The prevalence of diabetic nephropathy among the German Democratic Republic (GDR) population is substantial, as is true of many other countries. An epidemiologic survey performed in the county of Neubrandenburg revealed increased creatinine values in 44.9% of diabetics with diabetes duration greater than 15 years, and in 24.9% of those with the disease less than 15 years. Given these data, the prevalence of renal insufficiency due to diabetic nephropathy is estimated as 27/100,000 in diabetics with greater than 15 years, and 9/100,000 in diabetics with less than 15 years of diabetes, including only patients up to the age of 49 years; this must be substantially greater when considering all age groups. Only 13% of all patients on chronic hemodialysis are diabetics. Although we offer each of our nephropathic diabetics such kidney replacement therapies as dialysis and transplantation, a substantial number of diabetics are not treated, presumably due to advanced macrovascular complications.

Age Factors↗

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Causes of death in insulin-dependent diabetic patients treated with hemodialysis.

Causes of death were analyzed for 63 diabetic patients treated with hemodialysis. In all cases, autopsy-based death certificates were evaluated. The causes of death were compared during the periods 1969 through 1979 versus 1980 through 1987, and the causes of death in patients who died after less than 18 months versus those who died greater than 18 months after starting hemodialysis treatment. Our population of decreased diabetics had a mean age of 41.8 years, with a mean of 23.4 years of diabetes duration. The mean age at manifestation of diabetes was 18.2 years. Cardiac failure has been shown to be the most prevalent cause of death (55.6%), while sepsis accounted for 20.6% of the deaths. In both the period from 1969 through 1979 and that from 1980 through 1987, cardiac failure was identified as the commonest cause of death, with an equal proportion of septic causes (i.e., 20% versus 21.05%). When comparing causes of death among diabetics on hemodialysis for less than 18 months versus those receiving greater than 18 months of treatment, cardiac failure was responsible for 54% versus 61.5% of deaths. Septic causes were found to be more prevalent after a longer duration of treatment (i.e., 30.8%). Therefore, it is concluded that to prevent cardiac deaths, blood pressure control has to be as tight as possible in patients with diabetic kidney disease. To prevent late-occurring septic deaths, good nutritional status in patients undergoing hemodialysis seems to be of importance. The prevention of macroangiopathy in diabetes represents a major medical problem that needs to be solved.

Adult↗

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The progression of diabetic nephropathy in type I diabetics: relationship to metabolic control and blood pressure.

This study was designed to investigate the importance of risk factors such as hyperglycemia and elevated systolic and diastolic blood pressures on the progression of renal insufficiency in diabetics suffering from diabetic nephropathy. Seventeen patients with Type I, insulin-dependent diabetes mellitus (IDDM) (8 women and 9 men) undergoing chronic hemodialysis were investigated by retrospective follow-up and compared with 17 age and sex matched IDDM patients without diabetic nephropathy (controls). According to the time interval of creatinine increase from 200 to 600 mumol/l, the patients were divided arbitrarily into two groups with rapidly (group I less than 20 months) or slowly progressive (group II greater than or equal to 20 months) renal insufficiency. This period was 13.4 +/- 2.05 months in group I (age 36.67 +/- 2.47 years, diabetes duration 23.55 +/- 2.37 years) and 32.75 +/- 4.34 months in group II (age 40.62 +/- 2.63 years, diabetes duration 26.62 +/- 2.63 years, P.n.s.), respectively. The IDDM patients studied exhibited individually differing progressions of renal insufficiency at different times after manifestation of diabetes. After 15 years of diabetes duration, both risk factors, that is blood pressure and blood glucose concentrations, were elevated in nephropathic diabetics when compared with controls (p less than 0.01). During the phase of declining kidney function, mean blood pressures were found to be higher in IDDM patients with rapid progression of renal insufficiency when compared with slowly progressing diabetics. Although both risk factors were related to diabetic nephropathy, during the phase of renal insufficiency hypertension appeared to be more closely related to the further deterioration of kidney function.

Antihypertensive Agents↗

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Use of the artificial B-cell (Biostator) in improving insulin therapy in unstable insulin-dependent diabetes.

The present study was designed to improve the conventional subcutaneous insulin treatment of labile insulin-dependent diabetic patients by means of the artificial B-cell (Biostator) during a combination of conventional treatment and a glucose-controlled insulin infusion. Eleven patients with no residual B-cell function and poor metabolic control were studied. All patients were treated as effectively as possible by conventional methods using a combination of regular and intermediate insulin under clinical conditions. In order to determine the inadequacy of previous insulin treatment, all patients were connected to the Biostator, and the profile of daily physical activity was simulated using a bicycle ergometer. Metabolic control was compared during a 6-day period before and after a 30-50-h connection to the artificial B-cell. Using a preselected blood glucose level of 80 mg/dl (4.44 mmol/L), the additional insulin requirement amounted to 45.5 +/- 11.1 U/24 h (N = 6). The day after connection to the artificial B-cell, the patients received a new insulin regimen according to the additional insulin delivery determined by the Biostator. No better metabolic control was achieved and frequent hypoglycemic episodes occurred in this group. Another group (N = 5) was therefore studied at a preselected blood glucose level of 130 mg/dl (7.22 mmol/L). The mean additional insulin delivery by the Biostator was lower (17.2 +/- 2.1 U/24 h; P less than 0.05) and all patients were significantly better equilibrated after the new insulin regimen derived from data given by the Biostator. The ratio of short-acting to intermediate-acting insulin was 3:1; 40% of the total dosage was given in the morning. This study demonstrates that using the Biostator in addition to subcutaneous insulin allows determination of the amount of additional regular insulin that should be administered to improve glycemic control in labile diabetes.

Adult↗

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Treatment of acne vulgaris with salicylic acid pads.

Most cases of acne vulgaris are either mild or moderate in severity and well-suited for treatment with nonprescription agents that are safe, effective, and convenient to use. A review of four clinical studies and a comedolytic assay attests to the efficacy and safety of 0.5% and 2% solutions of salicylic acid for the treatment of acne vulgaris. In three placebo-controlled studies and a comedolytic assay, salicylic acid pads reduced the number of primary lesions and thereby the number and severity of all lesions associated with acne. Comparative studies of salicylic acid have shown it to be superior to benzoyl peroxide in reducing the total number of acne lesions. Adverse reactions to salicylic acid are generally limited to mild, local irritation occurring in a minority of patients.

Acne Vulgaris↗

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