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PubMedDate not supplied

Serum insulin levels in non-obese, non-diabetic Asian Indians with acute coronary and non-coronary events.

Significant insulin resistance and hyperinsulinemia has been observed to be associated with coronary heart disease in epidemiological studies, particularly so in Asian Indians. This study attempted to investigate if hyperinsulinemia accompanies acute cardiovascular events in Asian Indians, and that it is not a metabolic response to acute stress alone. To test this hypothesis, a case-control study was carried out in a tertiary referral hospital in northern India. Group I (n = 19), consisting of non-diabetic, non-hypertensive, non-obese patients presenting with first episode of acute coronary event (first episode of angina or myocardial infarction) were compared with non-diabetic, non-hypertensive, non-obese patients of group II (n = 21) presenting with non-cardiovascular emergencies (severe abdominal pain e.g. uncomplicated ureteric colic or non-specific intestinal colic. Blood was analysed for glycosylated haemoglobin, fructosamine and insulin levels within 24 hours of the acute event. Elevated serum fructosamine was observed in 11 (57.8%) subjects in group I and 9 (42.9%) in group II (p = NS). Glycosylated haemoglobin was 6.8 +/- 0.1 percent in group I versus 5.9 +/- 0.04 percent in group II (p < 0.01). Three out of 11 subjects in group I and 1/9 subjects in group II having elevated serum fructosamine level also had increased glycosylated haemoglobin level. Five (26.3%) subjects in group I and 2 (9.5%) in group II with elevated glycosylated haemoglobin level were excluded from the analysis as these patients might have been diabetic. Mean serum insulin values were significantly higher in group I (161.3 +/- 8.15 micro IU/mL and 17.5 +/- 1.9 micro IU/mL in groups I and II, respectively; p < 0.001). Eleven (57.8%) subjects in group I had insulin values above 100 uIU/ml. The present study indicates that significant hyperinsulinemia accompanies acute cardiovascular events and it is not an acute response to pain or stress hyperglycemia. Markedly high insulin levels observed in these patients may have a potential role in the pathophysiology of acute coronary event, and may be further studied as a possible prognostic marker.

Case-Control Studies↗
PubMed2000

The effects of inorganic chromium and brewer's yeast supplementation on glucose tolerance, serum lipids and drug dosage in individuals with type 2 diabetes.

OBJECTIVE: To study the effects of supplementation with organic and inorganic chromium on glucose tolerance, serum lipids, and drug dosage in type 2 diabetes patients, in the hope of finding a better and more economical method of control. METHODS: Seventy eight type 2 diabetes patients were divided randomly into two groups and given Brewer's yeast (23.3ug Cr/day), and CrCl3 (200ug Cr/day) sequentially with placebo in between, in a double blind cross-over design of four stages, each lasting 8 weeks. At the beginning and end of each stage, subjects were weighed, their dietary data and drug dosage recorded, and blood and urine samples were collected for analysis of glucose (fasting and 2 hour post 75g glucose load) fructosamine, triglycerides, total and HDL-cholesterol, and serum and urinary chromium. RESULTS: Both supplements caused a significant decrease in the means of glucose (fasting and 2 hour post glucose load), fructosamine and triglycerides. The means of HDL-cholesterol, and serum and urinary chromium were all increased. The mean drug dosage decreased slightly (and significantly in case of Glibenclamide) after both supplements and some patients no longer required insulin. No change was noted in dietary intakes or Body Mass Index. A higher percentage of subjects responded positively to Brewer's yeast chromium, which was retained more by the body, with effects on fructosamine, triglycerides, and HDL-cholesterol maintained in some subjects when placebo followed it, and mean urinary chromium remaining significantly higher than zero time mean. CONCLUSION: Chromium supplementation gives better control of glucose and lipid variables while decreasing drug dosage in type 2 diabetes patients. A larger scale study is needed to help decide on the convenient chemical form, and dosage required to achieve optimal response.

Adult↗
PubMedDate not supplied

Laboratory monitoring of gestational diabetes.

The consequences of uncontrolled gestational diabetes is severe to both maternal and fetal well-being. An ideal laboratory test to monitor gestational diabetes should accurately reflect short-term glucose changes. Glycated albumin, by virtue of its short half-life of 14 to 19 days, lends itself as a test to monitor and control gestational diabetes. Analytical approaches for the measurement of glycated albumin are reviewed, and the non-specificity of the simple colorimetric fructosamine assay is stressed. The performance characteristics of fructosamine assay, and the merits of the one hour oral glucose screening test and three-hour oral glucose tolerance test are discussed. An objective strategy for laboratory monitoring of gestational diabetes would include other assays such as fasting plasma glucose to correlate with glycated albumin (fructosamine) and even to complement the less sensitive glycated hemoglobin assay.

