How can we prevent cardiovascular disease in diabetes

Shared links between type 2 diabetes mellitus and Alzheimer's disease: A review

Epidemiological studies have proved that, there are pathophysiological connections between Type 2 Diabetes Mellitus (T2DM) and Alzheimer's disease (AD). Diabetic patients have higher incidences of cognitive impairment and hence they are more at the risk of developing AD. Some of the recent evidences have majorly stated the effects of insulin resistance in the disturbance of various biological processes and signaling pathways. Both hyperglycemia and hypoglycemic conditions contributes in dysfunctioning of cognitive abilities and functions. The present review summarizes the evidences which establish the possible links between the two pathologies on the account of molecular, biochemical and at histopathological level. The information regarding their interactions was collected from different databases and journals. The gathered information will clearly establish the link among the two pathologies and will be helpful in future for the development of drugs for Type 3 Diabetes.

Reducing the modifiable risks of cardiovascular disease in Turkish patients with type 2 diabetes: the effectiveness of training

Our goal was to reduce the number of modifiable risk factors for cardiovascular disease (CVD) through providing lifestyle adjustment training and counseling to patients with type 2 diabetes. In this pre-post intervention study, 139 patients with diabetes were provided with training to reduce the modifiable risks of CVD. One hundred three patients attended the post-training evaluation. Two phone counseling sessions were provided with 1-month intervals. Consumption of red meat and processed food decreased and water consumption, carrying on the recommended diet, and the frequency of exercise increased (p = .000), A1C decreased (p = .05), and the use of aspirin increased (p = .03). Thus, a contribution to the reduction of CVD risk factors in patients with type 2 diabetes was achieved. The training program for reducing CVD risk factors in patients with type 2 diabetes was effective in improving nutrition and lifestyle behaviors and decreasing glycemic control.

Diabetes mellitus and Alzheimer's disease: shared pathology and treatment?

Epidemiological and basic science evidence suggest a possible shared pathophysiology between type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD). It has even been hypothesized that AD might be 'type 3 diabetes'. The present review summarizes some of the evidence for the possible link, putative biochemical pathways and ongoing clinical trials of antidiabetic drugs in AD patients. The primary and review literature were searched for articles published in peer-reviewed sources that were related to a putative connection between T2DM and AD. In addition, public sources of clinical trials were searched for the relevant information regarding the testing of antidiabetic drugs in AD patients. The evidence for a connection between T2DM and AD is based upon a variety of diverse studies, but definitive biochemical mechanisms remain unknown. Additional study is needed to prove the existence or the extent of a link between T2DM and AD, but sufficient evidence exists to warrant further study. Presently, AD patients might benefit from treatment with pharmacotherapy currently used to treat T2DM and clinical trials of such therapy are currently underway.

Survival disparities in patients with lymphoma according to place of residence and treatment provider: a population-based study

PURPOSE

Health disparities exist according to an individual's place of residence. We evaluated the association between primary area of residence (urban v rural) according to treatment provider (university based v community based) and overall survival in patients with lymphoma and determined whether there are patient groups that could benefit from better coordination of care.

PATIENTS AND METHODS

Population-based, retrospective cohort study of 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states and treated by university-based or community-based oncologists from 1982 to 2006.

RESULTS

Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB), and 861 (37%) were treated by community-based providers (RCB). The relative risk (RR) of death among UUB, UCB, and RUB were not statistically different. However, RCB had a higher risk of death (RR, 1.37; 95% CI, 1.14 to 1.65; P = .01; and RR, 1.26; 95% CI, 1.06 to 1.49; P = .01) when compared with UUB and RUB, respectively. This association was true in both low- and intermediate-risk patients. Among high-risk patients, UCB, RUB, and RCB were all at higher risk of death when compared with UUB.

CONCLUSION

Survival outcomes of patients with lymphoma may be associated with place of residence and treatment provider. High-risk patients from rural areas may benefit from better coordination of care.

