Diabetes high risk groups

Influenza vaccine. Influenza vaccine is recommended annually for children age >6 months with certain risk factors (including but not limited to children with asthma, cardiac disease, sickle cell disease, human immunodeficiency virus infection, and diabetes and household members of persons in high-risk groups [see MMlV/ 2003 52(RR-8) 1-36j) and can be administered to all others wishing to obtain immunity. In addition, healthy children age 6 to 23 months are encouraged to receive influenza vaccine if feasible, because children in this age group are at substantially increased risk of influenza-related hospitalizations. Eor healthy persons age 5 to... 

Screening for gestational diabetes mellitus utilizes the oral glucose challenge test. Groups at high risk are African Americans, Native Americans, Asian Americans, Latino Americans, and Pacific Islanders. 

In high-risk individuals and groups people with clinical evidence of macrovascular disease other than CHD, the Heart Protection Study (HPS) (II) with diabetes, the HPS and Collaborative Atorvastatin Diabetes Study (CARDS) (12) the elderly, Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) (13) or with hypertension, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (14) and Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) (15). 

The major advantages of the systemic approach to restenosis should be the relatively inexpensive and also powerful and safety method to reduce restenosis in selected group of patients. Oral rapamycin can also be used in determining high risk subsets of patients such as those with diabetes, bifurcations, and in-stent restenotic lesions, alone or in conjunction with DES. In insulin-dependant diabetic patients, oral rapamycin together with DES may help to reduce the still higher than acceptable risk of restenosis that is currently reported with DES. 

The authors estimated that 5 years of statin treatment will prevent 100 major vascular events in every 1000 patients with previous myocardial infarction, or 70-80 events in patients with other forms of coronary heart disease or diabetes. There was no upper age limit to this benefit, and no lower limit to the level of LDL at which benefit was seen. Heart Protection Study Collaborative Group 2002 MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals. Lancet 360 7-22. 

In a randomized comparison of celecoxib and diclofenac plus omeprazole, renal adverse events, including hypertension, peripheral edema, and renal insufficiency, were common and similar in the two groups (105). They occurred in the 24% of the patients who took celecoxib and in 31% of those who took diclofenac plus omeprazole. Among patients with renal impairment at baseline, 51% of those who took celecoxib and 41% of those who took diclofenac plus omeprazole had renal adverse events. Careful monitoring of renal function in patients taking COX-2 inhibitors or traditional NSAIDs is mandatory, especially in high-risk subjects (for example those with pre-existing renal disease, diabetes, or heart failure). 

Fig. 1. Hazard ratios, with 95% confidence intervals as floating absolute risks, as estimate of association between category of update mean HbAlc concentration and any end point or deaths related to diabetes and all cause mortality. Reference category (hazard ratio 1.0) is HbAlc <6% with log-linear scales, p-value reflects contribution of glycaemia to multivariate model. Data adjusted for age at diagnosis of diabetes, sex, ethnic group, smoking, presence of albuminuria, systolic blood pressure, high- and low-density lipoprotein cholesterol and triglycerides [2].

Current guidelines recommend that asymptomatic patients with a CACS of <100 not undergo MPI, since this group has a low hkehhood of significant CAD, a very low incidence of stress-induced ischemia (<2%) and an exceedingly low cardiac event rate (Brindis et al. 2005). Notable exceptions may include asymptomatic high-risk patients, like diabetics. Conversely, patients with a CACS of >400 should routinely undergo... 

In a randomized controlled trial in patients with diabetic macular edema who were randomised to intravitreal ranibizumab 0.5 mg, focal or grid laser, and a combination of these interventions, there was one serious adverse event (a stroke in a high-risk patient), which was presumed to be unrelated to the use of ranibizumab because it occurred 6 weeks after the injection [10 ]. There was no difference in blood pressure. Eight patients across the groups had vitreous hemorrhages, and in one patient it was combined with worsening of the macular edema, while in the others it was mild and had cleared at 6 months. 

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