Diabetes, Gestational↗
PubMed1990

A study of the fasting diabetic patients during the month of Ramadan.

Twenty two Muslim diabetic patients on oral hypoglycaemic agents were studied during the fasting month of Ramadan to determine the effect of fasting on their diabetic control. All the patients completed their fast during the month. Their mean (+/- standard deviation) blood glucose, serum fructosamine and body weight before the fasting month were 10.7 +/- 4.6 mmol/l, 6.64 +/- 3.64 mmol/l and 60.5 +/- 12.6 kg and by the end of the fasting month were 10.9 +/- 4.4 mmol/1,4.34 +/- 1.08 mmol/l and 59.8 +/- 12.3 kg respectively. There was no significant difference between the blood glucose levels but there were significant reductions in the mean body weight and fructosamine values (p = 0.01 and p = 0.03 respectively). The mean decrease in body weight and fructosamine were 0.7 +/- 1.3 kg and 2.29 +/- 3.09 mmol/l respectively. There were also statistically significant differences between the mean daily calorie content before the fasting and during the fasting month (1480 +/- 326 vs 1193 +/- 378 Cal/day - p less than 0.005) and between the mean daily carbohydrate content (389 +/- 298 vs 187 +/- 46 gm/day - p less than 0.005). In conclusion, fasting was safe for diabetic patients on oral hypoglycaemic agents and it was associated with weight reduction and improvement in the overall diabetic control. This was most likely due to decrease in food intake.

Adult↗
PubMedDate not supplied

[Glycosylated proteins and various acute phase factors in patients with type II diabetes].

In the plasma of patients with type II diabetes a statistically significant increase was found of the concentration of glycosylated proteins, haptoglobin and sialic acid, in relation to controls. The concentration of glycosylated proteins was determined by the fructosamine method and by a method based on reaction with thiobarbituric acid. The "r" correlation coefficient between both methods in the diabetics was 0.58. No significant correlation was found between fructosamine concentration and the determined acute phase factors. The statistical analysis of the obtained results related to the coexistence of macroangiopathy or microangiopathy, diabetes duration or treatment method showed only a significantly higher fructosamine concentration expressed as mM of fructose in relation to one gram of albumin when the group of diabetics with vascular complications was compared with that without these complications.

Aged↗
PubMed1989

Protein glycation: measurement and clinical relevance.

This review of protein glycation deals with the biochemical background of glycated blood proteins, their methods of determination and their clinical significance. General reaction principles for determination of glycated proteins are discussed with special emphasis on the determination of glycated serum proteins in the clinical laboratory. Binding methods like boronate affinity, immunoassay, phenylhydrazine binding and ion exchange chromatography leave the analyte intact, whereas chemical methods like strong or mild hydrolysis or reduction in alkaline medium (fructosamine assay) results in destruction of the glycated protein. As most reactions are nonstoichiometric (except ion exchange chromatography and periodate oxidation), varying results are obtained from laboratory to laboratory. Up to now boronate affinity chromatography, mild hydrolysis yielding hydroxymethylfurfural and the fructosamine assay have been mostly used for determination of glycated serum proteins. The fructosamine assay appears to be most practical, because it is quick, economic and precise, but it suffers from unspecific side reactions. Although other methods like immunoassays or boronate ester formation in solution appear promising, there is currently no commercially available assay for the economic, precise and accurate determination of glycated serum protein. The clinical relevance of glycated serum protein determination is difficult to evaluate because the assays are based on different reaction principles and hence yield variable results. Nevertheless, the following conclusion may be drawn from the reports now available. i) The possibility that glycated serum proteins may discriminate better than glycated haemoglobin between "normal" and "diabetic" is still controversial. ii) Glycated serum proteins are formed faster than glycated haemoglobin, reflecting the changes in glycaemia for shorter periods of time (medium-term control). iii) It has not been yet established, using large cohorts, whether the glycated serum proteins allow the detection or exclusion of diabetes. iv) Determination of glycated serum proteins should not be considered as a substitute for the determination of glycated haemoglobin, but rather as a complementary determination, leading to the improved laboratory control of the diabetic patient.

