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Biomedical subjects

G Panzram

Publications and source records attributed to G Panzram.

At least 19 recordsLinked to original sources
PubMed1988

[Development of angiopathies in type 2 diabetes mellitus--results of a prospective 10 year study].

In 150 newly detected type 2 diabetics the formation of macro- and microangiopathic complications during a 10-year control period was prospectively analysed, in order to demarcate possible factors of influence for the vascular prognosis under preventive points of view. Already at the time of manifestation there was with 34.3% an above average high prevalence of the coronary heart disease, particularly in the female sex. The prevalence of the coronary heart disease further increased to 49.7% in the course of diabetes and showed a correlation to the initial age, to the existence of overweight, hypertension, hyperlipoproteinaemia and nicotine consumption. The PMA was found comparatively more infrequent in the manifestation of diabetes (9.7%), but in the course of the disease highly significantly and independently of sex increased to 61.9%. The development of PMA was correlated with the age, the existence of hypertension and overweight. The frequency of retinopathy increased from initially 3.7% to 18.7%, the prevalence of nephropathy from 4.0% to 22.2%, without having found prognostic influence factors at the date of the diagnosis of diabetes.

Adult↗
PubMed1988

Lipoprotein pattern in long-term diabetes of an at least 35 years' duration. Results of the Erfurt Study.

All diabetic patients suffering from the disease for at least 20 years and living in the closed area of the Erfurt district in 1970 have been followed prospectively since that time. In 47 of them still alive in 1985, i.e. after more than 35 years of diabetes, serum lipid and apolipoprotein concentrations were measured and compared to those of non-diabetic subjects without cardiovascular diseases (n = 47) pair-matched by sex, age, and body weight. In males (n = 27) significantly (p less than 0.01) higher levels of HDL cholesterol and apolipoprotein A-I as well as lower concentrations of triglycerides and a lower total cholesterol/HDL cholesterol risk ratio than in nondiabetic control subjects could be found. In long-term diabetic females (n = 20), apolipoprotein A-I levels were also increased (p less than 0.02). Trends in HDL cholesterol and triglycerides were similar to those found in males but did not reach statistical significance. Higher concentrations of total cholesterol (p less than 0.02), LDL cholesterol (P less than 0.05), and apolipoprotein B (p less than 0.02), however, did not fit in with a beneficial lipoprotein pattern. The frequency of pathological lipoprotein patterns was not higher than among the non-diabetic control subjects (32% and 40%, respectively). According to these findings an antiatherogenic lipoprotein pattern might be considered, at least in males, as one of the determinants causing the multifactorial event of long-term survival in diabetes.

Cholesterol↗
PubMed1988

Serum lipids and apolipoproteins in relation to glycaemic control and diabetic nephropathy in long-term survivors of diabetes: results of the Erfurt Study.

Follow-up data of all 208 long-term diabetics (duration of the disease at least 20 years) living in the closed area of the Erfurt district in 1970 had demonstrated the importance of lipoprotein pattern for longevity. Now the dependence of lipoprotein levels on both the diabetes-related conditions nephropathy and glycaemic control has been examined in 47 of them, still alive in 1985 that means 35 or more years after the onset of diabetes. Glycaemic control was assessed by measuring the glycosylated haemoglobin (n = 44). Diabetic nephropathy was assumed in case of persistent proteinuria. Poor glycaemic control (n = 16) was associated with increased levels of atherogenic lipoproteins as reflected by higher concentrations of total cholesterol, LDL cholesterol, apolipoprotein B, and triglycerides, as well as a changed HDL composition indicated by a decreased HDL cholesterol/apolipoprotein A--I ratio. Higher ratios of total cholesterol to HDL cholesterol and apolipoprotein B to apolipoprotein A--I point to an increased risk of developing atherosclerotic diseases in poorly controlled diabetics. 86% of the well controlled long-term diabetics had non-pathological values of LDL cholesterol, triglycerides, apolipoprotein B, HDL cholesterol, and apolipoprotein A--I but only 31% of the poorly controlled patients did so. Diabetic nephropathy in the absence of chronic renal failure (n = 10) was characterized by higher values of LDL cholesterol, triglycerides, total cholesterol/HDL cholesterol, and apolipoprotein B/apolipoprotein A--I. 80% of the subjects with a pathological lipoprotein pattern were proteinuric or in poor glycaemic control or both. Therefore, it is concluded that prevention of these two conditions might help to delay atherosclerosis via its beneficial influence on lipoprotein metabolism.

