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PubMed1994

Efficacy and safety of fluvastatin in hyperlipidaemic patients with non-insulin-dependent diabetes mellitus.

In this preliminary report of a 20-week trial, 66 patients with non-insulin-dependent diabetes mellitus (NIDDM) and hyperlipidaemia who remained eligible after an 8-week dietary stabilization phase were randomly allocated to receive 20 mg of fluvastatin or placebo once daily for 6 weeks. Fluvastatin was subsequently increased to 20 mg twice daily and administered according to the same schedule, versus placebo, for a further 6 weeks. Both dosages of fluvastatin substantially improved serum lipid profiles compared with baseline and placebo. Both dosages of fluvastatin significantly reduced low-density- and very-low-density-lipoprotein (LDL, VLDL), cholesterol and triglyceride (TG) compared with placebo, and both dosages significantly elevated high-density-lipoprotein (HDL) cholesterol. The ratio of LDL to HDL was also significantly decreased. Amongst the 58 patients who completed the study, there was no evidence either of myopathy or of hepatotoxicity; mean creatine kinase values remained stable in the fluvastatin arm. Fasting glucose, glycosylated haemoglobin, and fructosamine levels were not markedly affected by active treatment. No serious adverse events attributable to the drug were reported. In conclusion, both dosages of fluvastatin appear to be effective and safe in the management of hyperlipidaemia in this outpatient, maturity-onset, diabetic population.

Adult↗
PubMed1993

Glycosaminoglycans in urine of type 1 diabetic patients.

Diabetic nephropathy is accompanied by changes of glomerular and tubular functions manifesting already in the early stages by an increase of glycosaminoglycans excretion into urine. We evaluated urinary glycosaminoglycan excretion in 38 Type 1 diabetic patients with no markers of developed nephropathy. Glycosaminoglycan excretion related to creatinine concentration was significantly higher in diabetic patients with or without retinopathy than in healthy persons (3.9, 1.2-12.7 or 3.7, 0.9-15.9 vs 2.0, 0.8-5.1 micrograms/mumol creatinine, p < 0.01). A positive correlation between glycosaminoglycan excretion and albuminuria was observed in all diabetic patients (r = 0.60, p < 0.01). Urinary glycosaminoglycan excretion did not correlate with serum fructosamine concentration.

Adult↗
PubMed1994

[Injection site for quick-acting insulin. Significance for glycemic control in basal bolus insulin regimen].

The impact on glycaemic control of soluble insulin injected either intramuscularly into the thigh (IMT), subcutaneously into the abdominal wall (SCA) or subcutaneously into the thigh (SCT) was evaluated in 49 Type 1 diabetic outpatients following a randomised three-month intervention study. Insulin doses were adjusted based on patients' self-monitored blood glucose values and reported hypoglycaemic episodes. More patients in the SCA and IMT groups than in the SCT group had serum fructosamine values within normal limits following intervention. Blood glucose at 03.00 was lower in the SCT group than in the SCA and IMT groups, due to a higher number of low nocturnal blood glucose values (less than 4 mmol/l) in the SCT group. In conclusion, s.c. injection of soluble insulin into the abdominal wall or intramuscularly into the thigh is preferable compared to s.c. injection into the thigh in the basal bolus insulin delivery regimen. Soluble insulin injection s.c. into the thigh during daytime is a risk factor for nocturnal hypoglycaemia.

Abdominal Muscles↗
PubMed1994

[Insulin dependent diabetes and pregnancy: evaluation of the insulin pump].

OBJECTIVE: To evaluate the effectiveness of continuous insulin infusion (insulin pump) on the materno-foetal morbidity during pregnancy in patients with insulin-dependent diabetes mellitus. METHODS: A retrospective study from 1980 to 1991. SITE. Gynecology-Obstetrics Unit, University of Caen. POPULATION: Eighty-one patients with insulin-dependent diabetes mellitus known to be affected before their pregnancy were followed in the unit from 1980 to 1991. This population was divided into two groups: in the first group, an insulin pump was installed before 15 weeks of amenorrhoea (n = 36) and in the second group, conventional treatment was given with three daily injections of insulin or with a pump installed after 15 weeks of amenorrhoea (n = 45). RESULTS: In the first group with the insulin pump before 15 weeks, there was a higher proportion of severe diabetes, the first consultation occurred earlier, there were half as many cases of neonatal jaundice and the length of hospitalization during the first trimester of pregnancy was longer. There was no difference in Apgar scores, cord pH, birth weight and the proportion of foetal macrosomia, length of the hospitalization in the neonatality ward, rate of malformation, infection, low blood glucose and calcium, transitive respiratory distress and neonatal polycythaemia, length of hospitalization of the mother during the second and third week postpartum, the rate of urinary infection, high blood pressure, hydramnios during pregnancy, delivery route, haemoglobin Alc or fructosamine during pregnancy. There was no perinatal death. CONCLUSION: Although there was no significant difference in the results, which may be explained by the higher number of severe cases of diabetes in the first group, the use of the insulin pump did not appear to improve control of blood glucose levels, and thus to improve the materno-foetal prognosis, except by the bias of earlier attentive management of the pregnancy which led to better outcome.

