Increased frequency of diabetic foot publications.
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Diabetes Mellitus↗
Biomedical subjects
C Berne
Publications and source records attributed to C Berne.
Accelerated gastric emptying during hypoglycaemia is not associated with changes in plasma motilin levels.
This study examined whether or not changes in plasma concentrations of motilin and other gastrointestinal hormones known to affect gastric motility are associated with the accelerated gastric emptying seen during hypoglycaemia. While studying gastric emptying by scintigraphy in eight healthy subjects, the plasma concentrations of glucagon, adrenaline, motilin, gastrin, neuropeptide Y and somatostatin were measured during normoglycaemia and hypoglycaemia with simultaneous infusion of either atropine or saline. Blood glucose concentrations were checked by an insulin-glucose clamp. The plasma levels of glucagon and adrenaline increased markedly during both hypoglycaemic examinations compared with normoglycaemia. Neither motilin nor any of the other hormones displayed considerable changes during hypoglycaemia with and without atropine compared with normoglycaemia. No further information about the mechanisms behind the accelerated gastric emptying rate during hypoglycaemia was obtained by analysing motilin and the other gastrointestinal hormones.
Adult↗
Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus.
BACKGROUND & AIMS: Marked hyperglycemia slows and hypoglycemia accelerates gastric emptying. The aim of this study was to determine the effect of physiological changes in blood glucose gastric emptying. METHODS: In 8 healthy subjects and 9 patients with insulin-dependent diabetes mellitus (IDDM) without gastrointestinal tract symptoms or evidence of neuropathy, gastric emptying of a mixed meal was measured by scintigraphy. Using an insulin-glucose clamp, the blood glucose concentration was stabilized at 4 and 8 mmol/L on 2 separate days. RESULTS: The intragastric retention of the solid meal component at 100 minutes was 55.2% +/- 4.5% at 8 mmol/L vs. 36.7% +/- 5.5% at 4 mmol/L (P = 0.004) in normal subjects and 44.2% +/- 4.2% vs. 35.7% +/- 4.2% (P = 0.004) in patients with IDDM. The time taken for 50% emptying of the liquid meal was 57.0 +/- 10.8 minutes at 8 mmol/L vs. 32.2 +/- 12.6 minutes at 4 mmol/L (P = 0.002) in normal subjects and 41.3 +/- 3.4 minutes vs. 29.1 +/- 3.5 minutes (P = 0.002) in patients with IDDM. CONCLUSIONS: Changes in blood glucose within the normal postprandial range have a significant impact on gastric emptying in both normal subjects and patients with IDDM.
Adult↗
The counterregulatory response to hypoglycaemia in women with the polycystic ovary syndrome.
OBJECTIVE: The pathogenetic mechanisms behind insulin resistance in polycystic ovary syndrome (PCOS) are far from fully elucidated. Aberrant counterregulatory responses to hypoglycaemia have been reported in patients with insulin resistance, and recent reports suggest that plasma glucose may be regulated at lower levels in women with PCOS. In this study we investigated the complete hormonal counterregulatory response to hypoglycaemia in women with PCOS. DESIGN: Prospective cross-sectional study. PATIENTS: Eight obese (BMI > or = 25) and 10 non-obese (BMI < 25) women with PCOS, diagnosed by means of ultrasonography and clinical signs of chronic anovulation. Eight obese and 9 non-obese controls. MEASUREMENTS: Hypoglycaemia was induced by an intravenous bolus of soluble insulin (0.15 IU/kg body weight). The counterregulatory responses of cortisol, GH, catecholamines, glucagon, chromogranin A (CGA), and neuropeptide Y (NPY) were studied together with symptoms of hypoglycaemia. RESULTS: The obese women with PCOS had a more pronounced truncal-abdominal body fat distribution (waist hip ratio, WHR) and were hyperinsulinaemic, compared with the obese controls. All the women exhibited blood glucose levels (< 2 mmol/l) well below the threshold for the hormonal counterregulatory response and for the appearance of clinical symptoms. The non-obese women with PCOS showed a greater increase in serum concentrations of GH than the lean controls. The obese women with PCOS exhibited blunted responses of noradrenaline and NPY, but similar increases of adrenaline and CGA, compared with the obese controls. They also showed a lower symptom score during hypoglycaemia. The response of noradrenaline to hypoglycaemia correlated inversely with fasting insulin levels in the women with PCOS. Among all the obese women (PCOS and controls pooled) basal levels of noradrenaline correlated inversely with the WHR. CONCLUSIONS: All the women with PCOS, independent of BMI, body fat distribution and insulin levels, showed preserved counterregulatory responses to hypoglycaemia. The reduced plasma levels of noradrenaline and the lower perception of hypoglycaemic symptoms in the obese women with PCOS could both reflect a lower activation of the sympathetic nervous system. This aberration seems related to truncal-abdominal obesity and hyperinsulinaemia. The finding of an increased response of GH in the lean women with PCOS could support previous suggestions of an altered activity of the GH/IGF-I system in these women.
