Academic literature on the topic 'Diabetic angiopathies – Treatment'

One of the most disabling complications of diabetes mellitus is angiopathy of the lower extremities. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with vascular complications of diabetes mellitus, which significantly aggravate the course of the disease and contribute to high mortality. Diabetic polyneuropathy and diabetic foot syndrome are closely associated with the diabetes mellitus vascular complications that significantly aggravate the course of the disease and contribute to high mortality. Despite the improvement in the results of pharmacotherapy of diabetes mellitus, the problem of treating its vascular complications is far from being solved. Traditionally, therapeutic physical training is used among the methods of non-drug treatment of diabetes mellitus and its complications. As a method of pathogenetic focus on many risk factors for the development of diabetes and its complications, physical therapy exercises contribute to the correction of the syndrome of hypodynamia, obesity, and muscle atrophy. At the same time, there is insufficient data on how exercise therapy affects the quality of life of patients, functional characteristics of walking and objective indicators of blood flow in the lower extremities. This review identifies the main approaches to the application, advantages and disadvantages of individual methods of therapeutic physical training in the correction of functional disorders in patients with lower extremities diabetic angiopathies. We can currently talk about the proven safety of the physical therapy use in patients with diabetic angiopathies. Meanwhile, the scientific data on the high efficiency of this method is still insufficient.

These effects were studied in 52 patients with degrees III-IV diabetic angiopathies of the lower limbs. Microcirculation parameters were found changed in this patient population, this leading to disorders of the oxygen budget and development of metabolic acidosis. Development of destructive changes in the limb evidences failure of the compensatory adaptive mechanisms of microcirculation. Addition of hyperbaric oxygenation to multiple-modality treatment of patients with diabetic angiopathies was conducive to improvement of the blood rheology, of tissue saturation with oxygen, and to essential reduction of metabolic acidosis. The detected microcirculation disorders necessitate addition to the therapeutic complex of the drugs improving the biophysical characteristics of the blood.

Diabetic involvements of the organ of vision may be divided into extraocular and ocular. The first group includes xanthelasma and eczemas of the eyelids, hordeolum, chalasion, blepharitis, acute and chronic conjunctivitis, conjunctival angiopathies, and pareses of the extraocular muscles. The second group in- cludes*iridal dystrophy, anterior uveitis, cataract, glaucoma, asteroid hyalosis, lipemia rctinalis, and diabetic retinopathy with its complications (hemophthalmia, detachment of the retina, and neovascu- lar glaucoma). Diabetic retinopathy is a late complication of diabetes mellitus. The author discusses the epidemiology of this condition, its pathophysiological and clinical features, classification, contribution of local factors to its pathogenesis, and possibilities of treatment and prevention of the disease. He emphasizes the leading role of optimal correction of carbohydrate metabolism as a means preventing diabetic retinopathy and of timely laser photocoagulation of the retina in its treatment.

For the application in surgical practice the treatment method of diabetic angiopathy of lower extremities is proposed involving the intravenous injection of ozonized solutions. The method proposed allowed to localize fast the pyo-necrotic process, to reduce the number of amputations, to decrease the terms of hospitalizations. The method is simple, it does not require special skills and is pathogenetically justified.

Background. The problem of diabetic angiopathy is characteristic of countries even with a high level of development of medicine. The high frequency of complications of diabetes with high biological and social significance determines the need for their correction. The purpose of the work was to increase the effectiveness of rehabilitation treatment for patients with diabetic angiopathy through the combined use of therapeutic exercises and functional electrical stimulation of the lower extremities. Methods. A prospective cohort study was conducted, in which 90 patients (63 men and 27 women) with an established diagnosis of type 2 diabetes took part. Results. It was found that the use of therapeutic gymnastics and training walking on a treadmill and functional neuroelectrostimulation of the lower extremities increase the motor capabilities of patients due to the analgesic effect, improved neurogenic control of vasoconstriction of arteriovenous anastomoses and increased capillary blood flow. Conclusion. Functional electrical stimulation method can be effectively used in physical therapy programs for patients with diabetic lower limb angiopathies at the inpatient and outpatient stages.

