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Article
Predictors of Blood Pressure Control in Patients with Type2 Diabetes and Hypertension
تنبؤات السيطرة على ضغط الدم الشرياني لدى مرضى داء السكري عندالبالغين

Authors: Hazim Abdul-Razak د.حازم عبد الرزاق --- Ali Jabbar د. علي جابر
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2008 Volume: 21 Issue: 3 Pages: 204-211
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: The overall prevalence of hypertension (HT) in diabetic patients is greater than 70%, and elevated blood pressure (BP) significantly increases the risk of complications of diabetes mellitus (DM). BP is not well controlled in the majority of patients with both DM &HT. Randomized clinical trials have demonstrated that strict BP control in DM reduces cardiovascular morbidity and mortality.Objective: This clinical study was conducted to determine predictors of BP control in patients with both Type2 DM&HT who attend National Diabetic Centre (NDC).Methods: This study is an observational prospective study enrolled 100 patients with type2 DM&HT who had been randomly selected from those attending the NDC Al-Mustansiriya University during the period of the 1st. of March 2006 to 1st. of September 2006. Detailed history had been recorded and thorough physical examination had been performed for each one of them. Readings of fasting and postprandial plasma glucose, HbA1c, body mass index (BMI=Wt./Ht.2) had been recorded. Results: This study revealed that age group between 50-59 yrs. had higher frequency of uncontrolled BP 77.77% than the age group 30-39yrs 33.33%.(p value=0.04). High percentage of uncontrolled BP was in males 80% compared with females 58.33 % (p value=0.04). 71.42% of those with longstanding DM (11-15yrs.) had uncontrolled HT. 78.12% of patients who use more than one drug to control their BP had uncontrolled HT as compared to 61.76% of those who use monotherapy (p value=0.001). Good control of BP in patients who use insulin as part of their treatment or use insulin alone as compared to other modalities of therapy ( p value=0.01) .Conclusion: Predictors of poor BP control in type2 DM were as follows: 1) older age vs younger age group 2) male sex vs. female 3) use of oral hypoglycemic drugs vs. insulin 4) use of more than one drug to control BP vs single antihypertensive drug.Keywords: Hypertension, Type2 Diabetes

تمهيد: بصورة عامة إن شيوع إرتفاع ضغط الدم الشرياني لدى مرضى داء السكري هو أكثر من ٧٠٪. إن إرتفاع ضغط الدم الشرياني يزيد من خطر المضاعفات المصاحبة لتطور مرض داء السكري. كما إن ضغط الدم الشرياني المصاحب لداء السكري في أغلب المرضى غير مسيطر عليه علماً بان التجارب السريرية العشوائية أثبتت بوضوح بأن السيطرة الدقيقة تقلل من الإصابة بالمضاعفات القلبية الوعائية . الأهداف: لتحديد تنبؤات السيطرة الجيدة والسيطرة الضعيفة في ضغط الدم الشرياني لدى المرضى المصابين بداء السكري عند البالغين مع إرتفاع ضغط الدم والمراجعين للمركز الوطني للسكري .الطرق: إشتملت هذه الدراسة السريرية على (۱٠٠) مريضًا مصابًا بداء السكري عند البالغين مع إرتفاع ضغط الدم اختيروا عشوائياًً من المركز الوطني للسكري في كلية الطب/الجامعة المستنصرية في بغداد للفترة من ۱/٣/٢٠٠٦ إلى غاية ۱/۹/٢٠٠٦. سجل التاريخ المرضي مع فحص سريري لكل مريض. أجريت فحوصات السكر في الدم في حالة الصيام وساعتين بعد الطعام, وخضاب الدم المعسل.النتائج: هذه الدراسة اظهرت ان الفئة العمرية50-59 سنة تتميز بنسبة عالية من عدم السيطرة على ارتفاع ضغط الدم 77.77% مقارنتا" مع الفئة العمرية 30-39 سنة 33.3% (P 0.04). نسبة عالية من عدم السيطرة على الضغط لدى الذكور 80% مقارنتا" مع الاناث 58.33% (P 0.04). 71.42% من الذين مضى على السكر لديهم 11-15 سنة غير مسيطر على ظغطهم. 78.12% من المرضى الذين يتناولون اكثر من دواء لعلاج الضغط غير مسيطر على ظغطهم مقارنتا مع 61.76% من الذين يتناولون دواء" واحدا" ((P 0.001. السيطرة على الضغط افضل عند الذين يستعملون الانسولين لمعالجة السكري مقارنتا مع وسائل علاج السكري الأخرى (( P 0.01الاستنتاجات: أظهرت هذه الدراسة بأن تنبؤات السيطرة الضعيفة لضغط الدم كالآتي : ۱. تقادم العمر ٢.الجنس الذكري ٣.إستخدام الأدوية الخافضة للسكر بالدم ٤.استخدام أكثر من دواء واحد خافض لضغط الدم.تنبؤات السيطرة الجيدة : ۱. الأعمار الصغيرة ٢.الجنس الانثوي ٣. استخدام الإنسولين ٤.إستخدام دواء واحد خافض لضغط الدم.


