6, 7). Diabetes mellitus (DM) and congestive heart failure (HF) are frequently associated. The presence of DM in HF patients determines an increased number of adverse events compared with patients without DM. Recent guidelines regarding glycemic control emphasized the importance of the individualization of therapy and targets depending of patient diseases and the risks associated with hypoglycemia. This balance in establishing therapeutic targets may be particularly relevant in patients with DM and HF (8). The aim of the study was to evaluate the relation between ejection fraction (EF), diabetes characteristics and cardiovascular risk factors. MATERIAL AND METHODS During January 202 and December 203, we carried out a cross-sectional study in 7 patients hospitalized at the Sf. Spiridon Emergency Clinical Hospital, in Iasi. The inclusion criteria were the presence of insulin-treated type 2 diabetes. The exclusion criteria were type diabetes, type 2 diabetes treated with non-insulinic agents, patients refusal. The information obtained from patients was directly registered in a well-structured questionnaire filled in as part of direct interview. The questions here comprised referred to the following aspects: demographic data, previous myocardial infarction, history of high blood pressure and duration of diabetes. The diagnosis of arterial hypertension was assessed in the presence of values higher than 40/85 mmhg, or normal ones in treated patients for high BP. All patients underwent physical examination, laboratory investigations and diagnostic tests having as aim to search for asymptomatic organ damage and cardiovascular risk factors. A complete 2 lead ECG was registered to identify patients with previous asymptomatic myocardial infarction (MI). Global ejection fraction (EF) was evaluated through 2-D echocardiography. We examined the relation between EF, diabetes characteristics and cardiovascular risk factors. Continuous data was expressed as medium and standard deviation. The Shapiro- Wilk test was used to evaluate the normal distribution of the analyzed data. The chisquare test was used to determine significant differences between various categories formed out of the frequency data. Association between variables was estimated by Pearson correlation coefficient. Stepwise multiple regressions were used to identify the variables with a predictive role in ejection fraction. The study was conducted after obtaining written informed consent in accordance with the Declaration of Helsinki. We paid full respect to the confidentiality and intimacy terms when maneuvering the data and records keeping of the participating subjects to the study. RESULTS We conducted a cross-sectional study on a sample of 7 patients with insulintreated type 2 diabetes. The mean duration of the disease was 9.56 years and almost three quarters had a poor glycemic control. The criteria associated to metabolic control which were analyzed were: LDLc, HDLc, Hb Ac, microalbuminuria and blood pressure. Most of the patients had abnormal levels of these parameters, indicating a poor metabolic control (tab. I). 947
3 Gina Botnariu et al. 82.5% of the patients had high blood pressure (BP) and 24.6% had had myocardial infarction in their medical history. All normotensive patients had not had a previous myocardial infarction, while 42 (29.8%) of hypertensive ones experienced it (p<0.00). The ejection fraction (EF) was also evaluated by 2-D Echocardiography, having a mean value of 54.82%. However a high proportion of the participants had cardiac failure (35.%) (tab. I). In the sample studied the ejection fraction had significant negative correlations with the duration of the disease (p=0.007) and the microalbuminuria (p=0.00)(fig. ). However, there were noticed some differences between the categories realized by grouping the patients according to the presence and/or the association of hypertension and previous myocardial infarction (tab. II). In patients without personal history of cardiovascular disease, EF was related only with LDLc levels. In the hypertensive patients without myocardial infarction it was related with diabetes duration, Hb Ac and LDLc, while in those with both conditions, EF had significant correlations with Hb Ac and microalbuminuria (tab. II). In the multivariate analysis, we included as potential predictors of EF the following parameters: diabetes duration, microalbuminuria, HDLc, LDLc, HbAc. When analyzing the entire sample, the predictors of EF were only diabetes duration and microalbuminuria (R=0.33, R 2 = 0.). Age (mean ± SD) TABLE I. Background characteristics Mean Gender males (N, %) 84 (49,) Smokers (N, %) 2 (2,3) Diabetes duration (mean ± SD) ±.052 y.o. 9.56±6.52 years High BP (N, %) 4 (82,5) Myocardial infarcts (N, %) 42 (24,6) Ejection fraction (mean ± SD) 54,82±2,50 Hb Ac %(mean ± SD) ±2.46 LDLc mg/dl (mean ± SD) 56.64±53.99 HDLc mg/dl (mean ± SD) 38.68±0.93 Microalbuminuria mg/dl(mean ± SD) 63.43±36.87 Polineuropathie (N, %) 23 (7,9) Cardiac failure (N, %) 60 (35,) HbAc>7% (N, %) 26 (73,7) LDLc>00 mg/dl (N, %) 35 (78,9) HipoHDLc (N, %) 47 (87) 948