BACKGROUND “Skin is a mirror of internal diseases”. Diabetes mellitus (DM) is a metabolic disorder that needs considerations of many different specialities but the importance of dermatologist’s knowledge has not drawn much attention. As a result, we intend to study various cutaneous manifestation of diabetes mellitus. Prior to diagnosis of diabetes mellitus, patient may present with cutaneous manifestation. Thus, it can help in early diagnosis, management and prevention of complication and help in improvement of quality of life. METHODS This is a descriptive cross-sectional study. A total of 500 diabetic patients with cutaneous manifestations, who attended skin outpatient department (OPD) at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bengaluru, Karnataka, India, were evaluated. Detailed history was taken along with physical and mucocutaneous examination. Cutaneous manifestations, general description of diabetes mellitus like duration, type, and drug history as well as the demographic data were collected and analysed using descriptive statistics. RESULTS Among a total of 500 diabetes mellitus subjects, the most common cutaneous manifestations were infections (35 %) followed by pruritus (11 %). Among infections, tinea infections (48.29 %) were the most common followed by intertrigo (21 %). CONCLUSIONS The ignorance of skin manifestations in diabetes or improper treatment may worsen the condition. Early detection and treatment of common skin manifestations in diabetes will prevent further complications especially in cases of extensive tinea corporis, pruritus, psoriasis, lichen planus, macro and micro angiopathies, trophic ulcers etc. KEYWORDS Cutaneous manifestations, Diabetes mellitus

A scientific and practical symposium Essential phospholipids in the treatment of diabetes mellitus and dyslipidemia organized by RON-PULENK RORER (Cologne, Germany) was held at the State Central Scientific Medical Library of the Ministry of Health of Russia. The basic concept of the development of dyslipidemia (DLP) and the working classification of this metabolic state were presented in a report by Yu. A. Knyazev (Moscow). In the message K. Gundermann et al. (Cologne, Germany) the mechanism of action of essential phospholipids (EPL) at the molecular level, the level of insulin receptor and postreceptor interactions in cytomembranes, as well as in lipolytic and cholinesterizing enzyme systems was described. The feasibility of using EPL preparations for the prevention of diabetic angiopathies (AP) by transplanting pancreatic incretory cell cultures, with conservative and surgical treatment of AP with the aim of stabilizing or even reversing the development of atherosclerotic vascular lesions, was substantiated in a report by A. A. Chirkin et al. (Vitebsk, Belarus). The results of the study of intravascular microcirculation in patients with diabetes with clinical signs of AP made it possible to evaluate lipostabil (a drug containing EPL and prescribed together with hypoglycemic agents) as an effective tool in the plasma-cell type of microcirculatory disorders in patients with diabetes aged 19 to 68 years (I. M Kakhnovsky et al., Moscow). Under the influence of lipostabil forte, an increase in insulin sensitivity is possible (L. L. Vakhrusheva et al., Moscow), which underlies a decrease in the need for exogenous insulin and a tendency to normalize indicators of carbohydrate and fat metabolism, the level of counterinsulin hormones. 6 months after the start of lipostabil forte administration, an inhibition of AP progression was noted against the background of an adequate dose of insulin.

