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PubMed2002

Assessing diabetic control--reliability of methods available in resource poor settings.

AIMS AND METHODS: To examine the reliability of random venous or capillary blood glucose testing, random urine glucose testing, and a current symptom history in predicting a high HbA1c in Type 2 diabetic patients taking oral hypoglycaemic agents in a poorly controlled rural African population. RESULTS: For a cut-off point for HbA1c of > or = 8%, for random venous plasma glucose of > or = 14 mmol/L (present in 47.2% of subjects), specificity was 97.1% (95% CI 85.1-99.9), sensitivity 56.8% (48.8-64.5) and positive predictive value (PPV) 98.9% (94.2-99.9). HbA1c > or = 8% is predicted by a random capillary blood glucose of 17 mmol/L (present in 28.4% of subjects) with specificity 100% (90.0-100.0), PPV 100% (93.7-100.0) and sensitivity of 34.3% (27.2-42.1). HbA1c > or = 8% is predicted by the presence of heavy glycosuria (> or = 55 mmol/L) (present in 35.6%) with specificity 94.1% (80.3-99.3), sensitivity of 41.9% (34.1-49.9) and PPV 97.1% (89.9-99.6). Polyuria/nocturia (present in 31.3%) was the only symptom found to be associated with poor control, with a specificity for predicting HbA1c of > or = 8% of 81.5% (61.9-93.7), PPV 89.1% (76.4-96.4) and sensitivity 30.6% (22.9-39.1). CONCLUSIONS: Where resources are short, random glucose testing can be used to detect a significant proportion of those with the worst control with a high degree of specificity enabling primary care staff to modify treatment safely. Where facilities are limited capillary blood or urine testing with reagent strips, may be substituted for venous plasma testing in the laboratory. A symptom history was insufficient to replace biochemical testing, but where this is unavailable, urinary symptoms may be helpful.

Black People↗

PubMed1991

Hypoglycemic effects of sesquiterpene glycosides and polyhydroxylated triterpenoids of Eriobotrya japonica.

The effects of the constituent sesquiterpene glycosides 1-3 and polyhydroxylated triterpenoids 5-6 isolated by MeOH extraction of Eriobotrya japonica were studied in genetically diabetic mice (C57BL/KS-db/db/Ola) and normoglycemic rats. The sesquiterpene glycoside 3 and the polyhydroxylated triterpenoids 5 and 6 produced a marked inhibition of glycosuria. Furthermore, 5 and 6 were able to reduce blood glucose levels in normoglycemic rats. While there are already some data reported on hypoglycemic activity of polyhydroxylated triterpenoids, there are no previous data showing hypoglycemic activity of sesquiterpene glycosides.

Animals↗

PubMed1992

Immunotherapy with ciamexon in the non obese diabetic (NOD) mouse.

Ciamexon (CMX), a new immunomodulatory compound acting mainly on B-lymphocytes was given orally to 42 NOD mice divided into three sex and litter matched groups (A: 0.3 mg/mouse/day CMX, B: 1.5 mg/mouse/day CMX, C: control) from 7 weeks of age. Animals were followed up for evaluation of diabetes incidence up to 32 weeks of age. There was a tendency for a delayed onset of hyperglycemia in mice of group B up to 26 weeks of age; however no significant difference in the cumulative incidence of diabetes at 32 weeks of age was observed (A: 57.5%, B: 38.5%, C: 38.5%). No differences were found in the number of infiltrated islets in animals culled at 10 weeks of age treated with CMX from 4 weeks of age. We conclude that CMX does not modify the course of insulitis and diabetes incidence in NOD mice although though the appearance of glycosuria was delayed by this treatment.

Adjuvants, Immunologic↗

PubMedDate not supplied

Total care for juvenile diabetics--a Swedish experiment.

