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PubMed2006

Metabolic characteristics of patients with apparently normal fasting plasma glucose.

AIMS: To describe the prevalence of dysglycaemia in patients with fasting glucose <6.1 mmol/L. METHODS: Consecutive patients referred for OGTT between July 2002 and December 2003 to eight Diagnostic Medical Laboratory depots in the Auckland region of New Zealand were invited to participate. In addition to a standard OGTT, patients' BMI was calculated and HbA1c, fructosamine, lipids, and insulin concentrations were measured. Patients were grouped according to fasting glucose of <5.5 mmol/L=normal, 5.5-6.0 mmol/L="high fives", 6.1-6.9 mmol/L="old" impaired fasting glucose, and greater than and equal to 7 mmol//L=diabetes. RESULTS: 310 patients were studied. 111 patients had a fasting glucose of <5.5 mmol/L, and of these, 23 had IGT and 2 diabetes on OGTT; 85 patients had a fasting glucose 5.5-6.0 mmol/L, and 18 of these had IGT and 11 diabetes on OGTT; 75 patients had a fasting glucose of 6.1-6.9 mmol/L, and of these, 33 had IGT and 21 diabetes on OGTT; 39 patients had a fasting glucose greater than and equal to 7 mmol/L and 38 were confirmed diabetic on OGTT. CONCLUSION: This study suggests that the upper limit of normal fasting glucose be lowered to <5.5 mmol/L in line with Australian and American Diabetes Society guidelines.

Blood Glucose↗
PubMed1991

[Glycosylated proteins and the rheological properties of the erythrocytes in carbohydrate metabolic disorders].

The level of glycosylated hemoglobin (Hb AIc), the concentration of glycosylated proteins in red blood cell membranes (GPCM), and fructosamine were measured in patients with different carbohydrate metabolism abnormalities (glucose tolerance test disorders, insulin-dependent diabetes mellitus/IDDM/). The "pyrene" probe was used to examine rheological disorders in different shift rates and microviscosity of red blood cell membranes. Close correlations were established between glycosylated proteins and microviscosity as well as between GPCM and viscosity of red blood cell suspension. In addition to an increase of the content of glycosylated proteins, deterioration of the rheological properties, and a rise of microviscosity associated with hypoxic phenomena, a group of patients suffering from IDDM with low microviscosity and graver clinical manifestations (microangiopathies, coronary heart disease, cerebral atherosclerosis) were distinguished. Low microviscosity can also be seen in normoglycemia. The cumulative action of the hemorheological shifts, a decrease of red blood cell deformity accompanied by tissue hypoxia favour the development of diabetic angiopathies. A possibility is revealed of the use of microviscosity of red blood cell membranes together with Hb AIc as markers of early carbohydrate metabolism abnormalities and early microcirculatory disorders.

Adult↗
PubMed1991

[Effects of deprivation and replacement by percutaneous 17 beta estradiol and oral progesterone on blood pressure and metabolic parameters in menopause patients with non-insulin-dependent diabetes].

The main purpose of this randomized controlled study was to assess the effects of postmenopausal estrogen replacement therapy on blood pressure (BP) and plasma renin substrate (PRS) in non insulin-dependent diabetic patients (DNID). We randomized 32 postmenopausal DNID (mean age: 55.3 +/- 4.2 years) into two groups: 16 women were untreated, and 16 received percutaneous estradiol (E2) 17 beta and natural progesterone for 6 months. Systolic (SBP) and diastolic (DBP) blood pressure were monitored by an automatic device at inclusion and on the 1st, 3rd and 6th months of therapy. Treatment efficacy was proven by significant E2 plasma increase to 92.2 +/- 13.4 pg/ml in the treated group, which is a sufficient level for preventing postmenopausal osteoporosis. No significant inter or or intra-individual variation in SBP or DBP was observed in either group. The same stability was noted for plasma renin substrate. No significant difference was noted between the two groups in terms of body weight, fructosamine and glycosylated hemoglobin A1c after 1, 3 and 6 months. There was also no change in plasma levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and apolipoproteins A1 and B. All the patients who received replacement therapy wished to continue treatment. We conclude that the association of percutaneous E2 17 beta and natural progesterone had no deleterious effects, in diabetic patients, on BP, carbohydrate and lipoprotein metabolism. Thus this postmenopausal replacement therapy appears preferable in this vascular high risk population, particularly since estrogens via the parenteral route may have an antiatherogenic effect by direct action on the vessel walls.

