DIABETES 9
Researchon diagnosis and treatment of .
results when the body is incapable of processing glucose into energy.Glucose is the main source of energy in the body. After digestion,the body turns the food into carbohydrates, proteins, and fats.Carbohydrates are the foods that affect the body’s sugar level.When carbohydrates are digested, they are formed into glucose. Theglucose is later transferred into the blood for later use by thecells as energy. The conversion of glucose from the blood into thecells requires a hormone known as insulin. Insulin is synthesized bythe beta cells that are found in the pancreas (Colagiuri, 2010).
Forpeople with diabetes, the process of producing insulin is impaired.Consequently, the beta cells in the pancreas fail to produce enoughinsulin to ensure total conversion of glucose from the blood to thecells. Consequently, there are two types of diabetes- type 1 and type2. In type 1 diabetes, the body produces defective insulin that failsto move the glucose from the blood to the cells. In type 2 diabetes,the body synthesizes inadequate amounts of insulin that cannot movethe glucose from the blood to the cells (Guyton & Hall, 2006).
Type1 diabetes occurs mostly in children and young adults. However, itcan develop at any age. In the United States, type 1 diabetes makesup 5-10 percent of all the population diagnosed with diabetes. Type 2diabetes affects adults. In the United States, it constitutes 90 to99% of all the cases of diabetes. Some of the most commoncarbohydrates include pasta, potatoes, rice, bread, corn, fruit, andmilk products. It is advisable for people diagnosed with diabetes toeat carbohydrates in moderation (Njolstad et al., 2003).
Accordingto Ryden et al., (2013), diabetes is a silent disease. Half of thediabetic patient population is unaware that they are suffering fromthe condition. A majority, 350 million out of 550 million patients,indicate early symptoms of changes in glucose homeostasis, andconsequently, they are at a higher risk of developing type 2 diabetes(Guyton & Hall, 2006).
Thestudy by Preiss (2011) revealed that the presence of cardiovasculardisease and high levels of proteinuria identify with a high-riskcohort of diabetic patients. Cardiovascular disease increases themortality rate of diabetic patients by threefold.The currentliterature on the diagnosis of diabetes proposes for the use ofglycated hemoglobin combined with fasting plasma glucose. Glycatedglucose is a simple indicator of chronic hyperglycemia.
Paneniet al., (2013) revealed that there exists a strong biologicalrelationship between the insulin resistance among patients andhyperglycemia. Diabetic high-risk patients have elevated levels ofglucose that trigger endothelial inflammation and mitochondrialoxidative stress. Subsequently, such patients encounter a shortage ofnitric acid that further increases the chances of developing acardiovascular condition. The increased vulnerability tocardiovascular disease further leads to the development ofmicrovascular dysfunctions and coronary atherosclerotic lesions thatenhance retinopathy and nephropathy. In the absence of cardiovasculardisease, glycated hemoglobin can diagnose the presence of diabeteswithin low-risk patients by reflecting the condition of a patient’sglucose homeostasis (Preiss et al., 2004).
Assumptionsin the current literature and missing information
TheCurrent literature assumes that the combination of Glycatedhemoglobin and fasting plasma glucose can rule out diabetes inpatients with cardiovascular disease. The major characteristic ofpatients with high susceptibility to diabetes is their level ofcardiovascular risk. The current literature proposes for the use oforal glucose tolerance test for diabetic patients that are likely tosuffer from cardiovascular disease. Nevertheless, it fails to provideinformation on the effect of cardiovascular risk on glucosehomeostasis. Besides, most diabetic patients are considered asintermediate risk patients. The use of glycated hemoglobin test wasan oversimplification of the diabetes test (Colagiuri, 2010).
Thecurrent literature on the diagnosis of diabetics fails to provideadequate diagnostic tools for the risk of cardiovascular diseaseamong diabetic patients. The gaps prevail due to the lack of clarityon the best approach to categorizing cardiovascular risk within thediabetic population. Besides, an appropriate approach to identifyfuture implications and management of cardiovascular risk does notexist. Since diabetes is related to substantial atheroscleroticburden, the literature on the need for vascular imaging remainspoorly defined. The available literature identifies that the use ofcalcium imaging of the coronary artery is a superior approachcompared to the established risk factors for predicting myocardialischemia among high-risk cohorts of diabetic patients. Unfortunately,the approach is expensive and cannot be suitable in developingnations (Paneni et al., 2013).
Approachesto the stated problem and justifications
Thehigh mortality rates associated with cardiovascular risks of diabeticpatients calls for the need to develop an appropriate intervention.The first approach to treating cardiovascular risk factors is throughthe application of cardiovascular therapies, which include, the useof anti-hypersensitive agents and statins. Therapies are used toimprove the outcome of diabetic patients (Ryden et al., 2011).
Multifactorialinterventions have indicated a reduced risk of cardiovascular-relateddeaths among diabetic victims. The current European Association forthe Study of (EASD) guidelines promote the use of statinsfor both diabetes one and two, regardless of the level of thecardiovascular condition. In contrast, the use of therapies to raisethe level of high-density lipoprotein (HDL) is discouraged for levelI-III of cardiovascular risk factors. The new evidence on the use oftherapies has established that increased high lipoprotein levels arenot healthy for diabetic patients. Besides, further studies havedemonstrated that the high-density lipoprotein cholesterol loses itsprotective abilities in diabetic patients with high-riskcardiovascular disease (Preiss et al., 2004).