4 Associated factors of ejection fraction in insulin-treated patients with type 2 diabetes Fig.. Association between ejection fraction and microalbuminuria TABLE II Significant correlations between the ejection fractions and characteristics of diabetes Diabetes Micro Ejection fraction Age Hb Ac LDLc HDLc duration albuminuria r ** ** Total sample p Patients without high BP and MI (N=30) Patients with high BP and without MI (N=99) Patients with high BP and with MI (N=42) r ** p r ** * -.28 * p r ** * p However, we identified different predictors of EF, when analyzing on the subgroups determined by the presence of high BP and previous myocardial infarction. In diabetics without cardiovascular diseases, only one predictor was identified: LDLc (R=0.47, R 2 =0.22). Hypertensive diabetics with MI had as predictors of EF, diabetes duration and microalbuminuria (R=0.30, R 2 =0.09). The participants with high blood pressure, but without MI had as predictors of EF both LDLc and Hb Ac (R=0.65, R 2 =0.42) (tab. III). 949
5 Gina Botnariu et al TABLE III Multiple linear regression coefficients and associated p-values for ejection and specific characteristics Standardized Coefficients p. 95% Confidence Interval for B Beta Lower Bound Upper Bound Total sample (Constant) microalbuminuria (Constant) microalbuminuria diabetes duration Patients without high BP and MI (N=30) (Constant) LDL Patients with high BP and with MI (N=42) (Constant) microalbuminuria (Constant) microalbuminuria diabetes duration Patients with high BP and without MI (N=99) (Constant) Hb Ac (Constant) Hb Ac LDL DISCUSSION Diabetes is currently among the most challenging threats to public health. It is estimated that 382 million people worldwide have diabetes and the majority will likely die from cardiovascular disease (9). In patients with type 2 diabetes, HbAc is used to evaluate the long term glycemic control and represents an indicator of development of micro vascular and macrovascular complications. Even if the improvement of glucose control significantly reduces the risk of micro vascular complications, most of the trials failed to show if there is also a decrease of risk for atherosclerotic diseases. Despite this, the value of HbAc is still used as a surrogate measure of anti diabetic drugs potential to lower cardiovascular risk. Some authors considered that this assumption is no longer acceptable (0). Cardiovascular diseases are the main causes of death and disability among people with type 2 diabetes. It is estimated that 65% of diabetics would die due to heart disease or stroke. Also, they are two to four times more likely to have atherosclerotic cardiovascular diseases than adults without diabetes (). In our sample, 24.6% had myocardial infarction in their medical history. However a higher proportion of the participants had cardiac failure (35.%). The incidence of HF in patients with ischemic heart disease was 35.7% in non diabetic patients, and 45.7% in diabetic patients (2). Several studies have suggested that diabetics, with or without previous cardiovascular disease, 950
6 Associated factors of ejection fraction in insulin-treated patients with type 2 diabetes have up to five-fold increased risk of heart failure (3). At least 3 mechanisms are involved in inducing HF in diabetic patients: associated diaseases or favoring coronary atherosclerosis or through diabetic cardiomyopathy (4). In the sample we studied, the ejection fraction had significant negative correlations with the duration of the disease and the levels of microalbuminuria and the predictors of EF were only diabetes duration and microalbuminuria. Other studies, such as UK Prospective Diabetes Study (UKPDS), demonstrated a strong association between the incidence of HF and HbAc levels in diabetic patients (5). A large trial, conducted in 48,858 diabetic patients, showed that the increase of Hb Ac with % was associated with a 2% increased risk of hospitalization for the same patients (6). In our study, Hb Ac was significantly associated with EF in patients with high blood pressure even if myocardial infarction was present or not. In normotensive patients, there were no correlations between Hb Ac and EF. However, in these patients diabetes duration was a significant predictor of left ventricular systolic function. Other studies demonstrated that the onset of HF may be better correlated with the duration of the disease. It is considered that the development of HF may be more closely related to the duration of DM than to glycemic control (4). In patients without personal history of cardiovascular disease or high blood pressure, EF was correlated only with LDLc levels. In the hypertensive patients without myocardial infarction it was correlated with Hb Ac and microalbuminuria, while in those with both conditions, EF had significant correlations with diabetes duration, Hb Ac and LDLc. In another study, performed in a well characterized population of patients with anterior MI and mild residual left ventricular dysfunction or preserved ejection fraction, diabetes is associated with worse functional class and a greater risk of developing congestive heart failure in the following year (3). In our study, the predictors of EF in patients with previous MI were: diabetes duration, microalbuminuria, HDLc, LDLc, HbAc. CONCLUSIONS The results of our study suggested that there would be some differences between determinants associated to heart failure in type 2 insulin-treated diabetics, according to the presence of high blood pressure and myocardial infarction. Future research will clarify the extent of this association and its relevance for clinical practice. REFERENCES. