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Cardiovascular Risk/Epidemiology
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Intensified Multifactorial Intervention in Patients with Type 2 Diabetes Mellitus
Takayoshi Sasako, Toshimasa Yamauchi, Kohjiro Ueki
Diabetes Metab J. 2023;47(2):185-197.   Published online January 12, 2023
DOI: https://doi.org/10.4093/dmj.2022.0325
  • 6,817 View
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  • 13 Web of Science
  • 13 Crossref
AbstractAbstract PDFPubReader   ePub   
In the management of diabetes mellitus, one of the most important goals is to prevent its micro- and macrovascular complications, and to that end, multifactorial intervention is widely recommended. Intensified multifactorial intervention with pharmacotherapy for associated risk factors, alongside lifestyle modification, was first shown to be efficacious in patients with microalbuminuria (Steno-2 study), then in those with less advanced microvascular complications (the Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care [ADDITION]-Europe and the Japan Diabetes Optimal Treatment study for 3 major risk factors of cardiovascular diseases [J-DOIT3]), and in those with advanced microvascular complications (the Nephropathy In Diabetes-Type 2 [NID-2] study and Diabetic Nephropathy Remission and Regression Team Trial in Japan [DNETT-Japan]). Thus far, multifactorial intervention led to a reduction in cardiovascular and renal events, albeit not necessarily significant. It should be noted that not only baseline characteristics but also the control status of the risk factors and event rates during intervention among the patients widely varied from one trial to the next. Further evidence is needed for the efficacy of multifactorial intervention in a longer duration and in younger or elderly patients. Moreover, now that new classes of antidiabetic drugs are available, it should be addressed whether strict and safe glycemic control, alongside control of other risk factors, could lead to further risk reductions in micro- and macrovascular complications, thereby decreasing all-cause mortality in patients with type 2 diabetes mellitus.

Citations

Citations to this article as recorded by  
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    Takayoshi Sasako
    Diabetology International.2024; 15(1): 34.     CrossRef
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    Wenjuan Feng, Chenhui Lv, Le Cheng, Xin Song, Xuemin Li, Haoran Xie, Shuangzhi Chen, Xi Wang, Lushan Xue, Cheng Zhang, Jie Kou, Lili Wang, Haifeng Zhao
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  • External validation of a minimal-resource model to predict reduced estimated glomerular filtration rate in people with type 2 diabetes without diagnosis of chronic kidney disease in Mexico: a comparison between country-level and regional performance
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    Priyanka Sati, Praveen Dhyani, Eshita Sharma, Dharam Chand Attri, Arvind Jantwal, Rajni Devi, Daniela Calina, Javad Sharifi-Rad
    Current Nutrition Reports.2024; 13(2): 166.     CrossRef
  • Lipids as potential mediators linking body mass index to diabetes: evidence from a mediation analysis based on the NAGALA cohort
    Song Lu, Qun Wang, Hengcheng Lu, Maobin Kuang, Min Zhang, Guotai Sheng, Yang Zou, Xiaoping Peng
    BMC Endocrine Disorders.2024;[Epub]     CrossRef
  • Potential of FGF21 in type 2 diabetes mellitus treatment based on untargeted metabolomics
    Shuai Li, Zilong Song, Chunxiang Fan, Weiwei Zhang, Tianyi Ma, Xu Li, Qi Zhang, Ming Zhao, Tianfei Yu, Shanshan Li
    Biochemical Pharmacology.2024; 225: 116306.     CrossRef
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    Takayoshi Sasako
    Endocrine Journal.2024; 71(7): 651.     CrossRef
  • Modern Challenges in Type 2 Diabetes: Balancing New Medications with Multifactorial Care
    Alfredo Caturano, Raffaele Galiero, Maria Rocco, Giuseppina Tagliaferri, Alessia Piacevole, Davide Nilo, Giovanni Di Lorenzo, Celestino Sardu, Erica Vetrano, Marcellino Monda, Raffaele Marfella, Luca Rinaldi, Ferdinando Carlo Sasso
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  • The gaps between the guidelines definitions and routine of care adopted in primary health care regarding diabetes kidney disease: a real-life study
    Silvia Ferreira Bortoto, Jacira Xavier de Carvalho, Mozania Reis de Matos, Cristiane das Graças Dias Cavalcante, Elenilda Almeida Silva Andrade, Márcia Silva Queiroz
    Journal of Public Health.2024;[Epub]     CrossRef
  • Cardiovascular Risk Reduction in Type 2 Diabetes: Further Insights into the Power of Weight Loss and Exercise
    Seung-Hwan Lee
    Endocrinology and Metabolism.2023; 38(3): 302.     CrossRef
  • Sarcopenia: Loss of mighty armor against frailty and aging
    Takayoshi Sasako, Kohjiro Ueki
    Journal of Diabetes Investigation.2023; 14(10): 1145.     CrossRef
Pathophysiology
Article image
Blood Pressure Target in Type 2 Diabetes Mellitus
Hyun-Jin Kim, Kwang-il Kim, on Behalf of the Policy Committee of Korean Society of Hypertension
Diabetes Metab J. 2022;46(5):667-674.   Published online September 19, 2022
DOI: https://doi.org/10.4093/dmj.2022.0215
  • 7,990 View
  • 549 Download
  • 7 Web of Science
  • 12 Crossref
AbstractAbstract PDFPubReader   ePub   
The prevalence of diabetes mellitus continues to increase worldwide, and it is a well-established cardiovascular risk factor. Hypertension is also an important cardiovascular risk factor to be controlled and is common among patients with diabetes mellitus. Optimal blood pressure (BP) goals have been the subject of great debate in the management of hypertension among patients with diabetes mellitus. This review provides detailed results from randomized controlled trials and meta-analyses of clinical outcomes according to the target BP in patients with type 2 diabetes mellitus. In addition, the target BP in patients with diabetes mellitus recommended by different guidelines was summarized and presented. A target BP of <140/90 mm Hg is recommended for patients with hypertension and diabetes mellitus, and BP should be controlled to <130/80 mm Hg in patients with diabetes mellitus who have high-risk clinical features. We hope that this review will be helpful to clinicians and patients by promoting the understanding and appropriate application of BP control in the comprehensive management of patients with diabetes mellitus.

