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Interventional and Surgical Treatment of Peripheral Artery Disease in Diabetic Patients

Journal of Korean Diabetes.2019;20(1):33-41. doi:10.4093/jkd.2019.20.1.33

After diagnosis of peripheral artery disease in diabetic patients, revascularization can be considered in those who are not improved after guideline-directed medical therapy. Recently, more aggressive approaches with interventional treatment have been recommended. Before revascularization therapy, it is important to differentiate patients with claudication or critical limb ischemia, and the final goal and treatment modality of interventional treatments should be based on clinical diagnosis. For patients with claudication, the goal of revascularization is improvement of functional capacity or quality of life; however, in more severe forms of critical limb ischemia, the purpose of revascularization is limb salvage and ultimately saving patient's life. With improvement of vascular interventions, interventional treatment for peripheral artery disease is preferred, although surgical treatment might show better results than intervention in some cases.
Diabetes Mellitus ; Diagnosis ; Extremities ; Humans ; Ischemia ; Limb Salvage ; Peripheral Arterial Disease ; Quality of Life

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Pharmacological Therapy of Peripheral Artery Disease in Patients with Diabetes Mellitus: Cardiovascular Risk Factor Management

Suk CHON

Journal of Korean Diabetes.2019;20(1):24-32. doi:10.4093/jkd.2019.20.1.24

Peripheral arterial disease is an arteriosclerotic disease that can affect the arteries of the whole body except the coronary arteries and the aorta. In general, disease of the descending aorta, iliac artery, and lower limb arteries below the renal artery is referred to as peripheral artery disease (PAD) or lower extremity artery disease. PAD is highly associated with ischemic heart disease, cerebrovascular disease, and mortality. Diabetes mellitus (DM) is a major risk factor for a variety of cardiovascular diseases, especially PAD. Recent studies have shown that PAD patients with DM have a significantly higher rate of major adverse cardiovascular events, all-cause mortality, and limb amputation compared with patients with PAD alone. To prevent and manage various complications of patients with DM, aggressive diagnosis and management and treatment of PAD play an important role in prevention of complications threatening quality of life such as cardiovascular disease and limb amputation.
Amputation ; Aorta ; Aorta, Thoracic ; Arteries ; Cardiovascular Diseases ; Cerebrovascular Disorders ; Coronary Vessels ; Diabetes Mellitus ; Diagnosis ; Extremities ; Humans ; Iliac Artery ; Lower Extremity ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Quality of Life ; Renal Artery ; Risk Factors

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Diagnosis of Peripheral Artery Disease: Focus on the 2016 American Heart Association/American College of Cardiology and 2017 European Society of Cardiology Guidelines

Kyu Yeon HUR

Journal of Korean Diabetes.2019;20(1):17-23. doi:10.4093/jkd.2019.20.1.17

Peripheral artery disease (PAD) is the most frequent cause of reduced perfusion in peripheral arteries. Patients with PAD often have manifestations of atherosclerosis of the lower limb, although both symptomatic and asymptomatic disease is common. The clinical signs of PAD can differ in diabetic and non-diabetic patients. Diabetic patients are at high risk for PAD characterized by symptoms of intermittent claudication or critical limb ischemia. However, the majority of PAD patients are clinically asymptomatic. In addition to history taking, physical examinations including inspection of the skin, palpation of leg and foot pulses, and determination of the ankle-brachial index (ABI) are considered for diagnosis of PAD. The ABI measurement is the easiest and most common investigative technique for PAD. For hemodynamic assessment, additional diagnostic modalities could be considered.
Ankle Brachial Index ; Arteries ; Asymptomatic Diseases ; Atherosclerosis ; Cardiology ; Diabetes Mellitus ; Diagnosis ; Extremities ; Foot ; Heart ; Hemodynamics ; Humans ; Intermittent Claudication ; Investigative Techniques ; Ischemia ; Leg ; Lower Extremity ; Palpation ; Perfusion ; Peripheral Arterial Disease ; Physical Examination ; Skin

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Epidemiology of Peripheral Arterial Diseases in Individuals with Diabetes Mellitus

