Myocardial infarction in maturity-onset diabetics. A retrospective study.
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Biomedical subjects
Publications and source records attributed to J A Weaver.
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Vitamin-B(12) malabsorption has been found in 21 (30%) of 71 diabetic patients taking long-term metformin therapy in addition to dietary management. The patients with evidence of B(12) malabsorption had significantly lower haemoglobin levels (and significantly higher serum folic acid levels) than those with normal B(12) absorption. Steatorrhoea was found in only one patient. Stopping metformin therapy resulted in reversion of B(12) absorption to normal in most patients examined. Four patients with B(12) malabsorption were found to have pathologically low serum B(12) levels. The causes and implications of these findings are discussed and it is concluded that all patients on long-term metformin therapy should have annual serum B(12) estimations.
In hyperthyroidism suppression and non-suppression of early radioiodine neck uptake by exogenous thyroid hormone after a course of antithyroid drugs does not indicate clearly those patients who will eventually relapse or have a remission. Sixty-four hyperthyroid patients have been followed up for two years after an 18 to 24 months' course of carbimazole. Twenty-eight patients had suppressed at the end of the carbimazole course and 20 of these remained in remission for two years, and 36 were non-suppressed and 21 of these relapsed.Patients with the highest neck uptakes relapsed soonest after stopping treatment. Pronounced rebound occurred in neck uptakes at one month after stopping treatment, both in patients who relapsed and in those who remained in remission. By one year after stopping treatment those who remained in remission had shown a further fall in early neck uptake. In two patients who relapsed after exposure to stressful events no change in 20-minute radioiodine neck uptakes was found in relation to the supposed stress.
In an initial trial of glibenclamide in the treatment of maturity onset diabetes mellitus 28 patients were treated for up to one year and no toxic effects or side-effects were encountered. The hypoglycaemic potency of this drug is such that 5 mg. of glibenclamide corresponds to about 1,500 mg. of tolbutamide and 375 mg. of chlorpropamide.
A cardiovascular study of a group of 90 newly diagnosed diabetic women aged 35 to 75 years was begun in 1965 and a repeat examination was carried out on the same patients in 1968. A high prevalence of ischaemic heart disease was found in these patients at the time of diagnosis, and this finding had some predictive value as regards prognosis over the three-year period.A comparative study with general medical outpatients and long-established diabetics (greater than 10 years' duration of disease) confirmed the high prevalence of ischaemic heart disease in late-onset mild diabetics controlled by diet or oral drugs. It is suggested that this type of milder diabetic patient contributes in undue proportion to the high prevalence of ischaemic heart disease in diabetes.
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Ventilatory tests (F.E.V.(1)/F.V.C.) have been studied in 16 asthmatic subjects during intermittent administration of corticotrophin, and the responses correlated with the plasma cortisol levels. The improvement in respiratory function was found to last for a longer period than the enhanced adrenocortical activity.
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