Apolipoproteins↗
PubMed1987

[Prospective analysis of the natural course of non-insulin dependent diabetes mellitus in early adulthood].

Non-insulin-dependent diabetics with early manifestation of the disease (NIDDM) who were registered by an epidemiological cross-sectional study 1979 in the Erfurt district were pursued prospectively and 47 of the 58 patients underwent a re-examination five years later. The changes of therapy performed (7 new administrations of insulin, 9 change from diet to normal food) as well as the metabolic development of the patients under epidemiological aspect prove the heterogeneity of NIDDM and the doubtfulness of hitherto existing MODY-criteria. The oGTT performed in 37 patients 9 times resulted in a full remission and in 4 cases in an IGT. Including the 10 insulinized patients 34 diabetics (72.3%) had remained manifest. In contrast to the initially different degree of post-load hyperglycaemia in patients with and without remission the behaviour of the insulin secretion did not show any significant differences in the course and between the groups of patients. Young non-insulin-dependent diabetics are mainly among a representative target population type-II-diabetics with early onset. In contrast to this type-I-diabetics with a long insulin-free initial phase go into the background. In our population real MODY-cases are apparently extraordinarily rare.

Adolescent↗
PubMed1987

[Long-term effect of combination glibenclamide-insulin treatment in the secondary failure of sulfonylurea therapy--results of a one-year double blind study].

The long-term efficacy of combined insulin-glibenclamide treatment was investigated in 79 secondary drug failure patients by means of a double-blind, randomized placebo-controlled study. During a one-year follow-up period the patients on insulin plus glibenclamide required significantly lower exogenous insulin doses. Coincidentally, C-peptide concentrations were significantly raised in the verum versus the placebo group. Additionally, the administration of glibenclamide resulted in a decreased level of hyperglycaemia during the first six months of the observation period. Glibenclamide withdrawal after six and again after twelve months of the combined therapy provoked a deterioration of glycaemic control, as well as a lowering of the C-peptide concentrations. The findings demonstrate a prolonged beneficial effect of the combined treatment, in contrast to the solely short-term effects predicted by numerous studies. The metabolic improvement must be ascribed in part to the beta-cytotropic effect of glibenclamide. Extrapancreatic pathways via receptor/postreceptor mechanisms cannot be excluded.

Blood Glucose↗
PubMed1987

[Prospective follow-up studies in long-term diabetes. Results of the Erfurt study].

In 1970, in cooperation with the 14 district diabetic consultation centers of the Erfurt region (German Democratic Republic), all 208 known diabetics of the region with a known history of diabetes of at least 20 years (maximally 42 years) were registered and underwent multidisciplinary investigations. They were followed prospectively for at least 15 years. At the end of this period of observation, in 1985, 135 patients had died, 59 were still alive, the course of 14 is unknown. Of the 59 patients who were still alive in 1985, 49 (44 type I) were re-examined. There was a 2.1 times excess mortality rate compared with metabolically normal, interindividually paired (by age, sex and weight) controls. Cause of death in 89 patients (69.9%) was arteriosclerosis, predominantly of the coronaries, renal failure in only 9 (6.7%). Nearly all those patients who already in 1970 had evidence of advanced microangiopathies (proliferating retinopathy; persistent proteinuria) and/or macroangiopathy (authors' scoring system for coronary, cerebral and peripheral vascular disease) died during the observation period. Ophthalmoscopically normal or only mildly abnormal fundi revealed little tendency towards progression, despite the 35-55 years' duration of diabetes. Similar observations were made in the survivors as regards initially normal ECGs. The prognosis of long-term diabetes was decisively influenced by age and the severity of any arteriosclerotic disease, but not by the duration of diabetes.

Adult↗
PubMed1985

[Circadian behavior of hemostaseologic parameters in diabetic patients and metabolically healthy individuals].

