Embed Size (px)
Citation preview
DIABETES AND VTEMrunalini Ghangrekar, Roumika Patil, The GTF Group
Global Thrombosis Forum, Atlanta, GA
INTRODUCTION
SUMMARY AND CONCLUSIONS
References
PREVELANCE OF DIABETES
REFERENCESINCIDENCE OF DIABETES
ABSTRACT
■ Age adjusted, county-level prevalence ofdiagnosed diabetes among adults over 20 years inthe US, 2013
PERCENTAGE OF VTE AMONGMEN AND WOMEN OF DIFFERENT
ETHNICITIES■ The incidence of VTE very high in American
Indians, Alaskan Natives, Blacks and Hispanics.■ Lower in Asians and Whites. ■ VTE is well represented in both genders
■ Goldhaber and Piazza (2012): Diabetics whodeveloped VTE were more likely to suffer acomplicated clinical course and had a low rate ofthromboprophylaxis.
■ Diabetics with VTE in the elderly have a higherrisk.
■ Age-adjusted risk of VTE among diabetics is two-fold higher than in non-diabetics.
■ The risk of VTE is dramatically increased with age.
RELATIONSHIP BETWEENDIABETES AND VTE
MECHANISM OF VTE IN DIABETES
■ Diabetic prothrombotic state is caused byendothelial dysfunction, coagulative activationand platelet hyper-reactivity.
■ Diabetics have dysregulation of signalingpathways leading to enhanced adhesion,activation and aggregation.
■ These alterations result from interaction amonghyperglycemia, insulin resistance, inflammationand oxidative stress.
HEART
■ Increased risk of damage to blood vessels overtime, including damage to the small blood vesselsin the brain.
■ With the nerves in the brain damaged, changes inthinking (vascular cognitive impairment or vasculardementia) appear.
■ The longer one has diabetes, the more of a chancethere is of developing dementia.
BRAIN
ACKNOWLEDGEMENTS
■ The authors want to thank Sagar Garud, MD forhis continuous help in preparation of this work.
■ Diabetics have an increased risk of inflammationof the gums (periodontitis) if blood glucose is notproperly managed.
■ Periodontitis is a major cause of tooth loss,associated with an increased risk ofcardiovascular disease.
■ http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf
■ Stein, Paul; Goldman, Jose; Matta, Fadi, et al :Diabetes Mellitus and Risk of VenousThromboembolism, Amer Journal of MedicalSciences, 337, 259-264, 2009
■ Piazza, Gregory and Goldhaber, Samuel Z.:Venous Thromboembolism in Patients withDiabetes Mellitus, Amer Journal of MedicalSciences, 125, 709-716, 2012
■ Vazzana, N; Ranalli, P; Cuccurullo, C and Davì, G:Diabetes mellitus and thrombosis, Thromb Res,129 (3):371-374, 2012
NERVES
■ Diabetes causes diabetic neuropathy and nervedamage.
■ High blood sugar injures nerves throughout thebody, mostly in the legs and feet.
■ Symptoms of diabetic neuropathy: pain,numbness in legs and feet, problems withdigestive system, urinary tract, blood vesselsand heart.
■ The incidence of diabetes is very high in theUnited States with a large and scary incidence(1.4%) of VTE in diabetics.
■ Diabetes affects almost every organ in the body,and often with inadequate thromboprophylaxis.
■ We find a close and direct relationship betweendiabetes and VTE and recommend stringentmeasures to control diabetes to reduce theoccurrence of VTE.
ORAL COMPLICATIONS
■ There appears to be a very close associationbetween Diabetes and VTE. The purpose of thisresearch was to investigate if indeed there is aconnection between the two conditions. Over 100million people are affected by diabetes orprediabetes in the U.S., of which 1,267,000 (1.4%)had VTE. The areas of the U.S. which are mostaffected by diabetes are the South, Southeast,and East. The American Indians and AlaskanNatives have the highest prevalence of diabetes.The risk of VTE is dramatically increased with age.The diabetic prothrombotic state is caused byendothelial dysfunction, coagulative activation,and platelet hyper-reactivity. Diabetes affectsevery organ in the body: skin, teeth, brain, eyes,heart, arteries, kidneys and nerves. Diabetes mayalso affect pregnancy in an adverse manner. Inconclusion, we find a close and direct relationshipbetween diabetes and VTE and recommendstringent measures to control diabetes to reducethe occurrence of VTE.
■ One clot forms every minute, and one death due tothrombosis appears every six minutes.
■ There appears to be a very close associationbetween Diabetes and VTE
■ The purpose of this research was to investigate ifindeed there is a connection between the twoconditions.
■ Over 100 million people affected by diabetes orprediabetes in the U.S.
■ Several reports connecting diabetes and thromboticevents have been published
■ Among 92,240,000 patients with diabetes between1979 and 2005, 1,267,000 (1.4%) had VTE.
■ Heart attacks are more serious and more likelyto be fatal in diabetics.
■ For adults over 60, type 2 diabetes and CVdisease shortens life expectancy by an averageof 12 years.
■ High blood glucose from diabetes can damageblood vessels and the nerves that control theheart and blood vessels.
