The aim of this work was to observe whether different types of carbohydrates might require different insulin doses. Five type 1 CSII-treated diabetic subjects (age 39 +/- 4 years), C-peptide negative and in optimal metabolic control (HbA1c 7.5 +/- 0.2) were selected for the study. They were connected to the Biostator 6 times with an interval of 4-10 days between sessions and fed a meal containing 75 g of carbohydrates of different types: bread, pasta, potatoes, apples, oranges and sucrose. The following net (above basal) insulin requirement for the 30 meals were found (IU - mean + SD): bread 9.15 +/- 1.97; pasta 6.00 +/- 1.37; potatoes 7.05 +/- 2.58; apples 4.54 +/- 1.42; oranges 6.21 +/- 2.62; sucrose 7.83 +/- 2.33. A statistically significant difference was found by ANOVA among insulin requirements for foods (p less than 0.05). Single comparisons between bread and the other foods showed a statistically significant difference only between bread and apple (p less than 0.05). Mean coefficient of variation was 33.9% for the subjects and 30.7% for the meals. A significant correlation was found between Jenkins' glycaemic index and insulin requirement (r = 0.897; p less than 0.001). In conclusion, the high intraindividual variability of insulin requirement does not advice the use of the glycaemic index during optimized insulin therapy.

Adult↗

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Risk factors for lower limb complications in diabetic patients. The Italian Study Group for the Implementation of the St. Vincent Declaration.

Diabetic lower extremity complications may be influenced by a number of factors, including those related to the interaction between patients and the health-care system. Our objective is to identify risk factors for the development of lower limb complications, by looking for classical clinical variables and those related to quality of care. A case-control study was carried out between December 1993 and June 1994 by interviewing 348 patients with lower-limb diabetic complications and 1050 controls enrolled from 35 diabetes outpatient clinics and 49 general practitioner's offices in Italy. Among sociodemographic characteristics associated with increased risk of lower limb complications were male gender [odds ratio (OR) = 2.5, confidence interval (CI) 1.6-3.9], age between 50 and 70 years as opposed to younger than 50 (OR = 3.6, CI 2.1-6.3) and being single as opposed to married (OR = 1.4, CI 1.1-1.8). Among clinical variables, treatment with insulin for IDDM and NIDDM patients was an important predictor of lower extremity complications compared to NIDDM patients not being treated with insulin. Cardio-cerebrovascular disease and presence of diabetic neuropathy were associated with a higher risk of being a case (OR = 1.4, CI 1.2-1.8 and OR = 3.0, CI 2.1-4.2, respectively). Patients who needed help to reach the health facility before the onset of the complications and those who did not attend health facilities regularly were more liable to develop complications (OR = 1.5, CI 1.1-2.2 and OR = 2.0, CI 1.3-3.0, respectively). Patients who had never received educational intervention had a threefold risk of being a case as compared to those who received health information regularly. The study identifies factors most likely to be related to adverse outcome and permits to discriminate between avoidable and unavoidable factors.

Adult↗

PubMedDate not supplied

Hyperinsulinaemia in hypertension and diabetes mellitus: a chronobiological approach.

Blood pressure was continuously recorded for 24 h in 31 non-insulin-dependent diabetic men with borderline, mild, or moderate systolic and/or diastolic hypertension. A 2-h oral glucose tolerance test was also performed with blood glucose, serum insulin and C-peptide determination at 30-min intervals. Significant correlations were found between fasting and post-glucose integrated area of blood glucose, insulin and C-peptide concentrations versus blood pressure measures. Total insulin area appeared to correlate significantly with diastolic measures [casual, daytime, night-time, mean computational (mesor), hyperbaric impact and percent time elevation], mean blood pressure, and mesor and hyperbaric impact systolic measures. It is concluded that the more accurate assessment of the circadian pattern of blood pressure by a chronobiological procedure allowed the existence of close correlations between metabolic and blood pressure measures to be established, confirming the importance of hyperinsulinaemia in the pathophysiology of arterial hypertension.

Blood Glucose↗

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Community acquired pneumonia in internal medicine: a one-year retrospective study based on pneumonia severity index.

Community acquired pneumonia (CAP) represents the sixth cause of death and the first cause of death for an infectious disease in the USA. The aim of the present study is to evaluate how CAP is managed in a hospital setting, with particular attention to the wards of internal medicine, compared to the recommendations based and validated PSI (Pneumonia Severity Index). 42 subjects were included in the study, 25 males and 17 females. According to the PSI, nine (21%) patients were classified in class I, two (5%) in class II, ten (24%) in class III, fifteen (36%) in class IV and six (14%) in class V. Three patients died during the stay in the hospital (2 males and 1 female), all in the highest PSI class (V). According to the criteria used to evaluate the adequacy of the admission to the hospital, twentyeight patients were classified in the HRG, with an appropriate admission, whilst fourteen (33%) were in the LRG, with an inappropriate admission to the hospital. The data of the study confirm the validity of a PSI based strategy for the management of CAP since admittance to the hospital. This approach is not yet widely implemented in Italy, and a better dialogue between hospital and health system representatives would be convenient, to reduce costs and ensure the safety of patients affected by CAP.

Adult↗

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Circadian rhythm of albumin excretion rate in healthy subjects.

Many studies have reported the predictive role of unphysiological levels of microalbuminuria for the development of diabetic nephropathy. It is known that physiological levels of 24-h microalbuminuria do not exceed 20 micrograms/min (28.8 mg/day), but a few data are available for shorter periods. Since an accurate 24-h urine collection is difficult to obtain in screening programs, it seems important to study whether a circadian oscillation exists and, if so, to find more precise reference values. Eleven healthy subjects (mean age 30.6 +/- 2.46 years) with normal glucose tolerance and no family history of diabetes mellitus or nephropathy were studied during the usual routine activity. Urines were collected 6 times at 4-h intervals. It was possible to document the existence of a statistically significant circadian rhythm with the following parameters: MESOR 6.95 +/- 0.49 micrograms/min; amplitude 1.96 +/- 0.37 micrograms/min; acrophase 15(06); 95% CL 13(01)-17(45). These data show that reference values are higher during daytime as compared with nighttime and suggest that the time of urine collection must be taken into consideration in order to define the upper physiological limits more precisely.

Adult↗

PubMedDate not supplied