Flexible initial dosing of atorvastatin based upon initial low-density lipoprotein cholesterol levels in type 2 diabetic patients

BACKGROUND/AIMS

We used flexible starting doses and early titration of atorvastatin to determine the rate of achievement of a low-density lipoprotein cholesterol (LDL-C) target for hyperlipidemic patients with type 2 diabetes mellitus.

METHODS

This study was a multicenter, open-label, prospective trial of atorvastatin therapy in hyperlipidemic patients with type 2 diabetes. The patients were divided into three groups according to initial LDL-C levels (130-149, 150-159 and > or = 160 mg/dL), and 10, 20, and 40 mg of atorvastatin was administered to each group, respectively. If LDL-C did not reach the 100 mg/dL target level at four weeks after initiation of treatment, the doses were increased by one step. Endothelial function tests and plasminogen activator inhibitor (PAL)-1 levels were measured in 41 patients.

RESULTS

Groups of 62, 18, and 69 patients were started on 10, 20, and 40 mg of atorvastatin, respectively, and 91% of the patients achieved the LDL-C target after four weeks of treatment. The overall percentage of patients achieving the LDL-C target after eight weeks of treatment was 89.3%: 87.5% in the 10 mg group, 86.4% in the 20 mg group, 93.9% in the 40 mg group, and 66.7% in the 80 mg group. A statistically significant reduction was observed in the mean percentage change in flow-mediated endothelium-dependent dilatation after eight weeks of treatment (P < 0.0001).

CONCLUSIONS

Flexible initial dosing and early aggressive titration of atorvastatin according to LDL-C levels is an efficient and safe strategy for achieving the target level and for improving endothelial dysfunction in hyperlipidemic patients with type 2 diabetes.

Antihyperlipemic and antihypertensive effects of Spirulina maxima in an open sample of Mexican population: a preliminary report

Background

Spirulina maxima is a filamentous cyanobacterium used as food supplement because of its high nutrient contents. It has been experimentally proven, in vivo and in vitro that posses several pharmacological properties. The purpose of this study was to evaluate the effects of Spirulina maxima orally supplied (4.5 g/day, for 6 weeks) to a sample of 36 subjects (16 men and 20 women, with ages between 18–65 years) on serum lipids, glucose, aminotransferases and on blood pressure. The volunteers did not modify their dietary habits or lifestyle during the whole experimental period. From each subject, a sample of blood was drawn in fasting state of 12 hours to determi the plasma concentrations of glucose, triacylglycerols (TAG), total cholesterol (TC), cholesterol associated to high density lipoprotein (HDL-C) and aspartate aminotransferase (AST). Anthropometric measurements including systolic (SYST-P) and diastolic (DIAST-P) blood pressure, height, weight and Body Mass Index (BMI) were also recorded.

Results

Comparing initial and final data, the results showed that there were no significant changes in the values of glucose and AST, but significant differences in TAG, TC, and HDL-C, were observed: TAG 233.7 ± 177.8 vs. 167.7 ± 100.7 mg/dL (p < 0.001), TC 181.7 ± 37.5 vs. 163.5 ± 34.4 mg/dL (p < 0.001), C-HDL 43.5 ± 14.4 vs. 50 ± 18.8 mg/dL (p < 0.01). The univariated analysis showed that the changes in the HDL-C and TC concentrations were dependent on TAG concentration (p = 0.247 and p = 0.108, respectively); nevertheless the calculated values for cholesterol associated to low density lipoprotein (LDL-C) were significantly reduced by the Spirulina maxima treatment but independently of the TAG changes. In addition, significant differences were found comparing initial and final SYST-P and DIAST-P blood pressure in both male and female: SYST-P male 121 ± 9 vs. 111 ± 8 mm Hg (p < 0.01), DIAST-P male 85 ± 6.5 vs. 77 ± 9 mm Hg (p < 0.01); SYST-P female 120 ± 9.5 vs. 109 ± 11 mm Hg (p < 0.002), DIAST-P female 85 ± 11 vs. 79 ± 7.5 mm Hg (p < 0.03).

Conclusion

The Spirulina maxima showed a hypolipemic effect, especially on the TAG and the LDL-C concentrations but indirectly on TC and HDL-C values. It also reduces systolic and diastolic blood pressure.