Citations

Citations to this article as recorded by  
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    Hack-Lyoung Kim
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    Leon Kopitar, Iztok Fister, Gregor Stiglic
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    María González-Amor, Beatriz Dorado, Vicente Andrés
    Frontiers in Cell and Developmental Biology.2023;[Epub]     CrossRef
  • Effects of Diabetes and Voluntary Exercise on IgA Concentration and Polymeric Immunoglobulin Receptor Expression in the Submandibular Gland of Rats
    Jaebum Park, Yuko Yamamoto, Kouki Hidaka, Satoko Wada-Takahashi, Shun-suke Takahashi, Toshiya Morozumi, Nobuhisa Kubota, Makiko Saita, Juri Saruta, Wakako Sakaguchi, Masahiro To, Tomoko Shimizu, Yuko Mikuni-Takagaki, Keiichi Tsukinoki
    Medicina.2023; 59(4): 789.     CrossRef
  • A diabetes update
    Zachary Bloomgarden
    Journal of Diabetes.2023; 15(7): 542.     CrossRef
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    I. P. Dunaieva, N. O. Kravchun, І. A. Ilchenko
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    Filippos Triposkiadis, Pantelis Sarafidis, Alexandros Briasoulis, Dimitrios E. Magouliotis, Thanos Athanasiou, John Skoularigis, Andrew Xanthopoulos
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    Min Kyong Moon
    The Journal of Korean Diabetes.2023; 24(3): 120.     CrossRef
Cardiovascular Risk/Epidemiology
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Association between Variability of Metabolic Risk Factors and Cardiometabolic Outcomes
Min Jeong Park, Kyung Mook Choi
Diabetes Metab J. 2022;46(1):49-62.   Published online January 27, 2022
DOI: https://doi.org/10.4093/dmj.2021.0316
  • 6,526 View
  • 244 Download
  • 6 Web of Science
  • 10 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReader   ePub   
Despite strenuous efforts to reduce cardiovascular disease (CVD) risk by improving cardiometabolic risk factors, such as glucose and cholesterol levels, and blood pressure, there is still residual risk even in patients reaching treatment targets. Recently, researchers have begun to focus on the variability of metabolic variables to remove residual risks. Several clinical trials and cohort studies have reported a relationship between the variability of metabolic parameters and CVDs. Herein, we review the literature regarding the effect of metabolic factor variability and CVD risk, and describe possible mechanisms and potential treatment perspectives for reducing cardiometabolic risk factor variability.