■ The longer the patient has diabetes, higherchances of developing heart disease.
PREGNANCY COMPLICATIONS INDIABETIC PATIENTS
■ Children exposed for a long time to high bloodglucose in the uterus are at higher risk ofdeveloping diabetes in the future.
■ High blood glucose during pregnancy can lead tothe fetus putting on excess weight.
*9380846* 6122225_9380846 48 x 36Front 48 x 36 trim size
![, Z > X } r> Ç } v } ] W } ( } } ( Z u ] Ç µ P µ î ì í ôfacultyweb.kennesaw.edu/habbott/CV_06-2018.pdf · Z u ] Ç _ W Z Ç X Z u X Z u X W Z Ç X U í ô U î ì í](https://img.pdfslide.us/doc/110x75/5e162d4b9382695d87505c0f/-z-x-r-v-w-z-u-p-z-u-.jpg)
![Spatial & Frequency Domain f(x,y) * h(x,y) F(u,v) H(u,v) (x,y) * h(x,y) [ (x,y)] H(u,v) h(x,y) H(u,v) Filters in the spatial and frequency](https://img.pdfslide.us/doc/110x75/56649f435503460f94c6345d/spatial-frequency-domain-fxy-hxy-fuv-huv-xy-hxy.jpg)
![NonabelianGaugeTheoryofStrongInteractionsusers.physik.fu-berlin.de/~kleinert/b6/psfiles/Chapter-27-strongin.pdf · ∂µ +iqAµ(x)+U−1(x)∂µU(x) i = U(x)[∂µ +igAµ(x)]q(x),](https://img.pdfslide.us/doc/110x75/5ec6c7eacbf7fc191035d0c9/nonabeliangaugetheoryofstr-kleinertb6psfileschapter-27-stronginpdf-a-iqaxua1xaux.jpg)
![4th Mother Chess below 1600 - light BG€¦ · W Ç u v D } W í X Z u ] v Z } µ P Z Á Á Á X Z ( X } u U Á Á Á X Ç ð Z X } u](https://img.pdfslide.us/doc/110x75/5b3879987f8b9a5a518d76ff/4th-mother-chess-below-1600-light-bg-w-c-u-v-d-w-i-x-z-u-v-z-p.jpg)
![v P u · > ] ] v P u r D v µ o v ] Á Á Á X } } À ] o X } u X î µ } X W u o Z } v v _ } } U À r o À u } v U ] u ] u v U ] µ } } o _ ] } r](https://img.pdfslide.us/doc/110x75/60750da0607eae714159b641/v-p-u-v-p-u-r-d-v-o-v-x-o-x-u-x-x-w-u.jpg)
![& µ o Ç ] o } ( } u ( } } o o P t ] · ( } ^ µ Ì µ l ] rD ] Ç µ } µ o ] v P X < µ u U h X V µ Ç U W X V ^ ] v P Z U s X s X V W l Z U K X V ^ ] v P Z U X < X Z^ À î ì](https://img.pdfslide.us/doc/110x75/5f1a7789a56a3b724e4a3b00/-o-o-u-o-o-p-t-oe-l-rd-o-.jpg)
![Casillas Russ NewPatientPacket · D l X ] o o U : X D U D^ U & ^ U & ^ Z^ v Á : X Z µ D U & ^ U & ^ Z^ h v ] À ] Ç } o } v Z o ^ µ P Ç í õ ï ð o } , Á Ç U o P X U ^ X](https://img.pdfslide.us/doc/110x75/60408f4bebe39a25d7437850/casillas-russ-newpatientpacket-d-l-x-o-o-u-x-d-u-d-u-u-z-v.jpg)
![· ] } } v µ } ð ï ð n Á Á Á X ] } } v µ } X } u X ï ì u } & ] } } v µ } ñ ï ð n Á Á Á X ] } } v µ } X } u X ï ì u } &](https://img.pdfslide.us/doc/110x75/5e71d1b4814dd6098469d6e2/-v-n-x-v-x-u-x-u-v.jpg)
![5(*/$0(172 ,17(512 '( 25'(1 +,*,(1( < 6(*85,'$' &20(5 ... · d _ µ o } yy/ W o } u Æ ] u } P Z µ u v U > Ç E £ î ì X ì ì í ~> Ç o } X X X X X X X X X X X X X X](https://img.pdfslide.us/doc/110x75/5e9356eddc42f0622b2944fe/50172-17512-251-1-685-205-d-o-yy.jpg)
![~ 0 [u(x,y)/U e ] (1 – u(x,y)/U e )dy](https://img.pdfslide.us/doc/110x75/5681365b550346895d9de50f/-0-uxyu-e-1-uxyu-e-dy.jpg)
![D v µ ( µ u o ] v , ] Á Z U < v h X^ X X](https://img.pdfslide.us/doc/110x75/61bd3fd661276e740b10de18/d-v-u-o-v-z-u-lt-v-h-x-x-x.jpg)
![Á Á } µ o } µ u } ( W v Z Ç Z i U ] X X U µ u } Ç](https://img.pdfslide.us/doc/110x75/616a665f11a7b741a3521437/-o-u-w-v-z-z-i-u-x-x-u-u-.jpg)
