INTRODUCTION
Coronary artery diseases (CAD) as a kind of cardiovascular diseases are considered to be the major causes of morbidity and mortality in type 2 diabetic patients (Buse JB et al, 2007) (Stolar MW & Chilton RJ, 2003).
Diabetic patients frequently present various risk factors for CAD, including hyperglycemia,fluctuation of blood glucose levels, obesity, hyperlipidemia and hypertension etc (Stolar MW & Chilton RJ, 2003).
Glycaemic disorders in particular are the most important component of these risk factors.
Some studies concluded that patients with chronic hyperglycemia, which can be estamited by the determination of hemoglobin A1c (HbA1c) level integrating both basal and postprandial hyperglycemia (Sacks DB et al, 2002)(Gorus
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Recent studies have found that glycemic variability may play a substantial role in the pathogenesis of atherosclerosis suggesting that it may be an independent risk factor for developing cardiovascular diseases in diabetic patients (Ceriello A et al, 2008)(Monnier L et al, 2006)(Hu Y et al, 2010)(Temelkova-Kurktschiev TS et al, 2000). However, in the avaliable literature studies that specifically evaluate the role of glycemic variability in increasing severity of CAD are still scarce.
Therefore, the aim of this study is to evaluate the association between glycemic variability and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).
Rationale
To understand the reason behined one of the major causes of morbidity and mortality in diabetic patients that is coronary artery diseases. To determine the effect of Glycemic Variability (GV) on morbidity and mortality in a population of diabetic
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As the effect of GV on the diabetic patients is a chronic ongoing effect, which has to be studied during the lifetime of these patients. Also changes occur in the patient's coronary arteries can only be evaluated by doing investigational tool (angiography).
Research Question Is there a relationship between glycaemic variability and severity of coronary artery diseases?
Aim of the work
The aim of the study is to evaluate association between glycemic variability and severity of coronary artery disease(CAD) in patients with type2 diabetes mellitus(T2DM). Objective
1)To assess glycaemic variability (FBS,RBS and HBA1C) in adults with type2 DM.
2)To assess interday variability of serum glucose,by calculatingthe SD of the fasting blood glucose concentration ,mean of daily differences(MODD) using hourly blood samples taken over 24 hours,and it is correlation with severity of coronary artery disease as indicating by angiographic finding ,using Gensini score in diabetic patients,the angiography will be performing on the same day of taking blood sugar
Of the 14,385 members, 5,084 were from rustic ranges and 9,301 were from urban regions. The subjects were 16-88 years. 10.1% (1,456) of the subjects had sort 2 diabetes with 699 (11.4%) of them being men and 757 (9.2%) ladies. Event of disengaged weakened fasting glucose (IGF), segregated hindered glucose resistance (IGT), and consolidated IFG and IGT was 10.8%, 4.1% and 2.4% separately. Sort 2 diabetes recurrence was 7.0%, with men demonstrating a radically higher rate of diabetes than ladies (X2=18.28, P. Diabetologia 286-92 50(2)
Hyperglycemia is a very serious risk for heart disease and strokes. Complications from hyperglycemic diabetes may include coronary heart disease (CHD), heart failure, stroke, arrhythmias, or even death. High blood glucose (sugar) levels over time can lead to excess fatty deposits on the insides of your blood vessel walls. These deposits often affect blood flow, which increases the possibility of blood vessels clogging and/or hardening. As a result, this leads to heart disease. Furthermore, those with diabetic heart disease (DHD) may have less success with heart disease treatments, such as angioplasty or artery bypass grafting. “The common clustering of these risk factors in a single individual has been called the metabolic syndrome.” (Scott 1134) Uncontrolled diabetes, the biggest contributor to heart disease, is almost four times higher for adults than those without diabetes. The best way to prevent diabetic heart disease is to control it by way of reducing the risk factors through diet and lifestyle changes.
Diabetes mellitus (DM) is a pandemic that affects millions of people. The growth rate of unrecognized pre-diabetes in America is expected to rise up to 52% by 2020 (Lorenzo, 2013). As the prevalence of diabetes increases, so will the complications and burden of the disease. One of the leading causes for cardiovascular disease, renal failure, nontraumatic lower limb amputations, stroke, and new cases of blindness is DM (Lorenzo, 2013).