Citations

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    Hye Jin Yoo
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Original Articles
Cardiovascular Risk/Epidemiology
Article image
Appraisal of Guidelines for the Management of Blood Pressure in Patients with Diabetes Mellitus: The Consensuses, Controversies and Gaps
Menghui Liu, Shaozhao Zhang, Xiaohong Chen, Yue Guo, Xiangbin Zhong, Zhenyu Xiong, Yifen Lin, Huimin Zhou, Yiquan Huang, Zhengzhipeng Zhang, Lichun Wang, Xiaodong Zhuang, Xinxue Liao
Diabetes Metab J. 2021;45(5):753-764.   Published online April 23, 2021
DOI: https://doi.org/10.4093/dmj.2020.0134
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Currently available guidelines contain conflicting recommendations on the management of blood pressure (BP) in patients with diabetes mellitus (DM). Therefore, it is necessary to appraise the guidelines and summarize the agreements and differences among recommendations.
Methods
Four databases and the websites of guideline organizations were searched for guidelines regarding BP targets and thresholds for pharmacologic therapy in DM patients, and the included guidelines were appraised with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
Results
In 6,498 records identified, 20 guidelines met our inclusion criteria with 64.0% AGREE II scores (interquartile range, 48.5% to 72.0%). The scores of the European and American guidelines were superior to those of the Asian guidelines (both adjusted P<0.001). Most of the guidelines advocated systolic BP targets <130 mm Hg (12 guidelines, 60%) and diastolic BP targets <80 mm Hg (14 guidelines, 70%) in DM patients. Approximately half of the guidelines supported systolic BP thresholds >140 mm Hg (10 guidelines, 50%) and diastolic BP thresholds >90 mm Hg (nine guidelines, 45%). The tiny minority of the guidelines provided the relevant recommendations regarding the lower limit of official BP targets and the ambulatory BP monitoring (ABPM)/home BP monitoring (HBPM) targets and thresholds in DM patients.
Conclusion
The lower official BP targets (<130/80 mm Hg) in patients with DM are advocated by most of the guidelines, but they contain conflicting recommendations on the official BP thresholds. Moreover, the gaps regarding the lower limit of official BP targets and the ABPM/HBPM targets and thresholds need to be considered by future study.
Metabolic Risk/Epidemiology
Association between Higher Blood Pressure and Risk of Diabetes Mellitus in Middle-Aged and Elderly Chinese Adults
Xue Yang, Jian Chen, An Pan, Jason H.Y. Wu, Fei Zhao, Yue Xie, Yi Wang, Yi Ye, Xiong-Fei Pan, Chun-Xia Yang
Diabetes Metab J. 2020;44(3):436-445.   Published online November 14, 2019
DOI: https://doi.org/10.4093/dmj.2019.0081
  • 5,533 View
  • 89 Download
  • 12 Web of Science
  • 10 Crossref
AbstractAbstract PDFPubReader   
Background

To examine the prospective association between higher blood pressure (BP) and risk of type 2 diabetes mellitus (T2DM) in middle-aged and elderly Chinese adults.

Methods

A total of 9,642 middle-aged and elderly Chinese adults (≥45 years old; 47.30% men) without diabetes from the China Health and Retirement Longitudinal Study were included for analyses. Participants were categorized into three groups: normal BP, prehypertension, and hypertension, according to the 2010 Chinese Guidelines for the Management of Hypertension. The incidence of T2DM was determined by self-reported physician diagnosis during two follow-up surveys conducted in 2013 to 2014 and 2015 to 2016.

Results

During the 4-year follow-up, 429 participants (4.45%) developed T2DM, including 3.51% of the men and 5.29% of the women. The incidence rates of T2DM were 2.57%, 3.75%, and 6.71% in the normal BP, prehypertension, and hypertension groups, respectively. After adjustment for age, sex, education level, residence, smoking status, alcohol consumption, body mass index, waist circumference, and dyslipidemia, both prehypertension (odds ratio [OR], 1.32; 95% confidence interval [CI], 0.98 to 1.77) and hypertension (OR, 2.02; 95% CI, 1.54 to 2.64) were associated with increased risk of T2DM, compared to those with a normal BP. The ORs associated with T2DM were 1.08 (95% CI, 1.03 to 1.13) for an increase of 10 mm Hg in systolic BP and 1.06 (95% CI, 1.01 to 1.10) for an increase of 5 mm Hg in diastolic BP.