Administration, Cutaneous↗
PubMed1991

[Urinary excretion of N-acetyl-beta-D-glucosaminidase and microglobulin 2 in type I diabetes mellitus].

We studied the urinary elimination of two indicators of renal proximal tubular function. N-Acetyl-Gluosaminidase (NAG) and beta 2 microglobulin (beta 2m) in 23 healthy and 67 diabetic children aged 2-15 years and with disease evolution times between 1 month and 12 years. In order to obviate the variations of glomerular filtration present in the diabetes, both proteins were evaluated in the form of indices of excretion (IE). It was found that the diabetic children as a whole presented higher values of NAGIE than the controls (p less than 0.001), and that this increased as the degree of metabolic control worsened, the latter being judged by either fructosamin or HbA C (r = 0.59 for both). The increase in the urinary elimination of NAG had a directly proportional relation with the evolution time of the diabetes. With respect to the beta 2mIE, no significant differences were found on dividing the children according to the degree of metabolic control, although the values did increase with longer evolution times. Thus it may be concluded that NAGIE was shown to be a more useful parameter than beta 2m for evaluating the renal proximal tubular function in infant and juvenile diabetes.

Acetylglucosaminidase↗
PubMed1990

[Antidiabetic treatment and monitoring during pregnancy in diabetes].

In pregnant diabetic women one of the goals of antidiabetic treatment and monitoring is to maintain blood glucose near normal values between 4.4 and 6.1 mmol/l. If possible such values should be obtained before conception. To reach these goals four components of health care delivery are of major importance. Education dealing with contraception and planification of the pregnancy, diet modified according to the state of pregnancy, self blood glucose monitoring to allow anticipatory optimized insulin therapy. During pregnancy the systematic use of continuous subcutaneous insulin infusion does not seem to be associated with any significant benefit dealing with metabolic control or the perinatal and neonatal morbidity and mortality. In pregnant diabetic patients the usefulness of the dosage of glycated haemoglobin is limited due to the spontaneous fluctuations of this value during pregnancy, as well as the delay of the variation of this index during a period of poor glycemic control. In this condition glycated proteins as fructosamine may be more useful but many technical problems for this determination are still to be solved.

Biomarkers↗
PubMed1990

[Progress in clinical chemistry].

The basic and clinical studies that are expected to influence future laboratory medicine were presented by five speakers in the symposium held at the National Cardiovascular Center, in Osaka on January 27, 1990. Dr. Y. Katayama reported a new method for analyzing glycated protein by HPLC and the data on the positive error caused by superoxide anion in the value of fructosamine. Dr. Y. Harano described a sensitive method for enzyme immunoassay of apoprotein B and discussed cases of diabetes mellitus, hyperlipidaemia and hypo-apoprotein B with respect to the apoprotein B level. Dr. T. Noguchi reported the excellent results in DNA analysis of pyruvate kinase. Dr. N. Taniguchi presented a basic study on superoxide dismutase and noted the increased activity of this enzyme in certain diseases. The assay of this enzyme activity can now be routinely performed. Dr. H. Matsuo, the last speaker in this symposium, had received the Gakusiin award in 1989 for his studies on atrial natriuretic hormone (ANH). He outlined the history of ANH study developed in his laboratory. ANH also will be added to routine assay. We, the chairmen in this symposium, added comments concerning useful modern techniques for the clinical chemistry and the role of the clinical laboratory in large hospitals.

Chemistry, Clinical↗
PubMedDate not supplied

Antihypertensive and metabolic effects of nitrendipine in hypertensive diabetic patients.

The subjects were 15 patients, aged 53 to 74 years, with noninsulin-dependent diabetes mellitus and mild to moderate hypertension. Each received 20 to 40 mg of nitrendipine daily for six months. Mean supine blood pressures decreased significantly from 177/102 mmHg before treatment to 164/95 mmHg at three months and continued to decline during the following three months. Diastolic blood pressure was reduced to less than 90 mmHg in eight of the 15 patients. No changes in heart rate, glycemic control (serum levels of glucose, C-peptide, glycosylated hemoglobin, and fructosamine), or serum lipid levels (cholesterol and its lipoprotein fractions, triglycerides, and apolipoproteins A1 and B) were noted. It is concluded that nitrendipine is safe and effective in the treatment of hypertension in diabetic patients.

Aged↗
PubMed1990

[Assay of glycated fibrinogen in plasma as an indicator of blood glucose control].

