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Blomster J.I.,University of Sydney | Blomster J.I.,University of Turku | Chow C.K.,University of Sydney | Zoungas S.,University of Sydney | And 9 more authors.
Diabetes, Obesity and Metabolism | Year: 2013

Aims: There is limited evidence regarding the association between physical activity and vascular complications, particularly microvascular disease, in patients with type 2 diabetes. Methods: From the 11140 patients in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron modified release Controlled Evaluation) trial, the effect of physical activity, categorized as none, mild, moderate or vigorous, and the number of sessions within a week, was examined in multivariable regression models adjusted for potential confounders. The study end-points were major cardiovascular events, microvascular complications and all-cause mortality. Results: Forty-six percent of participants reported undertaking moderate to vigorous physical activity for >15min at least once in the previous week. During a median of 5years of follow-up, 1031 patients died, 1147 experienced a major cardiovascular event and 1136 a microvascular event. Compared to patients who undertook no or mild physical activity, those reporting moderate to vigorous activity had a decreased risk of cardiovascular events (HR: 0.78, 95% CI: 0.69-0.88, p<0.0001), microvascular events (HR: 0.85, 95% CI: 0.76-0.96, p=0.010) and all-cause mortality (HR: 0.83, 95% CI: 0.73-0.94, p=0.0044). Conclusions: Moderate to vigorous, but not mild, physical activity is associated with a reduced incidence of cardiovascular events, microvascular complications and all-cause mortality in patients with type 2 diabetes. © 2013 John Wiley & Sons Ltd.

Banu I.,Service dEndocrinologie Diabetologie Nutrition | Valensi P.,University of Paris 13
Medecine des Maladies Metaboliques | Year: 2011

Hypoglycemic events are practically unavoidable when glycemic control is optimized. The contribution of hypoglycemias to the augmentation of cardiovascular mortality in the ACCORD study is not clearly demonstrated. The lag time between hypoglycemic episodes and cardiovascular events is too long to consider these episodes as directly responsible. However several cardiovascular changes, including changes in hemodynamics and ventricular repolarization that involve in particular sympathetic activation may be observed at the time of or immediately after hypoglycemia. Insulin per se, especially in case of vascular insulin resistance, as well as cardiac autonomic neuropathy, may induce similar changes which may occur in addition to those induced by hypoglycemia. In each individual diabetic patient, glycemic target must be defined taking into account the risk of inducing hypoglycemia with its own consequences and the benefit of a better glycemic control. © 2011 - Elsevier Masson SAS - Tous droits réservés.

Valassi E.,Hospital Sant Pau | Santos A.,Hospital Sant Pau | Yaneva M.,Medical University-Sofia | Toth M.,Semmelweis University | And 15 more authors.
European Journal of Endocrinology | Year: 2011

Objective: The European Registry on Cushing's syndrome (ERCUSYN) is designed to collect prospective and follow-up data at EU level on Cushing's syndrome (CS). Design and methods: Baseline data on 481 CS patients (390 females, 91 males; mean age (±S.D.): 44 ±14 years) collected from 36 centres in 23 countries, including new patients from 2008 and retrospective cases since 2000. Patients were divided into four major aetiologic groups: pituitarydependent CS (PIT-CS) (66%), adrenal-dependent CS (ADR-CS) (27%), CS from an ectopic source (ECT-CS) (5%) and CS from other aetiologies (2%). Results: Proportion of men in the ECT-CS group was higher than in the other groups (P<0.05). The ADR-CS group was older than the PIT-CS (P<0.05). Prevalence of hirsutism (92%) and diabetes (74%) in ECT-CS was higher than in the other groups (P<0.05 and P<0.01 respectively). PIT-CS had more skin alterations, menstrual irregularities and hirsutism than ADR-CS (P<0.01). Reduced libido was more prevalent in men than women (P<0.01). Prevalence of spine osteoporosis was higher in men than women (P<0.05), and males had more vertebral and rib fractures than females (52 vs 18% for vertebrae; P<0.001 and 34 vs 23% for ribs; P<0.05). ECT-CS consulted a diabetologist more frequently than ADR-CS (P<0.05), while a gynaecologist was consulted more often by women with PIT-CS or ADR-CS than with ECT-CS (P<0.05). Overall, weight gain was more common in women than men (P<0.01). CushingQoL and EuroQoL visual analogue scale scores did not differ between the groups. Conclusions: The ERCUSYN project demonstrates a heterogeneous clinical presentation of CS at a European level, depending on gender and aetiology. © 2011 European Society of Endocrinology.

Schnell O.,Helmholtz Center Munich | Cappuccio F.,University of Warwick | Genovese S.,Gruppo Multimedica | Standl E.,Helmholtz Center Munich | And 2 more authors.
Cardiovascular Diabetology | Year: 2013

The presence of cardiovascular disease (CVD) in Type 1 diabetes largely impairs life expectancy. Hyperglycemia leading to an increase in oxidative stress is considered to be the key pathophysiological factor of both micro- and macrovascular complications. In Type 1 diabetes, the presence of coronary calcifications is also related to coronary artery disease. Cardiac autonomic neuropathy, which significantly impairs myocardial function and blood flow, also enhances cardiac abnormalities. Also hypoglycemic episodes are considered to adversely influence cardiac performance. Intensive insulin therapy has been demonstrated to reduce the occurrence and progression of both micro- and macrovascular complications. This has been evidenced by the Diabetes Control and Complications Trial (DCCT) / Epidemiology of Diabetes Interventions and Complications (EDIC) study. The concept of a metabolic memory emerged based on the results of the study, which established that intensified insulin therapy is the standard of treatment of Type 1 diabetes. Future therapies may also include glucagon-like peptide (GLP)-based treatment therapies. Pilot studies with GLP-1-analogues have been shown to reduce insulin requirements. © 2013 Schnell et al.; licensee BioMed Central Ltd.

Marre M.,Service dEndocrinologie Diabetologie Nutrition | Marre M.,French Institute of Health and Medical Research | Sauvanet J.-P.,Policlinique de Medecine Interne
Medecine des Maladies Metaboliques | Year: 2010

Clinical studies in diabetic patients with albuminuria or diabetic nephropathy at high cardiovascular risk, with drugs acting on renin-angiotensin system (RAS): angiotensin-converting-enzyme inhibitors (ACEI), or angiotensin II receptor blockers (ARB), indicate dissociated effects on renal and cardiovascular diseases' prevention and/or progression, independent of blood pressure reduction: renal protective effect with daily low doses, but daily higher doses needed to observe a cardiovascular protective effect. These trials support that a strong RAS blockade is needed to achieve not only a renal protective effect but also a cardiovascular preventive/protective effect. Therefore, use of a daily high dose is recommended, either with an ACEI or an ARB, and is preferable to the association of daily low dose of these two therapeutic classes. © 2010 - Elsevier Masson SAS.

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