Conclusion

Higher BP is a risk factor for T2DM in middle-aged and elderly Chines. It may be a potential target for diabetes prevention.

Citations

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Epidemiology
Association of Visit-to-Visit Variability of Blood Pressure with Cardiovascular Disease among Type 2 Diabetes Mellitus Patients: A Cohort Study
Zhe-Bin Yu, Die Li, Xue-Yu Chen, Pei-Wen Zheng, Hong-Bo Lin, Meng-Ling Tang, Ming-Juan Jin, Jian-Bing Wang, Kun Chen
Diabetes Metab J. 2019;43(3):350-367.   Published online March 6, 2019
DOI: https://doi.org/10.4093/dmj.2018.0108
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Increasing evidence has shown that visit-to-visit variability (VVV) of blood pressure (BP) is associated with an increased risk of cardiovascular disease (CVD). The objective of this study was to evaluate the impact of VVV of systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the risk of CVD among patients with type 2 diabetes mellitus (T2DM) in China.

Methods

We conducted a retrospective cohort study of 10,163 T2DM patients who were not previously diagnosed with CVD from January 2008 to December 2012 in Ningbo, China. The VVV of BP was calculated using five metrics, including standard deviation (SD), coefficient of variation (CV), variation independent of mean, average real variability, and successive variability (SV) of measurements, obtained over a 24-month measurement period. Hazard ratios and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression models for the associations of variability in BP with risk of CVD.

Results

A total of 894 CVD events were observed during a median follow-up of 49.5 months. The hazard ratio in the highest quintile of SD of SBP was 1.24 (95% CI, 1.01 to 1.52) compared with patients in the lowest quintile. The association between higher VVV of DBP and risk of CVD was not consistent across different metrics and sensitivity analyses.

Conclusion

Higher VVV of SBP was associated with an increased risk of CVD, irrespective of the mean SBP level. Future studies are needed to confirm these findings.

Citations

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Higher Prevalence and Awareness, but Lower Control Rate of Hypertension in Patients with Diabetes than General Population: The Fifth Korean National Health and Nutrition Examination Survey in 2011
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Diabetes Metab J. 2014;38(1):51-57.   Published online February 19, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.1.51
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AbstractAbstract PDFPubReader   
Background

We investigated the prevalence, awareness, treatment, and control rate of hypertension in Korean adults with diabetes using nationally representative data.

Methods

Using data of 5,105 adults from the fifth Korea National Health and Nutrition Examination Survey in 2011 (4,389 nondiabetes mellitus [non-DM]), 242 newly diagnosed with DM (new-DM), and 474 previously diagnosed with DM (known-DM), we analyzed the prevalence of hypertension (mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication) and control rate of hypertension (blood pressure [BP] <130/80 mm Hg).

Results

The prevalence of hypertension in diabetic adults was 54.6% (44.4% in new-DM and 62.6% in known-DM, P<0.0001 and P<0.0001, respectively) compared with non-DM adults (26.2%). Compared to non-DM, awareness (85.7%, P<0.001) and treatment (97.0%, P=0.020) rates were higher in known-DM, whereas no differences were found between new-DM and non-DM. Control rate among all hypertensive subjects was lower in new-DM (14.9%), compared to non-DM (35.1%, P<0.001) and known-DM (33.3%, P=0.004). Control rate among treated subjects was also lower in new-DM (25.2%), compared to non-DM (68.4%, P<0.0001) and known-DM (39.9%, P<0.0001).

Conclusion

Higher prevalence and low control rate of hypertension in adults with diabetes suggest that stringent efforts are needed to control BP in patients with diabetes, particularly in newly diagnosed diabetic patients.

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Management of Blood Pressure in Patients with Type 2 Diabetes Mellitus: A Nationwide Survey in Korean
Mi Hae Seo, Woo Je Lee, Cheol Young Park, Sung Rae Kim, Joong Yeol Park, Kun-Ho Yoon, Moon Kyu Lee, Sung Woo Park
Diabetes Metab J. 2011;35(4):348-353.   Published online August 31, 2011
DOI: https://doi.org/10.4093/dmj.2011.35.4.348
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AbstractAbstract PDFPubReader   
Background

Hypertension is common in patients with type 2 diabetes, affecting up to 60% of patients. The Korean Diabetes Association performed a nationwide survey about prevalence, awareness and control of hypertension among diabetic Koreans.

