70.8% of patients had LDL levels >2.6 mmol/L;
43.8% had triglycerides >2.2 mmol/L; 44.1% had HDL<1 mmol/L despite Etoposide cost 48% of the patients being on lipid lowering agents. Microvascular, macrovascular and severe late complications were reported in 39.2%, 9.9% and 12.1% patients respectively. The rates of diabetic complications were cataract 12.9%, microalbuminuria 15.7%, neuropathy symptoms 31.7%, leg amputation 1.2% and history of angina pectoris was 6.6%. The A1chieve Study (2013), was a 24-week, multinational, open-label, observational study of 66,726 diabetics who had begun using biphasic insulin aspart 30, insulin aspart, or insulin detemir in routine clinical care. Participants were enrolled from 28 countries across four continents (Asia, Africa, Europe and South America). Results, Complication rates were high (27.2% had macrovascular complications and 53.5% had microvascular complications), particularly in Russia, and use of vascular disease preventative drugs was lower than expected. Age, BMI, diabetes duration, LDL-C, and SBP were positively associated, and HDL-C negatively associated, with macro- and microvascular complications
(all p < 0.05) (Litwak et al, 2013). These results from the Diabcare Asia 2008 and A1chieve study suggests a worldwide failure to achieve glycaemic targets. A better diabetes management with earlier initiation and optimization of insulin treatment regimens may reduce the prevalence of vascular complications, improve the lives of people with diabetes and reduce the burden on healthcare systems. NAKAGAWA TAKAHIKO1,2, Dactolisib KOSUGI TOMOKI3, LANASPA MIGUEL A.2, ISHIMOTO TAKUJI2,3, NAKAYAMA TAKAHIRO2, JOHNSON RICHARD J2 1TMK project, Kyoto University Graduate School of Medicine, Japan; 2Department of Medicine, Etomidate University of Colorado Denver, USA; 3Department of Nephrology, Nagoya University Graduate School of Medicine, Japan Recently uric acid has attracted public attention as a potential cause for cardiovascular disease. Our group has been studying the role of uric acid in hypertension
and renal diseases. Both animal models and clinical studies consistently demonstrate that uric acid is positively associated with blood pressure, and pilot studies show that lowering serum uric acid reduces blood pressure in rats and humans. Likewise, a causal role for uric acid in kidney disease is suggested by evidence that lowering uric acid with either allopurinol (a xanthine oxidase inhibitor), or benzbromarone (a uricosuric agent) could slow the progression of renal disease in experimental models. The mechanism by which uric acid may drive hypertension and kidney disease involves the induction of endothelial cell dysfunction and vascular smooth muscle cell activation. A tubular epithelial cell is also a target for uric acid which leads to an inflammatory response with cellular phenotypic change. Likewise, some clinical studies have demonstrated an association of uric acid with the progression of diabetic nephropathy.