A Swedish Study Group for Childhood Diabetes has recently prepared a national treatment and care programme for diabetes in children and adolescents, which is briefly presented in this paper. The programme is based on the working hypothesis that long-term vascular and neurological complications - still the most serious threats to the well-being and survival of juvenile diabetics - may be prevented by continuously maintaining a normal or near-normal blood glucose level. Four levels (I--IV) of metabolic control are being defined, of which level I is the optimal goal and level II acceptable, while levels III and IV are regarded as inadequate. To achieve a satisfactory therapeutic result great efforts are required by both patients and the diabetic health teams at the pediatric clinics. In addition to insulin, diet and exercise, great emphasis should be laid on home-monitoring of blood glucose and glycosuria, on patient education and on psychological support both to the children and to their families. The therapeutic team should understand the psychological problems which frequently occur in diabetic families and be able to guide them through the different stages of the disease until the patients reach psychosocial maturity. The programme thus aims at providing a total - biological, functional, emotional and social - care for diabetic children and adolescents, and at thereby improving their quality of life on a long-term basis.

Adolescent↗

PubMed1982

The poor man's insulin "pump".

Twenty-five insulin-requiring patients whose diabetes was inadequately controlled on a conventional regimen of short- and intermediate-acting insulin given as two or more injections daily were changed to an alternative program in which approximately 40% to 50% of total insulin requirement was given in a single constant morning dose of ultralente insulin and the remainder in three varying doses of regular insulin, one 30 minutes before each meal. On the alternative program, control improved markedly in 23 of the 25 patients, as evidenced by lower fasting serum glucose concentrations and decreased glycosuria. Control was maintained in all 23 over a follow-up period of 2 to 61 months (mean 14 months).

Adult↗

PubMed1973

Virus-induced diabetes mellitus. I. Hyperglycemia and hypoinsulinemia in mice infected with encephalomyocarditis virus.

Infection of DBA/2N male mice with encephalomyocarditis virus resulted in a diabeteslike syndrome characterized by hyperglycemia, glycosuria, hypoinsulinemia, polydipsia, and polyphagia. Blood glucose levels were elevated within 4 days after infection and reached a maximum mean level of 320 mg/100 ml within 12 days. Approximately 60-80% of the animals developed a transient hyperglycemia while 10-15% of the animals remained hyperglycemic for well over 6 mo. The remaining animals failed to become hyperglycemic but many had abnormal glucose tolerance curves. Hyperglycemia was most pronounced when animals were allowed free access to food, and the incidence of byperglycemia was related both to the strain and sex of the animals, with few females developing hyperglycemia. The amount of immunoreactive insulin in the plasma of infected hyperglycemic mice was significantly lower than in appropriate controls, and injection of exogenous insulin resulted in a rapid drop in the blood glucose levels. Despite the fact that certain animals were hyperglycemic for many months, virus could not be recovered from the pancreas after the first 10 days of the infection.

Animals↗

PubMed1992

Bone marrow transplantation as a strategy for treatment of non-insulin-dependent diabetes mellitus in KK-Ay mice.

The effects of allogeneic bone marrow transplantation (BMT) on non-insulin-dependent diabetes mellitus (NIDDM) were examined using KK-Ay mice. KK-Ay mice reconstituted with KK-Ay bone marrow cells showed glycosuria, hyperinsulinemia, and hyperlipidemia. However, KK-Ay mice (H-2b) that had been lethally irradiated (9.0 Gy) and then reconstituted with T cell-depleted bone marrow cells from normal BALB/c mice (H-2d) showed negative urine sugar with decreases in serum insulin and lipid levels 4 mo after BMT. Morphological recovery of islets and glomeruli was also noted after allogeneic BMT. These findings suggest that BMT can be used to treat not only a certain type of NIDDM but also its complications such as hyperlipidemia and diabetic nephropathy.

Animals↗

PubMed2003

Tenofovir-related nephrotoxicity in human immunodeficiency virus-infected patients: three cases of renal failure, Fanconi syndrome, and nephrogenic diabetes insipidus.

We report 3 cases of renal toxicity associated with use of the antiviral agent tenofovir. Renal failure, proximal tubular dysfunction, and nephrogenic diabetes insipidus were observed, and, in 2 cases, renal biopsy revealed severe tubular necrosis with characteristic nuclear changes. Patients receiving tenofovir must be monitored closely for early signs of tubulopathy (glycosuria, acidosis, mild increase in the plasma creatinine level, and proteinuria).

