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Biomedical subjects

P Passa

Publications and source records attributed to P Passa.

At least 109 records · Page 6Linked to original sources
PubMed1989

Treatment of hypertension in diabetic patients.

There is increasing evidence that a slight elevation of blood pressure values may have a deleterious effect on diabetic angiopathy. Hypertensive diabetic patients are prone to suffer clinical and/or biological side effects of antihypertensive agents. More recently calcium antagonists and angiotensin converting enzyme inhibitors have proved effective and better tolerated in hypertensive diabetic patients. New data from the literature and from our group are reviewed. In patients with incipient or clinical nephropathy, angiotensin converting enzyme inhibition reduces urinary albumin excretion and preserves glomerular filtration rate. The effects of treatment of hypertension on blood pressure control obtained in small groups of selected and motivated patients are at variance from those obtained in routine practice. Poor compliance is the major problem in hypertensive diabetic patients. The rationale exists to provide early aggressive antihypertensive treatment in this population but we must develop new drugs that are more effective and better tolerated. We have also to improve health care delivery, information and education for these patients.

Antihypertensive Agents↗
PubMed1988

[Absence of effect of enalapril on the glycemic control and peripheral sensitivity to insulin in 10 diabetic patients treated with subcutaneous continuous infusion of insulin].

In diabetic patients, it has been suggested that angiotensin converting enzyme inhibitors may be associated with unexplained hypoglycaemic episodes. Such a side effect may limit the use of these drugs in diabetic hypertensive patients. Ten insulin-dependent diabetic patients mean age 38.4 +/- 13.1 years, mean diabetes duration 10.3 +/- 6.6 years (m +/- SD) were selected on the basis of good glycaemic control: HbA1: 7.6 +/- 0.9 per cent (upper limit of normal value less than 7.5 per cent) on continuous subcutaneous insulin infusion. In a double blind study, they were randomly and successively allocated for a 3 months period to enalapril 20 mg daily or placebo. Before treatment, after enalapril and placebo, mean blood glucose values, HbA1, daily insulin dosage were recorded as well as the number of clinical and biological (less than 3 mmol/l) hypoglycaemic episodes. Peripheral insulin sensitivity was assessed by euglycaemic insulin clamp technique. Compared to placebo, enalapril did not induce any modification of daily insulin dosage, glycaemic control. The incidence of hypoglycaemic episodes was similar. Neither peripheral insulin sensitivity was modified by enalapril. In the conditions of this study, enalapril did not interfere with glycaemic control in insulin-dependent diabetics in good metabolic control.

Administration, Cutaneous↗
PubMed1988

Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria.

STUDY OBJECTIVE: To assess the effectiveness of inhibition of angiotensin converting enzyme in preventing diabetic nephropathy. DESIGN: Randomised follow up study of normotensive diabetics with persistent microalbuminuria (30-300 mg/24 hours) treated with enalapril or its matched placebo for one year. Double blind for first six months, single blind for last six months. SETTING: Diabetic clinic in tertiary referral centre. PATIENTS: Treatment group and placebo group each comprised 10 normotensive diabetics with persistent microalbuminuria. INTERVENTIONS: Treatment group was given enalapril 20 mg daily and controls matched placebo. Patients were given antihypertensive treatment after one year. END POINT: Albumin excretion, arterial pressure, and renal function. MAIN RESULTS: In last three months of trial three of 10 patients taking placebo had diabetic nephropathy (albumin excretion greater than 300 mg/24 hours). No patients taking enalapril developed nephropathy and five showed normal albumin excretion (less than 30 mg/24 hours) (p = 0.005, Mann-Whitney test). Mean arterial pressure was reduced by enalapril throughout study (p less than 0.005) but increased linearly with placebo (p less than 0.05). Albumin excretion decreased linearly with enalapril but not placebo. An increase in albumin excretion with placebo was positively related to the increase in mean arterial pressure (r = 0.709, p less than 0.05, Spearman's rank test). With enalapril total renal resistances and fractional albumin clearances improved progressively (time effect, p = 0.0001). CONCLUSION: Inhibition of angiotensin converting enzyme prevents development of nephropathy in normotensive diabetics with persistent microalbuminuria. This may be due to reduction in intraglomerular pressure and to prevention of increased systemic blood pressure. Future studies should compare long term effects of inhibitors of converting enzyme with other antihypertensive drugs.

Adult↗
PubMed1987

[Relations between arterial hypertension and diabetic nephropathy].