Article
GONADAL DYSFUNCTION WITH POSTPRANDIAL HYPERTRIGLYCERIDEMIA IS RISK PREDICTORS OF CARDIOVASCULAR DISEASE IN MEN WITH TYPE 2 DIABETES MELLITUS

Authors: Zainab AA Al-Shamma زينب عبد الامير الشماع --- Yahya YZ Farid يحيى يحيى زكي فريد --- Hashim M Hashim هاشم مهدي هاشم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 2 Pages: 148-152
Publisher: Al-Nahrain University جامعة النهرين

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Background:The association of type 2 diabetes mellitus and risk of cardiovascular disease is well documented. Insulin resistance is the hallmark feature of type 2 diabetes and there is evidence to suggest that testosterone is an important regulator of insulin sensitivity in men, with a role for testosterone in lipid metabolism and specially the triglyceride fraction.Objective:To emphasize the association of low level of total testosterone with that of the postprandial triglyceride in male patients’ with type 2 diabetes mellitus.Methods:Forty two type 2 diabetes mellitus male patients and 42 healthy controls of age range between 30-60 years, during the period from December 2011 to June 2012. Postprandial venous blood used for random blood glucose, lipid profile, urea and creatinine measurement. Luteinizing hormone, follicle stimulating hormone, testosterone, and sex hormone binding globulin was done using Enzyme-Linked Immuno Sorbent Assay (Sandwich assay).Results:A negative correlation between testosterone, and postprandial triglyceride, in both type 2 diabetes mellitus and control groups with a significant difference in testosterone between the two groups. The sex hormone binding globulin was also correlated negatively with postprandial triglyceride in only the control group.Conclusion:Hypogonodism in male (decline in testosterone level) leads to increased postprandial hypertriglyceridemia, which could, both, be considered of predictors for cardiovascular disease risk factors in male patients with type2 diabetes mellitus.Key words:Postprandial triglycerides, type2 diabetes mellitus, testosterone.


Article
Relation of Oxidant-Antioxidant Status with Glycemic control in type 2 diabetic patients