Methods

The current survey included 3,859 diabetic patients recruited from 43 hospitals in Korea. Age, gender, height, weight and blood pressure (BP) were measured by standard methods. Data on fasting plasma glucose, glycosylated hemoglobin (HbA1c), awareness of hypertension, and compliance of antihypertensive medication were collected via interview and reviewed using patient medical records.

Results

A total of 57.5% of all patients were >60 years old. Their mean HbA1c was 7.6±1.5%. Among antihypertensive medication users, 39.9% had <130 mm Hg and <80 mm Hg, whereas 60.1% had ≥130 mm Hg or ≥80 mm Hg. The answer "BP is under good control" was given by 75.1% of the antihypertensive medication users. Out of these patients, 26.4% had <130 mm Hg and <80 mm Hg, whereas 73.6% had ≥130 mm Hg or ≥80 mm Hg. A total of 75.5% of antihypertensive medication users answered that they had taken their antihypertensive medication every day for the past 2 weeks. "Forgetfulness" was most frequently the reason of non-compliance for patients that did not take their antihypertensive medication regularly.

Conclusion

Approximately one third of the patients with diabetes were found to reach target blood pressure control in the 43 hospitals across Korea. Stricter control is needed to reduce severe complications of diabetes in Korea.

Citations

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Effect of Valsartan on Blood Pressure and Urinary Albumin Excretion in Hypertensive Type 2 Diabetic Patients: An Open-Label, Multicenter Study.
Se Jun Park, Dae Jung Kim, Hae Jin Kim, Soo Yeon Park, Ji A Seo, Nan Hee Kim, Sung Hee Choi, Soo Lim, Hak Chul Jang, Seung Hyun Ko, Ki Ho Song, Yu Bae Ahn, Soo Kyoung Kim, Yong Wook Cho, Jun Goo Kang, Sung Hee Ihm, Cheol Young Park, Sung Woo Park, Dong Hyun Shin, Yong Hyun Kim, Kwan Woo Lee
Korean Diabetes J. 2008;32(6):513-521.   Published online December 1, 2008
DOI: https://doi.org/10.4093/kdj.2008.32.6.513
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AbstractAbstract PDF
BACKGROUND
Activation of renin-angiotensin system (RAS) has been an important mechanism of microvascular and macrovascular complications in diabetic patients. It has been reported that RAS blockades reduce the development and progression of diabetic nephropathy. The aim of this study was to evaluate whether valsartan, an angiotensin II receptor blocker (ARB), reduced blood pressure and urinary albumin excretion rate (UAER) in hypertensive type 2 diabetic patients. METHOD: Three hundred forty-seven hypertensive type 2 diabetic patients who had not taken angiotensin converting enzyme inhibitors or ARB for 6 months prior to this study were enrolled. We measured blood pressure and UAER before and after 24 weeks of valsartan treatment. RESULT: Baseline mean systolic and diastolic blood pressure was 143 +/- 15 and 87 +/- 11 mmHg, respectively and the median albumin excretion rate was 27 ug/mg. Reduction in systolic and diastolic blood pressure was 16 mmHg/10 mmHg and the median UAER was 19.3 ug/mg after 24 weeks (P < 0.01, respectively). When we divided the subjects into three groups according to the UAER (normoalbuminuria, microalbuminuria and macroalbuminuria), significant changes were reported in the microalbuminuria and the macroalbuminuria groups. Thirty-eight (42%) patients with microalbuminuria improved to normoalbuminuria and twelve (41%) patients with macroalbuminuria improved to microalbuminuria. We found an association between the improvement of blood pressure and UAER (R = 0.165, P = 0.015). CONCLUSION: We concluded that valsartan reduces urinary albumin excretion and blood pressure in hypertensive type 2 diabetic patients.
Determinants of 1-Year Changes of Brachial Ankle Pulse Wave Velocity (baPWV) in Patients with Type 2 Diabetes Mellitus.
Kyung Won Yun, Bo Hyun Kim, Young Pil Bae, Byeong Do Yi, Seung Woo Lee, Hong Kyu Lim, Yeon Sik Ryu, Chang Won Lee
Korean Diabetes J. 2008;32(4):346-357.   Published online August 1, 2008
DOI: https://doi.org/10.4093/kdj.2008.32.4.346
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AbstractAbstract PDF
BACKGROUND
Cardiovascular disease is the leading cause of mortality in type 2 diabetes. PWV correlates well with arterial distensibility and stiffness and a useful approach for evaluating the severity of systemic atherosclerosis in adults, and, in particular, the measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple, noninvasive and practicable method. baPWV was mainly affected by age, SBP and sex. And also, baPWV was affected by many different factors such as body weight, BMI, waist to hip ratio, HbA1c, microalbuminuria, triglyceride, gammaGTP, duration of DM. We evaluated determinants of 1-year changes of baPWV in patients with type 2 DM. METHODS: The study group comprised 189 diabetic patients who measured ankle brachial pressure index (ABI), baPWV at base line and 1-year later. The anthropometric parameters, blood pressure, pulse pressure, fasting plasma glucose (FBS), fasting insulin, A1c, lipid profile, hsCRP, microalbuminuria, AST/ALT, gammaGTP were also checked concurrently. We also analyzed correlation between change of baPWV and subject's medications. We retrospectively analyzed the relationship between the 1-year changes of baPWV and the other factors. All analyses were performed with the SPSS Version 14.0 and P values < 0.05 were considered significant. RESULTS: baPWV change was affected by systolic blood pressure change, diastolic blood pressure change, pulse pressure change, body weight, BMI, triglyceride change, insulin treatment and total cholesterol. Multiple regression analysis of the relationship between change of baPWV and other associated variables shows that the 1-year change of baPWV was significantly associated with the changes of blood pressure and insulin treatment in patients with type 2 DM. CONCLUSION: 1-year change of baPWV was significantly associated with the changes of blood pressure in patients with type 2 DM.

