The combination of a large waist circumference and elevated plasma triglyceride (TG) levels in patients with Type 2 diabetes can predict the presence of coronary artery disease (CAD), study results show.

This combination, termed “hypertriglyceridemic waist,” could provide “a simple, low-cost biomarker for CAD, enabling the identification of patients who are at increased cardiovascular risk,” say Jeroen Bax (Leiden University Medical Center, The Netherlands) and colleagues in the American Journal of Cardiology.

Bax and colleagues aimed to see if the Quebec Cardiovascular Study finding of an association between the hypertriglyceridemic waist phenotype and the “atherogenic metabolic triad,” defined as increased insulin, small dense low-density lipoprotein particles, and apolipoprotein B, could be extended to patients with diabetes.

They assessed waist circumference and TG levels in 202 patients with Type 2 diabetes who were clinically referred for tomographic coronary angiography (CTA).

The patients were divided into four groups using threshold values for waist circumference (?88 or >88 cm for women and ?102 or >102 cm for men) and TG levels (<1.7 or ?1.7 mmol/l for both men and women) as previously described by the National Cholesterol Education Program Adult Treatment Panel III.

Patients with elevated waist circumference and TG levels (n=61, 31%) were considered to have the hypertriglyceridemic waist phenotype, while patients with low waist circumference and TG levels (n=49, 24%) served as the reference group.

Bax and colleagues found that in patients with hypertriglyceridemic waist, plasma cholesterol levels were significantly elevated while high-density lipoprotein cholesterol was significantly reduced compared with the reference group.

The presence of any CAD and obstructive CAD was significantly increased in patients with hypertriglyceridemic waist relative to the reference group, at odds ratios of 3.3 and 2.9, respectively.

In addition, a significantly larger number of noncalcified and mixed plaques was observed in the hypertriglyceridemic waist group relative to the reference group.

Discussing the findings, Bax et al note that screening for CAD in patients with Type 2 diabetes in the presence of two or more additional traditional cardiovascular risk factors has been endorsed by the American Diabetes Association, although evidence for the effectiveness of routine screening of patients is lacking.

“In this setting, the hypertriglyceridemic waist phenotype may potentially serve as a practical biomarker for CAD to increase risk stratification in this patient population,” Bax and colleagues comment.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Free abstract

Type 2 diabetes patients with high levels
of triglycerides in their livers show signs of impaired myocardial
metabolism, report researchers in the Journal of the American
College of Cardiology.

Diabetic cardiomyopathy can develop in diabetic patients even in
the absence of complications. It has a “high propensity to progress
into overt congestive heart failure,” say Michaela Diamant
(University Medical Center, Amsterdam, The Netherlands) and
colleagues.

The researchers’ study included 61 Type 2 diabetes patients who
did not have cardiovascular disease or other complications, which
they say allowed the “assessment of early myocardial abnormalities
in the absence of potentially confounding effects of coronary
artery disease and hypertension.”

The team divided the patients into those with high
(median=14.4%) and low (median=2.0%) liver triglyceride content.
Patients with high liver triglyceride content had significantly
more hepatic visceral fat than those with low content, at 2.6
versus 2.4 ml, and more subcutaneous fat, at 743 versus 604 ml.
They did not have significantly higher plasma triglyceride
levels.

Patients with high liver triglycerides had significantly
decreased whole-body insulin sensitivity compared with those with
low triglycerides.

They also had reduced myocardial perfusion, with a mean blood
flow of 1.07 versus 1.26 mg/g/mmHg/min/m in those with low liver
triglycerides. In contrast, myocardial vascular resistance was
increased in patients with high versus low liver triglycerides, at
118 versus 98 mmHg/ml/min/m.

Glucose uptake and the ratio of phosphocreatine to adenosine
triphosphate were both significantly reduced in patients with high
compared with low liver triglycerides.

Blood pressure and left ventricular systolic and diastolic
function were not associated with patients’ liver triglyceride
content, however.

The myocardial changes observed in the current study, “may
indicate an early alteration in myocardial tissue and/or vascular
properties in Type 2 diabetes mellitus patients with high liver
triglyceride content,” say the researchers.

They conclude: “The long-term clinical implications of this
association between liver steatosis and altered cardiac metabolism
require further study in Type 2 diabetes mellitus.”

MedWire (www.medwire-news.md) is an independent clinical news
service provided by Current Medicine Group, a trading division of
Springer Healthcare Limited. © Springer Healthcare Ltd;
2010

Free abstract

There is a strong association between the
metabolic syndrome and microvascular disease in people with Type 2
diabetes, Belgian researchers have shown.

Their analysis, which appears in the journal Diabetes &
Metabolic Syndrome: Clinical Research & Reviews, suggests
that the risk for microvascular complications increases in line
with both the presence and severity of the syndrome.

Michel Hermans (Universite catholique de Louvain, Brussels)
and team studied 738 adults with Type 2 diabetes, of whom 145 had
the metabolic syndrome. Participants with and without the syndrome
were well-matched with respect to age and diabetes duration.

The mean number of components of the metabolic syndrome was 1.8
in those without the syndrome versus 4.0 in those with.

Body mass index, waist circumference, relative/absolute fat
mass, visceral fat, conicity, insulin resistance, triglycerides,
glycated hemoglobin, systolic blood pressure, and inflammatory
markers were all significantly higher in those with versus without
the metabolic syndrome.

With regard to macrovascular disease, the prevalence of
peripheral artery disease, coronary artery disease, and
cerebrovascular disease were all higher in those with the syndrome
than without, at 11 vs 7%, 26 vs 10%, and 8 vs 5%,
respectively.