Bo Kyung KOO

Journal of Korean Diabetes.2019;20(1):10-16. doi:10.4093/jkd.2019.20.1.10

Epidemiologic studies have revealed diabetes mellitus is an important determining factor not only for the presence of peripheral arterial disease (PAD) but also for the severity of PAD. As PAD is closely related to mortality and morbidity in individuals with diabetes as well as the general population, the primary prevention for PAD is very important. Age, disease duration, the level of hyperglycemia, blood pressure, and smoking status are independent risk factors for development of PAD in diabetic patients, and management of those risk factors might be an effective tool for reducing PAD burden.
Blood Pressure ; Diabetes Mellitus ; Epidemiologic Studies ; Epidemiology ; Humans ; Hyperglycemia ; Mortality ; Peripheral Arterial Disease ; Primary Prevention ; Risk Factors ; Smoke ; Smoking

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Management of Hyperglycemia in Type 2 Diabetes: A Summary of New Consensus Report from the American Diabetes Association and the European Association for the Study of Diabetes in 2018

Jeong Mi KIM ; Sang Soo KIM

Journal of Korean Diabetes.2019;20(1):6-9. doi:10.4093/jkd.2019.20.1.6

In 2018, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a consensus recommendation on management of hyperglycemia. This consensus report emphasized the need for patient-centered management considering multimorbidity and individual patient preferences and barriers. Patients with type 2 diabetes with established atherosclerotic cardiovascular disease who fail to control blood glucose with the initial glucose-lowering medication are recommended a sodium-glucose cotransporter 2 (SGLT2) inhibitor or a glucagon-like peptide 1 (GLP-1) receptor agonist. For patients with chronic kidney disease and heart failure, SGLT2 inhibitors are recommended. In patients who need an injectable medication, GLP-1 receptor agonists are the preferred choice over insulin. In this section, we summarize “Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).”
Atherosclerosis ; Blood Glucose ; Cardiovascular Diseases ; Comorbidity ; Consensus ; Diabetes Mellitus ; Glucagon-Like Peptide 1 ; Glucagon-Like Peptide-1 Receptor ; Heart Failure ; Humans ; Hyperglycemia ; Insulin ; Patient Preference ; Patient-Centered Care ; Renal Insufficiency, Chronic

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Heart Failure: Complications of Type 2 Diabetes

Sang Hoon SEOL

Journal of Korean Diabetes.2019;20(1):1-5. doi:10.4093/jkd.2019.20.1.1

There is a close relationship between diabetes mellitus and heart failure, both of which are known to increase morbidity and mortality. Diabetes can cause or aggravate heart failure, and heart failure can precipitate diabetes. Diabetes mellitus causes structural and functional changes in the heart, such as fibrosis of the myocardium and left ventricular dysfunction. The mechanisms of diabetic cardiomyopathy are metabolic disturbance, myocardial fibrosis, microvascular disease, and autonomic dysfunction. Improper blood glucose control leads to deterioration of heart failure, but the role of strict glycemic control in reducing heart failure is unclear. The role of SGLT2 inhibitors in reducing the incidence of heart failure is of great importance in the treatment of diabetic patients. However, further long-term follow-up and safety studies are needed.
Blood Glucose ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Fibrosis ; Follow-Up Studies ; Heart Failure ; Heart ; Humans ; Incidence ; Mortality ; Myocardium ; Ventricular Dysfunction, Left

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Therapeutic Effect of Quadruple Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus Who Have Insulin Limitations

