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1. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 15, 2019, No. 1 , , ,

atherosclerosis, carbohydrate disorders, diabetes,
atherosclerosis, carbohydrate disorders, diabetes,
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In order to define the treatment approach for these patients, different carbohydrate disorders should be distinguished (increased fasting glycemia, impaired glucose tolerance, diabetes mellitus, metabolic syndrome).
Glycemic control disorders are one of the major factors for atherosclerotic changes of the body vessels. The early diagnosis and control give the opportunity for adequate and effective prevention of complications. Assessment of accidental blood glucose, fasting and post-challenge plasma glucose, glycosylated hemoglobin (HbA1c) and some novel methodologies as EZSCAN are used for screening. In order to define the treatment approach for these patients, different carbohydrate disorders should be distinguished (increased fasting glycemia, impaired glucose tolerance, diabetes mellitus, metabolic syndrome).
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Similar changes are also reported in individuals with different carbohydrate disorders.
Ultrasonographic studies in patients with diabetes mellitus reveal thickening of intimamedia complex of the carotid arteries, increased vascular resistance and different degrees of atherosclerotic plaques, more pronounced in type 2 diabetes mellitus [29, 30]. Similar changes are also reported in individuals with different carbohydrate disorders.
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Carbohydrate disorders are defined depending on the test results (Table 1).
Oral glucose tolerance test (OGTT) with 75 g of glucose should be performed for differentiation between normal state and DM. Carbohydrate disorders are defined depending on the test results (Table 1). Impaired fasting glucose (IFG) is diagnosed when the blood sugar is between
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In patients with vascular complications the metabolic state should be defined because of the worsening status in unrecognized and inadequately treated carbohydrate disorders.
should undergo oral glucose tolerance test. In patients with vascular complications the metabolic state should be defined because of the worsening status in unrecognized and inadequately treated carbohydrate disorders. Measurement of blood sugar alone should be avoided in these patients because they often have normal fasting glucose but demonstrate increased levels at the second hour of OGTT [5]. This is a predictive value for a 10-year period for DM development with approximate accuracy of 85% and helps the diagnosis of asymptomatic forms [15].
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A new and different approach for screening of carbohydrate disorders and their complications is the EZSCAN methodology.
A new and different approach for screening of carbohydrate disorders and their complications is the EZSCAN methodology. It is based on assessment of sweat gland function with reverse iontophoresis and chronoampermetry, and skin conductance measurement [8, 9, 10]. It estimates the metabolic and cardiovascular risk and gives the opportunity for studying the insulin resistance treatment. This method is noninvasive and is used for investigation of healthy patients with high risk for DM. A great advantage is that the results are ready for use immediately after the assessment and could be used for motivating the patients for life-style changes. This method shows high sensitivity and specificity [19].
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carbohydrate disorders [1] when the other results are still normal.
carbohydrate disorders [1] when the other results are still normal. Some authors use the glucose challenge test with glucose measuring at the first hour after 50 g of glucose intake for screening. For this test no fasting is needed [7] and it is more flexible for assessment of large, not prepared groups. The blood glucose levels during OGTT and their maximal deviations correlate with the IMT of carotid arteries (assessed with ultrasound methods) more than fasting blood sugar [28]. OGTT has eightfold higher diagnostic value for carbohydrate impairments than using fasting plasma glucose alone [20]. Oral glucose tolerance test needs to be performed in special conditions (after an 8-10 hour fasting period, with appropriate diet the last tree days with not consuming less than 150 g of carbohydrates).
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We don’t have yet a single algorithm for diagnosis and prevention of carbohydrate disorders and for their follow-up after recognition of atherosclerotic vessel changes.
We don’t have yet a single algorithm for diagnosis and prevention of carbohydrate disorders and for their follow-up after recognition of atherosclerotic vessel changes. There is no doubt that early assessment of metabolism disorders after a diagnosed vascular disease is needed; as well as assessment of the vessels when impaired glucose tolerance, increased fasting glucose or DM are revealed. The treatment on time will prevent life threatening and irreversible complications.
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