Diabetes mellitus is caused by one of the largest medical and social problems in Ukraine, because it causes a high risk of invasive disease. According to the WHO data, the number of patients is rising and people of varying age groups become ill, which causes an increase in the incidence of 3 to 4 pauses and the overall life expectancy of 20-30%. Pathogenesis of diabetes mellitus and enclosure, require the extraction of drugs for prophylaxis and treatment with late pharmacological effects. One of these is a herbal remedy. Analysis and systematization of the literature on metabolitotropic effects and substantiation of the use of new goat's-rue, blueberry and taurine phytocompositions for the correction of metabolic changes in diabetes type 2 were carried out. The methods of information search, analysis of literature on the medicinal plants with hypoglycemic action were used. The literary resources on pharmacological correction of metabolic changes in diabetes type 2 deal with natural herbs and amino acids that possess hypoglycemic action and can be used with therapeutic and prophylactic measure in patients with type 2 diabetes. In type 2 diabetes mellitus significant anticytolytic, detoxifying and antioxidant properties of phytocompositions were confirmed. It is known that in hyperglycemia and insulin resistance that occur at type 2 diabetes mellitus end products of glycosylation and glucose autooxidation are formed, which is accompanied by the activation of lipid peroxidation and the formation of a large number of free radicals. It is known that one of the basic mechanisms for the development of insulin resistance, diabetes mellitus and specific diabetic angiopathies is oxidative stress. One of the major pathogenetic factors in the development and course of type 2 diabetes mellitus is metabolic syndrome. It has been established that correction using both investigated phytocompositions and reference phytopreparation with different efficiency prevented the development of metabolic changes in metabolic syndrome. Biologically active components of medicinal plants, may show hypoglycemic effect which will influence the activity of the enzymes, glucose transcription and the function of the peptide to the incyline, the processes which play an important role in the pathogenesis of diabetes.

Diabetic foot syndrome is characterized by an intrinsic patient fragility and involves complex medical and surgical therapeutic approach. Lesions, often chronic, have a high risk of recurrence and amputation. The patient with diabetic foot is more frequently affected by comorbidities, not only for micro-angiopathic complications of diabetes mellitus but also for the frequent presence of cardiovascular disease. We report the case of a 63-year-old diabetic patient with multiple comorbidities. Treatment with linagliptin allowed to simplify the therapy for glycemic control, switching from a injective therapy four times daily to a therapy with only basal insulin and linagliptin. This therapy has proven to be safe and suitable to maintain good glycemic control even in a fragile patient with diabetic foot and middle-severe renal insufficiency of diabetic origin (Diabetology).

Introduction Phenotype match inherited by genes is in most cases present in monozygotic twins. Their phenotypic resemblance is unfortunately characterized by strong susceptibility for the development of chronic non-infectious diseases. One of the most common non-infectious chronic diseases that are phenotipically represented in twins is diabetes mellitus. Genetic imbalance is, in most cases, placed in 2, 3, 7, 8, 11, 12, 19 and 20 chromosomal pair of the human genome. CASE OUTLINE This study describes a pair of monozygotic twins, aged 54, who were diagnosed for diabetes type 2 ten years earlier. The first patient had trophic changes of muscles and skin tissues of the lower limb, and a necrotic wound on his right leg tibial region with the claudication distance of 50 m. After arteriography, he was referred by a vascular surgeon for hyperbaric oxygen therapy (HBO). HBO protocol implied 70 min. application of 100% oxygen at 2.5 absolute atmospheres. After the first series of HBO therapies consisting of 20 HBO treatments, claudication was eliminated and the necrotic wound healed. Next, surgical aortofemoral bypass was done. During the second HBO treatment, his monozygotic twin brother presented with angiopathic changes due to diabetes. In both patients, biochemical parameters corresponded to the expected level for diabetes type 2 imbalance, and the localization of the chromosomal defect (placed on 3, 11 and 19 chromosomal pair) was also in accordance with the respective disorder. After they were included into next 10 HBO treatments, Doppler imaging of the major arteries of limbs revealed normal findings. Conclusion Identical genetic impairment in monozygotic twins can lead to identical somatic changes with resultant consequences. HBO treatment of such patients associated with other therapeutic procedures (conducted by diabetologist, vascular surgeon and physiatrist) can postpone or prevent irreversible changes occurring due to blood vessel disorders.

