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Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis
CONCLUSIONS: In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.PMID:37334731 | PMC:PMC10278750 | DOI:10.1097/CM9.0000000000002730
Source: Chinese Medical Journal - June 19, 2023 Category: General Medicine Authors: Fengshi Li Rui Zhang Xiao Di Shuai Niu Zhihua Rong Changwei Liu Leng Ni Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - January 10, 2023 Category: General Medicine Authors: Jia Liu Lu-Ning Wang Source Type: research

Relationship between serum insulin-like growth factor 1 levels and ischaemic stroke: a systematic review and meta-analysis
Conclusion Higher serum IGF-1 was significantly correlated with a lower risk of ischaemic stroke. In view of the high degree of heterogeneity, it may need more studies to confirm the prognostic value of serum IGF-1 levels in ischaemic stroke and explore the sources of heterogeneity.
Source: BMJ Open - June 15, 2022 Category: General Medicine Authors: Li, Y., Yang, W., Li, J., Zhang, Y., Zhang, L., Chen, S., He, L., Zhang, Y. Tags: Open access, Neurology Source Type: research

Intensive Medical Management to Prevent Large and Small Artery Atherothrombotic Stroke
This Viewpoint examines the potential of using newer strategies to prevent ischemic stroke due to large and small artery atherothrombosis, including agents to lower LDL cholesterol, as well as increase eicosapentaenoic acid levels, insulin sensitivity and synthesis, and folic acid levels.
Source: JAMA - Journal of the American Medical Association - July 1, 2021 Category: General Medicine Source Type: research

(Ultra-)long-acting insulin analogues for people with type 1 diabetes mellitus
CONCLUSIONS: Comparing insulin detemir with NPH insulin for T1DM showed lower risk of severe hypoglycaemia in favour of insulin detemir (moderate-certainty evidence). However, the 95% prediction interval indicated inconsistency in this finding. Both insulin detemir and insulin glargine compared with NPH insulin did not show benefits or harms for severe nocturnal hypoglycaemia. For all other main outcomes with overall low risk of bias and comparing insulin analogues with each other, there was no true beneficial or harmful effect for any intervention. Data on patient-important outcomes such as QoL, macrovascular and microvas...
Source: Cochrane Database of Systematic Reviews - March 4, 2021 Category: General Medicine Authors: Bianca Hemmingsen Maria-Inti Metzendorf Bernd Richter Source Type: research

Maternal Cardiovascular Health
Historically, the focus on the development of atherosclerotic cardiovascular disease has been on individual risk factors. These factors, which are associated with increased risk of myocardial infarction and stroke, were identified in the Framingham Study and other longitudinal observational studies of adults. The traditional risk factors are hypertension, dyslipidemia, obesity, diabetes, and cigarette smoking. Subsequently, other potential risk factors, such as inflammation and insulin resistance, have been included in the discussion. The recognition of risk factors was a substantial advance because it provided clinical ta...
Source: JAMA - February 16, 2021 Category: General Medicine Source Type: research

Metformin monotherapy for adults with type 2 diabetes mellitus.
CONCLUSIONS: There is no clear evidence whether metformin monotherapy compared with no intervention, behaviour changing interventions or other glucose-lowering drugs influences patient-important outcomes. PMID: 32501595 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 4, 2020 Category: General Medicine Authors: Gnesin F, Thuesen ACB, Kähler LKA, Madsbad S, Hemmingsen B Tags: Cochrane Database Syst Rev Source Type: research

Treatment of Hyperglycemia in Patients With Acute Stroke
To the Editor The multicenter Stroke Hyperglycemia Insulin Network Effort (SHINE) randomized clinical trial enrolled 1118 patients with acute ischemic stroke and hyperglycemia (923 with known diabetes) to test the effect of different blood glucose control strategies on neurological outcome. No difference in favorable functional outcome was found with intensive vs standard glucose control. We wish to highlight several issues.
Source: JAMA - December 10, 2019 Category: General Medicine Source Type: research

Dynamic derangement in amino acid profile during and after a stroke-like episode in adult-onset mitochondrial disease: a case report
ConclusionsGrowth differentiation factor-15 can be used not only for the diagnosis of mitochondrial disease, but as an indicator of its acute exacerbation. A stroke-like episode of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes reflects a drastic derangement of multiple amino acids. The involvement of aspartic acid in the episodes should be explored in future studies.
Source: Journal of Medical Case Reports - October 20, 2019 Category: General Medicine Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack.
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - October 8, 2019 Category: General Medicine Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Effect of Intensive vs Standard Treatment of Hyperglycemia on Functional Outcome in Stroke
This randomized clinical trial compares the effects of continuous intravenous vs subcutaneous sliding scale insulin for treatment of hyperglycemia during acute ischemic stroke on functional outcome in adult patients in the United States.
Source: JAMA - July 23, 2019 Category: General Medicine Source Type: research

Metformin and second- or third-generation sulphonylurea combination therapy for adults with type 2 diabetes mellitus.
CONCLUSIONS: There is inconclusive evidence whether M+S combination therapy compared with metformin plus another glucose-lowering intervention results in benefit or harm for most patient-important outcomes (mortality, SAEs, macrovascular and microvascular complications) with the exception of hypoglycaemia (more harm for M+S combination). No RCT reported on health-related quality of life. PMID: 30998259 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 17, 2019 Category: General Medicine Authors: Madsen KS, Kähler P, Kähler LKA, Madsbad S, Gnesin F, Metzendorf MI, Richter B, Hemmingsen B Tags: Cochrane Database Syst Rev Source Type: research

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