Microvascular complications

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

Intensive therapy in patients with type 1 and type 2 diabetes reduces microvascular complications, including nephropathy. Intensive therapy can include insulin or oral drugs and involves blood sugar testing at least... 

Joy SV, Scates AC, Bearelly S, Dar M, Taulien CA, Goebel JA, Cooney MJ. (2005) Ruboxistaurin, a protein kinase-c beta inhibitor, as an emerging treatment for diabetes microvascular complications. Ann Pharmacother 39 1693-1699. 

Clarke M, Dodson PM. (2007) PKC inhibition and diabetic microvascular complications. Best Pract Res Clin Endocrinol Metab 21 573-586. 

Tolbutamide is one of the most widely used antidiabetic agents. Its action is preferably connected with stimulatory action of j3-cells in the pancreas, which results in intensive insulin secretion. It is used for type II diabetes melhtus of medium severity with no expressed microvascular complications. Synonyms of this drug are mebenol, oramid, ora-bet, tolbuton, butamide, rastinon, and others. 

This drug is also a derivative of first generation of sulfonylurea, and it possesses stimulatory action on 8-cells in pancreas, as well as the same range of action as all other drugs of the group of examined compounds. Tolazamide is used for non-insulin-dependeut diabetes mellitus without expressed microvascular complications. Synonyms of this drug are uor-glycin, tolanase, and others. 

Results of the DCCT in type 1 diabetes showed that improving glycaemia with intensive insulin treatment delayed the onset and slow the progression of microvascular complications, such as retinopathy, neuropathy and nephropathy. 

Tight control of diabetes, with reduction of HbAic from 9.1% to 7%, was shown to reduce the risk of microvascular complications overall compared with that achieved with conventional therapy (mostly diet alone, which decreased HbAic to 7.9%). Cardiovascular complications were not noted for any particular therapy metformin treatment alone reduced the risk of macrovascular disease (myocardial infarction, stroke). Epidemiologic analysis of the study suggested that every 1% decrease in the Aic achieved an estimated risk reduction of 37% for microvascular complications, 21% for any diabetes-related endpoint and death related to diabetes, and 14% for myocardial infarction. 

Tight control of hypertension also had a surprisingly significant effect on microvascular disease (as well as more conventional hypertension-related sequelae) in these diabetic patients. Epidemiologic analysis of the results suggested that every 10 mm Hg decrease in the systolic pressure achieved an estimated risk reduction of 13% for diabetic microvascular complications, and 12% for any diabetes related complication,... 

Adler AI etal Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36) Prospective observational study. Br Med J 2000 321 412. [PMID 10938049]... 

United Kingdom Prospective Diabetes Study (UKPDS) Group Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes UKPDS 38. Br Med J 1998 317 703. 

Drugs that selectively inhibit the aldose reductase enzyme represent a possible method for reducing peripheral neuropathies and other microvascular complications associated with poorly controlled type 1 or type 2 diabetes.26,45 This enzyme, which is located in... 

Chung SS, Chung SK. Aldose reductase in diabetic microvascular complications. Curr Drug Targets. 2005 6 475-486. 

Riihimaa P. Markers of microvascular complications in adolescents with type 1 diabetes. PhD dissertation, University of Oulu, Finland, 2003. 

Reusch JEB. Diabetes, microvascular complications, and cardiovascular complications what is it about glucose Journal of Clinical Investigation 2003, 112, 986-988. 

Correa RC, Alfieri A. Plasmatic nitric oxide, but not Willebrand factor, is an early marker of endothelial damage, in type 1 diabetes mellitus patients without microvascular complications. Journal of Diabetes and Its Complications 2003, 17, 264-268. 

A common genetic variation (A1166Q in the 3 untranslated tract at the ATI locus is associated with a small effect on blood pressure that may predispose individuals to essential hypertension (132,133). No consistent association of genetic variation in ATI has been observed to predispose individuals to myocardial infarction, ventricular hypertrophy, and microvascular complications (134)... 

There is little debate today regarding the benefits of tight glycemic control in type 2 diabetes. Results of the landmark United Kingdom Prospective Diabetes Study demonstrate conclusively that intensive glycemic control significandy influences the development of many of the destructive effects of type 2 diabetes. Over a 10-year period, for example, a reduction of 11 % in the HbAic of patients receiving intensive therapy was associated with a 25% reduction in microvascular complications (114). 

The Diabetes Control and Complications Trial (DCCT) has shown that intensified diabetes therapy resulted in HbAlc reductions of approximately 2% compared to conventional therapy, and that patients practicing intensified diabetes therapy enjoyed significant reductions in the feared microvascular complications of diabetes (DCCT Research Group, 1993). As such, the current aim of diabetes therapy is to achieve glycemic control that is as close to normal as possible while maintaining an acceptable quality of life for those patients for whom the therapy is prescribed.The DCCT also demon-... 

What are the macrovascular and microvascular complications of the condition, and which of them is he exhibiting ... 

The aim of treatment is for the patient to attain the target HbAlc level of 6.5%, but not below this, to reduce the risk of suffering with microvascular complications. All patients should be given structured education (such as diet and exercise) and self-monitor their plasma glucose to ensure that they attain their individually agreed target. All choices are based on patient acceptability and cost-effectiveness. The following steps are recommended if HbAlc is not maintained below 7.5% ... 

Stratton IM, Adler Al, Neil HAW, Matthews DR, Manley SE, Cnll CA, et al. Association of glycaemia with macrovascnlar and microvascular complications of type 2 diabetes (UKPDS 35) prospective observational study. BMJ. 2000 321 405-412. 

Complications of diabetes. A well-controlled diabetic is less liable to ketosis and infections. It is now certain that good control of glycaemia mitigates the serious microvascular complications, retinopathy, nephropathy, neuropathy and cataract. Too tight control of glycaemia can increase the frequency of attacks of hypoglycaemia. 

Most patients with both Type 1 and Type 2 succumb to either the macrovascular or microvascular complications — especially ischaemic heart disease and diabetic nephropathy, respectively. Indeed diabetes is the major indication for dialysis and transplantation. As discussed in other chapters, the treatment of hypertension and hyperUpidaemia is particularly important in patients with diabetes. Patients with diabetic nephropathy should receive either an ACE inhibitor or angiotensin receptor... 

Aggressive treatment ofType I, and probably Type 2. Successfully reduces microvascular complications. Close attention to associated risk factors, especially hyperlipidaemia and hypertension, is important in reducing risk of macrovascular disease. 

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