Should we be more aggressive in the therapy against cardiovascular risk factors? Should we prescribe statin and aspirin for every diabetic patient, or is it time for a polypill?

Abstract:

:The reality of primary and secondary prevention of cardiovascular complications in people with diabetes is alarming, even in developed countries with a well-structured medical system. Even though therapeutic targets have been more clearly defined during the last decades, their implementation is still suboptimal. Financial and structural reasons, insufficient information of physicians and patients, along with a low compliance of the latter are only a few reasons that have been incriminated. To eliminate some of these inconveniences, attempts to standardize and simplify therapies have been made. Treatment with aspirin and statin for every patient with diabetes has been postulated. Some went even further, developing the concept of a "polypill," an integrated pharmacological agent with up to six different compounds meant to prevent cardiovascular disease in the broad population. Likewise, the idea of a "polymeal" tries to implement healthy nutrients into the populations' lifestyle in a standardized fashion. Our article highlights some of the advantages and pitfalls of these concepts and reflects our point of view with regard to some treatment aspects in people with diabetes. As part of a pro and contra discussion, our article is arguing against the use of statins in all patients with diabetes and especially against the indiscriminate use of a polypill.

journal_name

Diabetes Care

journal_title

Diabetes care

authors

Stirban AO,Tschoepe D

doi

10.2337/dc08-s254

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

S226-8

eissn

0149-5992

issn

1935-5548

pii

31/Supplement_2/S226

journal_volume

31 Suppl 2

pub_type

杂志文章
  • Altered postprandial insulin requirement in IDDM patients with gastroparesis.

    abstract:OBJECTIVE:To evaluate the effect of gastric emptying on postprandial insulin requirement in insulin-dependent diabetes mellitus (IDDM) patients with and without gastroparesis. RESEARCH DESIGN AND METHODS:Postprandial insulin requirement and gastric emptying were simultaneously evaluated in five IDDM patients with gast...

    journal_title:Diabetes care

    pub_type: 临床试验,杂志文章

    doi:10.2337/diacare.17.8.901

    authors: Ishii M,Nakamura T,Kasai F,Onuma T,Baba T,Takebe K

    更新日期:1994-08-01 00:00:00

  • Alcohol consumption and the incidence of type 2 diabetes: a 20-year follow-up of the Finnish twin cohort study.

    abstract:OBJECTIVE:The aim of this study was to investigate alcohol consumption in relation to the incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS:The study population consisted of 22778 twins of the Finnish Twin Cohort. This cohort was compiled in 1975 and includes all same-sexed twins born in Finland before 1958. I...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.26.10.2785

    authors: Carlsson S,Hammar N,Grill V,Kaprio J

    更新日期:2003-10-01 00:00:00

  • Comparison of GAD and ICA512/IA-2 antibodies at and after the onset of IDDM.

    abstract:OBJECTIVE:Longitudinal changes in GAD antibody (Ab) and ICA512/IA-2 (ICA512) Ab were examined in relation to age at the onset of diabetes and autoimmunity against the thyroid gland. RESEARCH DESIGN AND METHODS:GADAb, ICA512Ab, and antithyroid autoantibody were examined at onset in 40 juvenile-onset IDDM patients (17 m...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.21.1.49

    authors: Yokota I,Matsuda J,Naito E,Ito M,Shima K,Kuroda Y

    更新日期:1998-01-01 00:00:00

  • Quantitative importance of dietary constituents other than glucose as insulin secretagogues in type II diabetes.

    abstract::In seven type II (non-insulin-dependent) diabetic patients, given either 50 g glucose or a mixed meal potentially containing 61 g glucose as starch and sucrose, the postmeal plasma glucose area integrated over 4 h was less after the mixed meal. The insulin area was considerably greater (2.1-fold). The greater increase...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.11.1.72

    authors: Nuttall FQ,Gannon MC

    更新日期:1988-01-01 00:00:00

  • Dissociation of insulin absorption and blood flow during massage of a subcutaneous injection site.