Biomarkers↗
PubMed1994

[Lipoprotein (a) and other risk factors in Chilean children with type I diabetes mellitus].

AIMS: To study serum Lp(a) levels and other metabolic cardiovascular risk factors in children with type I diabetes mellitus (DM) in comparison with sex and age matched nondiabetic children. To determine the influence of diabetes control on serum lipoprotein (a) concentrations. DESIGN: Transversal observational study. TARGET POPULATION: diabetic group: 70 type I DM children without microalbuminuria and no macro-microvascular nor neurological complications, aged from 8 to 15 years; 30 boys, 40 girls. Mean duration of type I DM was 8 +/- 4 years. Non diabetic group: composed by 123 healthy children with no family history of DM, aged from 8 to 15 years, 53 boys, 70 girls. METHODS: The lipids profile include: total cholesterol (TC) and triglyceride (TG), cholesterol high-density lipoproteins (C-HDL) cholesterol very-low-density lipoproteins (C-LDL) and cholesterol low-density lipoproteins (C-LDL). ApoAI, APOAII and ApoB, Lp(a) and fructosamine. RESULTS: Fructosamine concentration in diabetic children was 340 +/- 108 uM/1 in 240 +/- 25 uM/l nondiabetic children. Lp(a) serum levels did not significantly differ among both groups 17 +/- 16 mg/dl in diabetics 19 +/- 18 mg/dl in controls. Multivariate analysis showed that in the diabetic children the worsening of metabolic control as reflected by fructosamine, was positively correlated with the increase in total Lp(a) serum concentration. CONCLUSIONS: In children aged 8-15 years with uncomplicated IDDM lasting less than 15 years duration, Lp(a) serum levels are positively correlated with the poorest metabolic control.

Adolescent↗
PubMed1994

[Selected parameters of blood coagulation and fibrinolysis and their relationship to the level of diabetes control in patients with insulin-dependent diabetes mellitus].

The aim of the study was to evaluate plasma concentration of fibrinogen, plasma activity of antithrombin III (AT-III) and plasma activity of plasminogen activator inhibitor (PAI-I) in insulin-dependent diabetic (IDDM) patients and the assessment of correlation between them and the parameters of glyco-metabolic control comprising glycemia and concentrations of fructosamine and glycated hemoglobin HbA1c. Eighteen IDDM patients (mean age 28.3 +/- 11.3 ys, mean duration of disease 12.2 +/- 5.3 ys) without over nephropathy and without macroangiopathy were investigated. Control group consisted of 8 healthy subjects. Plasma fibrinogen concentrations were similar in IDDM patients and in controls (3.54 +/- 0.45 g/l and 3.31 +/- 0.54 g/l respectively). Plasma activity of AT-III in diabetic patients (90.6 +/- 22.4%) was similar to that in healthy subjects (94.6 +/- 25.0%). Fibrinogen concentrations and AT-III activities showed no correlation with glycemia and concentrations of fructosamine and HbA1c. Plasma activity of PAI-I was significantly lower in diabetics than in controls (respectively 1.56 +/- 0.72 U/ml and 2.75 +/- 1.25 U/ml, p < 0.005). PAI-I activity correlated negatively with fasting blood glucose (p < 0.05) but did not correlate with concentrations of fructosamine or HbA1c. The results suggest that glycemic control in diabetic patients do not influence on concentrations of fibrinogen and activity of AT-III but diminished activity of PAI-I is related to hyperglycemia.

Adolescent↗
PubMed1997

[Glycemic thresholds in spontaneous abortion during the first trimester in pregnant women with insulin dependent diabetes].

BACKGROUND AND AIM: To evaluate the hypothesis that insulin-dependent diabetic (IDDM) pregnant women have a threshold of glycemic control during the first trimester of pregnancy for an increased risk of spontaneous abortion. MATERIALS AND METHODS: Seventy IDDM pregnant women were enrolled before the 9th week of gestation and monitored throughout pregnancy. Fifteen pregnancies (21.4%) led to spontaneous abortion within the first trimester (study group) and 55 (76%) continued until term (control group). In order to evaluate the differences between the study group and the control group variance analysis and Student's t-test were used for constant variables and chi 2 and Fisher's exact test for discrete variables; p < 0.05 was considered statistically significance. RESULTS: Mean levels of glycosylated hemoglobin (HbA1c) and fructosamine at the initial prenatal visit were significantly higher in the study group (p < 0.03) compared to the control group. The threshold for an increased risk of spontaneous abortion in the first trimester was found to be initial concentrations > 8% for HbA1c and > 300 mmol/l for fructosamine. CONCLUSIONS: Pregnant women suffering from IDDM with initial HbA1c levels higher than 8% and fructosamine > 3 mmol/l have an increased risk of spontaneous abortion in the first trimester of pregnancy. Below this threshold the risk of spontaneous abortion during the first trimester of pregnancy is similar to that for non-diabetic pregnant women.