Adult↗
[Diabetes mellitus--current Swedish national guidelines].
In 1996, national guidelines for the care and treatment of patients with diabetes mellitus were drawn up by specialists, in collaboration with representatives of the patient organisation, diabetes nurses, the professional associations of various medical specialties and central authorities. The national programme is divides into three parts: summarised information for decision-makers, clinical guidelines and complete information for patients. The guidelines are designed to provide a basis for treatment programmes at the local level. Among other things, the national guidelines stress the importance of the diabetes nurse both in primary and tertiary care, and emphasise the need of regional centers providing access to information and education and promoting the development of treatment. Another important aspect is fostering the influence of patient organisations at the local level, in order for the guidelines to have an impact on the quality of care for the individual patient.
Cost of Illness↗
Excess risk of primary liver cancer in patients with diabetes mellitus.
BACKGROUND: Chronic infection with hepatitis B virus, alcohol consumption, and cirrhosis of the liver are recognized risk factors for primary liver cancer. A few, but not all, studies have suggested that diabetes mellitus also increases risk for this cancer. PURPOSE: We conducted a population-based cohort study to analyze the risk of developing primary liver cancer and biliary tract (gallbladder, extrahepatic bile ducts, and ampulla of Vater) cancers among patients with diabetes. METHODS: A cohort of 153 852 patients with a hospital discharge diagnosis of diabetes in the period from 1965 through 1983 was identified by use of the Swedish In-patient Register. Follow-up for these patients extended from the date of cohort entry through December 31, 1989. Incident cases of cancer during follow-up were identified through the Swedish Cancer Registry. To minimize the impact of selection bias, we excluded from the analysis patients who were diagnosed with liver and biliary tract cancers during the first year of follow-up. Standardized incidence ratios (SIRs) and their 95% confidence intervals (CIs) were computed by use of nationwide rates of liver and biliary tract cancers, adjusted for age, sex, and calendar year, for comparison. RESULTS: During 1-24 years of follow-up, 819 incident cancers in the combined category of primary liver (n = 533) and biliary tract (n = 286) were identified in the cohort, yielding an overall SIR of 2.5 (95% CI = 2.3-2.6). The risk was higher in men (SIR = 3.2; 95% CI = 2.9-3.6) than in women (SIR = 2.0; 95% CI = 1.8-2.2). The incidence of primary liver cancer alone was increased fourfold (SIR = 4.1; 95% CI = 3.8-4.5); again, the risk was higher in men (SIR = 4.7; 95% CI = 4.2-5.2) than in women (SIR = 3.4; 95% CI = 2.9-3.9). Smaller increases in risk were seen for cancers of the gallbladder, the extrahepatic bile ducts, and the ampulla of Vater. After exclusion of diabetic patients with concomitant diseases that predispose to primary liver cancer, such as alcoholism, cirrhosis, and hepatitis, the persistence of an approximately threefold excess risk was observed. CONCLUSIONS: Our findings suggest that patients with diabetes are at increased risk of developing primary liver cancer and perhaps cancers of the biliary tract. The mechanisms involved in the association of diabetes and liver cancer remain to be clarified. Additional studies are needed to determine whether patients with insulin-dependent diabetes mellitus and those with non-insulin-dependent diabetes mellitus differ in their risk for primary liver cancer or whether the risk is affected by the type of diabetes treatment.
