Cardiometabolic Risk In India Ecab

Cardiometabolic disease is the leading cause of death in many parts of the world. There are many potentially modifiable and non-modifiable risk factors associated with the same. Although with the recent advances in management and preventive strategies the mortality rates have reduced, but no patient actually achieves an adequate control of the CVD risk factors with the declining quality of life. In addition, growing obesity and DM in younger age groups has further undermined the improvements achieved in CVD. Diabetes and CVD share a "common soil" in their etiology and the causative factors for these diseases are termed as "cardiometabolic risk factors." Cardiometabolic risk (CMR) is the global risk of developing type 2 diabetes and CVD. CMR factors include overweight or obesity, high blood glucose, HTN, dyslipidemia, inflammation and hypercoagulation, physical inactivity, smoking, age, race and ethnicity, gender, and family history. Among these, age, race/ethnicity, gender, and family history are non-modifiable risk factors. The remaining are modifiable risk factors and closely interrelated. Recently, systematic prospective studies have shown evidences that moderate lifestyle modifications help in reducing the metabolic risk factors. The major principles include cessation of smoking, enhanced physical activity, and reduction of excess weight. Healthy diet also has a major role in controlling overweight and maintaining ideal weight. Each of the risk factors poses a danger to good health; the propensity increases with multiple risk factors. It is also shown that the CMR factors tend to cluster as the metabolic syndrome. This book is designed to address such questions with supportive typical clinical scenarios, with which all readers will be able to identify. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Diabetes is one of the most important non-communicable lifestyle diseases. Diabetes is a multifaceted disorder which possibly influences and impacts body pathophysiology by different mechanisms and in varied ways. Diabetes has a very distinguished impact on cardiovascular system and plays a detrimental role in development of cardiovascular disorders. Metabolic memory is used to describe the impact of exposure to glucotoxicity, lipotoxicity and other metabolic disturbances, either as an adverse or a beneficial cell response which determines the later development of vascular complications. Terms such as metabolic imprint, legacy effect, glycemic memory or latent hyperglycemic damage are also used. Diabetes has significant impact on different facets of life. Diabetes has a distinguished but significant impact on development of various cancers. Diabetes has a positive, negative and even neutral impact on pathogenesis and progression of cancer depending upon the tumor site. On the contrary, cancer also has a significant effect on diabetes development and management. These facets tend to get overlooked in the study of diabetes development and management. All these aspects are being thoroughly covered in this project so as to facilitate better management of diabetics.

Even though we have many advances in the development of oral hypoglycemic agents, an ideal drug for treating type 2 diabetes is still a distant reality. Today, physicians can choose from a variety of medications targeting numerous facets of disease, but each drug class poses some limitations. The age-old molecules, such as sulfonylureas and biguanides, are still valued because of their well-studied mode of action, safety, tolerability, and predictable pharmacodynamic effects. This book attempts to describe the historical aspects and advances in the arena of oral hypoglycemic agents, extended- and sustained-release formulations of glipizide and metformin (both of which have great promise in the treatment of type 2 diabetes mellitus) as well as evaluates the role of the group in diabetic foot infections.

Critical Issues and Diabetes - ECAB - E-Book

Diabetes is a chronic disease that is reaching an epidemic proportion in many parts of the world. Despite the high incidence of diabetes, individuals diagnosed with the disorder are only 50%. The main challenge of medical professionals in diagnosing and treating the diabetic patients is the lack of understanding of the disease, which usually leads to problems with treatment compliance and monitoring. There is strong evidence to show that an effective intensive glycemic control reduces various microvascular and neuropathic complications of diabetes mellitus. The Diabetes Control and Complications Trial (DCCT) showed that the intensive glycemic control prevented diabetic complications in type 1 diabetic patients, and the HbA1c levels reduced by 1.5–2.0%. In the UKPDS study, a modest improvement in HbA1c (a difference of 0.9 %) in the intensively treated group than in the control group brought about a 25% reduction in microvascular complications and a 12% reduction in all diabetes related events. There are several methods with differing utilities and limitations existing for monitoring glycemic status in individuals. Diabetes care in India leaves much to be desired and suggested, and there is a need for efforts to increase awareness of both the patients and the doctors for better treatment and monitoring.

