2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2019

Abstract

Background. Endothelial dysfunction, induced by some cardiovascular risk factors, is the early determinant of atherosclerotic cardiovascular disease. Moreover, it predicts incident type-2 diabetes that is associated with an increased risk of fatal and nonfatal cardiovascular events; however, no data demonstrating a possible interaction between them in predicting cardiovascular outcomes are available. Thus, we designed present study to evaluate the prognostic signi cance of the joint effect of endothelial dysfunction and new-onset type-2 diabetes in hypertensives. Methods. We enrolled 653 white never-treated hypertensive outpatients free of cardiovascular events from the CATanzaro Metabolic Risk factors (CATAMERI) study. All subjects were without type-2 diabetes, heart failure and chronic kidney disease. Endothelium-dependent vasodilation was investigated by intraarterial infusion of acetylcholine, and laboratory determinations were obtained by standard procedures. Follow-up included periodic control visits every six months in our outpatients Clinic and ranged from 26-206 months (median 113). Patients were treated to reduce blood pressure <140/90 mmHg using standard lifestyle and pharmacological treatment. Incident type-2 diabetes and following cardiovascular events were monitored: fatal and nonfatal myocardial infarction and stroke, TIA, unstable angina, coronary revascularization procedures and symptomatic aortoiliac occlusive disease. Results. We documented 191 new cardiovascular morbid events (3.1%) at the cardiac (n=134), cerebrovascular (n=50), or peripheral (n=7) level. Dividing the study population in progressors and nonprogressors, progressors were older and had a higher baseline heart rate, fasting insulin, HOMA, creatinine, and hs-CRP mean values, while e-GFR and acetylcholine-stimulated forearm blood ow (FBF) were lower. Similarly, incident type-2 diabetes was higher in the progressors group. In the multiple Cox regression analysis, incident diabetes (HR=2.015, 95%CI=1.416-2.868), hs-CRP (HR=1.306, 95%CI=1.213-1.407) and acetylcholine-stimulated FBF (HR=0.729, 95%CI=0.633-0.839) maintained an independent association with the outcomes. The interaction between new-onset diabetes and FBF demonstrated that patients with new diabetes and maximal FBF under the median show a higher risk for subsequent cardiovascular events (HR=7.411, 95%CI=4.875-11.265). Conclusions. Endothelial dysfunction and new-onset diabetes predict cardiovascular events and their joint effect greatly increases this risk. These results highlight the importance of interaction between hemodynamic and metabolic alterations in predicting cardiovascular events.

Cluster Analysis Based on Fasting and Postprandial Plasma Glucose and Insulin Concentrations

“…It is important to note that we have named cluster C1 the one with the most subjects and cluster C3 the one with fewer subjects, as shown in Table 1. Moreover, the results of the clustering algorithm are in accordance with the diagnostic values of diabetes and prediabetes stated by the American Diabetes Association [6]: cluster C2 contains prediabetics, The variable shows significant difference between clusters C1 and C3.…”

“…Diabetes is a progressive disease characterized by high blood glucose levels due to poor performance in the production or action of insulin [6,17]. There is no clear knowledge about the instant in which diabetes occurs but there are pre-diabetic conditions, such as impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), that predispose the development of diabetes [10] and increase the risk of cardiovascular diseases [19].…”

“…Diabetes, IGT and IFG can be diagnosed from the oral glucose tolerance test (POTG) [20], a clinical test consisting of five plasma glucose and insulin measurements, one in fasting and, after oral intake of 75 grams of liquid anhydrous glucose, four others each 30 minutes. IGT is diagnosed when plasma glucose levels at 120 minutes are between 140 and 200 mg/dL and IFG is diagnosed when fasting glucose levels are between 100 and 125 mg/dL [6].…”

Characteristics and Early Hypoglycemic Medications of Patients at Risk of Progression to Type 2 Diabetes in Japan: A Retrospective Cohort Study of Health Checkup and Claims Data

“…This indicated that, except in patients with severe disease, hypoglycemic medications were started far earlier than the period recommended by the current guidelines, which showed the efficacy of preventing type 2 diabetes with 1-4 years of lifestyle interventions. 1,17) The guidelines recommend lifestyle interventions, but the terms of these interventions have not been clarified for patients with risks of type 2 diabetes. Thus, it seems that patients have difficulty improving their lifestyle in clinical practice.…”

The relationship between periodontitis and diabetic retinopathy: A cross-sectional longitudinal study

“…6 The American Diabetes Association recommended a glycated haemoglobin target of <7 to prevent microvascular complications including diabetic retinopathy. 7 Periodontitis is a chronic inflammation of periodontal tissue and may result in tooth loss due to destruction of surrounding bone, the disease is the six complication of diabetes after microvascular and macrovascular complications and delayed wound healing. Besides, periodontitis could be considered as a potential modifiable and independent risk of diabetes mellitus.…”