Saccharin and its salts are the most extensively consumed artificial sweeteners in the United States today. The current controversy about the risks of their use to human health has surfaced from research findings that report an increased incidence of cancer, primarily of the urinary bladder, in certain animal species and man chronically exposed to these agents. The April 1977 proposal by the Food and Drug Administration to restrict use of saccharin was based on these investigations. The intense public response against any ban has led to Congressional deliberations over the fate of saccharin during the present moratorium and information-gathering period. Since diabetic patients are among the principal users of this compound, it appears timely to review the evidence for and against its carcinogenic potential.

Adolescent↗

PubMedDate not supplied

Rhabdomyolysis associated with hyperosmolar nonketotic coma.

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Creatine Kinase↗

PubMedDate not supplied

The course of peripheral vascular disease in non-insulin-dependent diabetes.

The present report is an analysis of the course of peripheral vascular disease (PVD) in 619 patients with non-insulin-dependent diabetes (NIDDM) recruited within 1 yr of diagnosis and followed quarterly for up to 14 yr (X = 10.5 yr). At 13 yr duration, the actuarially determined cumulative risks for intermittent claudication (IC), nonpalpable dorsalis pedis pulse (NPUL), and arterial calcification (CALC) were, respectively, 37.9%, 34.5%, and 60.9% for men and 24.3%, 37.6%, and 32.2% for women. Major amputations (AMP) occurred in only 1.3% of the patients, equivalent to approximately one case per 1000 patients per year. The corresponding incidences of IC, NPUL, and CALC were, respectively, 29, 27, and 47 per 1000 men and 19, 27, and 25 per 1000 women per year. CALC and NPUL were strongly related to mortality. Baseline risk factors with probability levels that suggest a relationship to PVD were, in women, age versus CALC (P less than 0.01), age versus NPUL (P less than 0.05), weight versus NPUL (P less than 0.05), systolic BP versus CALC (P less than 0.01), summed glucose tolerance test versus CALC (P less than 0.01), and triglyceride level versus CALC (P less than 0.05). In men, the only significant risk factors were diminished vibration perception, which was related to NPUL (P less than 0.05), and the serum triglyceride level, which was related to IC (P less than 0.05). In patients who are carefully followed prospectively, IC is far more common, but AMP is far less common than has been generally appreciated. Further studies are needed to clarify the roles of the diverse risk factors that are possibly related.

Amputation, Surgical↗

PubMedDate not supplied

Diabetic foot lesions: pathogenesis and management.

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Diabetes Complications↗

PubMedDate not supplied

Diabetic foot ulcers: pathogenesis and management.

Approximately 60,000 major lower extremity amputations annually are performed on diabetic patients in the United States. Diabetic foot ulcers are a major factor in 84% of these amputations. The ulcers develop as a result of minor trauma or callus breakdown in the insensate foot. Infection and vascular insufficiency lead to gangrene and amputation. Delay in treatment of these ulcers is a major factor leading to gangrene and amputation. The most important treatments of the ulcer are debridement to healthy bleeding tissue, proper culture and antibiotic therapy, identification of osteomyelitis, metabolic control, keeping weight off the foot, and (when indicated) peripheral arterial reconstruction to improve blood flow. Therapeutic shoes to prevent recurrence of the ulcer are extremely important in posttreatment of these ulcers. Because the management of ulcers is complicated, the team approach and consultation are frequently necessary. The most important step in prevention of foot ulcers in the diabetic is repeated patient education in foot care.

Diabetes Complications↗