Adult↗
PubMedDate not supplied

[The clinical efficacy of Vuglesorb enterosorbent in diabetic patients].

Carbonic fibrous enterosorbent "Vuglesorb" used as a part of complex anti-diabetic treatment contributes to normalization of metabolism, promotes liquidation of ketoacidosis and principal morbid manifestations. Alongside with this, glycaemia and fructosamine blood level come to the norm. Marked anti-atherogenic effect was also observed. The drug is recommended for the treatment of patients with diabetes mellitus.

Carbon↗
PubMed1994

A cross-sectional study of diabetes in Mt Eden Prison, Auckland.

AIMS: To study the control, complications and management of prisoners with diabetes on treatment with oral hypoglycaemic agents or insulin in Mt Eden prison, Auckland. METHODS: A cross-sectional study of those prisoners known to be on oral hypoglycaemic agents or insulin by personal interview using a structured questionnaire followed by physical examination and random measurement of fructosamine, lipids and renal function. RESULTS: At the time of the study the prison population was 438 (47 females). Fifty three percent were Maori, 29% European, 14% of Pacific Islands origin and 4% of other nationality. Five males were known to be on oral hypoglycaemics and three further males, also with non-insulin dependent diabetes (NIDDM) were on insulin. Two other males were insulin dependent diabetics (IDDM) aged 22 and 25 years. All were Maori. The mean age (range) of NIDDM patients was 50 (35-68) years. As a group these prisoners were obese with a high prevalence of smoking, hypertension, dyslipidaemia, retinopathy, nephropathy and neuropathy. Four of the five insulin treated patients had been in hospital a total of 11 times in the preceding 12 months for diabetes related health problems accounting for a total hospital stay of 60 days. Three of these prisoners had recurrent self-induced hypoglycaemia or diabetic ketoacidosis. Metabolic control of glucose was however reasonable. CONCLUSIONS: Prisoners known to be on treatment for diabetes have a high prevalence of complications (many previously unrecognised) and display manipulative behaviour. This group requires specialised health care by diabetes trained staff with a knowledge of local prison conditions.

Adult↗
PubMedDate not supplied

[Atherogenic properties of blood serum in children with type I diabetes mellitus].

Blood serum atherogenicity was studied in children suffering from type I diabetes mellitus, as was the relationship between the serum atherogenicity and a number of clinical biochemical parameters. Of the 34 serum samples from children with diabetes 16 did not influence the intracellular cholesterol levels, the rest 18 were found atherogenic, that is, they increased the total cholesterol levels in the cells by 50-70%. Blood serum atherogenicity in all the examinees and in groups A and B separately was unrelated to the patients' age, insulin dose, fructosamine levels, or the disease standing. A positive correlation was detected between the patients' ages and the insulin dose.

Adolescent↗
PubMed1993

[Effect of training fitness on obesity, hypertension, hyperlipidemia and disorders in glucose metabolism].

Effects of physical training on obesity, hypertension, hyperlipidemia and disorders of glucose metabolism were investigated in 359 males, 30-59 years of age. Body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and fructosamine (FA) were measured before and after the 2 month period of physical training at intensities of about 50% of maximal O2 uptake. Results are summarized as follows; 1. Means of BMI, SBP, DBP, TC and FA after the training were significantly lower than before the training. Mean of HDL-C was significantly higher than before the training. 2. In subjects with high BMI (n = 124), high SBP (n = 129) and high DBP (n = 128), means of BMI, SBP and DBP decreased with increase of training time per week. In subjects with low HDL-C (n = 104), high TC (n = 135) and high FA (n = 66), changes in means of TC, HDL-C and FA after the training did not show a relationship to training time per week. 3. Differences observed for measured values before and after the training of 2-3 hours per week were 0.4 kg/m2 in BMI, 15 mmHg in SBP and 10 mmHg in DBP, suggesting that training of 2-3 hours per week was effective in intervention of obesity and hypertension.