[Formulae and special characters can only be approximated here. Please see the pdf version of the Abtract for an accurate reproduction.] Type 2 diabetes at least doubles the risk of cardiovascular disease. This can partly be explained by the increased prevalence of risk factors such as hypertension, dyslipidaemia and obesity. However, the underlying abnormality of insulin resistance and the presence of more recently identified risk factors including endothelial dysfunction, increased inflammation, and increased oxidative stress might also contribute towards the heightened cardiovascular risk. Fish oil, which contains eicosapentaenoic acid (EPA, 20:5 n-3), has wide-ranging beneficial effects on these and other abnormalities, and has reduced cardiovascular mortality in secondary prevention studies. Animal and human studies have recently established that in addition to EPA, docosahexaenoic acid (DHA, 22:6 n-3) also has beneficial effects, and furthermore, may have less detrimental effects than EPA on glycaemic control which has worsened in some fish and fish oil studies involving Type 2 diabetic subjects. Study 1 : This intervention study aimed to determine the independent effects of EPA and DHA on cardiovascular risk factors and glycaemic control in individuals with Type 2 diabetes receiving treatment for hypertension. In a double-blind placebo-controlled trial of parallel design, 59 subjects in good to moderate glycaemic control (HbA1c < 9%) were recruited from media advertising and randomised to 4 g/day of EPA, DHA or olive oil (placebo) for 6 weeks. Thirty-nine men and 12 post-menopausal women aged 61.2±1.2 yrs completed the study. Relative to placebo, and with Bonferroni adjustments for multiple comparisons, serum triglycerides fell by 19% (p=0.022) and 15% (p=0.022) in the EPA and DHA groups respectively. There were no changes in serum total cholesterol, or LDL- and HDL-cholesterol, although HDL2-cholesterol increased 16% with EPA (p=0.026) and 12% with DHA (p=0.05). HDL3-cholesterol fell by 11% (p=0.026) with EPA supplementation and LDL particle size increased by 0.26±0.10 nm (p=0.02) with DHA. Urinary F2-isoprostanes, an in-vivo marker of oxidative stress was reduced by 19% following EPA (p=0.034) and by 20% following DHA. DHA but not EPA supplementation reduced collagen-stimulated platelet aggregation (16.9%, p=0.05) and thromboxane release (18.8%, p=0.03), but there were no significant changes in PAF-stimulated platelet aggregation. Fasting glucose rose by 1.40±0.29 mmol/l (p=0.002) following EPA and 0.98±0.29 mmol/l (p=0.002) following DHA. Neither EPA nor DHA had any significant effect on HbA1c, fasting serum insulin or C-peptide, insulin sensitivity, stimulated insulin secretion, 24-hr ambulatory blood pressure and heart rate, markers of inflammation, and fibrinolytic or vascular function. Study 2 : This study aimed to examine the influence and causes of increased inflammation on vascular function in subjects recruited for Study 1. Compared with healthy controls (n=17), the diabetic subjects (n=29) had impaired flow-mediated dilatation (FMD) (3.9±3.0% vs 5.5±2.4%, p=0.07) and glyceryl-trinitrate mediated dilatation (GTNMD) (11.4±4.8% vs 15.4±7.1%, p=0.04) of the brachial artery. They also had higher levels of the inflammatory markers C-reactive protein (2.7±2.6 mg/l vs 1.4±1.1 mg/l, p=0.03), fibrinogen (3.4±0.7 g/l vs 2.7±0.3 g/l, p<0.001) and tumor necrosis factor-alpha (20.9±13.4 pg/l vs 2.5±1.7 pg/l, p<0.001). In diabetic subjects, after adjustment for age and gender, leukocyte count was an independent predictor of FMD (p=0.02), accounting for 17% of total variance. Similarly, leukocyte count accounted for 23% (p<0.001) and IL-6 for 12% (p=0.03) of variance in GTNMD. Von Willebrand factor, a marker of endothelial cell activation was correlated with leukocyte count (r=0.38, p=0.04), FMD (r=-0.35, p=0.06) and GTNMD (r=-0.47, p=0.009), whilst P-selectin, a marker of platelet activation was correlated with fibrinogen (r=0.58, p=0.001). Conclusion : EPA and DHA have similar beneficial effects on triglycerides, HDL2 cholesterol and oxidative stress in individuals with Type 2 diabetes and hypertension. However, DHA also increases LDL particle size and reduces collagen-stimulated platelet aggregation and thromboxane release, thus offering more potential than EPA as an anti-thrombotic agent. The beneficial effects of both oils were potentially offset by deterioration in glycaemic control. Neither oil affected blood pressure or vascular function. Longer-term studies with major morbidity and mortality as the primary outcome measures are required to assess the overall benefits and risks of EPA and DHA. The cross-sectional observations from Study 2 are consistent with the hypothesis that impaired vascular function in individuals with Type 2 diabetes and hypertension is at least in part secondary to increased inflammation, with associated endothelial and platelet activation.