Author: *Baydaa Ahmmad Abed بيداء احمد عبد
Journal: Al-Mustansiriyah Journal for Pharmaceutical Sciences مجلة المستنصرية للعلوم الصيدلانية ISSN: 18150993 Year: 2013 Volume: 13 Issue: 2 Pages: 48-57
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract:In diabetes mellitus, persistence of hyperglycemia was reported to cause increasedproduction of oxidative parameters, and decreased antioxidant status. Therefore, the presentstudy considered to evaluate the effect of glycemic control on oxidant-antioxidant status in type2 diabetic patients. The study examined 145 type 2 diabetic patients, who attend to the NationalDiabetic Center (Al-Mustansiyriah University). Patients were divided in two groups, as wellglycemic controlled (group1[75 patients]) (HbA1c< 7%, and FSG < 110 mg/dl) and poorlycontrolled (group2 [70 patients]) (had HbA1c≥ 7%, and FSG ≥ 110). All patients were reported inthe morning after overnight fast, and underwent physical examination and laboratory tests.Height and weight were noted for Body Mass Index (BMI), it was calculated as weight(Km)/height2 (m2).Laboratory evaluations consisted of measuring fasting serum glucose (FSG), glycatedhemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), malondialdehyde (MDA),erythrocyte-Glutation (GSH), ascorbic acid (AA), uric acid (UA), and cerulopalsmine (CP). Theresults indicate that fasting serum FSG, HbA1c, (MDA), (TC), and (TG), were increasedsignificantly (P<0.01 for FSG, HbA1c, MDA; and P<0.05 for TC, and TC) in poorly controlledsubjects comparing to well controlled. Instead of that there is significant increase in (CP)(P<0.05) in poorly controlled patients. On the other hand there is significant decreased in (GSH,(AA), (UA) (P<0.01 for GSH, AA; and P<0.05 for UA) in poorly controlled compared to wellcontrolled diabetic patients. Correlation analysis showed a significant positive correlation inserum HbA1c-MDA, GSH-AA (P<0.01; and P<0.05 respectively) in both group, while there isonly positive correlation in HbA1c-FSG (P<0.01) in well controlled patients, and positivecorrelation in HbA1c-TC in poorly controlled patients. On the other hand, there is a significantnegative correlation in MDA-GSH, MDA-AA, and MDA-UA in both studying group. Thepresent study concludes the increased risk of oxidative stress manifested by increased plasmaMDA, and decreased antioxidant levels in poor glycemic control. The study therefore suggests,the estimation of antioxidants levels with other routine investigations may be useful in reduce ofthe oxidative stress in diabetics.

الخلاصة:افادت دراسات عدیدة ان ارتفاع السكر بالدم للمرضى المصابین بداء السكر من نوع الثاني یؤدي الى زیادة معلماتالاكسدة وتراجع نسبة مضادات الاكسدة. لذلك اجریت ھذة الدراسة لتقییم مدى تاثیر سیطرة نسبة السكر في الدم لمرضىالنوع الثاني على معلمات الاكسدة ومضادات الاكسدة. شملت ھذه الدراسة 145 مریضمصاب بداء السكر من النوع الثاني منالمراجعین للمركز الوطني لعلاج وبحوث السكري/ الجامعة المستنصریة حیث تم تقسیم المرضى الى مجموعتین المجموعةذات G ذات السیطرة الجیدة ( 75 مریضا)(نسبة السكر بالدم < 110 وخضاب الدم المعسل< 7٪) والمجموعة الثانیة 2 G الاولى 1السیطرة السیئة( 70 مریضا )(نسبة السكر بالدم ≥ 110 وخضاب الدم المعسل ≥ 7%). اخذت جمیع العینات من المرضى بعدصیام 12 ساعة وبعد ان تم فحصھم سریریا ومختبریا. تم حساب معامل كتلة الجسم عن طریق اخذ الوزن والطول(الوزن علىمربع الطول بالامتار).اجریت للمرضى التحالیل التالیة (مستوى السكر بالدم, خضاب الدم المعسل,الكولسترول,الدھونحامض الاسكوربكِ,حامض الیوریك و ,erythrocyte–Glutation(GSH),(MDA)malondialdehyde, الثلاثیةاظھرت النتائج ان ھناك زیادة معنویة في مستوى كل من (السكر في الدم,خضاب الدم .ceruloplasmineالكولسترول والدھون الثلاثیة) حیث كانت ھنك زیادة معنویة عالیة جدا ,(MDA) malondialdehyde, المعس


Article
Evidence Based Updating of HbA1c Targets: Global Guidelines forGlycemic Control in Type 2 Diabetes Mellitus

