Diabetes associated diseases

For more information about the prevalence of diabetes, see URLs by the International Diabetes Federation at www.idf.org the World Health Organization at www.who.int the Center for Disease Control at www.cdc. gov/diabetes and the American Diabetes Association at www.diabetes. org. 

Low-dose diuretics and /3-blockers, which have demonstrated positive effects on mortality, are indicated as first choice treatment. This is still maintained in the new recommendations for patients with uncomplicated hypertension (Table 5). However, other treatments are recommended for hypertensive patients with associated diseases (Table 6). Hypertension with diabetes or renal dysfunction must be treated with an ACE inhibitor in the first instance. Patients with myocardial infarction should be treated with /S-blockers and in specific cases with an ACE inhibitors. For patients with heart failure, the treatment of choice is an ACE inhibitor and diuretics. For older patients with isolated SBP, low-dose diuretics are recommended as the first step treatment and some of the CCB with long acting profile can be considered an alternative treatment. 

According to the latest report of the American Diabetes Association in 2006, there are at least 20.8 million children and adults in the United States, or 7% of the population, who have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, unfortunately, 6.2 million people (or nearly one-third) are unaware that they have the disease. That is why diabetes is also known as the silent killer. The rapid increase in the number of silent killers has caught the attention of the research world and recently almost double the number of scientists are working in this area compared to the last decade. 

Intensive pharmacologic treatment of diabetes is known to decrease the risk for microvascular events such as nephropathy and retinopathy, but there is less evidence that it decreases macrovascular disease (28,29). DCCT/EDIC trial, however, demonstrated reduction in CVD (nonfatal Ml, stroke, death from CVD, confirmed angina, or the need for coronary-artery revascularization) in patients with type I diabetes assigned to intensive diabetes treatment compared with conventional treatment by 42% (p = 0.02) (30). Patients with lower extremity PAD and both type I and type 2 diabetes should be treated to reduce their glycosylated hemoglobin (Hb AIC) to less than 7%, per the American Diabetes Association recommendation (31). Subanalysis of the UKPDS showed no evidence of a threshold effect of Hb AIC a I % reduction in Hb Al C was associated with a 35% reduction in microvascular endpoints, an 18% reduction in Ml, and a 17% reduction in all-cause mortality. Frequent foot inspection by patients and physicians will enable early identification of foot lesions and ulcerations and facilitate prompt referral for treatment (32). 

Linkage of the HLA region to type-1 diabetes was demonstrated initially with 15 affected sib pairs (21) (Table la). This linkage, termed IDDM1, has been confirmed in many studies (Table lb), with a mean IBD sharing of parental alleles for HLA of 72% (22-25). For some other HLA associated diseases, e.g., multiple sclerosis and rheumatoid arthritis, the initial number of affected sib pairs required to show evidence of linkage has been larger, at least 50 and sometimes around 100 (26,27). 

The existence of non-HLA genes in many of the HLA associated diseases was established from theoretical considerations involving population prevalence, risks to relatives, and HLA IBD values in affected sib pairs (28-30). Type-1 diabetes shows an increased risk in siblings over population prevalence (Xs) of 15 in Caucasian populations (30), of which HLA contributes 3.4 approximately 45% of the type-1 diabetes genetic component under a multiplicative model (31). 

Recently, thalidomide has gained approval for use in the United States as an immunomodulatory agent in the treatment of HIV-associated diseases, arthritis, myeloma, and diabetic retinopathy. The FDA has instituted the System of Thalidomide Education and Prescribing Safety (STEPS) to prevent accidental exposures during pregnancy. 

Diabetes Cardiovascular Disease Review Flypertension in Diabetes, a publication of the American Diabetes Association/American College of Cardiology, 2002. 

Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascnlar diseases in people with diabetes mellitus a scientific statement from the American Heart Association and the American Diabetes Association. Circnlation 2007 115 114-126. 

