Diabetes mellitus, risk factor

Ryan, C.M., and D.J. Becker, Tlypoglycemia in children with type 1 diabetes mellitus. Risk factors, cognitive function, and management. Endocrinol Metab Clin North Am, 1999. 28(4) 883-900. 

Criteria for initiation of drug treatment now take into consideration total cardiovascular risk rather than blood pressure alone, such that treatment is now recommended for persons whose blood pressure is in the normal range but still bear a heavy burden of cardiovascular risk factors. Thus, the role of simultaneous reduction of multiple cardiovascular risk factors in improving prognosis in hypertensive patients is stressed. In addition, more aggressive blood pressure goals are recommended for hypertensive patients with comorbid conditions such as diabetes mellitus or renal insufficiency. 

Risk factors for embolic cerebrovascular accidents include previous ischemic stroke, transient ischemic attacks (TIA), systemic embolism, age >75 yr, moderately or severely impaired left ventricular systolic function, hypertension, diabetes mellitus... 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

The risk of gout increases as the serum uric acid concentration increases, and approximately 30% of patients with levels greater than 10 mg/dL (greater than 595 pmol/L) develop symptoms of gout within 5 years. However, most patients with hyperuricemia are asymptomatic. Other risk factors for gout include obesity, ethanol use, and dyslipidemia. Gout is seen frequently in patients with type 2 diabetes mellitus and coronary artery disease, but a causal relationship has not been established. 

For all ACS patients, treatment and control of modifiable risk factors such as hypertension, dyslipidemia, and diabetes mellitus are essential. 

The patient should be asked about existing personal risk factors for coronary heart disease (CHD) including smoking, hypertension, and diabetes mellitus. 

Other major risk factors include diabetes mellitus, dyslipidemia, and cigarette smoking. 

FIGURE 59-1. Pharmacotherapy treatment algorithm. A select population of individuals, based on body mass index (BMI) and waist circumference (WC) together with concurrent risk factors, may benefit from medication therapy as an adjunct to a program of weight loss that includes diet, exercise, and behavioral modification. (CHD, coronary heart disease DM, diabetes mellitus, HTN, hypertension INC WC, >40 inches for males and >35 inches for females LCD, low-calorie diet.)... 

Risk factors for TD include duration of antipsychotic therapy, higher dose, possibly cumulative dose, increasing age, occurrence of acute extrapyrami-dal symptoms, poor antipsychotic response, diagnosis of organic mental disorder, diabetes mellitus, mood disorders, and possibly female gender. 

The risk factors for vascular dementia are essentially the same as those for stroke and heart attack. They include high blood pressure, heart disease, diabetes mellitus, sickle cell disease, obesity, smoking, alcohol use, depression, and high cholesterol levels. 

Positive risk factors for CHD (other than high LDL) include Age (men 45 years of age or older women 55 years of age or older or women who go through premature menopause without estrogen replacement therapy) family history of premature CHD smoking hypertension (greater than 140/90 mm Hg) low HDL cholesterol (less than 35 mg/dL) obesity (more than 30% overweight) and diabetes mellitus. 

Stasis of the urinary flow (e.g. caused by kidney stones, anatomic abnormalities or an enlarged prostate), female gender and diabetes mellitus are risk factors for a UTI. 

Insulin resistance, frequently accompanied by obesity, is an important risk factor for HF development. Diabetes Mellitus itself increases the risk for HF as well. Those who are positive for urinary albumin excretion may develop more sever HF and are more at risk for mortal events. A recent report showed that diabetes is a potent, independent risk factor for mortality in patients hospitalized with HF. Interestingly, the excess risk in diabetic patients appears to be particularly prominent in females. In treating the patient with diabetes, one should pay attention to such variables. 

Management in all cases has the same three components. First, the obstruction must be removed or lysed. Second, risk factors such as cigarette smoking, hyperlipidaemia, diabetes mellitus or systemic hypertension recognized and corrected. 

Principal risk factors for heart disease are elevated levels of LDL cholesterol, a family history of heart disease, and hypertension. Other risks include being male, smoking, low levels of high density lipoprotein (HDL) cholesterol, diabetes mellitus, hyperhomocystinemia, high levels of lipoprotein a (Lpa), and high blood levels of C-reactive protein. (Table 23.1). C-Reactive protein is a marker for cellular inflammation. 

About 28% of patients develop IgG or IgE antibodies after a single exposure to protamine, but fortunately few develop a catastrophic allergic reaction on subsequent exposure to the drug. Nonetheless, prior exposure does increase the risk for an anaphylactic reaction. Other risk factors are fish allergy and patients with diabetes mellitus treated with neutral protamine Flagedorn (NPFI) insulin. After vasectomy, 22%... 

Atherosclerotic coronary heart disease (CHD) is a significant disease around the globe and is one of the major causes of death and cardiovascular morbidity in humans. Risk factors for CHD include hypertension, diabetes mellitus, male gender, cigarette smoking etc. but the most dominating risk factor is the serum cholesterol. 

In untreated women, the main risk factors for endometrial carcinoma are age, obesity, nulliparity, late menopause (and possibly early menarche), the Stein-Leventhal syndrome, exposure to exogenous estrogens, radiation, and certain systemic diseases, including diabetes mellitus, hypertension, hypothyroidism, and arthritis (SED-14, 1451) (88). Certain of these risk factors indicate that an altered endocrine state with increased estrogen stimulation is a predisposing cause, and one might thus in theory expect estrogen treatment (and notably hormonal replacement therapy) to increase the risk (SEDA-22, 466). 

Burge MR, Schmitz-Fiorentino K, Fischette C, Qualls CR, Schade DS. A prospective trial of risk factors for sulfonylurea-induced hypoglycemia in type 2 diabetes mellitus. JAMA I998 279(2) l 37 13. 

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