This particular research was driven by the demand of the regulatory guidelines that deals with reduction of risks. The cases of cardiovascular risks among patients are have been reported to increase in the recent days. The regulatory guidance require being presented for the cardiovascular outcomes that can be used in the therapies of type 2 diabetes treatment. However, the
Because we are all physiologically the same there are factors that must be addressed in all Diabetics
This particular research was driven by the demand of the regulatory guidelines that deals with reduction of risks. The cases of cardiovascular risks among patients are have been reported to increase in the recent days. The regulatory require being presented for the cardiovascular outcomes that can be used in the therapies of type 2 diabetes treatment.
Diabetes mellitus (or diabetes) is a threatening disease which occurs as a result of loss of uptake of glucose by cell thus increasing its concentration in the blood(Walker and Colledge 2013). Glucose, normally referred to as blood sugar is mainly present in blood and acts to provide energy to the body. It can be thought of a syndrome of hyperglycemic condition where disorders in metabolism occur(Tierney, Saint et al. 2002). It can be termed as metabolic sickness portrayed by hyperglycemia which result due to deformities in insulin discharge, its activity or both of these(Alberti and Zimmet 1998, American Diabetes 2010). The chronic state of disease is that in which hyperglycemia can lead to disorders affecting organs such as kidneys, heart ,eyes and blood vessels etc.(American Diabetes 2010).Diabetes occurs usually when the release of
According to Meng, Chunyan, Xiaosheng, Xiangren (2018), diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas or by the ineffectiveness of the insulin produced. The first WHO Global report on diabetes suggested that the most-to-date number of adults living with diabetes is 422 million, which has almost quadrupled since 1980. This dramatic rise is largely due to the prevalence of type 2 diabetes and the factors driving it include overweight and obesity (para. 1).
Guidelines from the American Heart Association (AHA)/American Diabetes Association (ADA) [7] and the European Society of Cardiology [8] present different recommendations for individuals with diabetes depending on an individual 's risk profile. To identify patients who will benefit most from
Diabetes mellitus (DM) is one of the major problems in health system and a worldwide general health risk that has increased drastically in the course of recent decades (1, 2). As per epidemiological studies, the number of patients with DM expanded from around 30 million cases in 1985, 177 million in 2000, 285 million in 2010, and evaluated if the circumstance continues with the same , more than 360 million individuals by 2030 will have DM (3).
Macrovascular inconveniences –are brought on by the dynamic improvement of atherosclerosis in the significant conduits of the body (aorta, carotid, coronaries and illiac vessels) prompting to myocardial dead tissue, heart disappointment, stroke, and fringe vascular malady –These difficulties have all the earmarks of being more identified with the other metabolic anomalies that most normally go with diabetes, basically hypertension, lipid variations from the norm, and expanded thrombogenesis as opposed to the real hyperglycemia alone.
Type II diabetes is a metabolic disease that affects many people of various ages, genders, and ethnicities all over the world. Many factors contribute to the disease, including
People with diabetes mellitus who have atherosclerosis are at a higher risk for developing macro- and micros-vascular complications. One reason for this is an increase incident of plaque instability and blood clotting. This is a consequence of the decreased size of the lumen of the blood vessel and the raised capillary pressure. Diabetes mellitus long-term complications alters the normal cell function of endothelium (smooth muscle) and platelets cells of the vascular system. These changes lead to widespread lesions of the arterial walls that are associated with atherosclerosis.
Diabetes Mellitus is one of the very prevalent metabolic diseases that affect about 6% of the population. The number of diabetic patients will reach 300 million in 2025. (International Diabetes Federation, 2001)
Many factors play a role in development of CVD in diabetes as dyslipidemia, poor glycemic control that cause direct damage to myocardium, or affect through atherosclerotic process , while other factors are still controversial (Zile & Brutsaert 2002), (Hogan et al., 2003), (Laing et al., 2003), (Paterson et al., 2007), (Fowler 2008), (Forbes & Cooper 2013).