Furthermore, the prevalence of microvascular complications
increased with increasing number of components of the metabolic
syndrome.

Specifically, diabetic retinopathy affected 3% of those with one
component versus 26% of those with five components. For peripheral
neuropathy the values were 19% and 35%, respectively, while for
albuminuria the values were 6% and 32%, respectively.

Discussing their results, Hermans and co-authors note that the
association with macrovascular disease is expected “as intrinsic to
the current definition of metabolic syndrome.”

By contrast, “it is much debated whether establishing the
presence of a metabolic syndrome in hyperglycemic states further
contributes to stratifying or predicting microvascular risk.”

They say their data “indicate a strong association between
metabolic syndrome and vascular disease, with respect to both
macro- and microangiography in a large, mostly Caucasian, cohort of
Type 2 diabetes mellitus patients of both genders.”

However they add: “Whether these risks are cumulative,
potentiating or permissive will be determined in prospective
studies on the natural history of microvascular disease in relation
with the serial acquisition of metabolic syndrome phenotype
components.”

MedWire (www.medwire-news.md) is an independent clinical news
service provided by Current Medicine Group, a trading division of
Springer Healthcare Limited. © Springer Healthcare Ltd;
2010

Free abstract

When you have type 2 diabetes, there are so many numbers to remember and none of them are your age! There are those daily blood sugar levels, three monthly HbA1c percentage… really important numbers you, as a diabetic, need to know.

Most people with type 2 diabetes monitor their blood sugar level daily. The blood sugar level you are striving for is:

• less than 120 mg/dL (6.7 mmol/L) according to many health care providers
• around 90 mg/dL (5 mmol/L) if you want to be really super.
• any number lower than 100 mg/dL (5.5 mmol/L) is considered normal
• many astute health care providers encourage their patients to keep them in the 70 to 85 mg/dL (3.9 to 4.7 mmol/L)

Some studies show blood sugar levels higher than 85 mg/dL (4.7 mmol/L) and above are at an increased risk for heart disease.

While you take these blood sugar readings daily, your health care provider is interested in another number… that of the HbA1c measurement. This number helps you to adjust your food and exercise and helps your health care provider with adjusting your medications. Of course, you are looking for a level less than 6.0%. The HbA1c gives you an average of your blood sugar over the last three months.

Doctors at the University of California, Irvine are now toying with the idea that another type of glycated molecule, glycated albumin, could be used in a new lab test to determine short-term indicators of how well diabetics are doing. The doctors reported in the November 2008 issue of the Journal of Diabetes Science & Technology that glycated albumin has a definite relationship to diabetic complications such as kidney damage and coronary artery disease.

Other studies have shown that glycated albumin is important in detecting short-term changes in blood sugar control, and the test is highly recommended to be used when looking for a glycemic indicator in pregnant mothers diagnosed with gestational diabetes.

Researchers also commented that the use of this test could save on health care costs.

So look for it in the next few years! It could save you a lot of time and suffering by knowing how well you are progressing on a month-by-month basis. Instead of waiting three months for results showing the indicator of how much damage has occurred… you could find out in a month and correct the cause. The more you control your blood sugar levels, the less risk you have of developing complications.

When you received your type 2 diabetes diagnosis, it was certainly easy to think you could take care of your high blood sugar levels with Metformin or any anti-diabetic drug actually. However, with any drug there are always risks. Many people who have undergone different surgical procedures often look back and say… “if they had only known, they would never have had the surgery.” The same applies to people taking various medications.

Metformin is a standard drug given to type 2 diabetics. It is taken orally and medical practitioners consider it to be the drug of choice, particularly for type 2 diabetics that are overweight with normal kidney function.

Metformin causes few side effects but, nevertheless, can be associated with:

1. General malaise, fatigue or a feeling of just being unwell. It is estimated 10 to 25% of women who take Metformin experience this as a side effect.

2. Nausea, diarrhea and/or vomiting: These gastrointestinal symptoms usually occur after you eat meals high in fats or sugar. What this means is you really can’t cheat on your eating plan just because you are taking medications; unfortunately you will pay the price with nausea, vomiting and/or diarrhea.

3. Reduced levels of vitamin B12: Up to 30% of people taking Metformin show a problem with absorption of vitamin B12. Symptoms include:

• memory loss
• an itchy or tingling tongue
• white spots in your skin which usually increase in size over time
• shortness of breath
• eye twitching
• facial pain
• migraine headaches,
• anemia that doesn’t respond to iron,
• depression, irritability and personality changes.

4. Elevated homocysteine: homocysteine is the amino acid associated with coronary artery disease, chronic fatigue, heart attack, fibromyalgia and cervical cancer levels.

5. Hair Loss: In males you may find hair loss at your temples and at the top of your head. Many women have reported this pattern of hair loss also.

6. Reduced levels of Thyroid Stimulating Hormone (TSH) if you already have low thyroid function. The problem here is many of the population already have low thyroid function. Reducing this hormone further causes symptoms such as fatigue, depression, and a definite inability to get out of bed in the morning.

7. Reduced testosterone production which leads to impotency.

So… knowing all these symptoms, do you still really think Metformin is the best way for you to lower your blood sugar levels? A healthy eating plan will give you weight loss, lower blood sugar levels and lessen your risk of diabetic complications… maybe this is something you want to think about. There are also alternative health and natural healing approaches… these help to build your health as well as aid with reversing type 2 diabetes.

The bottom line is: Why not follow a healthy eating plan and lifestyle… this is more effective than Metformin alone. With weight loss you will be able to reduce your dosage of Metformin or eliminate it altogether.