Acidosis↗

PubMed1979

Obesity, lipids, and glucose intolerance. The Framingham Study.

Some lipid and lipoprotein accompaniments of obesity and its association with glucose intolerance are examined in the Framingham cohort of 5209 men and women ages 30 to 59 examined biennially over 18 years. While beta and pre-beta lipoproteins were positively correlated with relative weight, high density lipoprotein cholesterol was inversely correlated. The association was strongest for high density lipoprotein cholesterol, varying little by age and sex. Triglyceride was a close second, but unlike high density lipoproteins, it and other lipids were more closely associated with obesity in men than women and in younger than older persons. Obese persons tended to have a greater likelihood of glycosuria and an increasing prevalence of diabetes. Relative weight in the Framingham cohort rose in both sexes to age 54, remained essentially unchanged until age 62 and then began to decline. Despite such changes body weights even 18 years apart had a correlation of 0.8. Men from each succeeding birth cohort were heavier, women were lighter, but even women from the most recent birth cohort were much more frequently above "desirable" weight than below it.

Adult↗

PubMed1984

Effect of dietary sucrose on the SHR/N-corpulent rat: a new model for insulin-independent diabetes.

A new congenic strain of genetically obese rat, SHR/N-corpulent (cp), was studied. Young male corpulent (cp/cp) and lean (cp/+ or +/+) rats approximately 5 wk of age were fed a diet containing 54% carbohydrate as either sucrose or cooked cornstarch for 9 wk. A phenotype effect was observed with body weight, fasting levels of serum insulin, triglyceride and total cholesterol, levels of serum insulin and glucose after an oral glucose load, and level of urine glucose (corpulent greater than lean), and with systolic blood pressure (corpulent less than lean). Only lean rats were hypertensive. Corpulent rats were hyperinsulinemic, hyperlipidemic, exhibited glycosuria, and were hyperglycemic after an oral glucose load. Lean rats were hyperinsulinemic, but normoglycemic. A diet effect (sucrose greater than starch) was observed with body weight, level of serum glucose after an oral glucose load, and urine volume in both corpulent and lean rats, and with levels of serum insulin and total urine glucose in corpulent rats. Corpulent rats fed sucrose had 20 to 40% higher levels of serum glucose and insulin after an oral glucose load, and twice the amount of total urine glucose, than did corpulent rats fed starch. The data demonstrate that corpulent rats have metabolic characteristics associated with insulin-independent diabetes in humans and that sucrose is more diabetogenic than starch. Manifestation of hyperglycemia in this model may be the result of superimposing obesity on an insulin-resistant genetic background.

Animals↗

PubMed1986

Effect of the alpha-glucosidase inhibitor Bay-O-1248 on the metabolic response of nondiabetic and diabetic rats to a high-carbohydrate diet.

The metabolic consequences of the addition of a new alpha-glucosidase inhibitor (BAY-O-1248) to a high carbohydrate diet (67% by calories) in which the carbohydrate comprised equal quantities (50% wt/wt) of wheat starch and sucrose (Diet A) or 100% glucose (Diet B) was studied in diabetic and nondiabetic rats. BAY-O-1248 led to a significant reduction in daily food intake and weight gain in rats fed Diet A but not Diet B. In diabetic rats fed Diet A with BAY-O-1248, daily urinary glucose was significantly diminished (6820 +/- 402 vs 3796 +/- 210 mg), while the postprandial plasma glucose excursions were similar. In nondiabetic rats, the addition of BAY-O-1248 decreased the postprandial plasma glucose level with no change in urine glucose. In summary, addition of an alpha-glucosidase inhibitor to a starch plus sucrose containing diet led to reductions in glycosuria (diabetic rats) and serum glucose levels (normal rats).

1-Deoxynojirimycin↗

PubMed1989

Metabolic consequences of the alpha-glucosidase inhibitor BAY-M-1099 given to nondiabetic and diabetic rats fed a high-carbohydrate diet.