Abortion, Spontaneous↗
PubMed1990

The influence of hyperglycemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke.

Fasting serum glucose, glycosylated hemoglobin, and fructosamine concentrations were determined in 304 consecutive subjects admitted with acute stroke, within 48 hours of ictus. Based on the medical history and these results, subjects were divided into known diabetics, newly diagnosed diabetics, subjects with stress hyperglycemia, and nondiabetics. The type of stroke was classified as lacunar infarct, cerebral infarct, or intracerebral hemorrhage, based on clinical examination by a neurologist and computed tomographic brain scan and/or autopsy. Immediate and 3-month outcomes were examined in relation to (1) fasting glucose, glycosylated hemoglobin, and fructosamine levels by stroke subtypes, and (2) glucose tolerance categories by stroke subtypes. A high fasting glucose level was associated with an increased mortality, but this was observed only among patients with intracerebral hemorrhage. Patients with stress hyperglycemia, but not diabetics, had increased mortality. In spite of having similar glucose concentrations to those patients with stress hyperglycemia, diabetics did not have a worse outcome compared with nondiabetics. It is concluded that the association between glucose concentration and outcome is a reflection of stress relating to stroke severity, rather than a direct harmful effect of glucose on damaged neurons.

Acute Disease↗
PubMedDate not supplied

The Continuous Glucose Monitoring System (CGMS) in type 1 diabetic children is the way to reduce hypoglycemic risk.

BACKGROUND: Diabetic children treated with intensive insulin therapy are showing a dangerous increase in severe hypoglycemic episodes. The Continuous Glucose Monitoring System (CGMS) allows glycemic profiles to be monitored over a 72-h period. The aim of the present study was to evaluate whether this system is sufficiently sensitive to detect asymptomatic hypoglycemia, and to determine if its periodic application would help to minimize the hypoglycemic risk in children with type 1 diabetes mellitus (T1DM). METHODS: Twenty-seven T1DM children (age range 6-13.1 years) were enrolled in the study. The sensor was inserted subcutaneously in each patient and the standard four or five registrations of capillary glycemia per day were performed. Eighteen patients continued in the study and the glucose sensor was again inserted after a 6-week interval. At the beginning and end of the study, fructosamine, glycosylated hemoglobin (HbA(1c)), median glycemia, number and duration of hypoglycemic events and insulin requirement were evaluated. RESULTS: A significantly higher number of asymptomatic hypoglycemic events was revealed by CGMS in comparison with the standard system (3.6 +/- 2.3 vs 0.7 +/- 0.9; p < 0.0001). In patients who continued in the study, insulin therapy adjustments reduced the incidence of hypoglycemic events (2.5 +/- 1.7 vs 3.9 +/- 2.2; p < 0.05). At the 6-week point, the fructosamine level was reduced (330 +/- 30 vs 349 +/- 24 micro mol/l; p < 0.05). CONCLUSIONS: The CGMS is a useful device not only for detecting unrecognized hypoglycemia, but also for modifying insulin therapy in order to reduce hypoglycemic events. The system appears to be useful in avoiding long exposure to hypoglycemia.

Adolescent↗
PubMedDate not supplied

Effects of glipizide GITS and glibenclamide on metabolic control, hepatic glucose production, and insulin secretion in patients with type 2 diabetes.