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Background:Measurement of hemoglobin A1c (A1C) is a renowned tactic for gauging long-term glycemic control, and exemplifies an outstanding influence to the quality of care in diabetic patients.The concept of targets is open to criticism; they may be unattainable, or limit what could be attained, and in addition they may be economically difficult to attain. However, without some form of targeted control of an asymptomatic condition it becomes difficult to promote care at allObjectives: The present article aims to address the most recent evidence-based global guidelines of A1C targets intended for glycemic control in Type 2 Diabetes Mellitus (T2D).Key messages:Rationale for Treatment Targets of A1C includesevidence for microvascular and macrovascular protectionand changes in quality of life. More or less stringent A1C goals may be appropriate for individual patients, andgoals should be individualized based on:duration of diabetes, age/life expectancy, comorbid conditions, CVD or advanced microvascular complications,hypoglycemia unawareness, and individual patient considerations


Article
Amelioration effect of methanolic extract of Cyperus rotundus on type 2 diabetes mellitus, thyroid dysfunction and gall stone induce by dexamethasone in male rabbits
المستخلص الميثانولي لنبات السعدCyperus rotundus تأثير محسن لداء السكر النوع الثاني والخلل وظيفي للغدة الدرقية و حصى المرارة المستحدث بواسطة عقار الدكساميثازون

Author: Muna H. AL-Saeed منى حميد السعيد
Journal: Kufa Journal For Veterinary Medical Sciences مجلة الكوفة للعلوم الطبية البيطرية ISSN: 20779798 Year: 2016 Volume: 7 Issue: 1 Pages: 102-108
Publisher: University of Kufa جامعة الكوفة

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The research investigated the possible involvement of type2 diabetes mellitus, thyroid dysfunction and gall stone induce by dexamethasone, and therapeutic effect of Cyperus rotundus as antidiabetic potential. This study was carried out in the animal house of the College of Veterinary Medicine - Basrah University. The rabbit was used as a model to study the effects of type2 diabetes mellitus thyroid dysfunction and gall stone induce by dexamethasone, Twenty-four healthy adult domestic rabbits were divided randomly into four groups. The first group (C) had been regarded as control each rabbit in the control group was drenched 3ml of normal saline daily by using gastric tube for 15 days. The second group (DEX) was drenched (0.35 mg / Kg B.W. single dosage) of dexamethasone tablets which were powdered, dissolved in 3ml of normal saline daily for 15 days. The third group (DEX + Cyperus rotunus) was drenched (0.35 mg / Kg B.W. single dosage) of dexamethasone and Cyperus rotunus 0.5g / Kg B.W. single dosage, dissolved in 3ml of normal saline daily for 15 days. The forth group (Cyperus rotunus) was drenched ( 0.5g / Kg B.W. single dosage) of Cyperus rotunus, dissolved in 3ml of normal saline daily for 15 days.Cyperus rotundus was administered to -induced hyperglycaemic male rabbit and the alterations in serum concentrations of thyroid hormones, total cholesterol, triglycerides and fasting glucose were studied. Simultaneously changes in lipid peroxidation, reduced glutathione (GSH) content, superoxide dismutase and catalase activities in serum (which are commonly affected in diabetes mellitus), were also investigated. Administration of dexamethasone (0.35mg/kg/day orally for 15 days) caused hyperglycaemia with a parallel increase in serum glucose, total cholesterol, triglycerides and lipid peroxidation with a decrease in serum levels of both the thyroid hormones (triiodothyronine, T3 and thyroxine, T4). However, Cyperus rotundus administration (0.5 g/kg/day orally for 15 days) along with an equivalent amount of dexamethasone reverted most of these changes, including a marked an increase in the serum levels of both thyroid hormones. The present findings reveal that the test extract ameliorates corticosteroid-induced type 2 diabetes mellitus through an increase in serum thyroid hormone concentrations.