In three groups of test persons [10 persons each with healthy metabolism under fasting (A) and intake of food (B); 10 insulin-dependent diabetics (C)] the determinations of the thromboplastin time, the partial thromboplastin time, the bleeding time, the spontaneous fibrinolytic activity, the number of thrombocytes and the aggregation of platelets were carried out on the day (A) and round the clock (B abd C), respectively. The values of the fasting persons with healthy metabolism distributed themselves on the day constantly in the area of width of errors. Under food intake persons with healthy metabolism showed circadian variations of the several tests. In diabetics the parameters of haemostasis revealed in the course of day a clear increase of the unstable behaviour compared with the control group B. There were no relations to the actual blood sugar value. In a tendency to more coagulation-active values in the late afternoon interindividually a general biorhythmical behaviour pattern could not be recognized. The proved increased circadian labilisation of the haemostasis potential in diabetics deserves more attention with regard to the connection between thrombophilia and atherogenesis.

Adolescent↗
PubMed1985

[Clinical and functional studies of diabetic cardiopathy].

In 30 diabetics and 30 patients with healthy metabolism who anamnestically, clinically and electrocardiographically did not show any references to a coronary heart disease the systolic time intervals and contractility indices of the carotid pulse curve were determined in lying position as well as under passive and active orthostasis load. Diabetics with a microangiopathy already under conditions of rest showed a tendency to pathological values. Unequivocal deviations were to be registered under conditions of the tilting table, particularly when the values obtained under orthostasis are related to the measuring data in rest. The restricted cardiac regulation breadth of diabetics with microangiopathy is particularly expressed in a compared with the control groups clearly reduced reaction of the presphygmic phase, the time of pressure increase as well as the quotients PEP/LVET, LVET/ICT and PEPstanding/PEPlying.

Adolescent↗
PubMed1985

Long-term diabetes--associated factors in survivorship and mortality.

Patients with long standing diabetes mellitus were analysed in order to identify associated factors in survivorship and mortality. Two population-based investigations were performed. In the Erfurt district all 20 years' survivors (208 patients, survival time up to 42 years) were studied longitudinally. Within the total diabetic population of the GDR all 40 years' survivors (159 patients, survival time up to 59 years) were investigated cross-sectionally in a multicentre study. During a 12-year follow-up a 2,6 fold excess mortality was registered. Although most patients in both studies were insulin-treated type-1 diabetics, death due to renal failure was observed only in 7%. In general the appearance of macroangiopathy was considerably postponed. Coronary heart disease represented the main cause of death (41.9%). Taking together both studies, to successfully overcome several decades of diabetes appears to be associated with age, age of onset, body weight, blood pressure, daily insulin dose, serum triglycerides, dietetic adherence and degree of compliance. In long-term diabetics, duration of illness exerts no prognostic influence. Some patients have survived for even half a century of diabetes despite additional atherogenic risk factors and bad compliance. Obviously, long-term diabetes is a multifactorial event including protective mechanisms yet unknown. Most long-term studies in diabetes so for have been based on case material from specialized centres (Oakley et al. 1974, Paz-Guevara et al. 1975, Dekkert et al. 1975) or have been performed without an epidemiologic background (Chazan et al. 1970, Ryan et al. 1970, Cochran et al. 1979). Due to unavoidable selection factors those studies do not provide representative samples of the diabetic population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Longitudinal studies on the prognostic significance of plasma fibrinogen in diabetes mellitus].

In 243 diabetics of different duration of the disease the prognostic value of an initial estimation of plasma fibrinogen for life expectancy and development of macroangiopathy was controlled over a period of ten years. Diabetics with a cardiovascular cause of death showed at the beginning with 3.68 in contrast to 3.24 g/l weakly significantly higher fibrinogen values than the surviving patients. In analogy to this in the surviving patients the diabetics with a meanwhile appearing myocardial infarction, chronic ischaemic heart disease or manifest disturbances of the peripheral blood supply differed by higher fibrinogen concentrations from test persons without manifest macroangiopathy. There was a close correlation between plasma fibrinogen level and development of hypertension. The increase of plasma fibrinogen is apparently associated with the atherogenesis without rendering a secure prognosis in the individual case on account of a critical limiting value.

Coronary Disease↗
PubMed1984

Epidemiologic data on excess mortality and life expectancy in insulin-dependent diabetes mellitus--critical review.