Aside from an indirect effect of PPARgamma activation to reduce insulin resistance and to facilitate adiponectin release, PPARgamma agonist could also exert direct effects on blood vessels. I provided a first line of experimental evidence demonstrating that PPARgamma agonist rosiglitazone up-regulates the endothelin B receptor (ETBR) expression in mouse aortas and attenuates endothelin-1-induced vasoconstriction through an endothelial ET BR-dependent NO-related mechanism. ETBR up-regulation inhibits endothelin-1-induced endothelin A receptor (ETAR)-mediated constriction in aortas and mesenteric resistance arteries, while selective ETBR agonist produces endothelium-dependent relaxations in mesenteric resistance arteries. Chronic treatment with rosiglitazone in vivo or acute exposure to rosiglitazone in vitro up-regulate the ETsR expression without affecting ETAR expression. These results support a significant role of ETBR in contributing to the increased nitric oxide generation upon stimulation with PPARgamma agonist. This study provides additional explanation for how PPARgamma activation improves endothelial function.
Firstly, I demonstrated that adipocyte-derived adiponectin serves as a key link in PPARgamma-mediated amelioration of endothelial dysfunction in diabetes. Results from ex vivo fat explant culture with isolated arteries showed that PPARgamma expression and adiponectin synthesis in adipose tissues correlate with the degree of improvement of endothelium-dependent relaxation in aortas from diabetic db/db mice. PPARgamma agonist rosiglitazone elevates the adiponectin release and restores the impaired endothelium-dependent relaxation ex vivo and in vivo, in arteries from both genetic and diet-induced diabetic mice. The effect of PPARgamma activation on endothelial function that is mediated through the adiponectin- AMP-activated protein kinase (AMPK) cascade is confirmed with the use of selective pharmacological inhibitors and adiponectin -/- or PPARgamma+/- mice. In addition, the benefit of PPARgamma activation in vivo can be transferred by transplanting subcutaneous adipose tissue from rosiglitazone-treated diabetic mouse to control diabetic mouse. I also revealed a direct effect of adiponectin to rescue endothelium-dependent relaxation in diabetic mouse aortas, which involves both AMPK and cyclic AMP-dependent protein kinase signaling pathways to enhance nitric oxide formation accompanied with inhibition of oxidative stress. These novel findings clearly demonstrate that adipocyte-derived adiponectin is prerequisite for PPARgamma-mediated improvement of endothelial function in diabetes, and thus highlight the prospective of subcutaneous adipose tissue as a potentially important intervention target for newly developed PPARgamma agonists in the alleviation of diabetic vasculopathy.
To summarize, the present investigation has provided a few lines of novel mechanistic evidence in support for the positive roles of PPARgamma and PPARdelta activation as potentially therapeutic targets to combat against diabetic vasculopathy.
Type 2 diabetes mellitus and obesity represent a global health problem worldwide. Most diabetics die of cardiovascular and renal causes, thus increasing the urgency in developing effective strategies for improving cardiovascular outcomes, particularly in obesity-related diabetes. Recent evidence highlights the therapeutic potential of peroxisome proliferators activated receptor (PPAR) agonists in improving insulin sensitivity in diabetes.
While agonists of PPARalpha and PPARgamma are clinically used, PPARdelta is the remaining subtype that is yet to be a target for current therapeutic drugs. Little is available in literature about the role of PPARdelta in the regulation of cardiovascular function. The third part of my thesis focused on elucidating cellular mechanisms underlying the beneficial effect of PPARdelta activation in the modulation of endothelial function in diabetes. PPARdelta agonists restore the impaired endothelium-dependent relaxation in high glucose-treated aortas and in aortas from diabetic db/db mice through activation of a cascade involving PPARdelta, phosphatidylinositol 3-kinase, and Akt. PPARdelta activation increases Akt and endothelial nitric oxide synthase and nitric oxide production in endothelial cells. The crucial role of Akt is confirmed by selective pharmacological inhibitors and transient transfection of dominant negative Akt plasmid in these cells. Treatment with PPARdelta agonist GW501516 in vivo augments endothelial function in diabetic db/db and diet-induced obese mice. The specificity of GW501516 for PPARdelta is proven with the loss of its effect against high glucose-induced impairment of endothelium-dependent relaxation in aortas from PPARdelta knockout mice. In addition, oral administration of GW501516 in vivo fails to improve endothelial function in diet-induced obese PPARdelta deficient mice.
Tian, Xiaoyu.
Adviser: Huang Yu.
Source: Dissertation Abstracts International, Volume: 73-04, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 132-165).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.