    abstract::Nine healthy volunteers with normal body weights were injected subcutaneously with 125I-labeled soluble human insulin (10 U) in one thigh and 133Xe in the contralateral thigh for the measurement of subcutaneous blood flow on 2 consecutive mornings. On one of the days, standardized massage of both injection sites was p...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.9.6.570

    authors: Linde B

    更新日期:1986-11-01 00:00:00

  • Long-term predictors of insulin resistance: role of lifestyle and metabolic factors in middle-aged men.

    abstract:OBJECTIVE:Predictors of insulin resistance have hitherto only been examined in cross-sectional studies without information on lifestyle factors. Few researchers have measured insulin sensitivity directly and compared different metabolic and lifestyle predictors in a large population. RESEARCH DESIGN AND METHODS:Our ai...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc07-0360

    authors: Risérus U,Arnlöv J,Berglund L

    更新日期:2007-11-01 00:00:00

  • Glimepiride versus metformin as monotherapy in pediatric patients with type 2 diabetes: a randomized, single-blind comparative study.

    abstract:OBJECTIVE:To compare the efficacy and safety of glimepiride versus metformin in pediatric subjects with type 2 diabetes inadequately controlled with diet and exercise alone or oral monotherapy. RESEARCH DESIGN AND METHODS:This 26-week, single-blind, active-controlled, multinational study randomized 285 subjects to rec...

    journal_title:Diabetes care

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.2337/dc06-1554

    authors: Gottschalk M,Danne T,Vlajnic A,Cara JF

    更新日期:2007-04-01 00:00:00

  • Epidemiology and treatment of diabetic ketoacidosis in a community population.

    abstract::We evaluated the epidemiology of diabetic ketoacidosis in the period 1960-1979. In Frederiksborg County, Denmark, the incidence of ketoacidosis at the county hospital increased from 60 per 100,000 in the period 1943-1963 to 120 per 100,000 in the period 1960-1979. In the investigation period we found an increasing inc...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.7.6.528

    authors: Ellemann K,Soerensen JN,Pedersen L,Edsberg B,Andersen OO

    更新日期:1984-11-01 00:00:00

  • Repaglinide/troglitazone combination therapy: improved glycemic control in type 2 diabetes.

    abstract:OBJECTIVE:This multicenter open-label clinical trial compared the efficacy and safety of repaglinide/troglitazone combination therapy, repaglinide monotherapy, and troglitazone monotherapy in type 2 diabetes that had been inadequately controlled by sulfonylureas, acarbose, or metformin alone. RESEARCH DESIGN AND METHO...

    journal_title:Diabetes care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.2337/diacare.23.7.979

    authors: Raskin P,Jovanovic L,Berger S,Schwartz S,Woo V,Ratner R

    更新日期:2000-07-01 00:00:00

  • Skin intrinsic fluorescence correlates with autonomic and distal symmetrical polyneuropathy in individuals with type 1 diabetes.

    abstract:OBJECTIVE:To determine whether skin intrinsic fluorescence (SIF) was associated with autonomic neuropathy and confirmed distal symmetrical polyneuropathy (CDSP) in 111 individuals with type 1 diabetes (mean age 49 years, mean diabetes duration 40 years). RESEARCH DESIGN AND METHODS:SIF was measured using the SCOUT DM ...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc10-1791

    authors: Conway BN,Aroda VR,Maynard JD,Matter N,Fernandez S,Ratner RE,Orchard TJ

    更新日期:2011-04-01 00:00:00

  • Vitamin E reduction of protein glycosylation in diabetes. New prospect for prevention of diabetic complications?

    abstract:OBJECTIVE:This study evaluated the possibility of inhibiting protein glycosylation in vivo with vitamin E. RESEARCH DESIGN AND METHODS:Two groups of 10 insulin-requiring diabetic patients, matched for duration of disease and metabolic control, received daily vitamin E supplementation of 1200 and 600 mg, respectively, ...