OBJECTIVE: Evaluation of effects of glipizide gastrointestinal therapeutic system (GITS) administered once daily (AM or PM) and glibenclamide on glycemic control, insulin secretory response, and hepatic glucose production (HGP) in patients with type 2 diabetes. METHODS: In a randomized, double-blind, and placebo-controlled study, subjects (HbA(1c) between 8.6 and 10.0%) received a titrated daily dose (5-20 mg) of either glipizide GITS AM (n = 11), glipizide GITS PM (n = 10), glibenclamide (n = 11), or placebo (n = 10) for eight weeks. Fasting and 24-h glucose and insulin, HGP, fructosamine, and HbA(1c) were measured at baseline and at study conclusion; glucose and insulin were also evaluated after Sustacal challenge. RESULTS: Fasting and 24-h glucose were significantly reduced by glipizide GITS AM (33%, p < 0.001; 39%, p < 0.0001), glipizide GITS PM (33%, p < 0.0001; 32%, p < 0.0001), and glibenclamide (37%, p < 0.05; 37%, p < 0.0001). Fasting insulin was not significantly increased by any treatment; 24-h insulin was not increased by glipizide GITS AM, but was elevated by glipizide GITS PM (39%, p < 0.05) and glibenclamide (23%, p < 0.05). Fructosamine and HbA(1c) were significantly reduced by glipizide GITS AM (28%, p < 0.001; 22%, p < 0.0001), glipizide GITS PM (25%, p < 0.005; 24%, p < 0.005), and glibenclamide (17%, p < 0.001; 14%, p < 0.05). Glipizide GITS AM and glibenclamide significantly reduced HGP by approximately 19% (p < 0.05) and 17% (p < 0.01) respectively. Glipizide GITS and glibenclamide significantly (p < 0.0001) decreased the glucose excursion after Sustacal challenge. The reductions in glucose excursions were accompanied by significant (p < 0.05) increases in the insulin response, suggesting an improvement in meal-related insulin secretion. CONCLUSIONS: Glipizide GITS and glibenclamide treatment are effective agents for improving fasting plasma glucose and HbA(1c). Each possessed a suppressive effect on basal HGP and improved postprandial glycemia, but only glipizide GITS AM was effective without causing a persistent elevation in insulin. This profile of glipizide GITS AM is therapeutically attractive, as it is consistent with the potential for a reduced risk of hypoglycemia.

Adult↗
PubMed2002

Effect of age receptor blocker and/or anti-inflammatory coadministration in relation to glycation, oxidative stress and cytokine production in stz diabetic rats.

Until now the relation between advanced glycation end products (AGEs) and vascular lesion is still controversial. However, the interaction of the former with a receptor triggers the synthesis of cytokines particularly interleukin 1- beta(IL-1 beta) and tumour necrosis factor- alpha(TNFalpha ). Subsequent release of nitric oxide (NO) may in turn induce certain damage to beta cell islets. Several arguments indicated that AGEs and reactive oxygen intermediates (ROIs) could alter the function of the vessel wall. Therefore, this study was undertaken to investigate the effectiveness of aminoguanidine, AG (inhibitor of AGE formation) joined with omega -3-fatty acids, omega 3FAs (anti-inflammatory immunosuppressive drug) in STZ diabetic rats. Diabetes was induced in 48 female albino Wistar rats by a single intraperitoneal (i.p.) injection of streptozotocin (STZ, 50 mg kg (-1)). Diabetic animals were treated with AG (50 mg kg(-1) ) and/or omega 3FAs (12 mg kg (-1)) daily and orally for 4 weeks. Groups of age matched diabetic rats ( n= 10) and healthy animals ( n= 10) served as positive and negative controls. At the end of the study, plasma glucose, fructosamine, total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), the susceptibility of LDL to copper-catalysed oxidation, catalase activity, NO, IL-1 beta, TNF alpha were measured. Histopathological assessment of pancreatic slices were also determined. Diabetes remarkably increased plasma glucose, fructosamine and dyslipidaemia (increased TC, LDLC and decreased HDLC). Oxidative markers like oxidative susceptibility of LDL, catalase activity and NO levels were greatly enhanced. Finally, it increased the synthesis and release of cytokine (IL-1beta and TNF alpha). Treatment of diabetic rats with AG and omega 3FAs markedly reduced the above mentioned parameters. Combined form therapy has a better effect regarding oxidative cell markers, specifically NO level. Finally, omega 3FAs coadministration with AG nearly restored the atrophy of islets of Langerhan's and the peripheral lymphocytic infiltration compared to diabetic and AG treated groups. In conclusion, there is a direct correlation between glycation, oxidative stress and cytokine production with increased propensity of microvascular disorder in STZ diabetic rats. omega 3FA administration with AGE receptor blocker may represent a possible avenue of research for therapeutics directed for alleviating the complication associated with diabetes.

Animals↗
PubMed1995

Effect of octreotide and insulin on manifest renal and glomerular hypertrophy and urinary albumin excretion in long-term experimental diabetes in rats.

