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Type 2 Diabetes and Cardiovascular Disease

By: Team Hyderabad diabetes Centre

People with diabetes have 2 to 3 times higher risk of having a heart attack compared with people without diabetes.

People with diabetes should have a very strict control of factors that increase the risk of a heart attack such as high cholesterol and high blood pressure as well as good blood glucose control.

The way type 2 diabetes is treated may increase the risk of a heart attack and recently much attention is being paid to glucose-lowering drugs and their cardiovascular safety.

People with diabetes should know how to recognize the symptoms of coronary insufficiency because they should immediately start to do tests to see whether there is a need for an intervention.

Diabetic Kidney Disease

By: Team Hyderabad diabetes Centre

Diabetic nephropathy (DN) is a microvascular complication of diabetes mellitus characterized by persistent proteinuria, decline in GFR and increased morbidity and mortality in diabetics.

This is one of the most important causes of premature death among patients with diabetes and a major health concern.

Development of progressive renal disease is observed in only a proportion (20-30%) of individuals with type 2 diabetes and familial clustering provide clear evidence for genetic contribution.

Multiple mechanisms contribute to the development and outcomes of DN, such as an interaction between hyperglycemia-induced metabolic and hemodynamic changes and genetic predisposition, which sets the stage for kidney injury.

Initiators of DKD: Hyperglycemia, predisposing genes.

Promoters of DKD: Hyperglycemia, hypertension, dyslipidemia, insulin resistance, smoking, procoagulant state, long duration of diabetes, anemia, ethinicity/ westernization, sex, age, albuminuria.

Early detection of DN, the multifactorial approach targeting the main risk factors (hyperglycemia, hypertension, dyslipidemia and smoking), and the use of renoprotective agents such as the drugs that act on the rennin-angiotensin-aldosterone system, may delay progression of kidney disease in diabetes mellitus, besides reducing cardiovascular mortality.

Glycemic Goals in Clinical Practice: Targeting Postprandial Hyperglycemia

By: Team Hyderabad Diabetes Center

Postprandial hyperglycemia is common in diabetics and it precedes fasting hyperglycemia.

Indian diet is rich in carbohydrates unlike Western diet. High dietary carbohydrate load is associated with increased risk of T2DM.

PPG is important because T2DM patients may be in the postprandial state for more than 12 hours in a day.

Increased PPG is associated with endothelial dysfunction and oxidative and nitrosative stress making it a strong predictor of CV events in diabetic patients (DECODE, Honolulu Heart study, DECODA).

Postmeal plasma glucose should be measured 1-2 hours after a meal.

For good glycemic control, both FPG and PPG should be normal or at least near normal levels.

If A1c <7.5%, initial therapy should address PPG, preferentially.

Reducing postprandial hyperglycemia → decreased CVD related morbidity and mortality.

α-glucosidase inhibitors like voglibose and voglibose-based combination therapy can effectively control postprandial hyperglycemia as they delay absorption of carbohydrates and also offer added advantages of being weight neutral & least risk of hypoglycemia.

Insulin is Sole Therapy for Type 1 Diabetes

By: Team Hyderabad diabetes Center

Type 1 diabetes has no beta cell reserve.

Exogenous insulin is the only therapy in this situation.

They are insulin dependent and its deficiency precipitates ketoacidosis.

OAD of different mech. of action other than secretagogues are not fully efficient in controlling plasma glucose.