In insulin-dependent diabetics the course of the renal disease can be followed by measuring arterial blood pressure and urinary albumin excretion. Already at the stage of incipient nephropathy (microalbuminuria) a moderate but gradually increasing rise in blood pressure is noticeable. At the stage of patent nephropathy (macroalbuminuria) nothing but an effective antihypertensive treatment can slow down the deterioration of renal function and delay by a few years the occurrence of end-stage renal failure. When macroproteinuria or obvious arterial hypertension are present, it is much too late to institute an antihypertensive treatment. To really prevent diabetic nephropathy, this treatment must be given earlier, as soon as microalbuminuria is detected and irrespective of blood pressure values. Prescribing antihypertensive drugs, and especially angiotensin-converting enzyme inhibitors, seems to be the most effective way of reducing urinary albumin excretion. 6

Diabetes Mellitus, Type 1↗
PubMed1987

Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria.

The effects of a long term reduction in blood pressure on the kidney function of normotensive diabetic patients who had persistent microalbuminuria (30-300 mg albumin/24 hours) were studied in two groups of 10 such patients before and during six months of treatment with either 20 mg enalapril or placebo daily. Treatments were assigned randomly in a double blind fashion. Before treatment both groups had similar clinical characteristics, weight, diet, total glycosylated haemoglobin, median albumin excretion rate (enalapril group 124 mg/24 h, placebo group 81 mg/24 h), and mean arterial pressure (enalapril group 100 (SD 8) mm Hg, placebo group 99 (6) mm Hg). During treatment weight, urinary urea excretion, and total glycosylated haemoglobin remained unchanged. The mean arterial pressure decreased in the enalapril group but not in the placebo group (enalapril group 90 (10) mm Hg, placebo group 98 (8) mm Hg). The median albumin excretion rate also fell in the enalapril group but not in the placebo group (enalapril group 37 mg/24 h, placebo group 183 mg/24 h.) The glomerular filtration rate rose in the enalapril group from 130 (23) ml/min/1.73 m2 to 141 (24) ml/min/1.73 m2, and total renal resistances and fractional albumin clearance decreased while fractional albumin clearance increased in the placebo group. These results show that in patients who have diabetes but not hypertension a reduction in blood pressure by inhibition of converting enzyme for six months can reduce persistent microalbuminuria, perhaps by decreasing the intraglomerular pressure.

Adult↗
PubMed1987

Increased adhesion to fibronectin and Mo-1 expression by diabetic monocytes.

As excessive monocyte adhesion to blood vessel wall could produce endothelial cell injury, we undertook comparative studies on the monocyte adhesiveness in insulin-dependent diabetics with vascular complications (n = 26) and healthy, normal subjects (n = 36). In the diabetic group, the extent of monocyte adhesion on fibronectin- and autologous plasma-coated surfaces was significantly increased compared with that in the control group (p less than 0.01 on both types of surfaces). Monocytes adhesion to the plasma-coated surface, but not to the fibronectin-coated surface, could be inhibited by monoclonal anti-Mo-1 antibody in a dose-dependent manner. For diabetic monocyte adhesion, a higher amount of anti-Mo-1 antibody was required to produce a similar extent of inhibition as observed with control monocytes. This indication of increased Mo-1 expression on diabetic monocytes was further confirmed by analyzing the fluorescence intensity of monocytes labeled with the antibody anti-Mo-1. The results of the present study suggest that diabetic monocytes have increased adhesiveness as the result of increased expression of fibronectin and Mo-1 receptors.

Antibodies, Monoclonal↗
PubMed1987

Pancreatic polypeptide secretion in diabetic patients with idiopathic haemochromatosis.

In order to investigate the endocrine pancreatic dysfunction resulting from iron overload, plasma pancreatic polypeptide (PP) response to a protein-rich meal was studied in 10 healthy controls and 30 insulin-dependent (type I) diabetic patients: ten with idiopathic haemochromatosis (IH), ten with chronic pancreatitis and ten with idiopathic type I diabetes. While fasting plasma PP levels were slightly higher in diabetic with IH (40,8 +/- 7 pmol/l) than those in controls (27,1 +/- 3) on in type I diabetics (31,3 +/- 3) they were similar after the meal (peak level 95 +/- 18, 139 +/- 23, 100 +/- 36 respectively). In contrast the mean PP level was low in diabetics with chronic pancreatitis in the fasting state (15.9 +/- 3.6 pmol/l) and did not rise following the meal. These findings suggest that there is no PP cell injury in diabetics with IH.

Adult↗
PubMed1987

[A computerized file for the surveillance of diabetic patients: the MELLITEE system].