Adult↗
PubMed1994

[Action of trandolapril on the blood glucose balance and microalbuminuria in hypertensive diabetics].

The aim of this study was to evaluate the action of trandolapril on blood glucose control and microalbuminuria in mild to moderate hypertensive in patients with non-insulin-dependent diabetes. Sixty-seven patients, aged between 33 and 79, were enrolled. After a two week placebo run-in period, treatment with trandolapril as monotherapy was given for 3 months. The dose of trandolapril was adjusted between 1 and 4 mg/day according to antihypertensive response. Patients were assessed clinically and by laboratory investigations each month. Two patients were excluded from efficacy analysis because of major protocol deviations. Mean DBP fell, under the influence of treatment, from 101 +/- 5 mmHg to 82 +/- 7 mmHg (p < 0.0001) and mean SBP from 171 +/- 9 mmHg tp 147 +/- 11 mmHG (p < 0.0001). At three months, 54 patients (84%) had a DBP < or = 90 mmHg. Microalbuminuria decreased significantly (p = 0.03) during treatment. Microalbuminuria returned to normal in 11 of the 13 patients in whom the baseline value was above 21 micrograms/min and increased to above normal in 2 of the 26 patients who had a normal baseline value. Blood glycosylated hemoglobin, fructosamine, glucose and creatinine, and creatinine clearance remained stable. Plasma potassium rose slightly in 7 patients. Six adverse events were reported (4 coughs, 1 peripheral edema, 1 plantar mal perforans). One patient died from pulmonary embolism. In conclusion, trandolapril is an effective antihypertensive agent in hypertensive diabetics. Trandolapril causes a significant decrease in microalbuminuria and does not interfere with blood glucose control in these patients.

Aged↗
PubMed1994

Effect of enalapril on the microvascular albumin leakage in patients with diabetic microangiopathy and normal or mildly elevated blood pressure.

The transcapillary escape rate of albumin (TERalb) is often elevated in patients with diabetic microangiopathy. The objective of this study was to examine the effect of enalapril on the TERalb of diabetic patients with albuminuria and normal or mildly elevated blood pressure. Seventeen diabetic patients with diabetic retinopathy, albuminuria, a diastolic blood pressure below 100 mmHg and increased TERalb participated in the study. Blood pressure and TERalb were measured before and after 14 days of therapy with enalapril, 20 mg daily for 14 days. Systolic and diastolic blood pressure fell from 168 +/- 6 to 155 +/- 6 (p < 0.001) and from 87 +/- 2 to 81 +/- 2 mmHg (p < 0.005) respectively. Mean arterial pressure declined from 114 +/- 3 to 105 +/- 3 mmHg (p < 0.0001). The elevated TERalb decreased from 9.5 +/- 0.5 to 7.2 +/- 0.5%/hr (p < 0.005). In the hypertensive subset, systolic, diastolic and mean arterial pressure decreased significantly by 15, 7 and 10 mmHg (p < 0.005, p < 0.005 and p < 0.005 respectively); TERalb decreased from 9.5 +/- 0.6 to 7.3 +/- 0.6 (p < 0.03). In the normotensive subset, arterial pressure remained unchanged and TERalb decreased from 9.0 +/- 0.8 to 6.8 +/- 1.0%/hr (p < 0.03). Plasma fructosamine decreased from 373 +/- 23 to 347 +/- 20 (p < 0.05) in the hypertensive group and remained unchanged in the normotensive patients. No correlation could be demonstrated between variation in TERalb and changes in blood pressure. In conclusion, enalapril decreases microvascular albumin leakage in patients with diabetic microangiopathy and normal or mildly elevated blood pressure.

Blood Pressure↗
PubMed1993

[Evoked motor and somatosensory potentials in diabetic neuropathy].

The present study was aimed at evaluating the information obtained from evoked motor and sensitive potentials in a population of non-insulin-dependent diabetics compared to information yielded by electroneurographic study. Besides, we wanted to check any possible correlation between metabolic control and changes of evoked potentials. Electroneurographic study of 20 patients revealed signs of peripheral nervous impairment in 11 of these while results were normal in the remaining 9. Analysis of findings resulting from testing of evoked potentials showed a statistically significant increase of these parameters both in the group of patients with neuropathy and in the controls. Since these methods explore longer stretches of the nervous pathways, they are apt to identify lesions located in areas not accessible to common diagnostic methods. Our data did not show a correlation between metabolic control, as assessed by fructosamine assay, and latency of evoked motor and sensitive potentials, thus indicating that other factors, such as environmental and genetic ones, are apt to influence the onset of diabetic neuropathy.