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part : Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 998; 5: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 200; 285:
7 Gina Botnariu et al. 3. Balkau B, Charles MA: Commalet on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR).Diabet Med 999; 6: Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: Findings from the Third National Health and Nutrition Examination Survey. JAMA 2002; 287: Ferrannini E, Natali A, Capaldo B, Lehtovirta M, Jacob S, Yki-Jarvinen H: Insulin resistance, hyperinsulinemia, and blood pressure: Role of age and obesity. European Group for the Study of Insulin Resistance (EGIR). Hypertension 997; 30: Kaplan MN: Primary hypertension: Pathogenesis. In: Kaplan s Clinical Hypertension, 8 th Ed., Lippincott Williams & Wilkins, Philadelphia, USA, 2002, Cuspidi C, Meani S, Fusi V, Severgnini B, Valerio C, Catini E, Leonetti G, Magrini F, Zanchetti A: Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens 2004; 22: Nasir S., Aquilar D. Congestive heart failure and diabetes mellitus: balancing glycemic control with heart failure improvement.am J Cardiol. 202; 0(9 Suppl): 50B-57B. 9. Fonarow GC. Diabetes Medications and Heart Failure: Recognizing the Risk. Circulation. 204 Sep McMurray JJ, Gerstein HC2, Holman RR3, Pfeffer MA4. Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored. Lancet Diabetes Endocrinol 204; 2(0): Disease-Diabetes_UCM_33865_Article.jsp 2. Tenenbaum A, Motro M, Fisman EZ, Leor J, Boyko V, Mandelzweig L, Behar S: Status of glucose metabolism in patients with heart failure secondary to coronary artery disease. Am J Cardiol 2002; 90: Manes C., Greaves S., Pfeffer M.A, Rutherford J.D., Rouleau JL., Hennekens C., Solomon S.D.. Influence of diabetes mellitus on development of heart failure following anterior myocardial infarction Cardiovascular Medicine 204; 7(6): Bauters C, Lamblin N, Mc Fadden EP, Van Belle E, Millaire A, de Groote P. Influence of diabetes mellitus on heart failure risk and outcome. Cardiovascular Diabetology 2003; 2():. 5. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 32: Iribarren C, Karter AJ, Go AS, Ferrara A, Liu JY, Sidney S, Selby JV: Glycemic control and heart failure among adult patients with diabetes. Circulation 200; 03:
How To Determine The Prevalence Of Microalbuminuria
Research Journal of Pharmaceutical, Biological and Chemical Sciences Prevalence of Microalbuminuria in relation to HbA1c among known Type2 Diabetic Patients in Puducherry population Muraliswaran P 1 *,
More informationDiabetes Complications
Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation
More informationCardiovascular Disease in Diabetes
Cardiovascular Disease in Diabetes Where Do We Stand in 2012? David M. Kendall, MD Distinguished Medical Fellow Lilly Diabetes Associate Professor of Medicine University of MInnesota Disclosure - Duality
More informationADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,
More informationMetabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007
Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationPrescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital
Research Article Prescription Pattern of Anti Hypertensive Drugs used in Hypertensive Patients with Associated Type2 Diabetes Mellitus in A Tertiary Care Hospital *T. JANAGAN 1, R. KAVITHA 1, S. A. SRIDEVI
More informationDrug Treatment in Type 2 Diabetes with Hypertension
Hypertension is 1.5 2 times more prevalent in Type 2 diabetes (prevalence up to 80 % in diabetic subjects). This exacerbates the risk of cardiovascular disease by ~ two-fold. Drug therapy reduces the risk
More informationGlycemic Control of Type 2 Diabetes Mellitus
Bahrain Medical Bulletin, Vol. 28, No. 3, September 2006 Glycemic Control of Type 2 Diabetes Mellitus Majeda Fikree* Baderuldeen Hanafi** Zahra Ali Hussain** Emad M Masuadi*** Objective: To determine the
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationCASE B1. Newly Diagnosed T2DM in Patient with Prior MI
Newly Diagnosed T2DM in Patient with Prior MI 1 Our case involves a gentleman with acute myocardial infarction who is newly discovered to have type 2 diabetes. 2 One question is whether anti-hyperglycemic
More informationUnderstanding diabetes Do the recent trials help?
Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.
More informationGuidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes
Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center
More informationClinical Study The Sweet Spot: Continued Search for the Glycemic Threshold for Macrovascular Disease A Retrospective Single Center Experience
International Scholarly Research Network ISRN Cardiology Volume 2012, Article ID 874706, 5 pages doi:10.5402/2012/874706 Clinical Study The Sweet Spot: Continued Search for the Glycemic Threshold for Macrovascular
More informationGuidelines for the management of hypertension in patients with diabetes mellitus
Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes
More informationGUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY*
71 GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* Ryuichi KIKKAWA** Asian Med. J. 44(2): 71 75, 2001 Abstract: Diabetic nephropathy is the most devastating complication of diabetes and is now the
More informationSystolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
More informationManaging diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ)
Managing diabetes in the post-guideline world Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Overview Pathogenesis of T2DM Aims of treatment The place of glycaemic control Strategies to improve glycaemic
More informationDiabetes Mellitus. Melissa Meredith M.D. Diabetes Mellitus
Melissa Meredith M.D. Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose resulting from defects in insulin secretion, insulin action, or both Diabetes is a chronic,
More informationHypertension and Diabetes
Hypertension and Diabetes C.W. Spellman, D.O., Ph.D., FACOI Professor & Associate Dean Research Dir. Center Diabetes & Metabolic Disorders Texas Tech University Health Science Center Midland-Odessa, Texas
More informationInsulin degludec (Tresiba) for the Management of Diabetes: Effectiveness, Value, and Value-Based Price Benchmarks
Background: Insulin degludec (Tresiba) for the Management of Diabetes: Effectiveness, Value, and Value-Based Price Benchmarks Final Background and Scope November 19, 2015 The Centers for Disease Control
More informationDiabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW
Diabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW IT`S HARD TO GIVE GENERAL ADVICE! ``The Elderly`` Heterogeneous group ;widely varying
More informationRole of Body Weight Reduction in Obesity-Associated Co-Morbidities
Obesity Role of Body Weight Reduction in JMAJ 48(1): 47 1, 2 Hideaki BUJO Professor, Department of Genome Research and Clinical Application (M6) Graduate School of Medicine, Chiba University Abstract:
More informationMultiple comorbidities: additive and predictive of cardiovascular risk. Peter M. Nilsson Lund University University Hospital Malmö, Sweden
Multiple comorbidities: additive and predictive of cardiovascular risk Peter M. Nilsson Lund University University Hospital Malmö, Sweden Clinical outcomes: major complications of CVD Heart Attack/ACS
More informationAggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost
Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Naftali Stern Institute of Endocrinology, Metabolism and Hypertension Tel Aviv -Sourasky Medical Center and Sackler
More informationMedical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
More informationIn many diabetes units, people with type
Renal Microalbuminuria: Screening and management in type 2 diabetes Julia Arundale Introduction In many diabetes units, patients with type 1 or type 2 diabetes are screened for proteinuria. Screening for
More informationCardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg
Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate
More informationDiagnosis, classification and prevention of diabetes
Diagnosis, classification and prevention of diabetes Section 1 1 of 4 Curriculum Module II 1 Diagnosis, classification and presentation of diabetes Slide 2 of 48 Polyurea Definition of diabetes Slide 3