Raisingthe level of high-density lipoprotein among diabetic sufferersresults into pro-apoptotic and inflammatory phenotypes in thelong-term. Although the use of lower density lipoprotein strategy(LDL) has the potential to produce positive results in the future,the treatment of higher density lipoprotein remains unclear (Preisset al., 2004).
Thereis additional lipoprotein lowering strategies such as the use of theAMG1545. AMG145 is a monoclonal antibody used against the proproteinconverts such as subtilizing the type 9 proprotein convertasesubtilisin (PCSK9). The approach has obtained favorable comments as apromising approach in the management of subjects withhypercholesterolemia and undergoing the statin therapy. The processprovides additional benefit beyond the cholesterol reduction providedby low-density lipoprotein (Guyton & Hall, 2006).
Thecuring of combined with cardiovascular disease givespriority to controlling the blood pressure of the patient. Theprocedure requires the use of renin-angiotensin- aldosterone systemsblockers, especially, for patients with proteinuria andmicroalbuminuria. The appropriate blood pressure level for diabeticpatients is below 140/85 mmHg while for patients with diabetes bloodpressures are below 130/80 mmHg. Past studies have indicated thatthe mortality rate of diabetic patients with cardiovascular diseasereduces after a reduction in their blood pressure. Consequently, theuse of blood pressure approach has been individualized to selectedpatients with high-risk diabetes (Njolstad, 2003).
Thetreatment of moderate risk diabetic patients with a high risk ofcardiovascular disease and organic damage calls for the use ofaspirin. Patients with high-risk diabetes require personalizedantiplatelet therapy. Since the diagnosis of diabetes relates to ahigh risk of cardiovascular disease, the classification ofcardiovascular risk as either high or low makes little sense.Consequently, the engines that gather the risk factors to producepatients risk categories only enhance the handling of diabeticpatients. The potential to undertreat low or immediate risk patientsdepends on the quality of strategies used to classify cardiovascularrisk (Ryden et al., 2011).
High-riskdiabetic patients with low-risk cardiovascular disease require adifferent treatment to that of diabetic patients with the high-riskcardiovascular disease. The approach to treat diabetes is dictated bythe presence of the cardiovascular disease. For example, the use ofaspirin is only recommended as a secondary and not a primaryintervention. Although the risk thresh holds for various approachesremain undefined due to the low number of trials, high-risk diabeticpatients without the cardiovascular disease stand to benefit from theanti-platelet approach (Guyton & Hall, 2006).
Treatmentoptions
Thefirst approach to treating diabetes for patients with high risk ofsuffering from the cardiovascular disease is through Metformin.Metformin is an oral diabetes medication used in controlling thepatient’s blood-sugar level. The drug is administered together withinsulin. Metformin is the only remedy designated to reducingcardiovascular complications in patients with type 2 diabetes. Themedicine is effective in stabilizing biological processes such aslipid metabolism, vascular endothelial function, inflammation andmetabolism that influence atherogenesis (Paneni et al., 2013).
Thesecond approach is the use of myocardial revascularizationstrategies. The coronary artery bypass graft is the most preferredtreatment option for revascularization of patients with diabetes andhigh-risk of cardiovascular disease. The strategy is associated withimproved patient survival and the occurrence of fewer myocardialinfarctions. The greatest benefit from myocardial revascularizationstrategies is due to the lower risk associated with the need forrepeat intervention (Preiss et al., 2004).
Justification
Thefirst approach to lower diabetic glucose is using drugs. Currentresearch has indicated that metformin is the most effective remedydue to its safety profile and the ability to lower cardiovascularrisk. However, physicians should administer the medicationcautiously. Specifically, they should avoid combining metformin withthe sulphonylurea. Sulphonylurea increases the morbidity andmortality of diabetic patients. It also reduces the rate of patients’morbidity and mortality in the absence of metformin. However, thedrug is associated with increased weight and hypoglycemia.Consequently, absolute use of metformin is recommended for patientsdiagnosed with diabetes and high-risk cardiovascular disease (Rydenet al., 2011).
Second,physicians can use glitziness to modify cardiovascular outcomes ofdiabetic patients. However, the outcome from the drug is dependent onthe secondary composite of the proactive trial. During the proactivetrial, pioglitazone is used to reduce the mortality and fatality ofmetformin (Guyton & Hall, 2006).
Thesecond treatment strategy is using Myocardial revascularizationstrategies. Revascularization procedures are commonly applied indiabetic patients with moderate to high risk of cardiovasculardisease. The only challenge is the potential to reduce the effect ofatherosclerotic involvement of epicardial vessels. Consequently, theypose the challenge for the patient to develop restenosis after theimplementation of the percutaneous coronary intervention. Besides,patients have a potential to develop saphenous graft occlusion aftercarrying out the coronary artery bypass grafting (CABG). Thecomparison of PCI and CABG indicates that CBG is advantageous sinceit increases the survival rates of diabetic patients. The five-yearrate of mortality for CABG was 13% compared to those from PCI- 32%.Besides, a randomized controlled trial for a five-year treatment withPCI and CABG revealed that CABG was related to higher rates ofimproved patient outcomes compared to PCI. Consequently, the use ofthe CABG is recommended for patients with diabetes and cardiovasculardisease (Njolstad, 2003).
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