Impaired glucose tolerance, but not impaired fasting glucose, is a risk factor for early-stage atherosclerosis, results of a study demonstrate.

Impaired glucose tolerance and impaired fasting glucose are two established risk factors for the development of diabetes mellitus, Suichi Okada (Gunma University Graduate School of Medicine, Japan) and colleagues note in the journal Diabetic Medicine.

They add: “Similar to diabetes mellitus, impaired glucose tolerance is also associated with an increase in cardiovascular-related mortality, as well as mortality in general.

“However, the relationship between impaired fasting glucose and atherosclerosis is less clear.”

To address this question, the researchers used brachial-ankle pulse wave velocity (baPWV) as a marker for arterial stiffness and vascular damage in 2842 patients from Takasaki city in Japan who were undergoing routine medical check-ups.

“The technical simplicity and short sampling time of the method used to measure baPWV make the method more feasible for screening a large population than conventional methods, such as the applanation tonometric method applied to the carotid and femoral arteries,” Okada et al comment.

Patients were divided into the following five groups based on a 75-g oral glucose tolerance test: (i) normal fasting plasma glucose/normal glucose tolerance group, (ii) impaired fasting glucose group, (iii) impaired glucose tolerance group, (iv) combined glucose intolerance/fasting group, and (v) diabetic glucose intolerance group.

The researchers found that individuals with impaired glucose tolerance, combined impaired glucose fasting/tolerance, and diabetic glucose intolerance showed significantly higher baPWV values compared with the group with normal glucose parameters, at 1429 cm/s, 1491 cm/s, and 1534 cm/s versus 1300 cm/s, respectively.

Although the group with impaired fasting glucose had slightly increased baPWV values, the difference compared with the group with normal glucose parameters was not significant.

In multiple regression analyses, impaired glucose tolerance emerged as an independent predictor of baPWV, whereas no direct independent association was observed with fasting plasma glucose.

“Thus impaired glucose tolerance, but not impaired fasting glucose, is a risk factor for early-stage atherosclerosis… which is consistent with the data of earlier studies on the effect of post-prandial dysregulated metabolism on vascular damage,” Okada et al 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

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Giving primary healthcare physicians access to an electronic feedback system with information on all their patients with Type 2 diabetes leads to significantly improved quality of care, say researchers.

Trine Guldberg (Aarhus University, Denmark) and colleagues enrolled 86 Danish general practices (158 primary healthcare physicians) and 2458 patients with Type 2 diabetes aged 40-70 years in a randomized controlled trial of electronic feedback.

Half the practices were randomly assigned to receive electronic feedback, in the form of a CD-ROM distributed three times during the 15 month follow-up period, and half were not.

The CD’s provided to the physicians in the electronic feedback group allowed them to see lists of patients attending their practice with Type 2 diabetes and sort the data according to relevant variables such as glycated hemoglobin (HbA1c) and cholesterol levels, giving an overview of the health of the patients and their level of control over their condition.

Writing in the journal Diabetic Medicine, the team reports that provision of electronic feedback seemed to significantly improve the quality of patient care compared with no feedback.

For example, patients being treated at practices in the electronic feedback group redeemed more prescriptions for oral antidiabetic drugs (32.8% vs 12.0%), insulin (33.8% vs 12.4%), lipid-lowering medication (38.3% vs 18.6%), and blood pressure lowering medication (27.6% vs 16.3%) than those treated at practices that were given no feedback.

However, the authors note that no significant differences in mean HbA1c or total serum cholesterol were observed between the two patient groups.

“Our findings indicate that electronic feedback to general practitioners about their diabetes care improves prescription patterns, which seems to be the most accessible process measure to influence via electronic feedback,” write Guldberg et al.

“Whether the revealed effects are due to an increased attention to guideline measures by way of the system, or whether the system itself had features that specifically turned attention to prescription of Type 2 diabetes-related medicines is unclear,” they add.

“However, this will be explored further in a mixed-method study based on the results of this quantitative evaluation of the study and the results of the qualitative evaluation which has also been performed.”

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

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An elevated microaneurysm score is an important prognostic indicator for progression of diabetic retinopathy and reduced likelihood of regression, suggest study findings.

The researchers say that treatment of microaneurysms using renin-angiotensin system inhibitors may be effective for improving mild retinopathy.

Writing in the journal Diabetic Medicine, Anne Sjølie (Odense University Hospital, Denmark) and team report results from a post-hoc analysis of the DIabetic REtinopathy Candesartan Trials (DIRECT) study.

They included 893 patients with Type 1 (454 placebo; 439 candesartan treated) and 526 patients with Type 2 diabetes (264 placebo; 262 candesartan treated) with microaneurysms and diabetic retinopathy who were assessed for progression.