Treatment of diabetic rats with octreotide can inhibit early diabetic renal hypertrophy. Octreotide administration for 6 months from the day of diabetes induction inhibits renal hypertrophy and diminishes increase in urinary albumin excretion. To investigate the effect of octreotide on manifest diabetic renal changes, octreotide treatment was given for 3 weeks after an untreated diabetic period of 3 or 6 months. In addition, following 6 months of diabetes, a group of diabetic rats was treated with insulin for 3 weeks. Renal and glomerular hypertrophy, and increased urinary albumin excretion were observed in diabetic rats compared to non-diabetic control rats from 3 months and throughout the study period. Octreotide treatment did not affect body weight, food intake, blood glucose or serum fructosamine levels. We observed no effect of octreotide treatment on renal and glomerular hypertrophy or urinary albumin excretion compared to placebo-treated diabetic rats. Insulin treatment for 3 weeks after 6 months of untreated diabetes normalized blood glucose and serum fructosamine levels, and furthermore renal hypertrophy was significantly diminished compared to the placebo-treated diabetic rats. However, insulin treatment had no effect on glomerular hypertrophy or urinary albumin excretion. In conclusion, octreotide treatment for 3 weeks following an untreated diabetic period of 3 or 6 months is unable to reduce the increased renal and glomerular volume or urinary albumin excretion. However, insulin treatment for 3 weeks with induction of euglycaemia diminishes the renal hypertrophy but has no effect on glomerular volume or urinary albumin excretion.

Albuminuria↗
PubMed1996

Marine lipids normalize cholesteryl ester transfer in IDDM.

Patients with insulin-dependent diabetes mellitus (IDDM) have a pathological increase in cholesteryl ester transfer (CET) that enriches the apolipoprotein B-containing lipoproteins with cholesteryl ester and increases their atherogenicity. Since we have shown earlier that omega-3 (n-3) fatty acids present in marine lipids normalize both CET and lipoprotein composition in non-diabetic patients with hypercholesterolaemia, we sought to determine whether the same beneficial effects could be achieved in nine normolipidaemic (triglycerides 1.10; cholesterol 4.94, high density lipoprotein 1.10 mmol/l) IDDM patients (fructosamine 424 +/- 156; normal 174-286 mumol/l) treated for 2 months with n-3 fatty acids (4.6 g/day). Before treatment, CET measured by both mass and isotopic assays was abnormally accelerated (p < 0.001). While marine lipids modestly decreased triglyceride levels (-14%; p < 0.05 ), CET fell dramatically in all subjects (mass assay: -97% at 1 h; isotopic assay: -58%; p < 0.001) to below control levels with no change in glycaemic control (fructosamine 408 +/- 103 mumol/l). The mass of cholesteryl ester transfer protein paradoxically increased significantly (pre-treatment: 2.04 +/- 0.86 vs post-treatment 2.48 +/- 0.97 micrograms/ml; p < 0.05). Since it is believed that accelerated CET promotes the formation of atherogenic cholesteryl ester-enriched apo B-containing lipoproteins, the capacity of marine lipids to reverse this functional abnormality without altering glycaemic control suggests that these agents may have an adjunctive role to play in the nutritional therapy of IDDM.

Adult↗
PubMed1993

Impact of injection sites for soluble insulin on glycaemic control in type 1 (insulin-dependent) diabetic patients treated with a multiple insulin injection regimen.

The absorption rate of rapid acting (soluble) insulin is slow from the subcutaneous tissue of the thigh compared to intramuscular injection into the thigh and s.c. injection into the abdominal wall. The aim of the study was to evaluate the impact of soluble insulin injected either intramuscularly into the thigh (IMT), s.c. into the abdominal wall (SCA) or s.c. into the thigh (SCT) on glycaemic control in Type 1 (insulin-dependent) diabetic outpatients treated with the basal bolus insulin delivery regimen. Fifty-five, C-peptide negative Type 1 diabetic outpatients were included in a randomised 3-month intervention study. The insulin doses were adjusted frequently by blinded observers based on the patients' self-monitored blood glucose values and reported hypoglycaemic episodes. The serum fructosamine value was within normal limits in three patients in the IMT group, in six patients in the SCA group and in none of the patients in the SCT group following the intervention period (p < 0.01). However, the difference in mean serum fructosamine values did not reach statistical significance (IMT: 1.24 mmol/l (95% confidence interval; 1.17 to 1.31), SCA: 1.25 mmol/l (1.18 to 1.32), SCT: 1.34 mmol/l (1.26 to 1.41), (p = 0.09). Blood glucose excursions were larger in the SCT group than in the SCA and IMT group from post-lunch to pre-dinner measurements and from pre- to post-dinner measurements. A higher number of measured low nocturnal blood glucose values (less than 4 mmol/l) was observed in the SCT group (34 of 85) than in the IMT (14 of 64) and SCA (21 of 81) group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed2002

Serial change in 123I-MIBG myocardial scintigraphy in non-insulin-dependent diabetes mellitus.

