Treatment strategy for type 2 diabetes from the perspective of systemic vascular protection and insulin resistance

Figures & data

Figure 1 Risk of disease aggravation with diabetes progression.

Abbreviations: CKD, chronic kidney disease; MetS, metabolic syndrome.

Figure 2 Relationship between insulin resistance and PAD.

Reena L, et al. Circulation. 2008;118:33–41. © 2008 Wolters Kluwer Health.

Abbreviations: HOMA-IR, homeostatic model assessment of insulin resistance; PAD, peripheral artery disease.

Figure 3 Life expectancy in PAD patients.

Diehm, et al. Circulation. 2009;120:2053–2061. © 2008 Wolters Kluwer Health.

Abbreviation: PAD, peripheral artery disease.

Figure 4 Relationship between eGFR levels and PAD prevalence.

Selvin E, et al. Eur Heart J. 2009;30:1918–1925. © 2010 SAGE Publications.

Abbreviation: PAD, peripheral artery disease; eGFR, estimated glomerular filtration rate.

Figure 5 Relationship between CKD/PAD complication and cardiovascular death.

Luo Y, et al. Vasc Med. 2010;15:107–112. © 2010 SAGE Publications.

Abbreviations: CKD, chronic kidney disease; PAD, peripheral artery disease.

Table 1 Oral drugs of PAD

Nonproprietary	Trade	Pharmacological class	Indication			Dosage and administration (for adult)
			PAD		Other
			ASO	TAO
Beraprost sodium	Dorner Procylin	Oral prostacyclin derivative product	1) Improvement of ulcer, pain, and feeling of coldness associated with PAD		2) Primary pulmonary hypertension	120 μg/day in three doses postprandially 60 μg/day in three doses postprandially dose escalation: in case of dose escalation, thrice to four times/day up to a daily maximum dose of 180 μg
Cilostazol	Pletal	Antiplatelet	Improving ischemic symptoms secondary to PAD, such as ulceration, pain, and coldness		Inhibiting recurrence in post-cerebral infarction phase (except cardioembolic form)	A dose of 100 mg for twice a day, with adjustment as needed
Sarpogrelate hydrochloride	Anplag	5-HT2 blocker	Improving ischemic symptoms accompanying PAD, such as ulceration, pain, and coldness			A dose of 100 mg for thrce a day postprandially, with adjustment as needed
Ticlopidine hydrochloride	Panaldine	Antiplatelet	1) Improving ischemic symptoms accompanying PAD, such as ulceration, pain and coldness		2) Treating thrombosis/embolism and improving circulatory impairment secondary to vasculopathy and extracorporeal circulation 3) Treating thrombosis/embolism secondary to ischemic cerebrovascular impairments (transient ischemic attack or TIA, or stroke) 4) Improving circulatory impairments associated with cerebrovascular spasm secondary to subarachnoid cerebral hemorrhage	300–600 mg in two to three doses postprandially, with dose adjustment as needed 200–300 mg in two to three doses postprandially, with dose adjustment as needed 200–300 mg in two to three doses postprandially, with dose adjustment as needed; a single dose is possible in the case of 200 mg dose a day 300 mg in three doses postprandially, with dose adjustment as needed
Limaprost alfadex	Opalmon Prorenal	Oral prostaglandin E1 derivative product		1) Improving ischemic symptoms accompanying TAO, such as ulceration, pain and coldness	2) Improving subjective symptoms (pain, numbness in lower extremities) and ambulatory function associated with acquired lumber spinal stenosis (patients with normal SLR testing, presenting with bilateral intermittent claudication)	30 μg/day in three doses 15 μg/day in three doses
Ethyleicosapentaenoic acid	Epadel	EPA product	1) Improving ischemic symptoms accompanying ASO, such as ulceration, pain and coldness		2) Hyperlipidemia	600 mg for three times a day postprandially, with dose adjustment as needed 600 mg for three times a day postprandially In case of abnormal triglycerides, increase dose up to 900 mg three times a day

Abbreviations: ASO, arteriosclerosis obliterans; PAD, peripheral artery disease; EPA, eicosapentaenoic acid; TAO, thromboangiitis obliterans; SLR, straight leg raise.

Figure 6 Insulin transfer from vascular endothelial cells to skeletal muscle.

Kubota T, et al. Cell Metab. 2011;13:294–307. © 2011 Elsevier.

Figure 7 Development of vascular impairment in insulin-resistant state and treatment.

Abbreviations: PAD, peripheral artery disease; ARB, angiotensin receptor blocker; ACEI, angiotensin converting enzyme inhibitor.