    journal_title:Diabetes care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.2337/diacare.14.1.68

    authors: Ceriello A,Giugliano D,Quatraro A,Donzella C,Dipalo G,Lefebvre PJ

    更新日期:1991-01-01 00:00:00

  • Sex differences in renal responses to hyperglycemia, L-arginine, and L-NMMA in humans with uncomplicated type 1 diabetes.

    abstract:OBJECTIVE:Women exhibit exaggerated renal hemodynamic responses to hyperglycemia, which may promote kidney disease progression. Our aim was to determine if increased nitric oxide generation by l-arginine infusion would reverse this deleterious response to clamped hyperglycemia in women with type 1 diabetes mellitus. R...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc12-1305

    authors: Cherney DZ,Scholey JW,Sochett EB

    更新日期:2013-05-01 00:00:00

  • Family history of diabetes in relation to different types of obesity and change of obesity during 12-yr period. Results from prospective population study of women in Göteborg, Sweden.

    abstract::OBJECTIVE--To assess the relationship between family history and different types of obesity and change in obesity in a longitudinal population study. RESEARCH DESIGN AND METHODS--A longitudinal population study of 1462 randomly selected women (38-60 yr old) was conducted in Göteborg, Sweden, in 1968-69. The women were...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.15.11.1455

    authors: Lapidus L,Bengtsson C,Lissner L,Smith U

    更新日期:1992-11-01 00:00:00

  • A quantitative scale of acanthosis nigricans.

    abstract:OBJECTIVE:To develop and validate a scale for acanthosis nigricans (AN). RESEARCH DESIGN AND METHODS:Subjects were participants from the San Antonio Family Diabetes Study and the San Antonio Family Heart Study. A total of 406 subjects were independently examined for AN by at least two observers. Five locations were ex...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.22.10.1655

    authors: Burke JP,Hale DE,Hazuda HP,Stern MP

    更新日期:1999-10-01 00:00:00

  • Nonalcoholic fatty liver disease is a risk factor for type 2 diabetes in middle-aged Japanese men.

    abstract:OBJECTIVE:To determine the association between nonalcoholic fatty liver disease and the risk for development of diabetes. RESEARCH DESIGN AND METHODS:We conducted an observational cohort study in male workers > or = 40 years old in a Japanese company from 1997 to 2005. We excluded workers with alcohol intake > or = 20...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc07-0792

    authors: Shibata M,Kihara Y,Taguchi M,Tashiro M,Otsuki M

    更新日期:2007-11-01 00:00:00

  • Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male aging study.

    abstract:OBJECTIVE:The objective was to examine prospectively the association between low testosterone and sex hormone-binding globulin (SHBG) levels and the subsequent development of type 2 diabetes in men. RESEARCH DESIGN AND METHODS:Analyses were conducted on the cohort of the Massachusetts Male Aging Study, a population-ba...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.23.4.490

    authors: Stellato RK,Feldman HA,Hamdy O,Horton ES,McKinlay JB

    更新日期:2000-04-01 00:00:00

  • Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. HOE 901/3002 Study Group.

    abstract:OBJECTIVE:Available basal insulin formulations do not provide a constant and reliable 24-h insulin supply. We compared the efficacy and safety of glargine (a long-acting insulin analog) and NPH insulins in insulin-naive type 2 diabetic patients treated with oral antidiabetic agents. RESEARCH DESIGN AND METHODS:There w...

    journal_title:Diabetes care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.2337/diacare.23.8.1130

    authors: Yki-Järvinen H,Dressler A,Ziemen M,HOE 901\/300s Study Group.

    更新日期:2000-08-01 00:00:00

  • Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing Community Diabetes Study 4.

    abstract:OBJECTIVE:To investigate the association between neck circumference and central obesity, overweight, and metabolic syndrome in Chinese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS:A total of 3,182 diabetic subjects (aged 20-80 years) were recruited from 15 community health centers in Beijing using a m...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc10-0798

    authors: Yang GR,Yuan SY,Fu HJ,Wan G,Zhu LX,Bu XL,Zhang JD,Du XP,Li YL,Ji Y,Gu XN,Li Y,Beijing Community Diabetes Study Group.