Adult↗
Increased prevalence of upper gastrointestinal symptoms in long-term type 1 diabetes mellitus.
Using a validated postal questionnaire, we investigated the frequency of 24 gastrointestinal symptoms during the previous 3 months in a cohort of 110 young adult patients (54 males and 56 females, mean age 37.2 +/- 4.7 years) with onset of Type 1 diabetes mellitus at < 16 years of age. They were compared with 210 age- and sex-matched controls (104 males and 106 females). The main difference in the frequency of various symptoms between the two groups was a significant increase among the diabetic patients in upper gastrointestinal symptoms, such as loss of appetite (17.8% vs 3.6%, p < 0.001), early satiety (26.8% vs 6.1%, p < 0.001), nausea (22.7% vs 9.1%, p < 0.01) and vomiting (12.2% vs 3.0%, p < 0.01). No difference was noted in the frequency of symptoms from the lower gastrointestinal tract, apart from a significant increase in the feeling of incomplete defaecation (28.6% vs 17.0%, p < 0.04) in the diabetic patients. Patients with levels of haemoglobin A1c in the highest quartile had significantly more gastrointestinal symptoms than other diabetic patients. Further, the prevalence of symptoms was higher in females than in males. In conclusion, long-term Type 1 diabetes is accompanied by a markedly increased frequency of upper gastrointestinal symptoms, mainly in females and patients with poor metabolic control.
Abdomen↗
Increase in muscle nerve sympathetic activity after glucose intake is blunted in the elderly.
Muscle nerve sympathetic activity (MSA; involved in blood pressure regulation) was recorded by microneurography in the peroneal nerve for 90 min after ingestion of 100 g D-glucose in three groups of healthy subjects: young subjects (mean age 26 years) and 70-year-old men with normal and reduced insulin sensitivity as assessed by euglycaemic insulin clamp. Muscle nerve sympathetic activity at rest was lowest in the young and highest in the insulin-resistant subjects (burst frequencies 19.8 +/- 6.0, 47.7 +/- 7.0 and 55.1 +/- 11.5 bursts/min for the three groups, respectively). The young subjects responded to glucose intake with a pronounced increase in MSA, a response that was blunted in the elderly and weakest in the insulin-resistant subjects. A similar relationship was observed during a Valsalva manoeuvre, indicating that the blunted response in the elderly is a generalized phenomenon. Blood pressure remained stable in the young subjects but fell slightly and significantly in the elderly subjects. It is concluded that old subjects utilize their total capacity for MSA close to maximum at rest. Thus, the reserve for response to stimuli normally evoking a strong increase in MSA is restricted. This restriction may contribute to postprandial hypotension in the healthy elderly.
Adult↗
Relationship between diastolic hypertension and myocardial morphology and function in elderly males with diabetes mellitus.