A method of assay for glycated fibrinogen (C-Fbg) in plasma has been developed. This method is based on the measurement of 1-deoxy-1-morpholino-D-fructose (DMF) in the fibrinogen (Fbg) solution separated from plasma and redissolved. Twenty five NIH units of thrombin was added to 600 microliters of plasma. After incubation, the fibrin clot was separated and washed. The fibrin clot was redissolved with Owren's veronal buffer contained urokinase. After incubation, DMF was measured using a Fructosamine Kit. G-Fbg measured by this method correlated significantly with the amount of furosine that was a specific product by hydrolysis of glycated lysine residue. In this method, the CV for intraday assay ranged from 2.0 to 3.6% and that for interday assay was 3.9%. The average of G-Fbg values in 78 diabetic patients (23.8 +/- 10.7 mumol DMF/g Fbg) was significantly higher than in 26 normal subjects (9.2 +/- 3.8 mumol DMF/g Fbg). The G-Fbg value correlated with blood glucose at the same time or one day earlier than 1-2 weeks or 1 month earlier. These results suggest that assay of G-Fbg by this method may be useful in monitoring short-term control of blood glucose in diabetic patients.

Adult↗
PubMed1990

[Short-term metabolic compensation improves the lipo-apoprotein profile in type II diabetics in secondary insufficiency].

In the present study the effect of short-term metabolic control on plasma lipids and apoproteins in a group of subjects with type II diabetes mellitus in insulin treatment for secondary failure to oral agent therapy (sulphonylureas) was examined. For this reason 40 diabetic patients and 40 normal controls were studied. The lipoapoproteic pattern at the admission in the study and after a steady metabolic control, achieved by conventional insulin therapy and estimated by seric fructosamine, was evaluated. Diabetic patients, when compared with normal controls, showed a more atherogenic lipo-apoproteic profile and after achieving metabolic control, showed a reduction of triglyceride and apo B levels and a significant increase of the apo AI levels. The achievement of a good metabolic control, even after a short time, was associated with an improvement of the lipo-apoproteic profile, altered in diabetes mellitus in secondary failure.

Apoproteins↗
PubMed1989

[Roles of arterial hypertension and diabetes mellitus in early nephropathy].

The aim of this study was to assess and compare microalbuminuria (mu Alb mg/24 h +/- SD) in populations with hypertension and or diabetes mellitus leading to determine the effects of each pathology and their association in nephropathy. In hospital population studies were (mean +/- S.D.): (table; see text) No other pathology was found. Creatinine was in normal limits and macroproteinuria less than 1 g/24 h. Microalbuminuria was measured with laser immunonephelemetry. Glucose tolerance was assessed by fructosaminemia values (N less than or equal to 2.8 mmol/l). Student's test and linear regression test were used. There was no correlation between microalbuminuria and the other parameters: fructosamine, creatinine, age, in the 5 groups. Early nephropathy defined as a value of microalbuminuria between 30 and 300 mg/24 h was found in 23 p. 100 (H), mean 64.4 mg/24 h +/- 44, 37 p. 100 (D1), mean 127.7 +/- 149, 29 p. 100 (D2) mean 95.5 +/- 88, 47 p. 100 (D1H) mean 96.8 +/- 72, 39 p. 100 (D2H) mean 90 +/- 70. Microalbuminurias in diabetic populations were upper than in hypertensive (NS). Early nephropathy was most frequent when hypertension was associated with diabetes. Follow-up and treatment of hypertension in populations at high risk of vascular disease, as diabetics, will probably decrease the prevalence of early nephropathy.

Adult↗
PubMed1989

[Reconditioning of diabetics--a progressive therapeutic method].

The authors discuss an untraditional comprehensive therapeutic method of diabetes where in 30 patients marked improvement of parameters of the carbohydrate and lipid metabolism was achieved. The value of the mean fasting blood sugar level declined from 11.28 mmol/l to 5.28 mmol/l, fructosamine declined from 2.54 mmol/l to 2.01 mmol/l. Total cholesterol declined from 6.93 mmol/l to 6.32 mmol/l and triacylglycerols from 3.69 mmol/l to 2.69 mmol/l. Improvement of the objective and subjective health status of the patients and their better cooperation with health workers suggest ways to be selected in future years for preventive trends of our health services. The interest of patients in the success of the programme signalizes the so much needed active attitude to problems of the subjects' own health.

Aged↗
PubMedDate not supplied

[Nutrition in school-age children: a survey at a nursery school].

