This study shows that 2 years of structured care combining lifestyle and pharmacological interventions improved several CV risk factors and reduced the estimated 10-year absolute risk for CHD in patients with Type 2 diabetes.

Significant CAD was found in 21% of asymptomatic patients with T2DM with >or=1 CV risk factor. Inflammatory markers may be helpful in identifying patients that are likely to have significant CAD, but larger studies are warranted.

Background: Diabetic foot ulcers (DFUs) are common complications of diabetes mellitus (DM), with a complex pathogenesis. Treatment is difficult and no single treatment with measurable clinical impact is available. In the present clinical pilot trial, we investigated whether statins could be of use against some of the pathogenic factors in DFUs. Methods: Thirteen diabetic patients (10 men; 11 with Type 2 DM; mean age 64 years; mean duration of DM 18 years) with neuropathic DFUs <4 months were randomized to treatment with either 10 mg (six patients; six ulcers) or 80 mg (seven patients; nine ulcers) atorvastatin for 6 months in addition to conventional DFU care (i.e. prompt debridement, DFU pressure relief, and management of any underlying infection). Results: There were no significant differences in background factors (i.e. HbA1c 8.9%, micro-and macrovascular complications, concomitant medications) or DFU characteristics (duration, surface area, grading) between the two groups. All ulcers in the group receiving 10 mg atorvastatin healed, compared with six of nine ulcers in the group receiving 80 mg atorvastatin (NS). However, two previously healed DFUs recurred and six new DFUs developed in the low-dose group compared with none and one, respectively, in the high-dose group (P = 0.048). There was a significant decrease in C-reactive protein ()1.5 mg ⁄ L; P = 0.044) and a non-significant trend towards beneficial effects on lipids and the ankle-arm blood pressure index in the high-dose compared with the low-dose group. Conclusions: We observed a possible beneficial effect of 6-months high-dose atorvastatin on DFUs, which should be tested in appropriately sized prospective studies.

BackgroundNovel and robust cardiovascular (CV) markers are needed to improve CV morbidity and mortality risk prediction in type 2 diabetes (T2D). We assessed the long term predictive value of 4 novel CV risk markers for major CV events and mortality.MethodsWe included patients with T2D who had cytokines (interleukin [IL]-6 and activin A [actA]), a maximum stress ECG test (evaluated by the normalization pattern in early recovery phase) and echocardiography (evaluated by a measure of the left ventricular filling pressure - E/Em) assessed at baseline. The primary endpoint was time to first of any of the following events: myocardial infarction, stroke, hospitalization for unstable angina pectoris and death. All outcomes were adjudicated by independent experts. We used Cox proportional hazard modeling, Harrell C-statistic and the net reclassification improvement (NRI) to assess the additional value beyond conventional markers (age, gender, prior CV disease, HDL, creatinine, diastolic BP, microalbuminuria).ResultsAt baseline the study cohort (n = 135, mean age/diabetes duration/HbA1c: 59 yrs/7 yrs/7.6% [59 mmol/mol], 26% females) had moderate elevated CV risk (42% microalbuminuria, mean Framingham 10 year CV-risk 9.6%). During 8.6 yrs/1153.7 person years, 26 patients experienced 36 events. All 4 novel risk markers were significantly associated with increased risk of the primary endpoint, however, only IL-6 and actA improved C-statistic and NRI (+0.119/43.2%, +0.065/20.3% respectively) compared with the conventional CV risk factors.ConclusionsIL-6 and actA may provide prognostic information on CV events and mortality in T2D beyond conventional CV risk factors.Trial registrationClinicalTrials.gov: NCT00133718

Background: The importance of spousal support in type 2 diabetes mellitus (T2DM) patient management is often neglected. We prospectively investigated spouses' needs for T2DM information, and whether their perceptions of health changes in their diabetic partners correlated with changes in objective and subjective health parameters for the partners. Methods: Spouses and partners with T2DM (n=52 per group) were followed for two years. Questionnaires on T2DM information/education and general health perception of themselves and their partners were given to spouses at start and end of study. Perceived changes in partners' health were compared with changes in objective (10-year Framingham coronary heart disease risk) and subjective (health-related quality-of-life [EuroQoL]) measures. Results: Spouses' (mean age±SD 58±10 years, n=42 females) self-reported needs for T2DM information/education were high at both assessments (61.5%/76.7%; 46.2%/63.0%, respectively). General health of diabetic partners (mean age 60±8 years, n=42 males) was perceived as improved by 10%, worsened by 27% and unchanged by 63% of spouses. Significant correlations were observed between spouses who perceived improvements in partners' health, and subjective and objective parameters of partners' health (EuroQoL scores increased by 18; Framingham risk reduced by 2.0±3.0%); similar correlations were observed in spouses who perceived worsening of partners' health (EuroQoL scores decreased by 7±15; Framingham risk increased by 1.7±4.1%). Spouses' results showed moderate sensitivity for capturing health worsening in relation to increase in Framingham risk (57%); specificity in relation to no change or reduction in Framingham risk was high (74%). Conclusion: Spouses' needs for T2DM information/education were high. Perceived changes in partners' health significantly correlated with subjective and objective outcome data. Further studies should investigate whether spouses' perceptions of negative changes could be used to trigger more intensive T2DM management strategies.