The existence of a distinct diabetic cardiomyopathy, characterized by a raised left ventricular mass, has previously been suggested. However, as diabetes mellitus is associated with both left ventricular hypertrophy and hypertension a confounding effect of raised blood pressure in diabetic patients has to be considered. In the present cross-sectional study an echocardiographical examination was performed as part of a health screening survey in 582 males, aged 70 years. After the exclusion of subjects with coronary heart disease or those on regular antihypertensive treatment, 30 normotensive subjects with diabetes were compared with 10 subjects with non-insulin-dependent diabetes (NIDDM) and a diastolic blood pressure 90 mm Hg or more and 203 normotensive control subjects with normal glucose tolerance. Both groups with NIDDM showed a significantly increased left atrial diameter (4.4 +/- 0.7 vs 4.0 +/- 0.5 cm, p < 0.05) and an increased atrial component in diastole (A-wave, p < 0.01) compared to the control subjects. Left ventricular mass was, however, only marginally and not significantly elevated in the diabetic subjects when compared to the healthy control subjects (133 +/- 19 and 133 +/- 28 vs 128 +/- 25 g/m2). Only in the subjects with concomitant diabetes and a raised blood pressure was the intraventricular septum significantly enlarged (p < 0.05). Thus, in the present sample no distinct diabetic cardiomyopathy with an increased left ventricular mass, independent of the influence of hypertension could be detected. The myocardial alterations in these diabetic males were restricted to an increased left atrial size and an impaired diastolic function.
Aged↗
Elevated ambulatory day-time blood pressure in women with polycystic ovary syndrome: a sign of a pre-hypertensive state?
The aim of this study was to evaluate office and 24 h blood pressures in women with polycystic ovary syndrome (PCOS) and normal controls in relation to insulin sensitivity. Office blood pressure, insulin sensitivity (euglycaemic hyperinsulinaemic clamp) and body fat distribution (skin-folds, waits:hip ratio) were investigated in 36 women with PCOS and 55 controls [body mass index (BMI) for PCOS patients, mean (confidence interval) 26.3 (24.6-28.2); controls, 25.1 (24.0-26.9)], and ambulatory 24 h blood pressure was recorded in representative subgroups of 17 and 16 women respectively. Compared with the controls, the women with PCOS had higher day-time systolic (mean +/- SD, 126 +/- 11 versus 119 +/- 12 mm Hg, P < 0.05) and mean arterial blood pressures (92 +/- 7 versus 86 +/- 7 mm Hg, P < 0.05) in ambulatory recordings, and greater increases in pulse rate (70%; P < 0.05) from night to day-time recordings, whereas the groups did not differ significantly in day-time diastolic blood pressure (74 +/- 6 versus 70 +/- 6 mm Hg, P = 0.05) or in night-time recordings. The women with PCOS had a more pronounced truncal-abdominal fat distribution (P < 0.05) and a lower insulin-mediated glucose disposal (P < 0.01) during the clamp. The increased day-time blood pressures in women with PCOS persisted after adjusting for BMI, body fat distribution and insulin resistance. It is concluded that women with PCOS have an increased prevalence of labile blood pressure, which may indicate a pre-hypertensive state, adding a further risk factor for cardiovascular disease in these women.
Androgens↗
Diazoxide treatment at onset preserves residual insulin secretion in adults with autoimmune diabetes.
Twenty islet cell antibody (ICA)-positive patients, aged 19-38 years, with IDDM were randomized at onset to treatment with either diazoxide, a K+ channel opener that inhibits the release of insulin, or placebo for 3 months, in addition to multiple insulin injection therapy. The patients who were given diazoxide displayed higher residual insulin secretion than the placebo group after 1 year (basal C-peptide level, 0.40 +/- 0.04 vs. 0.25 +/- 0.04 [mean +/- SE] nmol/l; P < 0.021) and at an 18-month follow-up (0.37 +/- 0.06 vs. 0.20 +/- 0.01 nmol/l, P < 0.033). Metabolic control did not differ between the two groups. During the course of the study, no differences in islet cell or GAD autoantibodies were detected between the two groups. The results of this study warrant further trials to explore the potential of inducing target cell rest in order to halt the loss of insulin-producing cells during the early course of the disease.
Adult↗
A population-based study of the prevalence of diabetes and impaired glucose tolerance in adults in northern Sudan.