Generalizations of prognosis with regard to insulin-dependent diabetes (IDDM) in epidemiological statistics are impaired not only by great intraindividual variations, but also due to methodical difficulties. Due to recent prognostic studies IDDM, particular in young age, must be considered as a rather serious disease with a 5 to 10 fold higher excess mortality in comparison with the general population. There are only few exact data about the extent of life shortening. Age of onset represents the most significant factor in life shortening. The younger the patient is at the age of onset the shorter he lives. From about 70 years onward diabetes has little or no effect on longevity. Whether the prognosis of IDDM has improved within the last decades remains uncertain. Long-term studies clearly indicate that IDDM is compatible also with a long life in a good health. Why many diabetics develop life shortening complications and why some patients do not cannot be answered with conclusive evidence.

Adolescent↗
PubMed1984

[Spontaneous rhythms of the cardiovascular system in autonomic diabetic neuropathy].

There are distinct differences of the visually and computerized investigated immediate heart rate rhythms, mean arterial pressure and skin temperature rhythms between 30 diabetics suffering from peripheral neuropathy and 10 healthy volunteers. The characterized disturbance patterns within the higher and lower frequencies of these cardiovascular rhythms suggest pronounced, but not only circumscribed lesions of the vagal efferences.

Adult↗
PubMed1983

[Results of a population study of non-insulin dependent diabetes mellitus in childhood and adolescence].

Among 40 927 diabetics centrally registered in the Erfurt district, 61 non-insulin-dependent diabetics (0.15%) in early life have been recorded. The age of onset of 58 examined patients (36 males, 22 females) was 10 to 24 years. The insulin secretion after a 50 g oral glucose load varied markedly and corresponded to a control group of 62 adult NIDDM patients. 76.4% of the patients had a diabetic parent. In 17 patients (30%) diabetes had been transmitted through at least three generations. Sporadic occurrence was found in 19% of the case material. Families of MASON type with a marked diabetes accumulation were observed in only 3 cases. In the HLA system (A, B and C locus) there were characteristic differences from insulin-dependent diabetics but no significant (Pcorr) differences in comparison to the normal population. Variations of heredity, as well as differences in body weight, insulin secretion and varying susceptibility to vascular complication suggest that NIDDM in early life is a heterogeneous disorder. Besides the early age of onset, the balanced sex ratio and the partly marked inheritance, most patients of this population study present the typical features of type 2 diabetes.

Adolescent↗
PubMed1983

[Studies on the systemic features of autonomic diabetic neuropathy].

Thirty diabetics with peripheral neuropathy underwent complex assessment of autonomic nervous disorders of seven different organ systems. Functional analysis was done of the cardiovascular system (respiratory arrhythmia at rest and during regulated breathing, 3rd order waves of cardiac frequency and of arterial mean pressure, active and passive orthostasis), pupillary regulation (infra-red pupillography), peripheral vasomotor regulation (skin temperature) and sudomotorics (psychogalvanic skin reflex). Involvement of the genitourinary system, of stomach and intestine was evaluated by clinical criteria. Twelve diabetics showed signs of autonomic neuropathy in four to six, eight patients in three organ systems. The amplitudes of respiratory arrhythmia during regulated breathing, spectral analytic evaluation of cardiac frequency waves of 3rd order and cardiac frequency immediate reaction during orthostasis were particularly indicative. The demonstrated disturbance of conduction of centrally generated cardiac frequency waves of 3rd order and the diminished amplitudes of the spontaneous rhythms of acral skin temperatures complement the previously known symptomatology of autonomic diabetic neuropathy. The systemic character of autonomic diabetic neuropathy objectivated by the investigations indicates a metabolic pathogenesis.

Adult↗
PubMed1982

[Results of a multicentric study on long term diabetes in the East German population].

In the diabetes population of the GDR by means of the dispensary network of the consulting points 159 diabetics with a duration of the disease of at least 40 years were recognized and investigated on the basis of a standardized documentation material. 23 diabetics had survived their disease for longer than 50 years. The number of benign long-term courses in males was absolutely and relatively higher. The following frequencies of normal findings were stated: 55 per cent good general condition, 78 per cent normal weight/or underweight, 33 per cent no retinopathy, 65 per cent no proteinuria, 49 per cent normal ECG in rest. A proliferating retinopathy was found in 10 per cent, creatinine increases in 10 per cent, coronary infarctions in 32 per cent, gangrene and amputations, respectively, in 9 per cent. There was no striking longevity of the parents. In the majority of cases disciplined patients with a well-balanced metabolic condition were concerned. The partly existing atherogenic factors of risk (hypertension, smoking habits) speak for complex causes of the favourable course, including vasoprotective factors up to now not yet clarified.

Adult↗