Diabetes Intervention and Complications

Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Intensive diabetes therapy and carotid intima-media thickness in type 1 diabetes mellitus. N Engl 3 Med 2003 348 2294. 

Danesh J, Whincup P, Walker M et al. (2000). Chlamydia pneumoniae IgG litres and coronary heart disease prospective study and metaanalysis. British Medical Journal 321 208-213 Danesh J, Whincup P, Walker M (2003). Chlamydia pneumoniae IgA litres and coronary heart disease prospective study and meta-analysis. European Heart Journal 24 881 Danesh J, Lewington S, Thompson SG et al. (2005). Plasma fibrinogen level and the risk of major cardiovascular diseases and non-vascular mortality an individual participant meta-analysis. Journal of American Medical Association 294 1799-1809 Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications Research Group (2003). 

At the conclusion of the DCCT, 95% of the participants enrolled in the long-term follow-up study, termed the Epidemiology of Diabetes Interventions and Complications (EDIC). Five years after the end of the DCCT, there was no difference in metabolic control (assessed by GHb measure-... 

A meta-analysis of 16 clinical studies showed a benefit of intensive blood glucose control in patients with type 1 diabetes as evidenced by a reduction in the frequency, severity, and a delay in the development or progression of diabetic comphcations including nephropathy. The Epidemiology of Diabetes Interventions and Complications study, which observed the DCCT subjects for an additional 4 years while they were receiving care from primary physicians, showed a continued benefit of IIT on the risk of nephropathy as defined by the development of microalbuminuria (53% odds ratio reduction in microalbuminuria). ... 

The Diabetes Control and Complications Trial (DCCT), the Stockholm Diabetes Intervention Study (DIS), the United Kingdom Prospective Diabetes Study (UKPDS), and the Japanese Kumamoto study show unequivocally that vigorous treatment of diabetes can decrease both the morbidity and mortality of the disease by reducing chronic complications. 

It has been proposed that the development of the complications of diabetes mellitus may be linked to oxidative stress and therefore might be attenuated by antioxidants such as vitamin E. Furthermore, it is discussed that glucose-induced vascular dysfunction in diabetes can be reduced by vitamin E treatment due to the inactivation of PKC. Cardiovascular complications are among the leading causes of death in diabetics. In addition, a postulated protective effect of vitamin E (antioxidants) on fasting plasma glucose in type 2 diabetic patients is also mentioned but could not be confirmed in a recently published triple-blind, placebo-controlled clinical trial [3]. To our knowledge, up to now no clinical intervention trials have tested directly whether vitamin E can ameliorate the complication of diabetes. 

Peripheral neuropathy (degeneration of peripheral sensory and/or motor neurons) represents another target for neurotrophic intervention. It often occurs as a complication of diabetes or in cancer patients receiving chemotherapy. In severe cases, amputation of limbs affected by neuronal loss is warranted. Pre-clinical studies have clearly shown that sensory and sympathetic neurons depleted in peripheral neuropathy respond to NGF. Indeed, NGF, along with IGF-1, can prevent the occurrence of drug-induced peripheral neuropathy in animals. Human clinical trials continue. 

HbAi, Is patient .complying with treatment protocol .. 10.6% (no. change in. a. -. year) Consider changing. treatment, closer monitoring of compliance, clinic visits and. . . consultations with, diabetes. . Persistently high HbAic carries increased risk of complications . intervention.necessary to decrease risk. ... 

A number of classification schemes have been developed to describe SSTIs. Bacterial infections of the skin can be classified as primary or secondary (Table 108-1). Primary bacterial infections usually involve areas of previously healthy skin and typically are caused by a single pathogen. In contrast, secondary infections occur in areas of previously damaged skin and are frequently polymicrobic. SSTIs are also classified as complicated or uncomplicated. Infections are considered complicated when they involve deeper skin structures (e.g., fascia, muscle layers, etc), require significant surgical intervention, or occur in patients with compromised immune function (e.g., diabetes mellitus, human immunodeficiency virus [HIV] infection, etc). ... 

---