SA Journal of Diabetes & Vascular Disease: Vol 5, Issue 2, June 2008

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SAJDVD: VOLUME 5, ISSUE 2, JUNE 2008

Title: Cardioprotection using insulin : the case for early introduction of insulin : editorial
Authors: Distiller, L.A.
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 52-54
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Abstract: Ambient blood glucose levels have been shown to induce both acute oxidative and inflammatory stress, as well as having a pro-thrombotic effect. On the other hand, the anti-atherogenic effects of insulin are well described and have recently been reviewed in detail by Dandona et al. It is, however, likely that the anti-inflammatory effects of insulin are only exerted when plasma insulin levels are maintained at high levels using intravenous infusions supported by glucose to prevent hypoglycaemia. This effect is known and utilised widely by cardiologists and intensivists in the post-infarction and post-coronary artery bypass settings.
Title: Residual cardiovascular risk reduction after statin initiation in type 2 diabetes mellitus : editorial
Authors: Makotoko, M.D.
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 57-59
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Abstract: Type 2 diabetes mellitus is associated with an increased risk of coronary heart disease. In the Framingham Heart study there was a two-fold risk of coronary heart disease in diabetic men and a three-fold risk in diabetic women compared to non-diabetics. Other studies have shown that diabetic patients with no coronary heart disease have the same risk of developing a coronary event as a non-diabetic with a prior event. Furthermore, diabetic patients have worse outcomes than non-diabetic patients following acute myocardial infarctions. Type 2 diabetes mellitus has therefore been recognised by the American Diabetes Association as a coronary artery disease equivalent, with the lower treatment targets for lipids.
Title: Postprandial glycaemia and cardiovascular : review
Authors: Peter, R.; Rees, A.
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 60-66
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Abstract: Cardiovascular disease (CVD) accounts for almost 75% of mortality in subjects with type 2 diabetes. There is emerging evidence (epidemiological and experimental studies) that postprandial glucose (PPG) contributes significantly to CVD risk, although to date there are no large scale interventional studies with the primary objective of reducing cardiovascular complications by targeting PPG. There is still continuing debate about the definition of postprandial hyperglycaemia. Moreover, we now know more of the cellular mechanisms being triggered in response to glucose excursions which may offer an explanation to this increased susceptibility to CVD. The contribution of PPG to glycosylated haemoglobin, is predominant in relatively well controlled subjects with type 2 diabetes. Hence, PPG is emerging as a legitimate therapeutic target to minimise CVD risk.
This review looks at the evidence linking postprandial hyperglycaemia to CVD, the cellular mechanisms explaining this enhanced risk and a therapeutic strategy to address PPG.
Title: The role of fenofibrate in reducing cardiovascular risk in type 2 diabetes : review
Authors: Pedro-Botet, J.
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 67-72
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Abstract: Dyslipidaemia (elevated triglycerides, low high-density lipoprotein-cholesterol [HDL-C] and an increase in small, dense low-density lipoprotein [LDL] particles) is an important contributor to the increased cardiovascular risk associated with type 2 diabetes. Lowering LDL-C levels with a statin is the main focus of lipid-modifying intervention. Fibrates are effective against all components of this atherogenic mixed dyslipidaemia. Adding a fibrate to primary statin therapy is a logical approach to achieving all lipid targets. Evidence from the Fenofibrate Invention and Event Lowering in Diabetes trial also shows that fenofibrate is a well-tolerated option with potential benefits on the progression of microvascular complications of type 2 diabetes. Thus fenofibrate-statin combination therapy may translate into greater reductions in vascular risk.
Title: Aldosterone antagonism in type 2 diabetes mellitus - a new therapeutic approach to diabetic macrovascular disease? : review
Authors: Swaminathan, K.; Davies, J.; Struthers, A.
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 76-79
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Abstract: The renin-angiotensin-aldosterone system has long been a target of pharmacological approaches for the control of blood pressure and increasingly for heart failure, myocardial infarction, nephropathy and diabetes. Clinical trials involving the renin-angiotensin-aldosterone axis have traditionally focused on angiotensin-converting enzyme (ACE) inhibitors or angiotensin (Ang) II receptor blockers, thereby laying the emphasis on inhibiting Ang II. It is now acknowledged that aldosterone is also an important culprit in addition to Ang II. Recently, major intervention trials in heart failure have demonstrated the marked cardiovascular beneficial effect of aldosterone antagonism over and above ACE-inhibitor therapy, underscoring the harmful effects of aldosterone in cardiovascular disease. Diabetes is now increasingly recognised as not only a metabolic disorder but a vascular disease as well. Therefore, the prospect arises that aldosterone antagonism may translate in reduced cardiovascular risk in a high-risk disorder like diabetes mellitus. If so, aldosterone antagonists may offer a new therapy in diabetes mellitus for the primary prevention of cardiovascular disease.
Title: How drugs work in heart failure : back to basics
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 74-75
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Abstract: How drugs work in heart failure : back to basics diagram
Title: Off target or wrong target : achieving best practice
Authors: Van Zyl, D.G.
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 81-82
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Abstract: During the past decades, significant strides in the treatment and management of diabetes mellitus have been made, especially with regard to the multifactorial approach in management. It is common knowledge that diabetes imposes a significant risk for both micro- and macrovascular complications. Microvascular disease can be prevented by strict glycaemic control, as proven in the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS). Sadly, the association between strict glycaemic control and macrovascular disease was not as clear as that for microvascular disease.
Title: Peripheral arterial disease - a cardiovascular time bomb : achieving best practice
