A significant loss of bone has been observed in diabetes mellitus. The pathogenesis is unknown, but an impairment of vitamin D metabolism might be involved. Consequently, we have studied vitamin D metabolism in five groups of insulin-dependent diabetic patients. Significantly reduced levels of serum 25(OH)D were seen only in patients with diabetic nephropathy. The serum levels of 1,25 (OH)2D were reduced only in diabetic ketoacidosis but normalized during recovery. It is concluded that vitamin D metabolism is largely normal in adult insulin-dependent diabetes, and it seems unlikely that a disturbance of the vitamin D metabolism can explain the bone loss in the ordinarily controlled diabetics.

24,25-Dihydroxyvitamin D 3↗

PubMedDate not supplied

High blood pressure is a major factor in progression of diabetic nephropathy.

Arterial hypertension is a frequent finding, even early in the course of diabetic nephropathy. Systemic and glomerular hypertension enhance the development of diabetic glomerulopathy and accelerate the rate of decline in glomerular filtration rate in diabetic nephropathy. Conversely, effective antihypertensive treatment reduces albuminuria and diminishes the rate of decline in glomerular filtration rate, thereby postponing end-stage renal failure in diabetic nephropathy.

Albuminuria↗

PubMedDate not supplied

ACE inhibition in diabetic nephropathy.

Explore the source record for details and available documents.

Albuminuria↗

PubMedDate not supplied

Effects of ACE inhibitors on renal function in incipient and overt diabetic nephropathy.

A total of 3463 hypertensive patients with type II diabetes were treated with lisinopril for 3 months. Lisinopril was well tolerated, adverse effects were observed in only 2.2% of the patients. Blood pressure values were effectively reduced by lisinopril, two-thirds of the patients could be treated with lisinopril monotherapy. Parameters of metabolic control (HbA1c, lipids) showed an overall improvement under lisinopril therapy. Serum levels of creatinine did not change in patients who were with normal pretreatment values, but were normalized in approximately 50% of patients with elevated pretreatment values. It can be concluded that under routine medical care ACE inhibitor lisinopril is a well tolerated, effective drug for treatment of hypertensive type II diabetic patients.

Albuminuria↗

PubMedDate not supplied

Hypotensive therapy reduces microvascular albumin leakage in insulin-dependent diabetic patients with nephropathy.

The effect of hypotensive therapy on the transcapillary escape rate of albumin (TERalb) was studied in eight hypertensive insulin-dependent diabetic patients (mean age 29, range 19-42 years) with nephropathy and retinopathy. Transcapillary escape rate of albumin (initial disappearance of intravenously injected 125I-labelled human serum albumin), urinary albumin excretion rate (radial immunodiffusion), and glomerular filtrate rate (single bolus 51-Cr-EDTA technique) were measured. After hypotensive treatment (mean duration, 23 months, range 7-39 months) with combinations of metoprolol, hydralazine, and frusemide or thiazide diuretics, arterial blood pressure fell from 152/103 +/- 18/6 mmHg (mean +/- SD) to 133/81 +/- 12/10 mmHg (p less than 0.01), transcapillary escape rate of albumin from 10.2 +/- 1.8 to 8.1 +/- 1.8% of intravascular mass of albumin/h (p less than 0.01), albuminuria from 1803 (370-5066) micrograms/min to 940 (101-2676) micrograms/min (median and range, p less than 0.05), and glomerular filtration rate from 103 +/- 23 to 84 +/- 22 ml/min/1.73 m2 (p less than 0.01). Our study suggests that effective hypotensive treatment reduces the abnormally elevated albumin leakage characteristically found in insulin-dependent diabetic patients with clinical microangiopathy. This may be due to a reduction in the hydrostatic pressure in the microcirculation.

Adult↗

PubMedDate not supplied

Effect of strict metabolic control on regulation of subcutaneous blood flow in insulin-dependent diabetic patients.

