[The ankle brachial index in type 2 diabetes]. / Kotníko-pazni index u nemocných s diabetes mellitus 2. typu.

INTRODUCTION: The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI < 0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated. METHODS: We examined 253 T2DM subjects (135 males, 118 females, aged 66 +/- 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined as manifest CV diseases, elevated coronary calcium score (CAC) by Agatston (> 101) or according to the global CV Risk Score > or = 5% (SCORE). STATISTICAL METHOD: Wilcoxon's unpaired test, chi2 test, multiple logistic regression. RESULTS: The ABI < 0.9 was found unilateral in 23 T2DM (8%), bilateral in 24 (9%), in older males (71 +/- 8 years) with higher CAC (600 +/- 707) (p < 0.01), higher total cholesterol (5.4 +/- 1.3 mmol/L) and total homocystein (17.2 +/- 7.1 micromol/L) (p <0.05) in comparison to those with the ABI > or = 0.9 (age 66 +/- 9 years, CAC 234 +/- 458, total cholesterol 5.0 +/- 0.9, total homocystein 14.3 +/- 78). Many CV risk factors correlated positively with the low ABI < 0.9; it was significantly independently associated with age (p < 0.001), smoking (p < 0.01), LDL-cholesterol, total homocystein and CAC (p < 0.05). Low ABI < 0.9 predicted ischemic stroke in subjects with T2DM and manifest CV diseases in the further 3 years. There was no correlation between the ABI and the ultrasensitive C-reactive protein. CONCLUSION: Low ABI < 0.9 was in a strong association with the CV risk. The ABI measurement is a simple, noninvasive, time-nonconsuming and inexpensive method for subclinical atherosclerosis detection; the ABI can supply standard methods for the CV risk prediction.

[Monitoring of cardiovascular risk factors in patients with diabetes type 2]. / Kontrola kardiovaskulárních rizikových faktoru u diabetiku 2. typu.

The control of basic cardiovascular risk factors was examined in a sample of 415 diabetes type 2 patients, aged 66 +/- 10 years, with a 9.4 +/- 8 years long history of diabetes, both genders represented proportionally; 95% of the sample were hypertensive. The recommended blood pressure value was achieved by 13% males and 17% females. Antihypertensive monotherapy was indicated in 40% of the sample. Renin-angiotensin-aldosteron system inhibitors were prescibed to 90% of the sample. The fasting glycaemia < or = 6 mmol/L were achieved in 10% males and 11% females; glycosilated hemoglobin < 4.5% in 20% males and 24% females; 60% of the sample had antidiabetic pharmacotherapy--44% males and 48% females used metformin. Total fasting plasma cholesterol < 4.5 mmol/L was achieved in 31% males and 23% females; LDL-cholesterol < 2.5 mmol/L was achieved in 31% males and 41% females. The target values for diabetics in secondary prevention of cardiovascular diseases or with subclinical atherosclerosis was achieved in 13% of the sample. Statins were prescribed in 60% of the sample, fibrates in 4%. Only 2 females achieved all the target values. Hypolipidemic and antihypertensive drug therapy is unsatisfactory; there is certainly a big potential in life style changes among the diabetic patients.

[Macrovascular and microvascular complications in type 2 diabetes patients]. / Makrovaskulární a mikrovaskulární komplikace u diabetiku 2. typu.

The prevalence of chronic vascular complications is higher in patients with type 2 diabetes mellitus (DM2). The objective of our cross-sectional study was to assess the incidence and types of macrovascular (MVC) and microvascular (mvc) complications and to analyse their relation to the different risk factors and biomarkers in order to improve their prevention. SET OF PATIENTS AND METHODOLOGY: 415 patients (219 men and 196 women) with an average age of 66 +/- 9 years enrolled in the study. A total of 95% of patients with DM2 had a history of hypertension, 27% had MVC (of which 55% had ischaemic heart disease), and 54% had mvc (ofwhich 95% had diabetic nephropathy). RESULTS: The patients with vascular complications were significantly older and had a longer history of DM2; they did not differ for their systolic blood pressure, but had a higher pulse pressure and took more antihypertensives. They did not differ for their lipid levels or the respective therapy. Diabetic patients with MVC and mvc had higher insulin resistance, higher plasmatic levels of total homocysteine and a higher incidence ofalbuminuria or proteinuria. The factors which significantly and independently associated with MVC were male gender, age over 60 years, higher hs-C-reactive protein (hs-CRP) exceeding 1 mg/l, glycaemia over 5.6 mmol/l, lower diastolic blood pressure and lower HDL-cholesterol; mvc associated with higher age over 60 years, a history of DM2 exceeding 8 years, and hs-CRP above 1 mg/l. CONCLUSION: Our results show that patients with DM2 have a high incidence ofvascular complications significantly associated with age, DM2 history and higher hs-CRP, irrespective of the other monitored parametres.