Management of type-2 diabetes with anti-platelet therapies special reference to aspirin

Abstract

Adult onset diabetes currently affects 380 million individuals worldwide and is expected to affect 380 million by 2025. Major defects contributing to this complex disease are insulin resistance and beta cell dysfunction. More than 80% of patients professing to type-2 diabetes are insulin resistant. Recent studies have shown that the Indian subcontinent ranks very high in the occurrence of Diabetes and Coronary artery disease (1, 2, 3). Patients with Type 2 diabetes carry an equivalent cardiovascular risk to that of a non-diabetic individual who has already experienced a coronary event. The risk of coronary artery disease in any given population seems to be 2-3 times higher in diabetics than non-diabetics. Inflammation, platelet activation, endothelial dysfunction and coagulation are the four processes, whose interplay determines the development of cardiovascular disease. In this article, we provide a brief overview on platelet physiology, vascular dysfunction, platelet hyper-function, and the role of platelet related clinical complications in diabetes mellitus and what is know about the management of this complex disease with anti-platelet drugs such as aspirin and Clopidogrel.

Evaluation the effect of low-dose aspirin on endothelial dysfunction in preeclamptic patients

“…also reported that antiplatelet treatment can reduce vascular dysfunction. [10] Magen et al . in a study at 2005 showed that addition of low-dose aspirin to antihypertensive treatment and statins in hypertensive and hypercholesterolemic patient can reduce systolic and diastolic blood pressure through improved NO-mediated endothelial function.…”

Antiplatelet and anticoagulant therapy in elderly people with type 2 diabetes mellitus in Poland (based on the PolSenior Study)

“…Coronary artery disease is the primary cause of death in diabetic patients aged > 65 years (about 70%), whereas cerebrovascular disease is the primary cause of death in about 15% [ 1 , 2 ]. The most frequent causes of thrombotic events in T2DM are the following: impaired platelet function (increased processes of adhesion, aggregation, and activation, increased platelet turnover), endothelial dysfunction (increased expression of adhesion molecules, enhanced production of vasoconstrictors such as angiotensin II, endothelin 1, thromboxane etc., decreased production of vasodilators such as nitric oxide, increased oxidative stress) and impaired fibrinolysis [ 3 – 5 ]. Until 2010, the use of acetylsalicylic acid (ASA) for cardiovascular protection had been recommended to each diabetic patient.…”

Diabetes Management: Expectations and Limitations

“…Eighty percent of Type-2 diabetes is preventable by changing diet, increasing physical activity and improving the lifestyle. As a part of its Global mission to promote diabetes care and prevention, International Diabetes Federation develops guidelines, which review evidence to date on post-meal-glucose values and the development of clinical complications of diabetes [10]. These guidelines and recommendations are intended to help clinicians and professional organizations in developing strategies for effective management of PMG in diabetics.…”

“…All Gulf countries have very high incidence of type-2 diabetes. According to the international Federation Guidelines, there is increasing evidence that supports the importance of controlling or managing all the three components of the glucose triad; hemoglobin A1c, Fasting Glucose, and Post Prandial Glucose [10]. Post-meal glycemia (PMG) is defined as 140 mg of glucose/dl, 2 hr after the ingestion of a meal.…”

“…A meta-analysis that included randomized controlled studies found that low carb, non-energy restricted diets appear to be at least as effective as low-fat energy-restricted diets, in inducing weight loss for up to one year. When discussing about the diet and diabetes, one can conclude that lowering the glycemic index and the absolute amount of carbohydrates in the diet, can have a profound effect upon lowering the blood glucose; whereas dietary protein has very little effect on blood glucose and dietary fat has none [9][10][11][12][13][14][15].…”