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Diabetic retinopathy treatment guidelines, Global epidemiology of prediabetes - present and future perspectives. - Abstract - Europe PMC

Lower extremity artery disease LEAD and microcirculatory alterations were screened by hand-held Doppler, transcutaneous partial tissue oxygen tension tcpO2tuning fork test, 6-minute walk test, erythrocyte aggregation and deformability.

Measurement of tcpO2 and hemorheological variables could be useful to discover patients at higher risk for diabetic f; oot complications. Background The prevalence of diabetes mellitus DM is increasing rapidly raising a huge burden on the healthcare system all over the world [1]. The complications of this disease e. Diabetes mellitus is a major risk factor for the development of atherosclerosis.

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Although its severe consequences are well known, organ damages remain frequently undiscovered resulting in the high rate of end-stage disease. Retinopathy as a complication of microarteriopathy can be the first detectable subclinical lesion in diabetes which may reflect microcirculatory damages in other parts of the vascular system.

The association between diabetes mellitus and peripheral artery disease PAD has also been well established in several studies [1, 2]. All rights reserved 2 K. Biro et al. It usually develops in both legs and progresses more rapidly resulting in multisegmental lesions.

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Revascularization procedures have poorer outcome and amputation is frequently needed. Furthermore, PAD is an independent factor of increased diabetic retinopathy treatment guidelines and cerebrovascular mortality.

Early detection could result in risk modification, slower progression and better outcome. In diabetes PAD is often asymptomatic, therefore systematic screening should be performed [2—5]. The diagnosis of PAD is routinely based on physical examination and Doppler-assisted peripheral blood pressure measurement.

Other non-invasive vascular tests, e. Microcirculatory disorders in diabetes may not be attributed only to angiopathies but at least partially to hemorheological changes, like increased red blood cell aggregation and reduced red blood cell deformability.

In a recent study correlation between whole blood viscosity and endothelial dysfunction was investigated in diabetes by Antonova et al. Methods 2.

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  • Global epidemiology of prediabetes - present and future perspectives. - Abstract - Europe PMC
  • Diabetes insipidus bitkisel tedavi
  • ‪Gábor Késmárky‬ - ‪Google Scholar‬
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Focus and aim of the study re c 2. Participants te d Our primary goal was to screen the prevalence of lower extremity artery disease in diabetic patients who were regularly checked for retinopathy but systematic screening for PAD had previously not been performed.

Our secondary aim was to find association between the measures of lower limb ischemia 6-minute walk test, tcpO2 and hemorheological variables. C or diabetic retinopathy treatment guidelines with type 2 DM were enrolled in the study, who regularly diabetic retinopathy treatment guidelines the out-patient clinic of the Department of Ophthalmology mean age To test age-dependent and independent changes two control groups were recruited.

Co-morbidities, risk factors, medication were questioned and physical examination including palpation of peripheral arteries dorsal pedal artery-DPA, posterior tibial artery-PTA, popliteal, femoral artery were done. Non-invasive arterial diagnostic procedures 2. The cuff was placed around the ankle approximately 1 cm above the medial malleolus with parallel wrapping. To calculate the ankle-brachial index ABIthe higher systolic blood pressure between both arms was used as the denominator while the higher pressure from the posterior tibial and dorsal pedal arteries at each ankle was considered as the numerator.

Transcutaneous tissue oxygen pressure Transcutaneous partial tissue oxygen pressure tcpO2 can give the estimation of the partial pressure of oxygen on the skin surface using a noninvasive method [10].

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The measured site of skin was shaved and cleaned with alcohol. The self-adhesive fixation ring was filled with a contact liquid. The Clark electrode was placed to three places on the body. A reference value was obtained by placing the electrode on the chest on the right side in the subclavicular region, thereafter the electrode was placed on the lateral part of the leg and on the dorsal part of the foot in the first intrametatarsal space - or if the patient underwent amputation on the most distal part of the leg - not over a visible vein, bony or tendon structure was chosen.

Global epidemiology of prediabetes - present and future perspectives.

The electrodes were allowed to equilibrate until stable values were achieved [11]. During the functional test the patient was in a resting recumbent position for 15 minutes, which was followed by 5 minutes elevation and another 5 minutes hanging stasis of the leg.

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Calibrated tuning fork test To examine sensory loss due to diabetic polyneuropathy Rydel-Seiffer calibrated tuning fork was used. The patient was asked to report the time at which vibration disappears [12—14]. The 6MWT was performed indoors along a straight corridor and walking course was 30 m in length according to the guideline of American Thoracic Society [15].

Management of Diabetic Retinopathy - - pskozmetika.hu

Blood sampling, sample preparation or Blood samples were collected for hemorheological measurements by venipuncture after overnight fast. The blood specimen was collected in EDTA-coated tubes.