Taking over a chronic disease like diabetes in a hospital clinic raises multiple problems. Large numbers of diabetic patients and prolonged follow-up periods result in a mass of data that only computers can control. MELLITEE is a computerized system developed to facilitate the longterm management of patients and to help in maintaining a high standard of care. It includes a structured and standardized medical record. Physicians of three Parisian hospital clinics agreed on the minimum content of the record. MELLITEE is operated at the Saint-Louis Hospital on a 68,000 based mini-micro computer (Fortune/Thomson Micromega-32), running under the Unix operating system and with the Lied data base management system. Data are keyed directly into the computer by physicians, nurses and dietitians from throughout the department. On-line registration of information allows the suppression of the corresponding part of the usual paper record. The clinical data base obtained from administrative and medical information can be used to facilitate more effective patient follow-up and clinic management. The system is to be set up in the other collaborating centres in the near future, allowing pooling of data. It will also provide long-term information which can be used for evaluation of care and epidemiological research.

Diabetes Mellitus↗
PubMed1987

Laser immunonephelometry for routine quantification of urinary albumin excretion.

We describe a laser-immunonephelometric method for quantifying urinary albumin excretion (UAE) in large numbers of samples. For a 150-microL sample incubated at room temperature for 45 min with 40 microL of antiserum specific for human serum albumin, the assay range for albumin was 0.34 to 43.0 mg/L. For samples analyzed undiluted and diluted 10-fold, the range of measurable albumin was from 0.34 to 430.0 mg/L. With an automated version of this method, one can assay 240 samples per hour. Intra- and interassay CVs were less than 6% and 9%, respectively. Measurements by this method (y) correlated well with those obtained by a RIA method (x): y = 1.00x + 0.163 mg/L (n = 233; r = 0.996). The day-to-day CV for UAE was determined for three consecutive determinations done on each of 60 controls according to the time of collection and in 212 diabetics according to the amount of 24-h UAE. For controls, UAE was 8.0 +/- 8.1 mg/24 h (mean +/- SD), CV 44 +/- 23%. The CV was similar for diurnal (50 +/- 28%) and overnight (58 +/- 32%) collections from controls; and for diabetics with normal values for UAE: 35 +/- 32%, with slight albuminuria (25-300 mg/24 h):37 +/- 28%, or with macroalbuminuria (greater than 300 mg/24 h): 47 +/- 42%.

Adult↗
PubMed1986

[Lack of benefit of blood glucose autosurveillance in insulin-treated diabetics routinely followed up in a department specializing in diabetology].

Home blood glucose monitoring (HBGM) may be useful to achieve better metabolic control in type I diabetes. The aim of this study was to evaluate longterm results in a large population. A questionnaire was given to 282 routinely insulin-treated diabetics regularly attending our clinic. Home blood glucose testing was performed by 64.5% of the patients. Seventy nine percent of them continued to test urines. Mean HbA1 at the time of the visit was not statistically different in patients performing home blood glucose testing only (9.3 +/- 2.1%), in patients monitoring both blood and urines (9.2 +/- 2%), or urines only (9.3 +/- 1.7%) and in patients who did not practice self-monitoring (9.5 +/- 1.8%). The influence of HBGM on metabolic control as currently performed by diabetic patients in everyday life may be overemphasized. These disappointing results are mainly due to the fact that patients carry out passive home glucose testing and not home blood glucose monitoring which implies day-to-day adaptation of insulin dosage. Such an attitude seems to be due to incorrect selection of the patients, insufficient education and care and, for some patients, poor compliance with medical advice.

Blood Glucose↗
PubMed1986

[Relation between urinary albumin excretion and retinopathy in insulin-dependent diabetics].

To study the relationship between retinal and renal microangiopathy, the albumin excretion rate (AER) was measured by radioimmunoassay in 111 insulin-dependent diabetics and compared to their stages of retinopathy, as assessed by ophthalmoscopic examination and fluorescein angiography. The prevalence of pathological AER differed from that of diabetic retinopathy. The stage of retinopathy was related to the duration of diabetes (r = 0.59; P = 0.001), which was not the case for AER (r = 0.06; ns). Half of patients with proliferative retinopathy (11/22) had a normal AER, while 12% of those without retinopathy had a pathological AER (microalbuminuria). No relationship was found between glycaemic control and AER. The highest prevalence of hypertension was found in patients with macroalbuminuria (greater than 500 mg/24 h) and/or severe retinopathy. The mean AER was higher in hypertensive diabetics than in non-hypertensive diabetics (P less than 0.005). These results suggest that the risk of retinopathy is dissociated from the risk of glomerulopathy in diabetics, and that hypertension associates with diabetes mellitus in a greater risk of pathological AER.

Adolescent↗