Wood D et al 1998 Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 80(Suppl) Sl-29. (British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, British Diabetic Association). 

Skeleton Renal phosphate diabetes associated with hypercalciuria may lead to osteomalacia or osteoporosis. Likewise, inflammatory or degenerative arthrosis is thought to be a late manifestation of Wilson s disease. (354) Often, these developments are combined with intra-articular calcium deposits and chondromalacia, in particular patellar chondromalacia. Bone fractures are frequently observed even with minor traumas. Calcification may occur in articular cartilage, capsule and tendinous insertions, and deposits of calcium pyrophosphate dihydrate can appear in the intervertebral disks. 

For diabetic patients overall, the mortality risk is about twice that in the age-matched non-diabetic population. ForType-I, the overall life expectancy is reduced by about 30%. The most frequent cause of mortality in Type-I diabetes is nephropathy (Palmberg et al., 1981) 35% of Type-I diabetics die from renal failure, 15% from coronary heart disease and 15% from infectious disease. Type-I diabetics whose disease appears before puberty have a still higher risk of developing nephropathy, associated with premature death. 

According to the Canadian Diabetes Association, four out of five people with diabetes die of heart disease. Other complications of diabetes include kidney and nerve damage, blindness, and sexual dysfunction. A study conducted by the University of Texas Southwestern Medical Center in Dallas found that people with Type 2 diabetes have highly acidic urine and are at greater risk of developing uric acid kidney stones.17... 

An abundance of food has obvious consequences it promotes our specific appetites. Lipids account for about 40% of the calories ingested in Western countries, whereas nutritional recommendations are 5-10% lower. This excessive lipid intake, associated with a qualitative imbalance (excess of saturated fatty acids and cholesterol, too high to6/to3 ratio) strongly favours the development of obesity and associated diseases (atherosclerosis, non insulin-dependent diabetes, hypertension, cancer). This attraction to fatty foods is not specific to humans. Rats and mice spontaneously prefer lipid-rich foods if provided with a free choice (Tsuruta et al. 1999 Takeda et al. 2000). This attraction to lipids is so strong that mice given free access to an oil as an optional diet rapidly become obese (Takeda et al. 2001a). The origin of this preference for lipids remains unclear. 

AECAPS/TexCAPS = Air ForceAexas Coronary Atherosclerosis Prevention Study (Downs et ah, 1998) Helsinki = The Helsinki Heart Study (Frick et al., 1 987) LRC-CPPT = The Lipid Research Clinics Coronary Primary Prevention Trial (insull et al., 1984) Oslo = The Oslo Study (Hjermann et ah, 1988) WOSCOPS = The West of Scotland Coronary Prevention Study (Shepherd et al., 1995) ALLHAT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial approximately 13-15% of patients had a history of coronary heart disease (CHD) events are CHD events only WHI = Women s Health initiative RRR = relative risk reduction ARR = absolute risk reduction NNT = number needed to treat NA = not available CEE = conjugated equine estrogen MPA = medroxyprogesterone acetate CARDS = Collaborative Atorvastatin Diabetes Study (presented at the 2004 American Diabetes Association meeting). 

Lacquemant, C., Lepretre, R, Pineda Torra, I., Manraj, M., Charpentier, G., Ruiz, J., Staels, B., and Froguel, P. (2000). Mutation screening of the PPARalpha gene in type 2 diabetes associated with coronary heart disease. Diabetes Metab 26, 393-401. 

Diabetes mellitus is a group of metabolic diseases characterized by an increased blood glucose level secondary to defects in insulin secretion and/or action. According to the American Diabetes Association, as of 2002, the United States diabetes prevalence is 18.2 million people (6.3% of the population). Diabetics suffer from acute complications of the disease such as diabetic ketoacidosis and hyperosmolar nonketotic syndrome as well as chronic complications ranging from microvascular disease (nephropathy, neuropathy, retinopathy) to macrovascular disease (1). 

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