    更新日期:2010-11-01 00:00:00

  • Skin autofluorescence as a noninvasive marker of vascular damage in patients with type 2 diabetes.

    abstract:OBJECTIVE:Advanced glycation end products (AGEs) are thought to have a role in the pathogenesis of diabetes complications. We recently reported the association between skin autofluorescence, as a measure of tissue AGE accumulation, and diabetic neuropathy in a selected diabetic population. In this study, we investigate...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc05-2173

    authors: Lutgers HL,Graaff R,Links TP,Ubink-Veltmaat LJ,Bilo HJ,Gans RO,Smit AJ

    更新日期:2006-12-01 00:00:00

  • Role of experimental socks in the care of the high-risk diabetic foot. A multicenter patient evaluation study. American Group for the Study of Experimental Hosiery in the Diabetic Foot.

    abstract:OBJECTIVE:To assess the acceptability of specially designed socks to provide satisfactory pressure relief in the insensitive, high-risk, diabetic foot. We have conducted a longitudinal multicenter patient evaluation study to assess the acceptability of such hosiery in neuropathic diabetic patients. RESEARCH DESIGN AND...

    journal_title:Diabetes care

    pub_type: 杂志文章,多中心研究

    doi:10.2337/diacare.16.8.1190

    authors: Murray HJ,Veves A,Young MJ,Richie DH,Boulton AJ

    更新日期:1993-08-01 00:00:00

  • Head-to-head comparison of sirolimus- and paclitaxel-eluting stent in the same diabetic patient with multiple coronary artery lesions: a prospective, randomized, multicenter study.

    abstract:OBJECTIVE:It is still controversial whether sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) are equally effective in patients with diabetes. In these patients, multiple individual variables may be responsible for neointimal hyperplasia, thus making difficult the comparison of the two drug-eluting stent...

    journal_title:Diabetes care

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.2337/dc07-1377

    authors: Tomai F,Reimers B,De Luca L,Galassi AR,Gaspardone A,Ghini AS,Ferrero V,Favero L,Gioffrè G,Prati F,Tamburino C,Ribichini F

    更新日期:2008-01-01 00:00:00

  • Fuel and fluid homeostasis during long-term exercise in healthy subjects and type I diabetic patients.

    abstract:OBJECTIVE:This study was designed to examine metabolic and hormonal effects of long-term exercise in healthy subjects and insulin-dependent (type I) diabetic patients. RESEARCH DESIGN AND METHODS:Two studies were performed. First, 16 healthy males (32 +/- 3 yr) were studied during a semitriathlon competition (2 km swi...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.15.11.1736

    authors: Koivisto VA,Sane T,Fyhrquist F,Pelkonen R

    更新日期:1992-11-01 00:00:00

  • Multifaceted determinants for achieving glycemic control: the International Diabetes Management Practice Study (IDMPS).

    abstract:OBJECTIVE:The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions. RESEARCH DESIGN AND METHODS:Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type ...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc08-0435

    authors: Chan JC,Gagliardino JJ,Baik SH,Chantelot JM,Ferreira SR,Hancu N,Ilkova H,Ramachandran A,Aschner P,IDMPS Investigators.