The effect of 10 weeks of improved metabolic control on the impaired autoregulation of the subcutaneous blood flow was studied at the level of the lateral malleolus in eight long-term insulin-dependent diabetic patients with clinical microangiopathy. Blood flow was measured by the local 133-Xenon washout technique. Mean arterial blood pressure was reduced by a maximum of 23 mmHg by elevating the limb above heart level and elevated to a maximum of 65 mmHg by head-up tilt; in the latter position venous pressure was kept constantly low by activation of the leg muscle vein pump (heel raising). Improved metabolic control was achieved using either continuous subcutaneous insulin infusion or multiple insulin injections. The blood glucose concentration declined from (median) 12.7 to 6.8 mmol/l and the HbA1C level from 10.1 to 7.5% during strict metabolic control (p less than 0.01 and p less than 0.01, respectively). The slope of the subcutaneous blood flow autoregulation curves during poor metabolic control (median: 11.6% per 10 mmHg, range: 8.0-30.5% per 10 mmHg) was not significantly different from the slope values during improved metabolic control (13.4% per mmHg, 10.1-24.4% per mmHG). No association was demonstrated between the impaired autoregulation of subcutaneous blood flow and the metabolic parameters. Our results indicate that improved metabolic control for 10 weeks has no effect on the impaired autoregulation of subcutaneous blood flow in long-term insulin-dependent diabetic patients with clinical microangiopathy.

Adult↗

PubMedDate not supplied

Surface charge of red blood cells in insulin-dependent diabetic patients with incipient and overt nephropathy.

The negative surface charge of red blood cells was studied in adults with insulin-dependent diabetes mellitus, using a chemical assay based on the binding of the cationic dye Alcian-blue 8GX to anionic sites on the cell surface. Twenty-one healthy non-diabetic adults, 21 normo-albuminuric diabetic patients, 25 diabetic patients with incipient nephropathy, and 19 diabetic patients with overt nephropathy were studied. The diabetic patients were matched for age, duration of diabetes, and glycaemic control. The red cell surface charge was nearly identical in the four groups studied. Our study does not suggest that loss of membrane negative charge is a generalized phenomenon in insulin-dependent diabetic patients with albuminuria.

Adolescent↗

PubMedDate not supplied

Effects of short-term strict metabolic control on kidney function and extracellular fluid volume in incipient diabetic nephropathy.

The effects of strict metabolic control (multiple insulin injections for 1 week) on urinary albumin excretion, glomerular filtration rate and extracellular fluid volume was evaluated in long-term Type 1 diabetic patients with (n = 9) and without (n = 10) incipient nephropathy. Investigations were carried out in poor (blood glucose 15 (interquartile range, 13-18) mmol l-1) and good metabolic control (5 (4-8) mmol l-1). In patients with incipient nephropathy glomerular filtration rate was 125 (SD 26) (poor control) vs 125 (20) ml min-1 (good control), urinary albumin excretion 60 (range 37-247) vs 60 (13-359) mg 24 h-1, fractional albumin clearance 6.1 (0.9-67.6) vs 6.7 (2.1-65.4) x 10(-6), extracellular fluid volume 13.4 (2.3) vs 14.3 (2.8) l (p less than 0.10). Apart from an increase in extracellular fluid volume during improved metabolic control (12.2 (1.6) vs 13.6 (2.5) l, p less than 0.02) all the above mentioned variables remained unchanged in the patients with normal urinary albumin excretion. In conclusion, strict metabolic control for 2-7 days has no effect on urinary albumin excretion and glomerular filtration rate in long-term Type 1 diabetic patients with or without incipient diabetic nephropathy.

Adult↗

PubMedDate not supplied

Evidence for diabetic encephalopathy.

Auditory brain stem responses were recorded in 20 normoacoustic long-duration Type 1 diabetic patients (duration of diabetes 26 (range 13-46) years, age 44 (25-66) years) with peripheral neuropathy and retinopathy and in 19 sex-matched normoacoustic short-duration Type 1 diabetic patients (duration of diabetes 2 (0-6) years, age 23 (18-50) years) without clinical signs of neuropathy or microangiopathy. Abnormal brain stem auditory evoked responses were demonstrated in 40% of the long-duration and in 5.3% of the short-duration diabetic patients (p less than 0.01). Interpeak latencies Jv-JI and JIII-JI were significantly prolonged in both patient groups compared with the non-diabetic control group (p less than 0.01). Magnetic resonance imaging was performed in 16 of the long-duration patients and in 40 age-matched healthy volunteers on a whole body MR-scanner. Subcortical and/or brain stem lesions with abnormally high signals were seen in 69% of the long-duration Type 1 patients and in 12% of the healthy volunteers (p less than 0.02). Neuropsychological examination including 17 tests for intelligence and cognition were performed in the 20 long-duration Type 1 diabetic patients. The results indicated a performance close to that seen in a control group of healthy age-matched control subjects. Our study demonstrates that a considerable proportion of long-duration Type 1 diabetic patients suffering from retinopathy and peripheral neuropathy additionally have signs but no symptoms of central nervous system affection, diabetic encephalopathy.

Adult↗