The effect of a new alpha-glucosidase inhibitor BAY-M-1099 on postprandial glucose levels in nondiabetic and diabetic rats after sucrose loading was studied. Evaluation was also made of the metabolic consequences of the addition of BAY-M-1099 to a high-carbohydrate diet consisting of equal quantities of wheat starch and sucrose (Diet A). This drug significantly reduced (p less than 0.05) postprandial glucose levels in nondiabetic and diabetic rats after sucrose loading. BAY-M-1099 led to a significant reduction in urinary glucose loss (177.8 +/- 54.2 vs 98.9 +/- 35.6 mmol/L) and in postprandial plasma glucose levels in diabetic rats fed diet A. Addition of BAY-M-1099 to the diet of nondiabetic rats significantly (p less than 0.05) decreased the postprandial plasma glucose level at 45, 90, 180, and 225 min after a meal test. Addition of BAY-M-1099 to a diet containing starch plus sucrose led to reduced glycosuria and serum glucose levels and may have potential benefit in the management of diabetes mellitus.

1-Deoxynojirimycin↗

PubMed1997

Glycosuric tests should not be employed in population screenings for NIDDM.

BACKGROUND: The aim was to evaluate self-testing for glycosuria in screening for diabetes mellitus (DM). METHODS: All inhabitants aged 45-76 years in the investigation area were invited (3041 individuals). Participants received two foil-wrapped dipsticks and were asked to examine their postprandial urine. Results were marked on the reply card and returned. Test-positive screenees were offered a fasting blood glucose test at the laboratory, as were a random sample of 143 test-negative screenees. RESULTS: The screening detected 15 cases of unrecognized DM. Among 106 test-negative screenees, 3 had DM and 4 had impaired glucose tolerance. Response rate was 76.9 per cent. Sensitivity was 20.80 per cent. Specificity was 99.14 per cent. Positive predictive value was 46.88 per cent. Negative predictive value was 97.17 per cent. Costs per new case of diabetes were 3155 DKK (approximately pounds 332). CONCLUSION: The test has such a low sensitivity that it cannot be recommended as a screening test. If screening for DM is to be performed, it should not be on the basis of a glycosuric test. At least 11 of the 15 cases of screening-detected diabetes belonged to a risk group, and might have been detected by selective screening. We suggest that screening be carried out in general practice using blood sugar tests on risk groups.

Aged↗

PubMed1982

Massive perioperative polyuria.

A 25-year-old man with a spinal cord transection secondary to a gunshot wound underwent surgical repair of a perforated prepyloric ulcer on the eighth hospital day. He received 68 liters and excreted 43 liters of intravenous fluid during the perioperative period. Causes of this massive polyuria during and after the second operation are unknown, although iatrogenically induced glycosuria and natriuresis may have contributed to its severity. The problems and their management are discussed.

Adult↗

PubMed2004

Renal tubular dysfunction associated with tenofovir therapy: report of 7 cases.

We describe 7 cases of renal tubular injury in HIV-infected patients receiving an antiretroviral regimen containing tenofovir. Our patients (5 women and 2 men) developed renal tubular dysfunction, with hypophosphatemia, normoglycemic glycosuria, proteinuria, and decrease of creatinine clearance. The first biologic signs of renal toxicity were observed after duration of tenofovir treatment from 5 weeks to 16 months, and they resolved less than 4 months after discontinuation of tenofovir. Six patients had a low body weight (<60 kg). Five patients received low doses of ritonavir, and 1 received didanosine. In 5 patients, the signs resolved with the discontinuation of only the tenofovir. A renal biopsy performed in 1 patient was consistent with tubulointerstitial injury. Proximal tubulopathy appears to be a rare adverse effect of long-term tenofovir therapy. In patients with low weight or mild preexisting renal impairment, regular monitoring of tubulopathy markers could lead to early detection of this dysfunction.

Adenine↗

PubMed2005

Twelve-year clinico-therapeutic experience in pemphigus: a retrospective study of 54 cases.

