Carotid intima media thickness in type 2 diabetes mellitus with ischemic stroke
ABSTRACT Diabetes mellitus is associated with high cardiovascular risk. Carotid intima media thickness (CIMT) is used commonly as a noninvasive test for the assessment of degree of atherosclerosis. The objective of this study was to find out the cut-off point for CIMT for ischemic stroke in patients with type 2 diabetes mellitus (T2DM) and to correlate CIMT with various parameters like smoking, hypertension, lipid profile and duration of T2DM.
A total of 80 subjects in the age group of 30-75 years (M:F = 57:23) were selected and divided into three groups, i.e. diabetes with ischemic stroke, diabetes and healthy subjects. All the participants were subjected to B-mode ultrasonography of both common carotid arteries to determine CIMT, along with history taking, physical examination and routine laboratory investigations including included fasting and 2-hour postprandial blood sugar, blood urea, serum creatinine, lipid profile, glycated hemoglobin, and microalbuminuria.
Patients with T2DM with or without ischemic stroke were found to have significantly higher prevalence of increased CIMT and a value greater than 0.8 mm was found to be associated with the occurrence of stroke. The mean carotid IMT of the group as a whole was 0.840 ± 0.2 mm. The mean carotid IMT was not significantly different between T2DM patients with or without ischemic stroke (1.06 ± 0.2 vs. 0.97 ± 0.26 mm, P = 0.08). However, the mean CIMT was significantly higher in diabetic subjects compared to healthy subjects (1.01 ± 0.28 mm vs. 0.73 ± 0.08, P = 0.006). Other parameters like higher age, smoking, hypertension, hyperlipidemia, low HDL cholesterol, the glycemic parameters and the duration of diabetes were independently and significantly related to CIMT.
A high CIMT is a surrogate and reliable marker of higher risk of ischemic stroke amongst type 2 diabetic patients. Our study demonstrates the utility of carotid IMT as a simple non-invasive screening test for the assessment of atherosclerosis risk/prognosis in type 2 diabetics.
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- "In multivariate analyses, glucose peak was a significant independent determinant of carotid intima-media thickness (CIMT) and explained 49% of the variability. In a recent study of type 2 diabetes mellitus with stroke, post prandial blood glucose (PPBG) was significantly associated with CIMT and stroke. "
ABSTRACT: Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice.07/2013; 17(4):611-9. DOI:10.4103/2230-8210.113751
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ABSTRACT: To investigate the relationships between carotid intima-media thickness (IMT) and conventional cardiovascular risk factors in Uygur population. In totally 226 Uygur subjects, common carotid IMT values were detected, and the anthropometric and laboratory measurements were recorded. Correlation analysis showed that the factors of age, BMI, SBP, DBP, PP, hypertension, TC, LDL-C, TG, Apo B, diabetes mellitus, glucose, smoking status, creatinine, IHD, and stroke were significantly and positively associated with carotid IMT in Uygur males. In Uygur females, significant positive associations with carotid IMT were observed for age, BMI, SBP, DBP, PP, hypertension, TC, LDL-C, TG, diabetes mellitus, glucose, IHD, and stroke, and a significant inverse association was found for HDL-C. Multiple regression analyses suggested that LDL-C, age, TG, creatinine, BMI, smoking, hypertension, and diabetes were independently associated with carotid IMT in Uygur males. However, for carotid IMT in Uygur females, SBP, age, TG, HDL-C, BMI, and diabetes were independent determinants. Carotid artery IMT could be used as a predictive tool for atherosclerotic lesions and cardiovascular diseases in Uygur population, which might contribute to the prevention and management of the local disease.International Journal of Clinical and Experimental Medicine 01/2014; 7(12):5412-20. · 1.42 Impact Factor
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ABSTRACT: Stroke is one of the disorders for which clinically effective therapeutic modalities are most needed, and numerous ways have been explored to attempt to investigate their feasibilities. However, ischemic- or hemorrhagic-induced inflammatory neuron death causes irreversible injuries and infarction regions, and there are currently no truly effective drugs available as therapy. It is therefore urgent to be able to provide a fundamental treatment method to regenerate neuronal brain cells, and therefore, the use of stem cells for curing chronic stroke could be a major breakthrough development. In this review, we describe the features and classification of stroke and focus on the benefits of adipose tissue-derived stem cells and their applications in stroke animal models. The results show that cell-based therapies have resulted in significant improvements in neuronal behaviors and functions through different molecular mechanisms, and no safety problems have so far arisen after transplantation. Further, we propose a clinical possibility to create a homing niche by reducing the degree of invasive intracerebroventricular transplantation and combining it with continuous intravenous administration to achieve a complete cure.Cell Transplantation 04/2014; 23(4):541-7. DOI:10.3727/096368914X678409 · 3.57 Impact Factor