أوجدت هذه الدراسة إن المستخلص الميثانولي لنبات السعد له تأثير مضاد لداء السكر النوع الثاني, الخلل الوظيفي للغدة الدرقية وحصى المرارة المستحدث بواسطة عقار الدكسامثازون.وقد أجريت الدراسة في البيت الحيواني لكلية الطب البيطري- جامعة البصرة على24 من ذكور الأرانب المحلية, قسمت حيوانات التجارب بصورة عشوائية إلى أربع مجموعات الأولى هي مجموعة الأرانب السيطرة عوملت بالمحلول الفسيولوجي (3مل)لمدة 15 يوم والمجموعة الثانية هي الأرانب التي عوملت بعقار الدكسامثازون بجرعة 0.35 مغلم/كغم من وزن الجسم لمدة 15 ايام لاستحداث النوع الثني من داء السكر ، إما المجموعة الثالثة فشملت الأرانب بعقار الدكسامثازون بجرعة 0.35 ملغم/كغم من وزن الجسم + 0.5 غم/ كغم)نبات السعدCyperus rotundus والمجموعة الرابعة عوملت فقط بنبات السعد0.5 غم/ كغم). ولوحظ التاثير المحسن نبات السعدCyperus rotundus لهرمونات الدرقية وإفراز الصفراء إذ له القابلية في تفتيت لحصى المرارة و يخفض مستوى الكوليسترول الكلي ومستوى لكلسيريدات الثلاثية ويرفع مستوى الهرمونات الغدة الدرقية الثاروكسين وثلاثي ايودو ثايرونين ويحسن مستوى اليوريا وحامض البوليك والكرياتنين وكذلك المعادن مثل الزنك واالسلينيوم والنحاس ومضاد للتأكسد عند اعطاءه بجرعة 0.5 غم/كغم لمدة 15 يوما.


Article
Polymorphism variation of l-selectin the pro213ser (rs2229569) in Iraqi Arab patient with type2 diabetes mellitus (T2DM)
Kebaa A.Saeed Asmaa M. S. Al-Mohaidi

Author: Kebaa A.Saeed Asmaa M. S. Al-Mohaidi
Journal: Iraqi Journal of Biotechnology المجلة العراقية للتقانات الحياتية ISSN: 18154794 Year: 2017 Volume: 16 Issue: 3 Pages: 46-56
Publisher: Baghdad University جامعة بغداد

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Abstract

Type2 diabetes mellitus (T2DM) is a disorder of metabolism and complex disease affected by genetic, environmental factors, and associated with inflammation, occurs when the pancreas either doesn’t make enough insulin or the body doesn’t use the insulin as it should, lead to insulin resistance (IR) along with gradual loss of ß-cell secretory capacity . The aim of this study was to investigate the role of L-selectin gene (P213S) polymorphism in diabetes mellitus type 2 patients. Study includes seventy six Iraqi Arabs patients (male and female) having newly diagnosed type 2 diabetes mellitus (T2DM) and fifty three Iraqi Arabs healthy subjects matched in age, sex and ethnic group. Patients and healthy subjects were genotyped, by PCR-RFLP analysis. Genotype spread analysis indicates that P213S is more frequent in the T2DM group (54.0 %), compared with the control group (16.9%). Thus our results suggest L-selectin (P213S) gene play a role in the development of DMT2 in Iraqi Arabs patients.


Article
Lipid Profile Among Diabetics in Al-Ramadi City, Iraq

Author: Khalid A. Al-Rawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 2 Pages: 109-112
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Hyperlipidemia is a strong predictor risk of cardiovascular events. There are insufficient data on the lipid profile in diabetics in Iraq. This study was carried out to determine the lipid profile among diabetics in Al-Anbar governorate.MATERIALS:A total of 136 diabetics (116 were with type 2 diabetes and 20 were with type 1 diabetes) attending Al- Ramadi general hospital, Al-Anbar, were included in the study. Total cholesterol, triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were estimated.RESULTS:Elevated total cholesterol, HDL, LDL, VLDL and TG were detected among patients with type1 and type2 diabetes. Only level of TG was associated with the duration of type2 diabetes, while levels of LDL, VLDL and HDL were significantly associated with duration of type 1 diabetes.CONCLUSION:Lipid and diabetes awareness program for Iraqi population should be applied in an attempt to improve the overall health status of Iraqi population.