PURPOSE: We performed 123I-MIBG (MIBG) myocardial scintigraphy twice in patients with non-insulin-dependent diabetes mellitus (NIDDM) to investigate whether MIBG distribution was improved by pertinent clinical control. To determine the influential factors for MIBG distribution, we investigated the association between various clinical parameters and the serial change in MIBG uptake parameters. PATIENTS AND METHODS: Twenty NIDDM patients with no cardiac disorders were evaluated. Planar images were taken at 30 minutes (early) and 3 hours (delayed) after MIBG injection. The heart-to-upper-mediastinum uptake ratio (H/M) and washout ratio (WR) were calculated as parameters for estimating cardiac sympathetic function. Patients were divided into two groups, eight in the improved group and twelve in the unimproved group, according to the serial change in H/M. The mean interval between the baseline and the follow up study was 2.1 +/- 0.6 year. Differences between the means of the laboratory data in patients in both groups were compared for the baseline and the follow up study by using the paired t-test. As a means of determining the influential factors for a serial change of MIBG uptake, Fisher's exact test was performed to evaluate the association between the serial change in cardiac MIBG parameters and changes in other clinical parameters, such as blood sugar (BS) control, BS control method (insulin therapy), serum cholesterol control, and severity of diabetic complications. We also analyzed the association between the changes in CV(R-R) (coefficient variance of R-R intervals at rest ECG) or NCV (velocity of posterior tibial nerve) and those of other clinical parameters. Associations among these neurological parameters (MIBG parameters, CV(R-R) and NCV) were also analyzed. RESULTS: Paired t-tests showed a significant decrease in fasting blood sugar and fructosamine in the improved group in the follow up study compared to those in the baseline study. Nevertheless, Fisher's exact test showed no significant association between FBS, HbA1C, fructosamine and the improvement in cardiac MIBG uptake. The only significant association was observed between the serial change in H/M and the BS-control method (insulin therapy). Within the neurological parameters, a significant association was noted between the serial changes in H/M and CV(R-R). CONCLUSION: Although BS control was likely to be an important factor, it did not always ameliorate cardiac MIBG uptake. Based on the significant association between the BS-control method (insulin therapy) and MIBG uptake change, the severity of diabetes mellitus was likely to be a more influential factor. It was suggested that cardiac MIBG uptake could improve within the mild stage if controlled by diet therapy or an oral hypoglycemic agent in NIDDM.

3-Iodobenzylguanidine↗
PubMed2000

Onset and evolution of nephropathy in rats with spontaneous diabetes mellitus.

The occurrence of renal diabetic complications was studied in diabetic nonobese IIM/FmeSS (eSS) rats. The results were compared with eumetabolic Wistar rats paired by sex and age. Between 6 and 12 months of age, eSS male rats had higher fructosamine values and glucose intolerance as well as increasing proteinuria and uremia. Enhancement in water, calcium and phosphorus fractional excretion with a concomitant lower sodium excretion, was observed from 12 months of age on. 18- and 21-month-old eSS rats exhibited fasting hyperglycaemia and rising values of fructosamine, glucose intolerance and glycosuria. Simultaneously, a notorious worsening of proteinuria as well as alterations in glomerular filtration were verified. Optic microscopy of 12-month-old eSS rat kidneys showed areas of tubular dilatation with protein cylinders. In 21-month-old eSS animals, kidneys appeared overtly damaged. Increased capsular, glomerular and Henle's thin loop diameters were verified in 12- and 21-month-old eSS rats. Glomeruli showed diffuse hypertrophy of mesangial tissue and thickening of the basement membrane. Areas of markedly atrophic and dilated tubules containing acidophilic proteinaceous material were observed. At age of 21 months, kidneys of eumetabolic Wistar control rats presented foci of interstitial and pielic inflammatory infiltrates.

Animals↗