OBJECTIVE: To study the prevalence of glucose intolerance in adult urban and rural populations in the northern parts of Sudan. RESEARCH DESIGN AND METHODS: A sample of 1,284 subjects aged > or = 25 years was selected using a multistage cluster method and underwent a 75-g oral glucose tolerance test. RESULTS: The crude prevalence was 3.4% (men, 3.5%; women, 3.4%) for diabetes and 2.9% (men, 2.2%; women, 3.3%) for impaired glucose tolerance (IGT). The highest crude prevalence was in the northern parts of Sudan (5.5%) and the lowest in the western desert-like parts (0.9%). Diabetes and IGT rates were not different between the urban and rural populations. New cases (2.2%) were almost twice as prevalent as previously known cases (1.3%). Family history of diabetes, obesity, and advanced age were associated with higher rates of diabetes. CONCLUSION: The results showed a high prevalence of diabetes in the adult population of Sudan, with a wide difference among the different areas. The high ratio of newly discovered to previously known diabetic cases may reflect poor public awareness and medical services. These findings will certainly have far-reaching implications for diabetes care delivery in this country.
Adult↗
Hypoglycaemia and gastric emptying.
The following studies show that insulin-induced hypoglycaemia increases the gastric emptying rate for both liquids and solid food in healthy volunteers and in patients with IDDM of short duration. This response to low blood glucose concentrations may help protect against sustained hypoglycaemia by increasing the uptake of ingested carbohydrates. The results suggest that gastric emptying in patients with diabetes should be examined under conditions that are standardized with respect to blood glucose concentration. The finding that cholinergic muscarinic blockade with atropine inhibited the hypoglycaemia-induced acceleration of gastric emptying indicates that vagal stimulation plays an important role in this mechanism. The fact that plasma pancreatic polypeptide concentrations were unchanged during hypoglycaemic episodes in the presence of atropine indicates that complete inhibition of the cholinergic transmission was achieved. It is not yet established whether hypoglycaemia directly stimulates vagal activity or whether this is achieved through the activation of hormones or other second messengers. It is likely, however, that vagal activity is an important determinant of the varying rate of gastric emptying at different glycaemic levels. The pancreatic polypeptide response in the atropine-treated subjects resembles that seen in diabetic patients with autonomic neuropathy when exposed to insulin-induced hypoglycaemia. Disturbances of vagal function are frequent in diabetic patients with autonomic neuropathy, and can lead to a reduction in the stimulated gastric output. A failure to increase gastric emptying in response to hypoglycaemia would be disadvantageous when ingestion of oral carbohydrates is used to restore normoglycaemia, and diabetic patients with autonomic neuropathy could therefore be at increased risk for severe hypoglycaemia. The influence of glycaemia on vagal activity and gastric emptying rate probably alters the optimal time interval between insulin injections and postprandial increases in the blood glucose concentration in patients treated with short-acting insulin administered at mealtimes. This may cause variations in blood glucose concentrations. Furthermore, it is possible that drugs that have anticholinergic effects (such as tricyclic antidepressants) may deleteriously decrease the gastric emptying rate during hypoglycaemia in diabetic patients.
Adult↗
[Gastric emptying is important for the patients with diabetes].
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Blood Glucose↗
Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study.
In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Well-being, Treatment Satisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated. Cronbach's alpha indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66-0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p < 0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.
Adult↗
Increased level of hemoglobin A1c, but not impaired insulin sensitivity, found in hypertensive and normotensive smokers.