Article
Study ABO / Rh Systems with IL-18 & IL-33 in Iraqi Patients with Diabetes Mellitus Type II
دراسة نظام مجاميع الدم والعامل ABO Rh الريسي مع العامل البين ابيضاضي -18 و العامل البين ابيضاضي -33 في مرضى عراقيين مصابين بالسكري من النوع الثاني

Authors: Rafid abdulwahid رافد عبدالواحد --- Zainab khudhair زينب خضيرعباس --- Isam N.Salman عصام نوري سلمان --- Asmaa M. Salih أسماء محمد صالح
Journal: Baghdad Science Journal مجلة بغداد للعلوم ISSN: 20788665 24117986 Year: 2014 Volume: 11 Issue: 3 Pages: 1136-1144
Publisher: Baghdad University جامعة بغداد

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Abstract

Type 2 diabetes mellitus (DM) is a group of metabolic disorder disease. The inflammatory markers act as a new risk factor for development of type 2 diabetes with a possible association with ABO/Rh blood groups. Human ABO genes are located on chromosome 9q34.1-q34.2. The aim of this study was to investigate the possible association between inflammatory markers, interleukin (IL) -18 and IL-33 in type 2DM and ABO blood groups. Sixty four patients with newly diagnosed type2 DM and control group consist of twenty healthy Iraqi individual. Laboratory test were include ABO blood groups using standard serological procedures and detection IL-18 and IL-33 in serum by ELISA kits. The Present data showed a significant increase in the serum level of IL-18 between type 2 DM patients and control, while there was no significant difference in the serum level of IL-33. At the same time both study blood groups O patients & control showed lowest level of serum IL-18, while blood group A with allele A showed less concentration of IL-33 in patients & control. Blood group O showed the highest percentage in patients & control, also Rh positive showed higher percentage. In conclusion, positive relation between IL-18 concentration and risk of type 2 DM, thus may be a predictor for newly diagnostic diabetic patient, while Serum levels of IL-33 might be a predictor marker of disease progression. No associations were found between ABO & Rh groups with type 2 DM.

داء السكري هو مجموعة من الاضطرابات الايضية و تمثل عوامل الالتهاب عوامل خطورة جديدة تساهم في تطور مرض السكري من النوع الثاني مع وجود احتمال علاقة بمجاميع الدم والعامل الريسي وقد هدفت الدراسة الى اكتشاف احتمالية وجود علاقة بين عوامل الالتهاب مثل العامل البين ابيضاضي 18 والعامل البين ابيضاضي 33 عند مرضى السكري من النوع الثاني وعلاقتها بمجاميع الدم شملت الدراسة 64 مريض تم تشخيص الاصابة لديهم بالسكري من النوع الثاني لاول مرة ومجموعة السيطرة 20 شخص سليم اجريت لهم اختبارات مجاميع الدم والكشف عن وجود مصل العامل البين ابيضاضي – 18 والعامل البين ابيضاضي – 33 باستخدام تقنية ELISA اظهرت البيانات وجود اختلافات معنوية في مستوى مصل العامل البين ابيضاضي – 18 بين مجموعة مرضى السكري من النوع الثاني ومجموعة السيطرة , في حين لم تظهر اختلافات معنوية في مستوى مصل العامل البين ابيضاضي – 33 , في الوقت نفسه اظهرت مجموعة الدم الفرعية O للمرضى والسيطرة افل تركيز للعامل البين ابيضاضي – 18 , بينما مجاميع الدم الحاوية على الاليل A اظهرت اقل تركيز للعامل البين ابيضاضي – 33 في المرضى والسيطرة. واظهرت فصيلة الدم O والاليل O اعلى نسبة لدى المرضى والسيطرة وكذلك العامل الريسي Rh+. اخيرا وجدت علاقة ايجابية بين مستويات العامل البين ابيضاضي – 18 وخطورة السكري من النوع الثاني والذي قد يعتبر مؤشرا لحدوث المرض , في حين ان مستويات مصل العامل البين ابيضاضي – 33 قد تكون مؤشر لتطور المرض. وتشير النتائج احصائيا الى عدم وجود علاقة بين مجاميع الدم ومجموعتا مرضى السكري من النوع الثاني والسيطرة.