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Parameters were measured within 2 hours from blood withdrawal. Erythrocyte deformability was examined at diabetic retinopathy treatment guidelines different shear stresses from 30 to 0. For deformability measurements, blood samples were suspended in a highly viscous One-way repeated ANOVA statistical test and Bonferroni post-hoc test were used to evaluate differences between and within the groups after using KolmogorovSmirnov test to check normality of the data distribution.

Data are shown as means ± standard error of mean SEM. Pearson correlation coefficients were calculated to analyze relationships between continuous variables. Results 3. Epidemiological data te d The study included patients with DM, 35 age-matched non-diabetic patients, and 42 non-smoking healthy volunteers.

No history of intermittent claudication, ischemic heart disease, polyneuropathy or retinopathy could be magas vérnyomás kezelésére cukorbetegség második típusú in the control groups.

Epidemiological characteristics are summarized in Table 1. Young volunteers did not take any medication regularly.

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Drug treatment of diabetic patients and aged-matched non-diabetic subjects is summarized in Table 2. In spite of antihypertensive therapy significantly higher blood pressure was observed both in the diabetic population and the age-matched non-diabetic group compared to the young persons Table 3.

The ABI of each young healthy volunteer was within the normal range. Most of the age-matched control subjects had normal 1. Two patients had critically low ABI value Table 4. Transcutaneous partial tissue oxygen pressure was measured to detect lower limb ischemia.

Lower limb ischemia and microrheological alterations in patients with diabetic retinopathy

In the diabetic population, significantly lower tcpO2 values were measured at every localization compared to the young volunteers and it was lower in the diabetic than in the non-diabetic group diabetic retinopathy treatment guidelines the level of the leg. Age-matched controls had also lower tcpO2 on the foot than the young population Table 5. Regarding the various tcpO2 ranges normal, borderline, decreased, severe ischemiaonly a fifth of the diabetic patients had normal values and almost one fifth of them had abnormal results characteristic for the severe limb ischemia Diabetic retinopathy treatment guidelines 6.

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Sensing of vibration in diabetic patients was deteriorated compared to the other groups. Age-matched control subjects had also lower sensing at the level of the toe than the young volunteers Table 7. The test was performed on both sides without a difference, values above represent the left side. Hemorheological alterations re c te d Pr oo f The results of RBC aggregation characterized by aggregation index, half-time for aggregation and disaggregation threshold shear rate are presented in Table 8.

Elongation index diabetic retinopathy treatment guidelines each measured shear stress was significantly lower among diabetic patients compared to the non-diabetic group, and significant difference could be observed between the diabetic and the young groups at low and intermediate shear stresses from the range 5. Significant difference could be found between the non-diabetic population and the young controls at high-intermediate and low shear stresses range from 0.

The RBC deformability results were analyzed by the Lineweaver-Burke nonlinear equation calculating the theoretical maximal elongation index at infinite shear EImax. Although significant difference could not be found in the EImaxthe shear stress required for the half of this maximal elongation SS½ was significantly higher in the diabetic patients compared to the healthy volunteers and the elderly persons Table 9.

Ankle pressures DPA, PTA diabetic retinopathy treatment guidelines tcpO2 values on the leg and on the foot at stasis correlated slightly, but significantly to the covered walking distance r values: 0.

Discussion C or re c te Lower extremity artery disease LEAD is the third leading cause of atherosclerotic morbidity, following coronary artery disease and stroke. The prevalence of LEAD is high but largely underestimated, and significant differences could be found in population studies and clinical series. LEAD is two to fourfold more frequent in diabetes mellitus based on the literature, but true prevalence of LEAD in diabetic population is difficult to determine, because most patients are asymptomatic partially due to polyneuropathyand screening has not been performed uniformly [3].

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Vascular abnormalities and hemorheological disturbances in diabetes impair the microcirculation provoking organic damages [18]. The presence of DM in LEAD patients increases the risk of adverse outcomes including progression to critical limb ischemia, amputation and death [19]. PAD is an independent predictor for cardiovascular CV ischemic events not only in symptomatic but also in asymptomatic diseases.

The high number of asymptomatic patients underlines the importance of vascular screening. Regular screening of diabetic patients for LEAD is recommended by several guidelines [3, 19, 20], but performed rarely. In our study we aimed to search for lower extremity arterial disease in a regularly checked diabetic population.

Two control groups were also studied to explore the age dependent and independent alterations. It is known that patient-reported symptoms underestimate LEAD prevalence [3, 19].

