SA Journal of Diabetes & Vascular Disease: Vol 2, Issue 2, August 2005

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SAJDVD: VOLUME 2, ISSUE 2, AUGUST 2005

Title: Skin blood flow in diabetes : editorial
Authors: Mars, Maurice
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.55-59
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Title: Natriuretic peptides in diabetes mellitus : editorial
Authors: Ranjith, N.
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.60-62
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Title: Should all diabetic patients receive an ACE inhibitor? Results from recent trials : cardiovascular drugs in diabetes
Authors: McDougall, Claire; Marshall, Gillian; Brady, Adrian J.B.; Fisher, Miles
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.63-67
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Abstract: Diabetes is associated with both premature cardiovascular disease and renal disease. The presence of microalbuminuria is itself an independent risk factor for the development of cardiovascular disease. Angiotensin-converting enzyme (ACE) inhibitors were initially shown to slow the progression of established renal disease in patients with type 1 diabetes. Subsequent trials have demonstrated a similar benefit in patients with type 2 diabetes and with the use of angiotensin II receptor blockers (ARBs). The use of ACE inhibitors to prevent cardiovascular events in patients with established cardiovascular disease but not left ventricular dysfunction was established in two large randomised trials - HOPE and EUROPA. These benefits were maintained within the diabetic subgroups of these trials and appear to be independent of blood pressure lowering. The LIFE trial also provides evidence of the benefits of ARBs in reducing cardiovascular events in a high-risk population of diabetic patients with hypertension and left ventricular hypertrophy. Ideally, therefore, all diabetic patients with renal or cardiovascular disease should be treated with ACE inhibitors or ARBs.
Title: Defining the role of statins in diabetes : cardiovascular drugs in diabetes
Authors: Tuomilehto, Jaakko; Leiter, Lawrence A.
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.68, 70-77
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Abstract: Diabetes increases cardiovascular risk, and is recognised as a cardiovascular disease equivalent. Effective reduction of cardiovascular risk factors in diabetes patients is therefore vital. Several landmark clinical trials, including the Heart Protection Study, showed that statins reduce cardiovascular risk, even in patients with pretreatment low-density lipoprotein cholesterol (LDL-C) below 3 mmol/L. The Collaborative Atorvastatin Diabetes Study demonstrated that statin therapy significantly reduces LDL-C and major coronary events in patients with type 2 diabetes. Several studies have assessed which statins are most effective at reducing LDL-C. In patients with diabetes, rosuvastatin 10 mg and atorvastatin 10 mg bring 94% and 79% of patients, respectively, to European LDL-C goals. The benefits of more effective lipid lowering using high-dose statin therapy are being investigated in trials such as Treating to New Targets. Furthermore, studies indicate that combining a fibrate or niacin with a statin may offer more comprehensive lipid control in diabetes patients.
Title: The laboratory evaluation of lower limb perfusion in diabetes mellitus. A clinical review : review
Authors: Williams, Dean T.; Pugh, Neil D.; Coleman, Declan P.; Harding, Keith G.; Price, Patricia
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.78-85
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Abstract: Non-invasive laboratory tests are commonly employed in the assessment of lower limb perfusion. The accuracy of non-invasive assessments in diabetes remains a concern. We evaluated the more commonly used methods with particular reference to diabetic foot disease.
A literature review and clinical evaluation of tests for macrovascular disease, including hand held Doppler, blood pressure measurement and indices, Doppler waveform analysis, colour duplex imaging and plethysmography was performed. Tests reflecting tissue perfusion, including infrared detectors, transcutaneous oxygen tension, laser Doppler, capillaroscopy and skin temperature were also reviewed.
Non-invasive laboratory tests reduce the requirement for invasive investigations and their inherent risks. More traditional non-invasive methods are being replaced by evolving techniques employing ultrasound technology. Arterial calcification and peripheral neuropathy associated with diabetes can potentially reduce the reliability of these methods. Distal limb and tissue perfusion assessments are more likely to reflect local vascularity. Tissue perfusion indicators are generally slow and vulnerable to environmental influences, thus limiting their clinical use. Nevertheless, non-invasive tests are an important adjunct to the clinical evaluation of diabetic foot disease. However, diabetes potentially reduces their reliability and the results require careful interpretation. Distal perfusion tests have potential advantages over macrovascular assessments. The influence of diabetes on non-invasive tests needs further evaluation.
Title: Physical disability and the cumulative impact of diabetes in older adults : review
Authors: Gregg, Edward W.; Caspersen, Carl J.
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.86-90
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Abstract: The already high and increasing prevalence of diabetes among older adults will make ageing-related outcomes like physical disability an increasingly important complication of diabetes. Disability is a key indicator of both overall morbidity and the success of public health efforts to compress the period of morbidity in old age for the overall population. Many cross-sectional and longitudinal studies have now associated diabetes with increased risk of disabilities in mobility and in instrumental and basic activities of living. The explanation for higher disability among persons with diabetes appears to be multifactorial with neuropathy, peripheral arterial disease, coronary heart disease, depression, obesity, visual impairment, and physical inactivity the most prominent factors. These factors are common in persons with diabetes and exert strong effects on risk of disability. Several promising interventions exist, ranging from exercise programmes and identification and treatment of depression, to long-term prevention of disability through better management of glycaemia and risk factors for cardiovascular disease. Preliminary findings from the U.S. Diabetes Surveillance System suggest that, like the general population, prevalence of physical disability may also have declined among persons with diabetes during the last decade. Ultimately, preventing disability will likely depend on a combination of secondary and tertiary prevention along with, ideally, preventing diabetes in the first place.
Title: Has ASCOT signalled the end for beta blockers as first-line antihypertensive agents? : current topics
Authors: Kirby, Mike
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.91-93
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Abstract: The blood pressure arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) compared treatment with atenolol and bendroflumethiazide against amlodipine and perindopril. This trial has been terminated early due to the emergence of significant benefits in the latter arm. Preliminary data from this trial, presented at the American College of Cardiology's 2005 meeting, are summarised and their implications for UK clinical practice are discussed.
Title: Moxonidine especially suitable for menopausal hypertensive women with metabolic syndrome : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.94, 97
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Title: Biphasic insulin analogues improve postprandial metabolism in type 2 diabetes : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.97
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Title: Erectile dysfunction - an early marker of endothelial dysfunction and coronary artery disease : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.98
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Title: 'The youthfulness of age' - motivation to reduce CV risk at primary care level : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.100
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Title: Oral anti-diabetic drugs show regression of carotid IMT in type 2 diabetes : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 2, Issue 2, Jul / Aug
Published: 2005
Pages: p.100
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