More informationDiabetic Nephropathy
Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal
More informationStatins and Risk for Diabetes Mellitus. Background
Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration
More informationPHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
More informationType 2 Diabetes Mellitus and Insulin resistance syndrome in Children
Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children Anil R Kumar MD Pediatric Endocrinology MCV/VCU, Richmond VA Introduction Type 2 diabetes mellitus (T2 DM) has increased in children
More informationRobert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy
Robert Okwemba, BSPHS, Pharm.D. 2015 Philadelphia College of Pharmacy Judith Long, MD,RWJCS Perelman School of Medicine Philadelphia Veteran Affairs Medical Center Background Objective Overview Methods
More informationJournal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
More information嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯
The Clinical Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Adults with Type 2 Diabetes Mellitus 嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 Diabetes Mellitus : A group of diseases characterized
More informationUse of antihypertensive medications in patients with diabetes in Ajman, UAE
Use of antihypertensive medications in patients with diabetes in Ajman, UAE Mohammed Arifulla 1*, Lisha J John 1, Jayadevan Sreedharan 2, Jayakumary Muttappallymyalil 2, Jenny Cheriathu 3, Sheikh Altaf
More informationPrognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
More informationHow To Know If You Have Microalbuminuria
3 PREVALENCE AND PREDICTORS OF MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL OBSERVATIONAL STUDY Dr Ashok S Goswami *, Dr Janardan V Bhatt**; Dr Hitesh Patel *** *Associate
More informationAtrial Fibrillation 2014 How to Treat How to Anticoagulate. Allan Anderson, MD, FACC, FAHA Division of Cardiology
Atrial Fibrillation 2014 How to Treat How to Anticoagulate Allan Anderson, MD, FACC, FAHA Division of Cardiology Projection for Prevalence of Atrial Fibrillation: 5.6 Million by 2050 Projected number of
More information1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME
1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME Izet Aganović, Tina Dušek Department of Internal Medicine, Division of Endocrinology, University Hospital Center Zagreb, Croatia 1 Introduction The metabolic syndrome
More informationRATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra
RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent
More informationAn important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and
An important first step in identifying those at risk for Cardiovascular disease The Accutrend Plus system: from the makers of the ACCU-CHEK and CoaguChek systems Cardiovascular disease: the #1 killer in
More informationEvidence-Based Secondary Stroke Prevention and Adherence to Guidelines
Evidence-Based Secondary Stroke Prevention and Adherence to Guidelines Mitchell S.V. Elkind, MD, MS Associate Professor of Neurology Columbia University New York, NY Presenter Disclosure Information Mitchell
More informationCoronary Artery Disease leading cause of morbidity & mortality in industrialised nations.
INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.
More informationTYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU
TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU Objectives: 1. To discuss epidemiology and presentation
More informationROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE
ROLE OF LDL CHOLESTEROL, HDL CHOLESTEROL AND TRIGLYCERIDES IN THE PREVENTION OF CORONARY HEART DISEASE AND STROKE I- BACKGROUND: Coronary artery disease and stoke are the major killers in the United States.
More informationTYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D.
TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type
More informationESC/EASD Pocket Guidelines Diabetes, pre-diabetes and cardiovascular disease
Diabetes, prediabetes and cardiovascular disease Classes of recommendations Levels of evidence Recommended treatment targets for patients with diabetes and CAD Definition, classification and screening
More informationtrends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223-
Review Article Pharmacological trends in the treatment of Diabetes type 2 - New classes of antidiabetic Silvia Mihailova 1*, Antoaneta Tsvetkova 1, Anna Todorova 2 1 Assistant Pharmacist, Education and
More informationCHAPTER V DISCUSSION. normal life provided they keep their diabetes under control. Life style modifications
CHAPTER V DISCUSSION Background Diabetes mellitus is a chronic condition but people with diabetes can lead a normal life provided they keep their diabetes under control. Life style modifications (LSM)
More informationMeasure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control National Quality Strategy Domain: Effective Clinical Care
Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage
More informationU.S. Food and Drug Administration
U.S. Food and Drug Administration Notice: Archived Document The content in this document is provided on the FDA s website for reference purposes only. It was current when produced, but is no longer maintained
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented National Quality Strategy Domain: Community / Population Health 2016 PQRS OPTIONS F INDIVIDUAL MEASURES:
More informationEchocardiography Guided Cardiac Resynchronization Therapy in Patients with Symptomatic Heart Failure and Narrow QRS Complex
Echocardiography Guided Cardiac Resynchronization Therapy in Patients with Symptomatic Heart Failure and Narrow QRS Complex Johannes Holzmeister, M.D. University of Zurich, Zurich, Switzerland on behalf
More informationPsoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis
Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic
More informationCOST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL
Malaysian Journal of Pharmaceutical Sciences, Vol. 5, No. 1, 19 23 (2007) COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL TRI MURTI ANDAYANI* AND IKE IMANINGSIH
More informationCardiovascular Effects of Drugs to Treat Diabetes
Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:
More informationCOMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION
European Medicines Agency London, 19 July 2007 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR
More informationScottish Diabetes Survey 2013. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2013 Scottish Diabetes Survey Monitoring Group Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 18 Duration of Diabetes... 18
More informationAfter acute myocardial infarction, diabetes CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS
CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS By Deborah Chyun, RN, PhD, Viola Vaccarino, MD, PhD, Jaime Murillo, MD, Lawrence H. Young, MD, and Harlan M. Krumholz,
More informationDRUG UTILIZATION EVALUATION OF ANTIHYPERTENSIVE DRUGS IN DIABETIC PATIENTS WITH CKD
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Elhami et al. SJIF Impact Factor 5.210 Volume 4, Issue 11, 1159-1166 Research Article ISSN 2278 4357 DRUG UTILIZATION EVALUATION OF ANTIHYPERTENSIVE
More informationEducation. Panel. Triglycerides & HDL-C
Triglycerides & HDL-C Thomas Dayspring, MD, ACP Clinical Assistant Professor of Medicine University of Medicine and Dentistry of New Jersey Attending in Medicine: St Joseph s s Hospital, Paterson, NJ Certified
More informationImproving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge
Improving drug prescription in elderly diabetic patients FRANCESC FORMIGA Hospital Universitari de Bellvitge High prevalence, but also increases the incidence. The older the patients, the higher the percentages
More informationCOMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION
European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE
More informationNova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines)
Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Authors: Dr. M. Love, Kathy Harrigan Reviewers:
More informationCardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011
Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process
More informationScottish Diabetes Survey 2014. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2014 Scottish Diabetes Survey Monitoring Group Contents Table of Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 21 Duration
More informationPublished Quarterly Mangalore, South India ISSN 0972-5997 Volume 4, Issue 1; January-March 2005
Published Quarterly Mangalore, South India ISSN 0972-5997 Volume 4, Issue 1; January-March 2005 Original Article Genetic Association Between Insulin Resistance And Total Cholesterol In Type 2 Diabetes
More informationDesign and principal results
International Task Force for Prevention Of Coronary Heart Disease Coronary heart disease and stroke: Risk factors and global risk Slide Kit 1 (Prospective Cardiovascular Münster Heart Study) Design and
More informationUse of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Number 84 Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus Summary Overview Clinical
More informationManagement of Diabetes in the Elderly. Sylvia Shamanna Internal Medicine (R1)
Management of Diabetes in the Elderly Sylvia Shamanna Internal Medicine (R1) Case 74 year old female with frontal temporal lobe dementia admitted for prolonged delirium and frequent falls (usually in the
More informationUsing a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes
Special Series: AAFP Award-winning Research Papers Vol. 31, No. 5 331 Using a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes Gary Ruoff, MD; Lynn S. Gray, MD, MPH
More information2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2
More information4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH
METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?
More informationEXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA
EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA A CASE STUDY EXAMINING RISK FACTORS AND COSTS OF UNCONTROLLED HYPERTENSION ISPOR 2013 WORKSHOP
More informationCan Common Blood Pressure Medications Cause Diabetes?