Won Sang YOO ; Do Hee KIM ; Hee Jin KIM ; Hyun Kyung CHUNG

Journal of Korean Diabetes.2019;20(2):117-126. doi:10.4093/jkd.2019.20.2.117

BACKGROUND: Insulin therapy is the treatment of choice in type 2 diabetes mellitus (T2DM) patients who are not achieving glycemic goals despite triple oral hypoglycemic agent (OHA) combination therapy. However, there is still no additional treatment option for patients who cannot afford insulin therapy or who have various clinical limitations. The purpose of this study was to evaluate the clinical efficacy and safety of four OHA combination therapy in poorly controlled T2DM patients who could not afford insulin therapy. METHODS: Forty-seven T2DM patients were enrolled according to the following criteria: 1) glycosylated hemoglobin [HbA1c] > 8.5%, 2) ongoing treatment with 3 OHA combination therapy (metformin, sulfonylurea, dipeptidyl peptidase-4 inhibitor), or 3) combined limitations for applying insulin therapy. Patients were given the fourth OHA (pioglitazone) in addition to their previous treatment for 12 months. We evaluated changes in HbA1c, body weight, hypoglycemic events, and side effects. RESULTS: At study completion, mean HbA1c and fasting plasma glucose were significantly reduced from 9.6% to 8.04% and from 198.4 mg/dL to 161.5 mg/dL, respectively (P < 0.001). Mean body weight was significantly increased from 66.7 kg to 69.3 kg. Hypoglycemia and side effects were observed 18 times and only 3 cases showed abnormal liver function tests or edema. In addition, subjects with higher initial HbA1c levels and HOMA-beta showed an independent association with a greater reduction in HbA1c. CONCLUSION: The 4 OHA combination therapy is effective and safe when insulin is not feasible.
Blood Glucose ; Body Weight ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Drug Therapy ; Edema ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin ; Liver Function Tests ; Treatment Outcome

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The Mentors, The Social Support and Patients with Diabetes Mellitus

Yu Jeong PARK

Journal of Korean Diabetes.2019;20(2):112-116. doi:10.4093/jkd.2019.20.2.112

In countries with advanced health practices, it is important to note the importance of social capital and social support as social determinants in patient health as early as possible, while minimizing the constraints on self-management and reducing health inequalities. Beyond the individual, we offer mentoring and a social support system for individuals using community resources. We examined the growth of mentors and mentees through mentoring effectiveness and mentoring, and discussed the issues to be considered when applying such in the field. Ultimately, educators who are accustomed to 1:1 education or communicative group education should have the opportunity for recognition reconstruction.
Diabetes Mellitus ; Education ; Humans ; Mentors ; Self Care ; Social Capital ; Socioeconomic Factors

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Intake of Fruits for Diabetics: Why and How Much?

Eun Young LEE

Journal of Korean Diabetes.2019;20(2):106-111. doi:10.4093/jkd.2019.20.2.106

Fruits are universally promoted as healthy. Fruits supply dietary fiber, vitamins, minerals and phytochemicals that function as antioxidants. But many people often have concerns that fruit intake has a negative impact on glycemic control in patients with diabetes. The results of a related study showed fruit intake may have no overall effect on fasting glucose and HbA1c. Also increased fresh fruit intake in ranges commonly consumed was associated with reduced risks of death and development of major vascular complications in diabetic patients. Korean Diabetes Association and American Diabetes Association recommend carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products. Fruit intake for diabetics should be included as part of a balanced diet and individual meal composition within the range of two exchanges (100~300 g).
Antioxidants ; Blood Glucose ; Dairy Products ; Diabetes Complications ; Diabetes Mellitus ; Diet ; Dietary Fiber ; Fabaceae ; Fasting ; Fruit ; Glucose ; Humans ; Meals ; Minerals ; Miners ; Phytochemicals ; Vegetables ; Vitamins ; Whole Grains

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Education of Patients with Diabetes Mellitus and Peripheral Artery Disease

Hye Ryoung YUN

Journal of Korean Diabetes.2019;20(2):99-105. doi:10.4093/jkd.2019.20.2.99

Peripheral artery disease (PAD) and diabetes increase the risk of significant morbidity and mortality and can affect quality of life. PAD is a progressive disease, and the presence of diabetes mellitus increases the risk of adverse outcomes among patients with PAD. Diabetes patients should undergo an initial screening for PAD that evaluates walking speed, leg fatigue, claudication, and pedal pulses. Healthcare providers should discuss with their patients controllable risk factors for PAD that can be modified. A comprehensive care plan for patients with PAD and diabetes mellitus is important and may include smoking cessation, structured exercise therapy, foot care, glycemic control and management of other cardiovascular risk factors (weight management, diet, and control of blood pressure and cholesterol). PAD with diabetes mellitus is a lifelong chronic medical condition, and prompt identification and treatment of PAD are crucial. Patient education is needed to prevent complications and to encourage a healthy and active lifestyle.
Blood Pressure ; Diabetes Mellitus ; Diet ; Education ; Exercise Therapy ; Fatigue ; Foot ; Health Education ; Health Personnel ; Humans ; Leg ; Life Style ; Mass Screening ; Mortality ; Patient Education as Topic ; Peripheral Arterial Disease ; Quality of Life ; Risk Factors ; Smoking Cessation ; Walking

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