April 25th 2024
A retrospective study challenges preoperative withholding of GLP-1 RAs in diabetes patients undergoing surgery, citing no increased risk of postoperative respiratory complications.
Coronary artery disease in asymptomatic diabetic patients
We evaluated the effectiveness of the current American Diabetes Association guidelines for the detection of coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes and assessed whether a more aggressive diagnostic strategy would permit detection of silent CAD at an earlier stage. The prevalence of myocardial perfusion defects and CAD in asymptomatic diabetic patients was high independent of risk factor profile, and an aggressive diagnostic approach in patients who would normally be excluded from screening permitted identification of CAD at an earlier stage, when coronary anatomy is more likely to respond to treatment.
Diabetes and inflammation influence the development of atherosclerosis. We performed a study that showed the inflammatory markers high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 were lowered with the use of fenofibrate, simvastatin, and combination therapy. The anti-inflammatory effects were most pronounced among patients with elevated baseline inflammatory markers. Combination therapy significantly altered lipid concentrations and exerted a greater positive effect on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides than monotherapy with either drug.
Effect of medication nonadherence in diabetes mellitus
September 10th 2008We evaluated the association between medication nonadherence and outcomes among subjects with diabetes mellitus. Nonadherent subjects had higher blood pressure, glycosylated hemoglobin, and low-density lipoprotein cholesterol levels. In addition, there was an association between medication nonadherence and an increased risk of all-cause hospitalization and all-cause mortality. These findings suggest that interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.
Medication adherence and meaningful clinical markers in diabetes mellitus
Diabetes mellitus is a chronic disease for which nonadherence to therapy is frequent.
Mortality of patients with diabetes mellitus and acute myocardial infarction
September 9th 2008We evaluated trends in the treatment and mortality of patients with and without diabetes mellitus and acute myocardial infarction over the last decade. Despite improvements in the provision of evidence-based care, patients with diabetes did not derive improvements in long-term survival.
Trends and enigmas in diabetic patients with acute MIs
September 9th 2008Two trends have collided in the last 10-20 years: 1) there is no question that both the prevalence and incidence of type 2 diabetes mellitus are on the increase; 2) conversely, the morbidity and mortality associated with acute coronary syndromes— especially myocardial infarction (MI)—are definitely declining.
Prediction of coronary artery disease in patients with diabetes and albuminuria
September 8th 2008We developed a set of equations to predict the risk or probability of developing coronary artery disease (CAD) in 10 years among American Indians. The equations are based on the significant risk factors identified in the Strong Heart Study, a longitudinal study of cardiovascular disease in American Indians. The equations can be used in patient education and to evaluate the efficacy of CAD prevention and intervention programs.
Diabetic patients with acute coronary syndromes are at higher risk for mortality, even if they have ST-segment elevation myocardial infarction. Diabetic patients with unstable angina/non–Q-wave infarction have impaired platelet responsiveness to nitric oxide, a physiological anti-aggregating autocoid. The extent of this impairment depends on the degree of hyperglycemia. Rapid correction of hyperglycemia with infused insulin restores responsiveness to nitric oxide, thus ameliorating platelet dysfunction.
Significance of hyperglycemia and platelet function in diabetic patients
Glucose-insulin-potassium (GIK) was initially advocated as a treatment of acute myocardial infarction (MI) to promote electrical stability.
Anticoagulation for atrial fibrillation-trends in the United States
The use of anticoagulation therapy for atrial fibrillation has slowly increased in the last decade, yet many patients at relatively high risk for thromboembolic events are still not receiving anticoagulants. Patients receiving therapy that is intended to maintain sinus rhythm may be at higher risk for underuse of anticoagulation therapy than those receiving rate control therapies. In addition, the increase in the use of anticoagulation therapy appears to have been particularly notable among patients for whom it may not be indicated and in whom safer, less expensive antithrombotic therapies would suffice.
Should metformin be used to prevent diabetes in high-risk patients?
As outlined by the authors, use of metformin is an appealing option because it is safe, produces few side effects, and is a cost-effective way to target some of the defects known to contribute to the metabolic defects associated with diabetes.
The effect of diabetes on death and hospitalization in heart failure patients
In the cohort study conducted by Ahmed and colleagues, the investigators assessed whether diabetes was associated with worse outcomes in heart failure regardless of the associated risk factors and comorbidities.
How do cardiac and noncardiac conditions affect survival after ICD implantation?
August 28th 2008The benefits of implantable cardioverter-defibrillators (ICDs) have been shown in randomized clinical trials. The factors that affect the risk–benefit ratio in a community setting, however, have not been evaluated.
Diabetes-related poor outcomes in chronic heart failure: Complex interactions with sex and age
July 15th 2008This propensity-matched study, in which patients with and without diabetes were well balanced in all measured baseline characteristics, including traditional risk factors and comorbidities, found that diabetes was associated with increased mortality and hospitalization in ambulatory patients who had chronic, mild-to-moderate heart failure and were receiving angiotensin-converting enzyme inhibitors. These findings also highlight the sex- and age-related variations in the effect of diabetes in these patients.