Can Common Blood Pressure Medications Cause Diabetes? By Nieske Zabriskie, ND High blood pressure, or hypertension, is a major risk factor for cardiovascular disease. In the United States, approximately
More information2013 ACO Quality Measures
ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating
More informationCardiovascular disease is the leading cause of morbidity
electronic health records Implementation of an Electronic Health Record with an Embedded Quality Improvement Program to Improve the Longitudinal Care of Outpatients with Coronary Artery Disease Allan G.
More informationKardiovaskuläre Erkrankungen ein Update für die Praxis, 22. Mai 2014 PD Dr. Matthias Wilhelm
Bewegungsbasierte kardiale Rehabilitation als 3. Säule fit für die Zukunft? Matthias Wilhelm Cardiovascular Prevention, Rehabilitation & Sports Medicine University Clinic for Cardiology Interdisciplinary
More informationObjectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History
Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize
More informationDCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study
DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study National Diabetes Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What
More information4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts
Cardiac Rehabilitation: From the other side of the glass door No disclosures, no conflicts Charles X. Kim, MD, FACC, ABVM Objectives 1. Illustrate common CV benefits of CV rehab in real world practice.
More informationListen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
More informationDiabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.
Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years
More informationMEDICATION THERAPY ADHERENCE CLINIC : DIABETES
MEDICATION THERAPY ADHERENCE CLINIC : DIABETES PHARMACEUTICAL SERVICES DIVISION MINISTRY OF HEALTH MALAYSIA First Edition, 2010 Pharmaceutical Services Division Ministry of Health, Malaysia ALL RIGHT RESERVED
More informationThe National Cholesterol Education Program s Adult
NHLBI/AHA Conference Proceedings Definition of Metabolic Syndrome Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition
More informationTrends in Prescribing of Drugs for Type 2 Diabetes in General Practice in England (Chart 1) Other intermediate and long-acting insulins
Type 2 Diabetes Type 2 diabetes is the most common form of diabetes, accounting for 90 95% of cases. 1 Charts 1 and 2 reflect the effect of increasing prevalence on prescribing and costs of products used
More information6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology
Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die
More informationPractical Applications of Insulin Pump Therapy in Type 2 Diabetes
Practical Applications of Insulin Pump Therapy in Type 2 Diabetes Wendy Lane, MD For a CME/CEU version of this article please go to www.namcp.org/cmeonline.htm, and then click the activity title. Summary
More informationHow To Treat Dyslipidemia
An International Atherosclerosis Society Position Paper: Global Recommendations for the Management of Dyslipidemia Introduction Executive Summary The International Atherosclerosis Society (IAS) here updates
More informationObesity in the United States Workforce. Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000
P F I Z E R F A C T S Obesity in the United States Workforce Findings from the National Health and Nutrition Examination Surveys (NHANES) III and 1999-2000 p p Obesity in The United States Workforce One
More informationMISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY
MISSING DATA ANALYSIS AMONG PATIENTS IN THE PINNACLE REGISTRY In order to improve the efficiency of PINNACLE Registry data analytics, a missing data analysis has been conducted on PINNACLE Registry data
More informationCASE A1 Hypoglycemia in an Elderly T2DM Patient with Heart Failure
Hypoglycemia in an Elderly T2DM Patient with Heart Failure 1 I would like to introduce you to Sophie, an elderly patient with long-standing type 2 diabetes, who has a history of heart failure, a common
More informationRisk factors for peripheral artery disease
www.tasc-2-pad.org Risk factors for peripheral artery disease Based on the Inter-Society Consensus Edited by Dr Denis Clement University Hospital, Ghent, Belgium Supported by an educational grant from
More informationBaskets of Care Diabetes Subcommittee
Baskets of Care Diabetes Subcommittee Disclaimer: This background information is not intended to be a comprehensive scientific discussion of the topic, but rather an attempt to provide a baseline level
More informationDeakin Research Online
Deakin Research Online This is the published version: Cameron, Adrian J., Shaw, J.E. and Zimmet, P.Z. 2003, Diabetes, in Diabetes and kidney disease : time to act, nternational Diabetes Federation, Brussels,
More informationSponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.
Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,
More informationIsabella Sudano & Franco Muggli
Swiss Hypertension Guidelines Isabella Sudano & Franco Muggli CoLaus, Swisshype ESC 2005 Dokumentenname Datum Seite 1 European Journal of Cardiovascular Prevention and Rehabilitation 2009 Guideline...
More information