Diabetic Neuropathies↗
PubMed1994

Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbuminuria. European Microalbuminuria Captopril Study Group.

OBJECTIVES: To study the effect of angiotensin converting enzyme inhibition on the rate of progression to clinical proteinuria and the rate of change of albumin excretion rates in patients with insulin-dependent diabetes mellitus and persistent microalbuminuria. DESIGN AND SETTING: Randomized, double-blind, placebo-controlled clinical trial of 2 years' duration at 12 hospital-based diabetes centers. PATIENTS: Ninety-two patients with insulin-dependent diabetes mellitus and persistent microalbuminuria but no hypertension. INTERVENTION: The patients were randomly allocated in blocks of two to receive either captopril, 50 mg, or placebo twice per day. MEASUREMENTS: Albumin excretion rate, blood pressure, glycosylated hemoglobin level, and fructosamine level every 3 months; urinary urea nitrogen excretion every 6 months; and glomerular filtration rate every 12 months. RESULTS: Twelve patients receiving placebo and four receiving captopril progressed to clinical proteinuria, defined as an albumin excretion rate persistently greater than 200 micrograms/min and at least a 30% increase from baseline (P = .05). The probability of progression to clinical proteinuria was significantly reduced by captopril therapy (P = .03 by log-rank test). Albumin excretion rate rose from a geometric mean (95% confidence interval) of 52 (39 to 68) to 76 (47 to 122) micrograms/min in the placebo group but fell from 52 (41 to 65) to 41 (28 to 60) micrograms/min in the captopril group, a significant difference (P < .01). Mean blood pressure was similar at baseline in the two groups and remained unchanged in the placebo group but fell significantly, by 3 to 7 mm Hg, in the captopril group. Glycosylated hemoglobin levels and glomerular filtration rate remained stable in the two groups. CONCLUSIONS: Captopril therapy significantly impeded progression to clinical proteinuria and prevented the increase in albumin excretion rate in nonhypertensive patients with insulin-dependent diabetes mellitus and persistent microalbuminuria.

Adolescent↗
PubMedDate not supplied

Peripheral nerve protein glycation and muscle fructolysis: evidence of abnormal carbohydrate metabolism in ALS.

Conversion of glucose to fructose via sorbitol depends upon the enzymes aldose reductase and sorbitol dehydrogenase and is called the polyol pathway. It is particularly active in muscle from patients with X-linked muscular dystrophies (15). This investigation shows enhanced metabolism of glucose to fructose in muscle from patients with ALS. Evidence is also presented showing increased activities of ketohexokinase and F-1-P splitting aldolase, which suggests that further metabolism of fructose may occur via a fructolytic pathway. Investigation of protein glycation, by an adapted fructosamine assay, in post mortem muscle, sural nerve and blood indicates that there is an increased concentration of glucose in muscle and nerve in the period prior to sampling, but blood glucose concentrations were within normal limits. The implications of fructolysis and the relationship of altered glucose metabolism in ALS are discussed.

Amyotrophic Lateral Sclerosis↗
PubMed1993

[Cardiovascular risk factors and treatment with insulin in type II diabetic patients in whom oral hypoglycemic drugs have failed].

BACKGROUND: To find whether insulin treatment in type II diabetic patients in whom treatment with oral hypoglycemic treatment has failed changes body fat distribution or modifies cardiovascular risk factors. METHODS: Twenty-six patients (16 women and 10 men with a mean age of 62.3 +/- 9.8 years and 12.8 +/- 8.5 years of evolution) were studied before and 3 months after starting insulin treatment at a daily dose of 0.3 IU/kg of body weight. RESULTS: HbA1c decreased from 9.9 +/- 2.1 to 8.2 +/- 1.6% (p < 0.001) similar to fructosamine (from 407 +/- 86 to 350 +/- 71 mumol/l; p < 0.001) following treatment with insulin, but a increase in body weight, body mass index, blood pressure and a decrease in the concentration of HDL-cholesterol (p < 0.05) were observed. Weight was gained in 21 patients (80%) (3.7 +/- 1.9 kg), increasing body fat of central distribution in 13 (50%) and of peripheral distribution in 8 (30%). The patients in whom body fat of central distribution was increased fundamentally differentiated from the remaining patients by having a greater body mass index (p < 0.01), in all cases greater than 25 kg/m2 upon initiation of the insulin treatment, and by a significantly greater increase in body weight, blood pressure and total cholesterol after the insulin treatment. Patients who increased body fat of peripheral distribution or who did not gain weight did not present these changes in cardiovascular risk factors and were characterized by an increase of at least 500 kcal/week consumed by physical exercise. CONCLUSIONS: Treatment with insulin in type 2 diabetic patients in whom oral hypoglycemic drugs have failed improves glycemic control, but induces an increase in weight and worsens cardiovascular risk factors in patients with a CMI greater than 25 kg/m2. This change may be prevented by an increase in physical activity.

