Type 2 diabetes and associated complications are not independent risk factors for incident venous thromboembolism (VTE), report researchers in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

Diabetes has previously been reported to be a risk factor for VTE, but John Heit (Mayo Clinic, Rochester, Minnesota, USA) and colleagues hypothesized that this could be because “persons with diabetes are frequently hospitalized for major surgery or acute medical illness, or confined to a nursing home or chronic rehabilitation facility, all of which are major risk factors for incident VTE.”

To test this, the researchers identified all residents of Olmsted County in Minnesota who met criteria for incident VTE over a 25-year period from 1976 to 2000, of whom 1922, aged 64.8 years on average at baseline, were included in the analysis. A group of 2115 controls matched for age, gender, and length of medical history were used for comparison purposes.

Heit and team assessed whether Type 2 diabetes or associated complications such as retinopathy, nephropathy, neuropathy, or ketoacidosis were independent predictors of VTE.

They found that 231 VTE cases and 199 controls had a diagnosis of Type 2 diabetes. Results from univariate analysis showed that, overall, a diagnosis of diabetes was associated with a 32% increased relative risk for incident VTE.

But after adjusting for factors such as hospitalization (including for surgery), acute medical illness, and nursing home confinement, the association disappeared completely.

The researchers therefore conclude that “diabetes mellitus and diabetes microvascular complications are not associated with overall or idiopathic incident VTE.”

They add: “Our findings suggest that the more direct path to reducing VTE incidence is to reduce the need for surgery, hospitalization for acute medical illness, or nursing home confinement among persons with diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Urinary adiponectin excretion in patients with Type 2 diabetes is an independent predictor of vascular damage, potentially identifying an increased risk for vascular events, report researchers in the journal Diabetes.

Experimental studies indicate that adiponectin is involved in glomerular homeostasis leading to suggestions that damage to the glomerular capillary wall in diabetes may result in loss of endothelial binding sites for adiponectin.

“We hypothesized that adiponectin appears in urine consequently reflecting early glomerular vascular damage in Type 2 diabetes rather than the metabolic changes associated with serum adiponectin,” write Maximilian von Eynatten (Munich Technical University, Germany) and co-workers.

They recruited 156 patients with Type 2 diabetes and a documented history of microalbuminuria being referred to a diabetes outpatient clinic for specialist treatment, and 40 healthy controls.

The researchers measured patients’ total urinary adiponectin excretion rate by enzyme-linked immunosorbent assay (ELISA), characterized their urinary adiponectin isoforms by western blot analysis, and assessed their level of pre-clinical atherosclerosis by measuring common carotid artery intima-media thickness (IMT). In all individuals, 24-hour urine samples were collected on three consecutive days.

In six patients with Type 2 diabetes who had undergone kidney biopsy, adiponectin distribution was assessed by immunohistochemistry. Noncancerous regions of resected kidneys distant from a tumor in patients without diabetes were used as control tissue.

The authors observed strong staining for adiponectin on the endothelial surface of glomerular capillaries and intrarenal arterioles in all non-diabetic kidneys, whereas staining was decreased in patients with diabetic nephropathy.

Urinary adiponectin levels were significantly increased in patients with Type 2 diabetes compared with controls at 7.68 versus 2.91 µg/g creatinine, respectively.

“Excretion could be a pathophysiological marker of vascular stress and may precede the onset of microalbuminuria and renal failure in Type 2 diabetes,” suggest the authors.

In this study, urinary adiponectin was superior to urinary albumin excretion in the prediction of increased carotid IMT and was a powerful independent predictor of carotid IMT in multivariable regression analyses.

“Measurement of urinary adiponectin may emerge as a novel and easy to obtain method for the clinical assessment of vascular stress and cardiovascular disease risk in Type 2 diabetes,” conclude the authors.

They caution that this should be validated in larger prospective studies and different samples including diabetes patients without a history of microalbuminuria.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Up to ten years before type 2 diabetes is diagnosed, there are signs of your body resisting insulin. This is why researchers now refer to this as the “silent” epidemic or the “silent” killer. And it is usually the accompanying heart disease they have the most concern with.

7 Important Signs of Insulin Resistance:

1. Hypertension or high blood pressure. This may be the result of the high amount of insulin required to keep your blood sugars normal. What often shows is that as the insulin-level rises so does your blood pressure reading.

2. Elevated triglycerides levels. These levels are often high if you are overweight. It is not just the result of excessive fat intake; refined carbohydrates such as sugar and white flour are the culprits also. Existing body fat is also responsible.

3. Low HDL levels. The way fat is carried on the inside affects your risk of heart disease.

4. Increased abdominal fat. The culprit is a particular type of body fat centered around your abdomen, particularly around the intestines. Usually the male who has this type of fat has a waist much larger than his hips. The females’ waist is at least 80% of her hip measurement.

5. Obesity. Everyone who is obese, or has a high proportion of fat in their body, is insulin-resistant.

6. Fatigue. This is the most common feature; for no apparent reason your spark is no longer there. Some people are tired in the morning, some in the afternoon and some all day. This is because your body’s cells are not getting enough of the glucose they need. Even though there is plenty of insulin, your body is resistant to it’s action

7. Unable to concentrate. Your memory is not so sharp; your brain needs a constant supply of glucose to work properly and fluctuations are sending your blood sugar levels too high, or too low, quickly. This results in disordered memory and foggy thoughts.

To prevent long term complications:

• there are a variety of drugs available to help treat elevated triglycerides and low HDLs
• it is really important to concentrate on controlling your type 2 diabetes by losing weight and reducing your resistance to insulin

Weigh loss is not always easy but it is doable. Often losing just ten or twenty pounds, (5 or 10 kilograms), is enough to reduce your insulin resistance and blood sugar levels, and therefore your type 2 diabetes. You will also have less worry about heart disease.