The results of a social-nutritional investigation in a maternal school are reported. Aim of the present study was to evaluate the dietary habits and life style in a group of 3-6 years old children and their compliance in following a diet in accordance with the LARN86 recommendations. The enquiry was carried out by a questionnaire, by an analysis of the ingesta and by a paediatric and auxological examination. Blood and instrumental tests (Lipids panel, Blood glucose, Insulin, Fructosamine, IgE, ECG) were performed in children with high familial risk of atherosclerosis. The main findings were the following: i. 17 children (21%) were classified as having high atherosclerosis familial risk; ii. the atherosclerosis high risk group showed also increased incidence (p less than 0.01) of familial allergy; iii. children had higher approval for food with high carbohydrate and animal protein content; iv. fat intake was proportional to the number of different types of fat bought by the families; v. excessive dietary lipids and low carbohydrate intake were found in most families. The revaluation at the end of the study showed a good compliance for the proposed diet scheme by children, but a poor compliance by their families.

Body Weight↗
PubMed1989

Renal effects from limitation of high dietary protein in normoalbuminuric diabetic patients.

Glomerular hyperfiltration may be a risk factor for late nephropathy. It has been shown that considerable protein restriction can lower glomerular filtration rate (GFR). To elucidate the effect of moderate protein limitation in type 1 (insulin-dependent) diabetics with normoalbuminuria, eight such patients were selected for the study (age 38 +/- 7 years SD, diabetes duration 21 +/- 9 years). The patients were randomized to follow, alternately, four weeks of their usual protein intake (19% of energy) and four weeks of a limited protein intake (12% of energy). Kidney function was investigated after the two dietary periods. GFR and renal plasma flow (RPF) were measured using a constant infusion technique (125I-iothalamate/131I-hippuran), and urinary albumin excretion (UAE) by radioimmunoassay. It was found that the limited protein diet reduced GFR from 146 +/- 23 to 132 +/- 24 ml/min/1.73 m2 (2P less than 0.005). A tendency towards a fall in RPF was seen (549 +/- 128 vs. 503 +/- 125 ml/min; 2P = 0.06), while total renal resistance rose from 0.17 +/- 0.03 to 0.20 +/- 0.05 mm Hg/ml/min (2P = 0.05). No significant changes in filtration fraction, UAE and blood pressure were seen. HbA1c, fructosamine, insulin dose and body weight were unchanged during the two diets; also serum protein, albumin, phosphate and calcium remained unaltered. Serum urea was significantly reduced on the limited protein intake. Patients were generally pleased with the limited protein diet. Thus, limitation of the often high protein intake in diabetics might be valuable and realistic. The long-term renal protective effect remains to be investigated.

Adult↗
PubMed1989

[Glucose and its protein environment in vivo].

The non-enzyme reaction by which glucose can combine with free amines has been known since the beginning of the century: in 1912, Mallard reported the combination of glucose with amino acids. This reaction results in the formation of cetoamine or fructosamine as well as often complex sub-products responsible for a change in the color of the medium that turns brown. This process, which food chemists are well-familiar with, was not observed in vivo until three-quarters of a century later. In 1975, hemoglobin A was shown to combine with glucose by means of a non-enzyme reaction, producing hemoglobin A1c. HbA1c is now believed to be a "black box", i.e. a cumulative reflection of all the hyperglycemic episodes that occurred over the last hundred days. This discovery was followed by an impressive number of similar observations: nearly all the available amines seem able to participate in this kind of reaction. Plasma proteins, membrane proteins, structural proteins such as collagen, the apolipoproteins of circulating lipoproteins, intracellular tubulines, and even nucleic acids seem capable of undergoing glycation. A great number of bioclinica uses of this phenomenon have already been developed. Diabetes mellitus has benefited most from these investigations and, from a broader viewpoint, studies in this field are unquestionably central to our understanding of atherosclerosis, inflammation, and cancer. Furthermore, the entire spectrum of these observations are related to ageing.

Apolipoproteins↗
PubMed1989

Longterm neuroendocrine and metabolic effects of physical training in intermittent claudication.

Twenty-five elderly patients with peripheral vascular disease and intermittent claudication were prospectively followed during a six-month session of physical training. Neuroendocrine and metabolic patterns as well as effects on walking performance were assessed during the training period. At the initial evaluation there was an inverse association between walking distance and serum cortisol and blood glucose levels. The walking distance increased during the training period. A positive effect on glucose homeostatis was seen with decreased basal fructosamine levels after training. During physical exercise a decrease in insulin and an increase in growth hormone was seen. Changes in growth hormone were, in contrast to insulin, more related to the pain level perceived than to the work load imposed. Apart from the marked effects on physical performance the results of the study suggest an improvement of hormonal and metabolic balance after physical training. This regularly applied exercise program improved the health status of rather old people.

