Conservative treatment of diabetic microangiopathy and macroangiopathy
Authors:
A. Šmahelová
Authors‘ workplace:
Univerzita Karlova v Praze, LF a FN Hradec Králové, Centrum a subkatedra diabetologie, Klinika gerontologická a metabolická
Published in:
Čas. Lék. čes. 2009; 148: 72-77
Category:
Review Article
Overview
Vascular complications represent the most frequent and the most serious complication of diabetes type 1 and type 2. High attention is paid to all manifestations of microangiopathy and macroangiopathy not only in studies of their pathogenesis, but also in numerous clinical reports revealing significant effect of conservative treatment in vascular diseases. It concerns namely microalbuminuria and proteinuria and also to the manifestations of diabetic nephropathy which are largely affected by antihypertensive and fibrate treatment as well as to diabetic retinopathy treatable by fibrates. In the treatment of diabetic microangiopathy a consistent attention must be paid to the treatment of hypertension and dyslipidemia, preferably using combinations of hypolipidemics. Already during selection of antidiabetics, possible vascular effects should be considered. Vascular wall and manifestations of vascular diseases can be positively influenced by so called insulin sensitizers, derivatives of sulphonylurea and metformin. In preparation there exist some other substances for the treatment of diabetic complications. Already now, every medical doctor should be able to select adequate treatment with antihypertensives, hypolipidemics and antidiabetics for the prevention or therapy of vascular diabetic complications.
Key words:
microangiopathy, macroangiopathy, vascular diseases, complication of diabetes, diabetic nephropathy, diabetic retinopathy
Sources
1. Geiss LS, et al. In national diabetes data group. Diabetes in America. Bethesda: National Institute of Health 1995; 233–257.
2. Fisman EZ, Tenenbaum A, et al. Cardiovascular diabetology. Advances in cardiology Basel: Karger 2008; 45.
3. Svačina Š, et al. Cévní komplikace diabetu. Praha: Galén 2005.
4. Adler AI, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ 2000; 12: 412–419.
5. Stratton IM, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 12: 405–412.
6. Stamler J, et al. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993; 16: 434–444.
7. Svačina Š. Hypertenze při obezitě a diabetu. Praha: Triton 2007.
8. Šmahelová A. Farmakoterapie diabetické retinopatie. Vnitř Lék 2007; 53: 512–520.
9. Kramer CK, et al. Impact of white-coat hypertension on microvascular complications in type 2 diabetes. Diabetes Care 2008; 31: 2233–2237.
10. Chatuverdi N, Sjoelie AK, et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes. The EUCLID Study Group. EURODIAB Controlled Trial of Lisinoperil in Insulin – Dependent Diabetes Mellitus. Lancet 1998; 35: 28–31.
11. Colhoun HM, Betteridge DJ, Durrington PN, et al. CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364: 685–696.
12. Wierzbicki AS. Fibrates after the FIELD study: Some answers, more questions. Diab Vasc Dis Res 2006; 3: 166–171.
13. Keech AC, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849–1861.
14. Duncan LJP, Cullen JF, Ireland JT, et al. A three-year trial of atromid therapy in exsudative diabetic retinopathy. Diabetes 1968; 17: 458–467.
15. Keech AC, et al. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet 2007; 370: 1687–1697.
16. Douglas K, et al. Meta-analysis: the effect of statins on albuminuria. Ann Intern Med 2006; 145: 117–124.
17. Fried LF, et al. Lipid modulation in insulin dependent diabetes mellitus: effect on microvascular outcomes. Journal of Diabetes and its Complications 2001; 15: 113–119.
18. Banerjee S, et al. Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease? Eye 2004; 18: 821–825.
19. Colman P, Rajamani K, Li L-P, et al. Benefits of long-term fenofibrate therapy on amputations in type 2 diabetes mellitus in the FIELD trial. On behalf of the FIELD study investigators, c/o NHMRC Clinical Trials Centre, University of Sydney, Sydney,Australia.http://www.fieldstudy.info/investigators/EASD2008_abstracts.asp
20. Nissen SE, et al. Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial. JAMA 2008; 299: 1561–1573.
21. Mazzone T, et al. Effect f pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized trial. JAMA 2006; 296: 2572–2581.
22. Ratner RE, et al. Assessment on the Prevention of Progression by Rosiglitazone on Atherosclerosis in diabetes patients with Cardiovascular History (APPROACH): Study design and baseline characteristics. Am Heart J 2008; 156: 1074–1079.
23. Shakuto S, Oshima K, Tsuchiya E. Glimepiride exhibits prophylactic effect on atherosclerosis in cholesterol-fed rabbits. Atherosclerosis 2005; 182: 209–217.
24. Katakami N, et al. Metformin or gliclazide, rather than glibenclamide, attenuate progression of carotid intima-media thickness in subjects with type 2 diabetes. Diabetologia 2004; 47: 1906–1913.
25. Danchin N, et al. Role of previous treatment with sulfonylureas in diabetic patients with acute myocardial infarction: results from a nationwide French registry. Diabetes Metab Res Rev 2005; 21: 143–149.
26. Siluk D, Kaliszan R, Haber P, et al. Antiaggregatory activity of hypoglycaemic sulphonylureas. Diabetologia 2002; 45: 1034–1037.
27. Dormandy JA, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macro Vascular Events): a randomised controlled trial. Lancet 2005; 366: 1279–1289.
28. Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 2007; 356: 2457–2471.
29. Home PD, Jones NP, Pocock SJ, et al. and RECORD Study Group. Rosiglitazone RECORD study: glucose control outcomes at 18 months. Diabet Med 2007; 24: 626–634.
30. Belch J, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; 337: a1840.
31. Ogawa H, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 2008; 300: 2134–2141.
32. Fong DS, Aiello L, Gardner TW, et al. and Klein R for the American Diabetes Association. Retinopathy in Diabetes. Diabetes Care 2004; 27: S84–S87.
33. Donnelly R, Idris I, Forrester JV. Protein kinase C inhibition and diabetic retinopathy: a shot in the dark at translational research. Br J Ophthalmol 2004; 88: 145–151.
34. Danis RP, Bingaman DP, Jirousek M, Yang Y. Inhibition of intraocular neovascularization caused by retinal ischemia in pigs by PKCbeta inhibition with LY333531. Invest Ophthalmol Vis Sci 1998; 39: 171–179.
35. Bakris GL, et al. Differential effects of beta-blockers on albuminuria in patients with type 2 diabetes. Hypertension 2005; 46: 1309–1315.
36. Hurley RW, et al. Pregabalin as a treatment for painful diabetic peripheral neuropathy: a meta-analysis. Reg Anesth Pain Med 2008; 33: 389–394.
37. Šmahelová A, et al. Effect of atorvastatin on non-cholesterol sterols in patients with type 2 diabetes mellitus and cardiovascular disease. Pharmacol Res 2005; 51: 31–36.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- Hypertension in pregnancy
- Abdominal obesity
- Conservative treatment of diabetic microangiopathy and macroangiopathy
- Double-balloon enteroscopy