Multiple risk factors for diabetes control
[Keywords:] diabetes, multiple risk factors, control
Study confirmed that strict glycemic control can reduce the incidence of diabetic microangiopathy. But some studies found evidence-based medicine in the prevention of cardiovascular complications of diabetes, the only good blood glucose control is not enough, even controlling for other risk factors, it is because of diabetes As part of the metabolic syndrome, gathered a large number of risk factors for cardiovascular disease include high blood glucose, lipid metabolism disorders, hypertension, central obesity, and chronic inflammation, hypercoagulable state, etc., these risk factors for atherosclerosis in the arteries formation. insulin
resistance metabolic syndrome exists as the soil, which is not only the occurrence of atherosclerosis in the initiating part, but also accelerated the development of atherosclerosis. At present the development of oral hypoglycemic agents, have begun to focus on its other hypoglycemic benefits of reducing cardiovascular disease risk factors.
1 antihyperglycemic effect of drugs on cardiovascular
Cardiovascular protective effect of metformin on plasma non-
esterified fatty acids, including lower levels, improve blood
lipids, reduce fat deposition in the vascular wall, inhibit vascular smooth muscle cell proliferation, anti-oxidative
stress, lower blood viscosity and so on. Its beneficial cardiovascular role in the UKPDS study has confirmed. in the
U.S. Diabetes Prevention Study (DPP found that metformin was also effective in treatment of central obesity, improve the response rate of metabolic syndrome.
Studies have shown that TZDs drugs thiazolidinediones (TZDs can decrease the blood of patients with type 2 diabetes small
and dense low-density lipoprotein cholesterol, C-reactive
protein, matrix metalloproteinase -9, plasminogen activator
inhibitor -1 levels, increased high-density lipoprotein
cholesterol levels, improve endothelial function, reduction in
diabetic patients with cardiovascular disease risk. from two studies of rosiglitazone, respectively, confirmed that it can effectively reduce the coronary artery after stent placement stenosis and carotid artery intima-media thickness. In TZDs
application process, attention should be Shuinazhuliu issue with caution in New York Heart Association functional class classification of 1,2-class patients, disabled patients at 3,4 level . study found that acarbose significantly decreased the occurrence of impaired glucose tolerance in patients with hypertension, myocardial infarction and any cardiovascular events, with good lower postprandial blood glucose and blood lipids, inhibit the activation of coagulation factors such as the role mechanism.
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2, insulin secretagogues on the cardiovascular effects
Found in human studies of glibenclamide inhibited cardiac ischemic preconditioning, and glimepiride no such adverse effects. In vitro cell studies glipizide, gliclazide and non-
sulfonylurea promote the secretion of agents - repaglinide
sulfonylurea receptor on ?? cells in the selectivity-l
glibenclamide. For the average cardiac events did not occur in patients with type 2 diabetes, the condition of patients selected sulfonylurea treatment is safe, for the determined to disease risk factors in patients with vascular disease or previous myocardial infarction have occurred if those who should choose to use sulfonylurea glimepiride, gliclazide or glipizide without glibenclamide benzene urea, for patients with acute myocardial infarction during the acute phase with intravenous infusion of insulin as control high blood sugar, followed by subcutaneous insulin, acute period, such as the condition to be used by diabetic sulfonylurea drugs, select
the method of Ibid.
Clinical study found that glimepiride reduces blood glucose in the same time, with the lipoprotein (a, plasminogen activator inhibitor-source -1 (PAI-1, homocysteine, tumor
necrosis factor - significantly @ lower adiponectin levels
were significantly increased. gliclazide found significant anti-oxidative stress, and improve blood viscosity, can effectively prevent diabetic vascular disease. animal and human studies have confirmed that repaglinide can reduce
oxidative stress, vascular endothelial protection and reduce carotid intima-media thickness.
In summary, the choice of antidiabetic drugs, when complications for patients to choose drugs with hypoglycemic effect outside, for heart failure, myocardial infarction,
acute coronary syndrome Vascular disease risk factors determined to hypoglycemic agents to carefully selected patients.
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