In addition, 438 patients with Type 1 and 216 with Type 2 diabetes who had significant potential to regress (Early Treatment Diabetic Retinopathy Study [ETDRS] severity scale score level 20 in both eyes) were also assessed for regression of retinopathy.

The researchers found that each additional microaneurysm observed at baseline on retinal photographs increased the risk for progression of retinopathy by 8% and 7% in Type 1 and Type 2 diabetes, respectively.

Chance of regression of retinopathy was reduced by a corresponding 21% and 15% per additional aneurysm scored at baseline.

Use of a renin-angiotensin system inhibitor, in this case candesartan, was observed to reduce the risk for microaneurysm score progression, note the authors.

“Our findings support the use of microaneurysm score as a useful surrogate clinical endpoint for progression and regression of retinopathy in clinical trials and may be more sensitive than the ETDRS in earlier stages,” write Sjølie et al.

“It should be emphasized that this is not applicable to screening for sight-threatening retinopathy in clinical practice,” they add.

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

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The prevalence of Type 2 diabetes among UK men has risen by 10.9% over the past three decades, with a dramatic increase in more recent years accounting for a large proportion of the overall increase, report UK researchers.

Prevalence of the condition has increased sharply worldwide in recent years, and researchers predict that the disease is likely to reach epidemic proportions during this century, explain Mary Thomas (University College London) and colleagues.

For this study, Thomas and co-investigators used data collected from a cohort of 7722 British men from across the UK, aged 40 “59 years at baseline, who were followed-up from 1978 “2005 for incidence of Type 2 diabetes.

The researchers carried out seven sequential surveys during the study period. Diagnosis of diabetes was defined by self-reported diagnosis of diabetes or self-reported use of anti-diabetes medication on returned questionnaires.

Writing in the journal Diabetic Medicine, the researchers report that the prevalence of Type 2 diabetes increased from just 1.2% in 1978 to 12.1% in 2005.

They calculated that the average age-adjusted increase in Type 2 diabetes prevalence over the study period was 7.0%.

However, the increase in prevalence was not uniform as the annual rate of increase from 1979 “2000 ranged from 4.3% to 6.9%, but increased dramatically to an average of 11.2% in the 2000 “2005 period.

Men from Scotland had the greatest increase in prevalence of Type 2 diabetes, with the lowest UK prevalence ” 0.52% ” in 1979 and the highest UK prevalence ” 13.0% ” in 2005.

The authors note that the rate of increase was strongly related to body mass index (BMI), with annual rates of increase rising with increasing BMI. Individuals with a BMI below 22.5 kg/m² had an annual increase of less than 3% compared with a higher than 10% annual increase in men with a BMI of 27.5 kg/m² or more.

Thomas et al estimate that if all participants had maintained a BMI of under 25 kg/m² for the entire duration of the study, 68% of diabetes cases would have been prevented.

“These results emphasize the urgency of population-wide measures to control the increase in Type 2 diabetes prevalence, particularly by limiting the rising prevalence of obesity at all ages,” concludes the team.

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

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Around two thirds of diabetic patients attending a clinic in Northern India are at risk for foot ulceration, only 19% of who follow correct foot care practices, study results show.

The researchers note that such a level of foot care compares unfavorably with Western rates and may be indicative of the challenges facing developing nations in general.

“This may be due to lack of awareness and/or failure of our health care system to educate the patients regarding preventive foot care,” say corresponding author Anil Bhansali and colleagues from the Postgraduate Institute of Medical Education & Research in Chandigarh.

India has more patients with diabetes than any other country. Foot disease there is exacerbated by sociocultural factors such as the prevalence of walking barefoot, lack of knowledge regarding diabetes foot care, and the socioeconomic status of patients.

Noting a paucity of data on diabetic foot syndrome in India and the developing world, the researchers assessed 1044 patients with diabetes who attended a diabetes clinic of a tertiary care centre in north India from January 2007 to May 2008.

They assessed patients for peripheral neuropathy using vibration perception threshold (VPT) and peripheral vascular disease (PVD) using Ankle Brachial Pressure Index (ABI) in addition to anthropometric measurements and foot examination. Based on this information patients were categorized as having an ulcer, having foot at risk for ulcer, or no risk factors.

Patients also completed a questionnaire to gauge adherence and knowledge of foot care practices.

As reported in the journal Diabetic Medicine, the prevalence of peripheral neuropathy was 34.9% and PVD 12.6%. Two thirds of the patients were considered at risk for foot ulceration; 9% had an ulcer and 20.2% required amputation.

The strongest predictors for presentation with ulceration were nephropathy, PVD, and neuropathy with odds ratios of 1.61, 1.52, and 1.40, respectively.

“The high prevalence of neuropathy and PVD, coexisting with poor adherence to foot care practices predisposes to foot problems in people with diabetes in our study population,” the researchers conclude.

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

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