Aged↗
PubMed1989

[Diagnosis and treatment of diabetes mellitus-recent advances].

In 1982, two years after the second report of the WHO Expert Committee on Diabetes Mellitus, new diagnostic criteria for diabetes mellitus were recommended by the Japan Diabetes Society and widely used in Japan. In the assessment of diabetic control, a blood ketone body measurement kit was developed and has been used for detecting its metabolic abnormality. Glycated hemoglobin has been introduced to clinical practice as an index of the past 1-2 months' diabetic control, fructosamine of the past 1-2 weeks' diabetic control and they are effectively used to achieve the good metabolic control. In the field of treatment, the extrapancreatic action of the sulfonylurea agent has been re-estimated and combination therapy with insulin is now being tested. In insulin treatment, conventional insulin injection (once a day) was not sufficient for preventing the chronic vascular complication of diabetes and intensive insulin therapy has been strongly recommended and is gradually coming into wide use. Since the development of an insulin injection pump, we have been able to mimic the normal insulin secretion pattern. With the increase of blood glucose self-monitoring, the sliding scale method can be used where the patient himself adjusts the insulin dose under certain circumstances.

Diabetes Mellitus↗
PubMed1989

The influence of zinc supplementation on glucose homeostasis in NIDDM.

Decreased serum zinc levels and hyperzincuria occur in some non-insulin dependent diabetic subjects (NIDDM). Zinc deficiency was demonstrated in various tissues of animal models for NIDDM. Serum zinc and 24-hr urine zinc of subjects with NIDDM were compared with that of age- and sex-matched healthy volunteers. Zincuria was significantly increased in the diabetic group. Thirteen diabetic subjects with hyperzincuria and hypozincemia were supplemented with zinc sulfate 220 mg x 3/day for 7-8 weeks. At the end of the study, glucose disposal (evaluated by kg) decreased significantly from 0.562 +/- 0.03 to 0.414 +/- 0.05 (p less than 0.05) and fasting glucose and fructosamine were significantly increased from 177 +/- 10 mg/dl to 207 +/- 15 mg/dl (p less than 0.05) and from 2.7 +/- 0.2% to 3.2 +/- 0.28% (p less than 0.05), respectively. T-lymphocyte response to phytohemagglutinin was increased significantly. We conclude that zinc supplementation to NIDD patients with hypozincemia and hyperzincemia might aggravate their glucose intolerance. More accurate methods to assess zinc deficiency in NIDD patients is needed to justify the supplementation of zinc in these patients.

Blood Glucose↗
PubMed1989

Effects of diet-therapy on urinary protein excretion albuminuria and renal haemodynamic function in obese diabetic patients with overt nephropathy.

Twenty-four type 1 and type 2 diabetic patients with obesity and overt nephropathy were studied for 12 months after hypocaloric diet change from 1870 to 1410 kcal/day (without changes of protein:carbohydrate ratio). Several parameters were evaluated: arterial blood pressure, blood glucose, fructosamine, HbA1c, proteinuria, albuminuria, glomerular filtration rate (GFR), creatinine clearance, triglycerides, HDL and total cholesterol. A significant reduction of body weight (body mass index from 33 +/- 1.6 to 26 +/- 1.8 kg/m2, P less than 0.001), concomitantly with a decrease of blood pressure levels (P less than 0.002) was demonstrated at the end of the study. Triglyceride (P less than 0.002), HDL (P less than 0.002), HDL (P less than 0.05) and total cholesterol (P less than 0.01) levels were reduced after diet-therapy, while a mild improvement of glycometabolic profile was observed in the same period. A marked decrease of proteinuria (from 1280 +/- 511 to 623 +/- 307 mg/24 h, P less than 0.01) and albuminuria (from 723 +/- 388 to 492 +/- 170 micrograms/min, P less than 0.01), and an improvement of GFR (from 66 +/- 13 to 81 +/- 11 ml/min/1.73 m2, P less than 0.01) and creatinine clearance (from 79 +/- 14 to 91 +/- 13 ml/min, P less than 0.01) was demonstrated after 12 months of diet-treatment. Our data suggest that body weight reduction by hypocaloric diet may delay the progression of clinical nephropathy in obese diabetic patients.

Albuminuria↗