Citations

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  • Independent association between glycated hemoglobin and arterial stiffness in healthy men
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Clinical Manifestation and Prognostic Factors in Nonketotic Hyperosmolar Coma.
Bo Wan Kim, Jung Guk Kim, Sung Woo Ha, Hyun Jeong Lee, Jeung Hun Han, Sang Won Jung, Jick Hwa Nam, Si Hyung Park, Soon Hee Lee
Korean Diabetes J. 1999;23(4):575-584.   Published online January 1, 2001
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AbstractAbstract PDF
BACKGROUND
Nonketotic hyperosmolar coma is usually a complication of non-insuli#n dependent diabetes and a syndrome of profound dehydration, hyperglycemia and hyperosmolarity. Therefore the patients present a progressive mental change. We evaluated the clinical manifestations of nonketotic hyperosmolar coma to assess the correlation between initial clinical manifestations and responses to treatment in patients with nonketotic hyperosmolar coma. METHODS: We studied 31 patients who had experienced proven nonketotic hyperosmolar coma at Kyungpook National University Hospital from March 1987 to February 1998. We divided nonketotic hyperosmolar coma patients into two groups, tbe complete recovery group and the incomplete recovery group, and compared clinical features and laboratory findings between these two groups. RESULTS: l) A total of 31 patients were studied. Eighteen patients were in the complete recovery group and thirteen patients were in the incomplete recovery group. 2) Mean age was 63.1+10.1 years old, initial blood glucose was 781.8+314.3 mg/dL, effective osmolarity was 342.6+34.9 mosm/L, arterial pH was 7.34. Serum creatinine level was 241.7+130.0 uol/L and BUN was 23.1+12.5 mmol/L. 3) Among clinical features of both groups (complete recovery and incomplete recovery groups), initial systolic blood pressure was 131.4+26.1 mmHg and 104.1+28.6 mmHg, diastolic blood pressure was 90.6+16.5 mmHg and 63.2+17.4 mmHg, and mean arterial blood pressure was 104.2 +18.2 mmHg and 76.8+19.7 mmHg. They revealed a significant difference statistically. 4) Arterial blood pH was 7.40 and 7.25, BUN was 18.4+11.7 mmol/L and 29.5+11.1mmol/L, and WBC count was 13850+4122/ mm and 19823+ 5946/mm. They revealed a significant difference statistically. 5) We also analyzed the significant factors together using multivariate logistic regression analysis. The only significant independent factor responsible for prognosis of nonketotic hyperosmolar coma was initial mean arterial blood pressure. CONCLUSION: Nonketotic hyperosmolar coma occurred more frequently in patients who were older and had abnormal renal function. The prognosis of patients was related with mean arterial blood pressure independently. Mean arterial blood pressure thought to be related to intravascular volume and arterial hypotension seems to reflect dehydration state. In conclusion, prevention and rapid correction of hypotension due to dehydration in older diabetics is the most important treatment to improve the prognosis.

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