Diabetes management, outcomes and prognosis are majorly affected by the lifestyle exercised by the diabetics. Diabetes has significant impact on the different facets of life. These facets tend to get overlooked in the management. The inter-relation of diabetes and marriage, sleep, travel, commute and uneven working hours seem to be trivial part of managing diabetes but are extremely important for a perfect recovery and management of the patient. Patients travelling with diabetes need to consider how to adapt their treatment programs to unfamiliar foods, irregular schedules, and varying amounts of exercise. Diabetes will be involved at every step of married life including vacations, outings, going to the movies, as well as intimate moments. Sleep and diabetes are interconnected. Sleep disorders have a slight but significant impact on diabetes management and it should be focused while attending a diabetic with sleep disorders. Shift workers make a special segment of diabetics, whose glucose monitoring and control need to be tailored in a special manner. With change in circadian rhythm and sleep pattern, diabetes management needs to be adjudged and adjusted. The main risks that arise in driving from having diabetes are hypoglycemia and the long term complications. All these aspects are being thoroughly covered in this book so as to facilitate better management of diabetes.

Type 2 diabetes mellitus is associated with a greater risk of developing atherosclerotic macrovascular diseases like myocardial infarction, stroke, and peripheral vascular disease. There is 2- to 4-fold increased risk of atherosclerotic heart disease and stroke in diabetic patients compared to non-diabetic patients. As the prevalence of type 2 diabetes is increasing rapidly, this diabetes related atherosclerotic disease is predicted to be a major public health problem. Atherosclerosis is a complex process and in diabetic patients, it behaves differently with increased lesion progression and severity. This accelerated atherosclerotic process in diabetics is explained on the basis of several risk factors like hyperglycemia, dyslipidemia, accelerated formation of advanced glycation end products, increased oxidative stress, and genetic factors. It is difficult to establish precisely the elements responsible for this atherosclerosis in diabetics, but by epidemiological, clinical, and by animal studies, it has been possible to get an idea of this problem in diabetics. Of the several risk factors for atherosclerosis in diabetes, dyslipidemia is the leading one, and an insight into the pathophysiologic relation of isolated triglyceridemia in Indian diabetics with the identification of the targets for control of lipids in diabetes (practical vs. ideal) needs to be well understood by the treating physician. This book is designed to address such issues with supportive typical clinical scenarios, with which the readers will be able to identify. Thus, it provides an excellent opportunity to widen one’s perspective in this area.

The insulin resistance syndrome can be defined as insulin resistance, compensatory hyperinsulinemia, and their associated co-morbidities. Clinically, the term insulin resistance syndrome describes a constellation of abnormalities such as obesity, hypertension, dyslipidemia, type 2 diabetes/hyperglycemia, and coronary artery disease. Insulin is responsible for glucose uptake into the body cells and tissues. The response of the cells to insulin varies from individual to individual. In some individuals, the tissue response to insulin may be diminished. This means that even with adequate levels of insulin, the glucose uptake into the cells and tissues is not optimal. This results in a compensatory over-secretion of insulin from the pancreas. The persistence of high levels of insulin in the blood or hyperinsulinemia is thought to be responsible for some of the abnormalities associated with this condition. However, the exact causal association of the condition with these disorders and the pathophysiology of their evolution are unclear. The most common underlying mechanism proposed is increased free fatty acids from abdominal fat in individuals with central obesity. This leads to deranged insulin signaling, reduced muscular glucose uptake, increased triglyceride synthesis, and hepatic gluconeogenesis. A genetic basis of the disease as well as several other factors such as tumor necrosis factor-α, adiponectin, leptin, Interleukin-6, and some adipokines have also been implicated. Insulin resistance syndrome is of clinical significance because of its association with potentially debilitating conditions that contribute to long-term morbidity and even mortality of the individual. People with insulin resistance syndrome are at an increased risk of developing type 2 diabetes, hypertension, dyslipidemia, myocardial infarction, polycystic ovarian disease, and fatty liver. In this book, we have tried to collate the experiences of the pioneers of this field on the subject and provide the reader a comprehensive view on the topic along with practical management points, which we are sure will benefit the physicians in their clinical practice. The contributors have focused on the condition as is prevalent in our subcontinent and have tried to give an insight on the issues pertaining to the same with a topical flavor.