Article
Residual cardiovascular risk in diabetes and obesity: Targeting lipid abnormalities other than LDL cholesterol

Author: Lewai S Abdulaziz MSc, Ph.D*, Faris AK Khazaal FRCP**
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2015 Volume: 11 Issue: 1 Pages: 1-5
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The majorities of statin-treated patients, in whom low-density lipoprotein cholesterol (LDL-C) targets have been achieved, have had recurrent cardiovascular events (CVE) with an absolute rate remain even higher among patients with disorders of insulin resistance, metabolic syndrome (MetS) and type2 diabetes mellitus (T2DM) as compared to patients devoid of these conditions.Objectives: Provide updated key messages of lipid and lipoprotein abnormalities as indicator for cardiovascular disease (CVD) risk in patients with T2DM and obesity, as well as the current evidence-based treatment targets and interventions to reduce this risk.Key messages: The Residual Risk Reduction Initiative (R3I) emphasized atherogenic dyslipidemia (AD) as the chief modifiable contributor to residual cardiovascular risk, especially in conditions associated with insulin-resistant,and call to improve awareness and clinical management.The probable benefit of residual CVD risk reductionsuggests a role for treatment of persistently high TGconcentration even in statin – treated patients, with TG lowering agents including fibrates, niacin, omega polyunsaturatedfatty acids, and other non statin treatment.Therapeutic lifestyle changes including; medically assistedweight loss, physical activity, and dietary changes, as well as improvement of glycemic control should be an adjunct to lipid-lowering pharmacological therapies. Therapy should be concomitantly assessed for treatment tolerance and adequacy with focused laboratory evaluations and patient follow-up. Therapy should be boosted to attain goals according to risk level, and that even more intensive therapy might be warranted in patients with CVD history.


Article
Antihypertensive Drugs patterns in Diabetes Mellitus and Their Impact on Glycemic Control

Author: Amir Omran
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2534-2542
Publisher: Kerbala University جامعة كربلاء

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Abstract

background: Hypertension management is paramount important in diabetic patients for cardiovascular events reduction. The utilization patterns of antihypertensive agents in diabetic patients must be consistent with recommended guidelines practice to produce a positive metabolic effect on glycemic control with proper control blood pressure and good compliance.Objectives: The study aims to evaluate utilization prescribing pattern of five groups of antihypertensive agents among Type2 diabetic hypertensive patients and to explore the adherence to prescribing existing guidelines and their impacts on glycemic control.Design: retrospective descriptive ,cross sectional studyPatients and Methods: A total of 230 Hypertensive Type2 diabetes patients on diet , Metformin and sulphonylureas drugs were enrolled in the study in diabetic clinic at Imam Al-Hussien medical city . The study was done between Jan 2009 And Jan 2014. The attendants' patients used five groups of the Anti-Hypertensive agents in single or in combinations patterns Angiotensin Converting enzymes inhibitor(ACEI), Angiotensin Receptor Blocker(ARB), Calcium Channels Antagonist(CCA), Beta Blocker(BB), Diuretics(Thiazide)). The study followed five groups of antihypertensive drugs for three months to evaluate prescribing patterns accordance to the evidence base guidelines and compare their impact on glycemic control. The study include gender, Age, age distribution, Glycemic control. The study excluded endocrine, liver, and renal diseases, and patients using steroids.Results: The majority of the patients on Antihypertensive drugs 191 patients (83%) were receiving monotherapy including ACEI 77 ( 33.5%) patient, ARB 46( 20%)patient, BB 60(26.1%) patint, CCB 6 patients (2.6%),Thiazide 2 (0.9%) patients, while two or three drugs combined patterns formed 39 ( 16.95%) patient.The proper and adequate glycemic control of both genders are 25.2% . The proper glycemic control of males 40.9% and in females16,7%( P˂0.05) , There were no significant differences of the impact on glycemic control compared between five groups, ACE or ARB compared with single BB (Atenolol, Metaprolol) or CCB, Diuretics, as monotherapy or polytherapy combination patterns. Conclusion; The utilization patterns of Antihypertensive agents (ACEI,ARBS,BBS) were more commonly prescribed followed by CCB, Thiazide Diuretics ,irrespective of mono or polytherapy. The majority of the patients were on monotherapy pattern.There was no significant difference among the five groups of Antihypertensive drugs regarding the impact on glycemic control.

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