Management of Diabetes in Patients with Heart Failure

Poorly controlled diabetes should be managed aggressively in any patient with CHF because the attendant metabolic stress can certainly have adverse effects on myocardial function. Stringent control of blood glucose reduces the incidence of several complications of diabetes, specifically retinopathy, neuropathy, and nephropathy, but no data are available pertaining to the long-term effects of stringent control on diabetic cardiomyopathy or CHF in general in patients with diabetes. To the extent...

Mechanisms Contributing To Diabetic Cardiomyopathy

There is virtually no definitive evidence delineating the mechanism(s) of diabetic cardiomyopathy in patients. This applies to both proximate mechanisms (e.g., defects in excitation-contraction coupling) and ''upstream'' mechanisms (e.g., possible alterations in gene expression that result in changes in the proteins responsible for excitation-contraction coupling). Even in experimental animal preparations, it is at present impossible to understand fully all of the potentially causative factors...

Vcardiomyopathy And Diabetes

Induction of cardiomyopathic changes in hearts of animals rendered insulin deficient is a well-recognized phenomenon. Accordingly, the term ''diabetic cardio- a myopathy'' has been extant for decades. Implicated derangements include impaired function of the sarcoplasmic reticulum, an organelle responsible for the uptake and release of intracellular calcium and, therefore, pivotal in modulating cardiac contractility. However, cardiomyopathy changes may not be related exclusively to metabolic...

Detection And Diagnosis Of Abnormal Glucose Metabolism In Insulin Resistance Syndrome

In 1997, the American Diabetes Association Expert Committee on the Diagnosis and Classification of Diabetes Mellitus established a new classification system and diagnostic criteria to define various states of abnormal glucose metabolism (43). Fasting plasma glucose was divided into three diagnostic categories (1) normal < 110 mg dL (6.1 mmol L) (2) impaired fasting glucose (IFG) 110 to 125 mg dL (6.1 to 6.9 mmol L) and (3) diabetes mellitus > 126 mg dL (7.0 -o mmol L). Likewise, the plasma...

Atherogenesis In The Prediabetic State

The 15 incidence of cardiac death in the first 10 years after the diagnosis of diabetes emphasizes the profound acceleration of progression of atherosclerosis that occurs long before diabetes becomes overt. The prediabetic state provides particularly fertile ground for germination of vulnerable plaques. Thus, a focus on treatment in the prediabetic state is likely to be important in preventing cardiovascular events later in ultimately diabetic subjects. One example is women with the polycystic...

Lifestyle Modifications Smoking Cessation And Exercise

Much of the work documenting the impact of smoking on health does not discuss results on subsets of subjects with diabetes, suggesting that the identified risks are at least equivalent to those found in the general population. Other studies of individuals with diabetes consistently report a heightened risk of morbidity and premature death associated with the development of macrovascular complications among smokers. Although smokers have repeatedly heard of the pulmonary effects of smoking, the...

Impaired Glucose Tolerance And Type 2 Diabetes

Obesity is a well-recognized risk-factor for development of type 2 diabetes, but alone is insufficient to cause glucose intolerance. Thus, while it is generally accepted that women with PCOS are predisposed to type 2 diabetes (13,14), the development of diabetes cannot be attributed solely to the obesity that typically accompanies PCOS. Initial studies placed the prevalence of diabetes in PCOS at approximately 20 (8). More recent data have established that the prevalence of impaired glucose...

Clinical Interventions In The Management Of The Insulin Resistance Syndrome

On the basis of convincing clinical studies, it is no longer questioned that the -o insulin resistance syndrome is associated with an increased morbidity and mortal- ity. A more relevant question is whether improvement of insulin resistance with effective clinical interventions will decrease mortality and morbidity associated with the syndrome. Addressing the question will be problematic, as a clinically practical and reliable test to assess insulin resistance, or a way to serially measure...

Diabetic Cardiomyopathy Does It Exist

In addition to the epidemiological data mentioned above, there are a host of other observations, both clinical and experimental, that point toward cardiomyopathic manifestations specifically related to the presence of diabetes. In reviewing clinical data for this purpose, it is important to search for evidence of cardiomyopathy in the absence of the confounding presence of coronary artery disease and hypertension, both of which can cause CHF by themselves. The occurrence of dilated...

Metabolic Syndrome

The metabolic abnormalities associated with DM are well recognized and include insulin resistance or, more appropriately, dysinsulinemia , hyperglycemia, hypertension, and dyslipidemia. These factors are associated with a panoply of biological perturbations that result in endothelial dysfunction with impaired coronary flow reserve, increased platelet activity, increased thromboxane A2 secretion, higher fibrinogen and factor VII levels, lower antithrombin III and plasma fi- S brinolytic...

Cefalu Wt 2000. Insulin Resistance In Medical Management. Of Dm. New York. Marcel Dekker Inc Pp 57 76.

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