    更新日期:2009-02-01 00:00:00

  • An analysis of dynamic forces transmitted through the foot in diabetic neuropathy.

    abstract:OBJECTIVE:Biomechanical studies in diabetic neuropathy have clearly demonstrated abnormal foot pressures, but information on other aspects of gait is limited. This study aimed to investigate and describe the forces transmitted through the foot during walking in diabetic subjects with varying degrees of peripheral neuro...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.21.11.1955

    authors: Shaw JE,van Schie CH,Carrington AL,Abbott CA,Boulton AJ

    更新日期:1998-11-01 00:00:00

  • Predictors of glycemic control in insulin-using adults with type 2 diabetes.

    abstract:OBJECTIVE:To determine the characteristics that influence glycemic control among insulin-using adults with type 2 diabetes. RESEARCH DESIGN AND METHODS:We studied all 1,333 eligible members of a large not-for-profit health maintenance organization who responded to a 1997 survey. We tested associations among demographi...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.23.3.273

    authors: Nichols GA,Hillier TA,Javor K,Brown JB

    更新日期:2000-03-01 00:00:00

  • Effects of gastric bypass surgery in patients with type 2 diabetes and only mild obesity.

    abstract:OBJECTIVE:Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes in severely obese patients through mechanisms beyond just weight loss, and it may benefit less obese diabetic patients. We determined the long-term impact of RYGB on patients with diabetes and only class I obesity. RESEARCH DESIGN AND METHODS:Sixty-...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc11-2289

    authors: Cohen RV,Pinheiro JC,Schiavon CA,Salles JE,Wajchenberg BL,Cummings DE

    更新日期:2012-07-01 00:00:00

  • Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry.

    abstract:OBJECTIVE:Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes. RESEARCH D...

    journal_title:Diabetes care

    pub_type: 杂志文章,多中心研究

    doi:10.2337/dc19-1360

    authors: Han D,Rozanski A,Gransar H,Sharir T,Einstein AJ,Fish MB,Ruddy TD,Kaufmann PA,Sinusas AJ,Miller EJ,Bateman TM,Dorbala S,Di Carli M,Liang JX,Hu LH,Germano G,Dey D,Berman DS,Slomka PJ

    更新日期:2020-02-01 00:00:00

  • Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study.

    abstract:OBJECTIVE:People with type 2 diabetes are at increased risk of age-related cognitive decline and dementia. Hypoglycemia is a candidate risk factor, but the direction of association between episodes of severe hypoglycemia and cognitive decline in type 2 diabetes remains uncertain. RESEARCH DESIGN AND METHODS:In the Edi...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc13-1384

    authors: Feinkohl I,Aung PP,Keller M,Robertson CM,Morling JR,McLachlan S,Deary IJ,Frier BM,Strachan MW,Price JF,Edinburgh Type 2 Diabetes Study (ET2DS) Investigators.

    更新日期:2014-02-01 00:00:00

  • Cerebral and ophthalmic artery hemodynamic responses in diabetes mellitus.

    abstract:OBJECTIVE:To address whether hemodynamic responses in the cerebral arteries and OAs may be altered in patients with diabetic retinopathy. We used TCD to evaluate the effects of changes in BP, posture, and exercise on MCA and OA blood flow velocities. RESEARCH DESIGN AND METHODS:We evaluated 13 patients with BDR, 19 wi...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/diacare.16.2.476

    authors: Albert SG,Gomez CR,Russell S,Chaitman BR,Bernbaum M,Kong BA

    更新日期:1993-02-01 00:00:00

  • The development and utility of a novel scale that quantifies the glycemic progression toward type 1 diabetes over 6 months.

    abstract:OBJECTIVE:We developed a scale to serve as a potential end point for 6-month glycemic progression (PS6M) toward type 1 diabetes (T1D) in autoantibody-positive relatives of individuals with T1D. RESEARCH DESIGN AND METHODS:The PS6M was developed from Diabetes Prevention Trial-Type 1 (DPT-1) data and tested in the Trial...

    journal_title:Diabetes care

    pub_type: 杂志文章

    doi:10.2337/dc14-2787

    authors: Sosenko JM,Skyler JS,Beam CA,Boulware D,Mahon JL,Krischer JP,Greenbaum CJ,Rafkin LE,Matheson D,Herold KC,Palmer JP,Type 1 Diabetes TrialNet and Diabetes Prevention Trial–Type 1 Study Groups.

    更新日期:2015-05-01 00:00:00