Smoking is associated with an abnormal plasma lipoprotein pattern. Recently, both insulin resistance and normal insulin action have been reported in smokers. In a total of 191 hypertensive and normotensive subjects recruited from a health survey, serum lipoprotein lipids, glucose tolerance (by intravenous glucose tolerance test (IVGTT), insulin secretion, and insulin sensitivity (euglycemic insulin clamp) were compared in the 41 smokers and 150 nonsmokers. Subjects were examined in the morning during a fasting state and after abstinence from smoking for 10 to 12 hours. Smokers showed a higher level of hemoglobin A1c (HbA1c) as compared with nonsmokers, 4.9% versus 4.7% (P < .05). There were no significant differences in fasting glucose, insulin, or insulin-mediated glucose disposal. However, a number of indices of insulin sensitivity tended to show enhanced insulin action among smokers. Only lower glucose and insulin values during the late phase (40 to 90 minutes) of the IVGTT reached statistical significance. Compared with nonsmokers, smokers had an expected higher level of serum triglycerides (2.1 v 1.8 mmol/L, P < .05) and an increased low-density lipoprotein (LDL) to high-density lipoprotein (HDL) cholesterol ratio (4.5 v 3.9, P < .05). These differences between smokers and nonsmokers were similar in both hypertensives and normotensives. In conclusion, smokers examined in the abstinence phase showed no signs of impaired insulin action. Lipoprotein abnormalities and elevated HbA1c may be caused in part by the insulin resistance induced during acute smoking and therefore may be quantitatively related to the time exposed to smoking. The effect on insulin sensitivity appears to be reversible over 10 to 12 hours.
Blood Glucose↗
Glycaemic control of insulin-dependent diabetes mellitus in Sudan: influence of insulin shortage.
Insulin availability and routine diabetes care were cross-sectionally investigated in 122 (M/F; 59/63) insulin-dependent diabetic patients aged 6-60 years with > or = 1 year duration using a structured questionnaire interview followed by a free conversation. Haemoglobin A1c, blood glucose, and serum lipids were measured in the fasting state to assess the metabolic control. Only 12% of the patients had acceptable glycaemic control (HbA1c < 7.5%). Increased age, shorter diabetes duration, and higher body mass index were associated with better metabolic control. Omission or reduction of the insulin dose was experienced by 51% of the patients due to insulin shortage. The interview data consistently indicated that insulin non-availability had induced poor compliance to therapy regimens and lack of motivation for optimum glycaemic control. Due to limited resources, most of the patients received insufficient diabetes care and education, leading to lower rates of clinic attendance (55%), and dietary non-compliance (78.5%). Elevated haemoglobin A1c was associated with higher fasting blood glucose levels (P < 0.001), serum triglycerides (P < 0.05), and urinary glucose (P < 0.001). Measurable fasting C-peptide was observed in 52.5% of the patients and was related to the age at diagnosis, and body mass index (P < 0.001 for both). There is a considerable potential to improve diabetes care and education practice, and if accessibility to insulin is simultaneously facilitated, the glycaemic control in Sudanese diabetic patients will improve.
Adolescent↗
Pattern of long-term complications in Sudanese insulin-treated diabetic patients.
The prevalence of long-term micro- and macrovascular complications was studied in 128 (M/F; 62:66) Sudanese insulin-treated diabetic patients aged 15-75 years and with > or = 1 year duration. Patients were recruited from the out-patient clinics of the general hospitals in three States in Sudan. Haemoglobin A1c (HbA1c) was measured to assess the degree of metabolic control. The prevalence of microvascular complications was, retinopathy 43%, nephropathy 22% and neuropathy 37%. For macrovascular complications the prevalence was, cardiovascular disease 28%, peripheral vascular disease 10% and cerebrovascular accidents 5.5%. The overall prevalence of long-term complications was 67%. Patients with these complications were significantly older (P < 0.005), had longer disease duration (P < 0.001), and had higher serum cholesterol and triglyceride concentration (P < 0.001 and P < 0.05, respectively). The glycaemic control was adequate in only 12.5% of the patients, and was not related to the prevalence of complications. Sudanese diabetic patients are more prone to both microvascular and macrovascular complications than previously reported. More attention from the patients and clinicians is required and all efforts should be made to reduce the incidence of these complications.
Adolescent↗