Authors: Belch, J.; Stansby, G.; Shearman, C.; Brittenden, J.; Dugdill, S.; Fowkes, G.; Jarvis, S.; McCann, T.; Mimnagh, A.; Monkman, D.; Morrell, J.; The Target PAD Group
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 83-86
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Abstract: Peripheral arterial disease (PAD) is a reliable marker of future vascular disease and is a substantial public health issue. In Europe and North America, 27 million people are estimated to have PAD, and in the UK around 100,000 people are diagnosed every year. People with PAD are six times more likely to die from cardiovascular disease within 10 years than people without PAD. Evidence suggests that aggressive risk factor management will prevent many premature deaths and associated morbidity. Therefore, it is vital to identify patients and initiate effective management strategies swiftly. However, whilst 40% of PAD patients have symptomatic disease ranging from intermittent claudication to critical limb ischaemia, around 60% are asymptomatic. As a result of the low rates of detection PAD is underdiagnosed and undertreated in the UK. The gravity of the problem has prompted the formation of professional bodies to address this situation through the development of national clinical guidelines. Indeed, with the focus of general practitioners' work covered by the quality and outcomes framework in the General Medical Services (GMS) contract, many consider that the inclusion of PAD in the GMS contract is critical to raising awareness and improving the management of PAD in primary care.
Title: You and your treatment : starting on your ACE inhibitor : Mavik (trandolapril) : patient information leaflet
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 87
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Abstract: ACE inhibitors protect the heart and blood vessels. They work on your kidneys to stop fluid and salt retention, both of which can put the heart and circulatory system under extra pressure. ACE inhibitors also lower your blood pressure by relaxing the blood vessels and this takes more stress off the heart. Trandolapril has been shown to be useful in conditions such as heart disease, diabetes, high blood pressure and heart failure, among others. This drug is prescribed if you have any condition that puts your heart or your circulatory system at risk of damage.
Title: ONTARGET shows telmisartan efficacy in high-risk patients without heart failure : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 90-91
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Abstract: The ONTARGET results presented at the American College of Cardiology (ACC) meeting in April show that telmisartan (Micardis) is equally protective when compared to ramipril, with fewer side effects in high-risk diabetes patients who do not have heart failure.
Title: Role of oscillating glucose levels assessed in type 2 diabetes : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 92
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Abstract: 'The need to intervene early and actively to lower HbA1c and control glucose levels in both type 1 and type 2 diabetes so as to avoid adverse health effects should be urgently promoted throughout the world', said Dr Antonio Ceriello, chairman of the IDF special steering group responsible for the recent IDF post-meal glucose management guidelines, during his recent visit to South Africa.
Title: The Internet's capability to provide psychological care for diabetics at relatively low cost : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 95
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Abstract: Lack of resources to provide psychological support for diabetic patients is increasingly leading to the development of self-help programmes that are web-based.
Title: Improving glycaemic control : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 95
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Abstract: Novo Nordisk presented a successful symposium at the recent SEMDSA Congress held in Cape Town.
In an excellent presentation on the transition from oral hyperglycaemic agents to insulin, Dr Fraser Pirie encouraged practitioners to use a simple titration when introducing insulin for type 2 diabetic patients. 'Use an analogue (modern) insulin if possible and encourage patient-led dose titration', he said.
Title: Glycaemic variability : it's not just about A1C anymore : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 96
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Abstract: A1c has long been the gold standard for assessing glycaemic control in patients with diabetes. Numerous prospective and epidemiological studies have demonstrated that lowering the A1C level reduces the risk and progression of diabetic complications. New data, however, show that glucose variability, independent of A1C, may also play a significant role in the risk of diabetic complications.
Title: DUAAL : atorvastatin provided an unexpectedly potent heart benefit in patients with chronic stable angina : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 96, 98
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Abstract: Results from the DUAAL study, released recently at the ACC 2008 meeting have shown the unexpected benefit of statin therapy in patients with chronic stable angina.
Title: Management of hyperglycaemia in type 2 diabetes : drug trends in diabetes
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 98
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Abstract: The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have recently updated and published their consensus statement in the light of new clinical trials and other data, in particular the advantages and disadvantages of the thiazolidinediones (pioglitazone and rosiglitazone) and exenatide and sitagliptin.
Title: Fighting diabetes : all swords drawn : drug trends in diabetes
Authors: Reasner, Charles
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 99
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Abstract: 'Diet and exercise are effective in lowering glycated haemoglobin (HbA1c) but patients don't keep it up. We need to give patients a chance to be successful by combining metformin treatment and lifestyle advice early on (when HbA1c is above 9%). Then, if HbA1c drops effectively, patients can be taken off metformin - they feel rewarded and gain courage to entrench healthier lifestyles.'
Title: Bayer and Novo Nordisk support diabetes kids camp in Tanzania : diabetes news
From: South African Journal of Diabetes and Vascular Disease, Vol 5, Issue 2, Jun
Published: 2008
Pages: 100
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Abstract: The audience walks all morning to reach this special kids camp in Dar Es Salaam, Tanzania, for children with diabetes to learn how to better manage their disease. Sponsored by Novo Nordisk and Bayer, the children are attentive as they learn how to use their glucose meters and manage their insulin use.

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