Indiana University-Purdue University Indianapolis (IUPUI)
Medication adherence remains a problem among Type-2 diabetes (T2D) patients despite availability of effective treatments. Three analyses of extant data sets were conducted to examine barriers to using medication as prescribed as an alternate method to assess medication adherence: 1) development and psychometric evaluation of the Murage-Marrero-Monahan-Medication barriers (4M) scale to assess patients’ perceived barriers; 2) patient demographic factors associated with barriers to using medication as prescribed, and 3) the association between patients’ perceived barriers to medication use and cardiovascular disease (CVD) risk factor control.Twelve focus groups and a cross-sectional study of 362 T2D patients contributed to develop and evaluate psychometric properties of the 4M scale. A cross-sectional survey of 964 T2D patients was used for the other two studies. Analysis of covariance identified demographic factors associated with reported barriers. Multivariable logistic regression was used to identify barriers associated with CVD risk factors (glucose, blood pressure and lipids) categorized as either poor or good control. Exploratory factor analysis with Varimax rotation resulted in a 19-item 4M scale with acceptable psychometric properties. As a five-domain (or single-domain) structure, coefficient alpha ranged from 0.70 to 0.83 (0.92). Both structures demonstrated discriminant validity and known-group validity. Age was inversely associated with all identified barriers while income was inversely associated with poor communication with providers and side effects. A unit increase in the overall barrier mean score on the 4M scale was associated with 92% increase in the odds of having poor control of two or more CVD risk factors compared to good control of all three risk factors (adjusted OR=1.92, 95% CI: 1.16–3.17; p<0.05). The 4M scale demonstrated acceptable psychometric properties in assessing barriers to using medication among T2D patients. Poor medication adherence has been previously associated with CVD risk. In this study, greater barriers were associated with poorer control of CVD risk factors making barriers a potential alternative to medication adherence, whose current assessment methods are limited. The 4M scale has the advantage to identify specific barriers inhibiting medication use that can facilitate patient-provider discussions and the development of targeted interventions.
Some parts of this dissertation work were jointly funded by Program Announcement 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency(s).

Includes publications published as a result of ideas developed in this thesis, inserted at end.
"April 2005"
Includes bibliographical references (leaves 210-242)
242 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005