BACKGROUND: Pemphigus, a common immunobullous disease of skin and mucous membranes affecting both sexes of all ages, was almost fatal before the advent of corticosteroids. Better strategies to avoid their side-effects and recent introduction of adjuvant therapy has further improved its prognosis. As the treatment remains need-based and patient-specific, different regimens and strategies have evolved, each with its own merits and demerits. This retrospective hospital-based study was carried out to understand the clinico-therapeutic aspects of pemphigus in our clinic. METHODS: Medical records of all new patients admitted to our hospital with the diagnosis of pemphigus from 1990 to 2002 were analyzed. The diagnosis was mainly clinical and confirmed by positive Tzanck's test and histopathology. All patients were assessed clinically on a severity score of 1+ to 4+. These patients had received treatment with dexamethasone-cyclophosphamide pulse (DCP) therapy, oral mini-pulse (OMP) with betamethasone, or intramuscular triamcinolone acetonide alone or with azathioprine, dapsone or cyclophosphamide. They were followed up for clinical remission and side-effects of therapy. RESULTS: There were a total of 54 new patients comprising 53.7% females and 46.3% males, and 12.9% of these were < 18 years of age. Pemphigus vulgaris was the commonest clinical type seen in 81.48% and mucosal involvement was seen in 63.63% of cases. The severity of mucosal lesions was not proportionate to that of cutaneous lesions. Associated diseases seen were seropositive rheumatoid arthritis, hypertension, diabetes mellitus and hyperthyroidism in one case each. Dexamethasone-cyclophosphamide pulse therapy was given to 75% of the pemphigus vulgaris patients while those having less severe disease were treated with other regimens. In general, clinical remission was seen after 2-16 (mean 6.5) DCP doses. Two patients have been in complete remission for the last 5 and 7 years of completion of DCP therapy, respectively. Addition of other adjuvants to corticosteroids was also helpful. However, azathioprine 50 mg/day was not as effective as cyclophosphamide 50 mg/day. Menstrual irregularities, amenorrhoea, azoospermia, rise in blood pressure and glycosuria were the major side-effects seen during DCP pulse therapy. Drop out rate was unacceptably high with all modes of treatment, although with DCP therapy it appears to be partly owing to early disease control. There was no mortality in this series. CONCLUSIONS: Pemphigus vulgaris is the commonest clinical type. Mucosal surfaces other than the oral cavity are uncommonly involved, it may herald the onset of disease and takes longer to heal. Dexamethasone-cyclophosphamide pulse therapy seems to have a definite advantage over treatment with steroids alone, especially in terms of better control of disease activity, near absence of steroid side-effects and significantly reduced hospital stay. However, ways and means to reduce gonadal toxicity of adjuvants need to be explored as DCP therapy is likely to stay as a treatment of choice.

Adolescent↗

PubMedDate not supplied

Urinary ethanol and diabetes mellitus.

Ethanol concentrations were assayed in urine samples obtained from 10 newly presenting diabetic patients (aged 50-69 years) with glycosuria and symptoms suggesting genito-urinary candidiasis. No alcohol was detected initially with diabetic urine samples, but when stored at room temperature 8 out of 10 samples showed increasing levels of ethanol from day 3 to day 20. Peak levels were more than 10,000 mg/l in three samples and more than 1500 mg/l in six samples. Studies were also performed using normal urine and urine to which was added glucose and/or Candida. Samples were kept at either room temperature or 4 degrees C for up to 21 days and ethanol assays performed at regular intervals. Studies with non-diabetic urine showed a maximum ethanol level of 500 mg/l after 11 days only in samples containing both glucose and Candida and kept at room temperature.

Aged↗

PubMedDate not supplied

New referrals to a diabetic clinic.

New referrals to a diabetic clinic were studied over 6 months. One hundred and twelve patients were referred from their General Practitioner (GP) and 49 from other hospital departments. Thirty percent of GP referrals and 10% of hospital referrals were made on the basis of glycosuria alone. From all the patients referred six were found to be non-diabetic and a further 19 had been prescribed drugs inappropriately (either the wrong drug or the right drug in excessive dose), some with potentially dangerous consequences. Almost half of the patients were given no dietary advice at all. There is, still much ignorance concerning diagnosis and initial management of diabetes in both general and hospital medical practice.

Blood Glucose↗