Macrovascular complications

Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include coronary heart disease, stroke, and peripheral vascular disease. 

The goals of therapy in DM are to ameliorate symptoms of hyperglycemia, reduce the onset and progression of microvascular and macrovascular complications, reduce mortality, and improve quality of life. Desirable plasma glucose and glycosylated hemoglobin (A1C) levels are listed in Table 19-2. 

Older patients have predominantly Type 2 diabetes mellitus, which shares with Type 1 the risk for retinopathy, nephropathy and neuropathy, but carries a greater risk for macrovascular complications such as coronary artery disease, stroke and peripheral vascular disease. Many such patients have associated obesity, hypertension and hyperlipidemia, compounding the risk of cardiovascular disease. The goals of treatment of DM in the elderly are to decrease symptoms related to hyperglycaemia and to prevent long-term complications. Treatment of type 2 DM can improve prognosis. In the UKPDS trial, sulphonylureas, insulin, and metformin were all associated with a reduction in diabetes-related... 

Macrovascular complications are related to the cardiovascular system. His blood pressure and cholesterol are being controlled. 

Macrovascular complications at or before diagnosis Rare Common... 

Macrovascular Complications. The connection between high insulin levels (hyperinsulinemia), insulin resistance, and cardiovascular events incorrectly leads some clinicians to believe that insulin therapy may cause macrovascular complications. The UKPDS and DCCT found no differences in macrovascular outcomes with intensive insulin therapy. One study, the Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study " reported reductions in mortality with insulin therapy. This group assessed the effect of an insulin-glucose infusion in type 2 DM patients who had experienced an acute myocardial infarction. Those randomized to insulin infusion followed by intensive insulin therapy lowered their absolute mortality risk by 11% over a mean follow-up period of approximately 3 years. This was most evident in subjects who were insulin-naive or had a low cardiovascular risk prior to the acute myocardial infarction. " ... 

Macrovascular Complications. Metformin reduced macro vascular complications in obese subjects in the UKPDS. " Metformin significantly reduced all-cause mortality and risk of stroke vs. intensive treatment with sulfonylureas or insulin. Metformin also reduced diabetes-related death and myocardial infarctions vs. the conventional treatment arm of the UKPDS. Metformin should be included in the therapy for all type 2 DM patients, if tolerated and not contraindicated, as it is the only oral antihyperglycemic medication proven to reduce the risk of total mortality and cardiovascular death. 

MacrovaSCular Complications. Macrovascular outcome studies are in progress. Thiazohdinediones improve endothelial function, raise HDL levels, shghtly lower blood pressure, and have been shown to reduce restenosis after percutaneous transluminal coronary artery stenting. 

Macrovascular Complications. The STOP-NIDDM study demonstrated that acarbose can decrease the conversion rate of impaired glucose tolerance to diabetes, as well as reduce the risk of... 

A comprehensive pharmaceutical care plan for the patient with DM will integrate considerations of goals to optimize blood glucose control and protocols to screen for, prevent, or manage microvascular and macrovascular complications. In terms of standards of care for persons with DM, one can review the document published by the American Diabetes Association that outlines initial and ongoing assessments for patients with DM. For quality-of-care measures, one can refer to the National Diabetes Quality Improvement Alliance web site at... 

Chronically elevated levels of glucose in the blood may contribute to the y w J development of the microvascular complications of diabetes mellitus, such as diabetic retinal damage, kidney damage, and nerve damage, as well as macrovascular complications such as cerebrovascular, peripheral vascular, and coronary vascular insufficiency. The precise mechanism by which long-term hyperglycemia induces these vascular changes is not fully established. 

One of the hypotheses for the development of vascular occlusion that precedes proliferative diabetic retinopathy is that disturbances in the thrombocyte aggregation lead to leukostasis and formation of microthrombosis in the retinal capillaries. Consequently, attention has been focused at treating diabetic retinopathy with inhibitors of thrombocyte aggregation. However, a prospective study has shown that acetyl salicylic acid does not reduce the development of diabetic retinopathy. Additionally, this treatment does not increase the risk of developing complications such as vitreous hemorrhage. This is important evidence since inhibitors of thrombocyte aggregation are often used to reduce the risk of the development of the macrovascular complications of the disease [12]. 

Glyeaemie control is not the only factor of importance with smoking in diabetics. Cigarette smoking may also accelerate progression of atherosclerosis, increase blood pressure, and increase macrovascular complications. Diabetics who smoke should be given all the help they need to stop smoking. ... 

The incidence of type 2 (noninsulin-dependent) diabetes mellitus continues to increase in the United States (1). Consequently, the associated morbid and mortal events from the associated microvascular and macrovascular complications of this disease have also risen (1). The preponderance of research toward the understanding of vascular disease in diabetes has been directed toward the delineation of end organ injury from microvascular disease. Consequently, the focus on macrovascular peripheral vascular disease has been relatively ignored. However, several studies have elucidated both the incidence and prevalence of peripheral vascular disease associated with both type 1 (insulin-dependent) and type 2 diabetes mellitus. In general, these studies have found that the duration of diabetes is perhaps the best correlate to predict the development of coronary artery and renal disease, as well as other associated end organ injuries that have not consistently correlated with the development of peripheral vascular disease. 

Rohatgi A, McGuire DK. Effects of the thiazolidinedione medications on micro and macrovascular complications in patients with diabetes—update 2008. Car-diovasc Drugs Ther 2008 22 233 10. 

The first test of the RAGE hypothesis in macrovascular complications of diabetes employed soluble RAGE. Initially, a model system of accelerated atherosclerosis was... 

Hyperglycaemia is less marked than in type I diabetes, because there is some insulin function. Type II diabetics do not become ketoacidotic. Patients are usually overweight and have slower progressing symptoms. They may present with complications of poorly controlled blood glucose, either macrovascular or microvas-cular. Macrovascular complications include ischaemic heart disease, cerebrovascular disease or peripheral vascular disease. Microvascular complications include retinopathy (eyes), nephropathy (kidney) or neuropathy (nerves). Type II diabetes is generally treated through a controlled diet and weight loss. 

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