Numerous non-invasive and invasive tests have been designed for screening and diagnosing LEAD in the clinical practice. Hand-held Doppler examination is a simple and cheap method to measure blood pressure of the lower extremities above the ankle. ABI is a good surrogate marker to detect atherosclerosis in the whole circulatory system and have a good prognostic value predicting cardiovascular events [22]. In our study ABI was normal in the young healthy volunteers; only a small portion of the age-matched non-diabetic population had abnormal ABI value, and no one had intermittent claudication.

The lower prevalence of LEAD in this group could be due to better controlled hypertension and active lifestyle. More than half of the diabetic patients had mild, moderate or severe diabetic retinopathy treatment guidelines artery disease in our cohort. Codjo et al.

The high prevalence may arise from the fact that retinopathy has been observed in our diabetic group, referring to already existing vascular damages in other vascular beds. Hwang et al. In their study about half of DFU patients had proliferative DRP, underlying the necessity of regular checking of retinal examinations [28].

Potier et al. In these cases, other methods should be applied, toe pressure or transcutaneous oxygen pressure measurement, in particular [19, 30]. Beyond the examination of macrocirculation, measuring tcpO2 could provide information on the microcirculation and tissue ischemia. Faglia et al. Karanfilian et al. We experienced significantly lower values in the diabetic population at rest and during provocation both at elevation and stasis compared to the young volunteers. Although mean values of the diabetic and the age-matched non-diabetic groups were not significantly different, a shift toward worse values could be observed in the diabetic population.

Our findings are in line with other studies showing that measurement of tcpO2 gives more information on the microcirculation than the measurement of peripheral blood pressure and provides good discrimination between PAD with silent ischemia and diabetic retinopathy treatment guidelines status [33, 36]. There is a reason to use tcpO2 in diabetic population because media sclerosis in the calf arteries can cause falsely higher ABI than it would be if intraluminal pressures were measured.

Reduced tcpO2 has been shown in other studies among diabetic patients and the deterioration was more expressed in those cases when patient suffers from diabetic complications, e.

Kalani et al. Therefore, detection of limb ischemia by transcutaneous oximetry should have a greater place in the vascular workup. To test physical capacity 6MWT was performed, which is a well-known but infrequently used diagnostic procedure in cardiology and angiology.

The guidelines approved by the American Thoracic Society in recognize the six-minute walk test as a useful and safe tool for the evaluation of physical efficiency in individuals with at diabetic retinopathy treatment guidelines moderate chronic obstructive pulmonary disease, heart failure and intermittent claudication [15]. In our study diabetic patients had the lowest walking distance. The tcpO2 measured in vertical leg position of the diabetic patients correlated to diabetic retinopathy treatment guidelines covered walking distance which may imply that ischemia at rest could predict functional capacity.

Polyneuropathy is a complication of diabetes which is responsible for more than half of all limb amputations, and it has high economic and quality-of-life costs. Neuropathy has a long asymptomatic latency period, therefore screening is of crucial importance. It may mask intermittent claudication in diabetic patients. In the diabetic population significantly decreased tuning fork value could be observed at each localization compared to the other groups.

Tuning fork value measured on the first toe was significantly different between young volunteers diabetic retinopathy treatment guidelines non-diabetic elderly patients, which could be due to age-related changes. In a clinical research Lauria et al. Higher values were measured in upper extremities in every group compared to the lower limbs, the difference could be due to axons being longer in the lower extremities and they are more susceptible to metabolic and hypoxic damages [39].

The background of the high prevalence of asymptomatic LEAD in our study could be due to polyneuropathy. Beyond hemodynamic changes, hemorheological alterations play a role in the disturbances of the microcirculation, particularly when the vasodilation capacity exhausted. Erythrocyte aggregation was examined in diabetic populations in several clinical studies which demonstrated that RBCs had an increased susceptibility to aggregate. RBC aggregation could lead to capillary disturbances due to sludge formation [16].

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In a previous study higher aggregation was observed among patients with retinopathy [18]. In this study diabetic patients had higher aggregation index and faster aggregate formation compared diabetic retinopathy treatment guidelines the young controls, what is in accordance with previous results [18, 40].

Between diabetic patients and age-matched control group significant difference could not be observed in these parameters, its reason is still unknown, some changes could depend more on age than disease. Disaggregation shear rate gamma was significantly higher in the diabetic patients compared to the two other groups. We could demonstrate the correlation of the 6MWT results and red blood cell aggregation variables. In a recent study Simmonds et al.

It is known that increased RBC aggregation can interfere with oxygen diabetic retinopathy treatment guidelines. Dupuy-Fons et al. Numerous clinical investigations have shown that erythrocyte deformability improves blood flow in the microvessels and in the large arteries at higher shear rates.