Adipose Tissue↗
PubMed1993

[A case of chorea-acanthocytosis associated with low glycohemoglobin A1c].

We reported the first case of chorea-acanthocytosis associated with low glycohemoglobin A1c. Fasting blood sugar, daily profile of blood sugar, serum fructosamine and 75 g glucose tolerance test were all within normal limits. While abnormal hemoglobins were not detected, red blood cell half-life was sharply reduced to 13.4 days. These findings suggest that the low glycohemoglobin A1c in this case is highly ascribable to the reduction of red blood cell half-life rather than to continuous hypoglycemia. However, we can not rule out that the abnormalities of red blood cell membrane, suggested factors in this disease, may be related to the low glycohemoglobin A1c value. Further investigations on chorea-acanthocytosis cases with normal red blood cell half-life are necessary in order to elucidate whether an abnormal glycohemoglobin A1c value is a specific indication regarding this disease.

Acanthocytes↗
PubMedDate not supplied

Comparison of glucose tolerance, lipids and blood pressure in young male Ethiopians from two different immigrations, 1989 and 1991.

The prevalence of glucose intolerance and hypertension was compared between a group of 87 young Ethiopian males (age 21.6 +/- 2.8 years) from the post Moses immigration of 1989 (group 1) and 89 age-matched Ethiopian males (age 21.4 +/- 3.1) from the Solomon immigration of 1991 (group 2). Both groups demonstrated a relatively high, for age, prevalence of glucose intolerance: 5% and 8% in groups 1 and 2 respectively (not significant). However, group 1 had a higher glucose level 2 h after an oral glucose tolerance test (P < 0.05) and a higher level of HbA1C (P < 0.05) and fructosamine (P = 0.07), concomitant with a lower fasting insulin (P < 0.005), when compared with group 2. Group 2 had a significant increase in both systolic and diastolic blood pressure when compared with group 1 (P < 0.05, P < 0.005 respectively). Group 2 had higher blood pressure levels and higher fasting insulin than group 1, suggesting a relationship between insulin levels and blood pressure in this population.

Adult↗
PubMed1993

[Does hypoglycemic treatment with gliclazide and gliquidone affect platelet function in type II diabetic patients?].

The estimation of the influence of gliclazide and gliquidone treatment on platelet function in type II diabetic patients was undertaken in the study. Aggregation parameters were assessed before and after the change of hypoglycemic therapy. Gliclazide was applied in the group I (11 patients, mean age 63.1 +/- 7.22 years, duration of diabetes 5.63 +/- 2.98 years), group II (19 patients, mean age 58.3 +/- 12.4 years, duration of diabetes 7.1 +/- 2.4) received gliquidone. The reference group consisted of 10 healthy volunteers (mean age 51.7 +/- 6.9). Aggregation parameters (threshold ADP concentration, intensity and velocity of the aggregation) were measured in examined groups of subjects. Metabolic control was estimated basing upon spectrophotometric measurement of fructosamine level. Significant increase in threshold ADP concentration (1.89 +/- 0.47 mumol/l before and 2.36 +/- 0.58 mumol/l after the treatment change p < 0.05) in group II was found. Threshold ADP concentration did not change significantly in group I (2.5 +/- 0.8 mumol/l before v 2.14 +/- 0.68 mumol/l after treatment). Significant decrease in the aggregation intensity was found in both groups (in group I 8.48 +/- 1.7 before v 6.39 +/- 2.17 after; in group II 7.35 +/- 1.73 before v 6.05 +/- 1.6 after 1 month treatment--both p < 0.05). The aggregation velocity did not change significantly (group I 61. +/- 11 before v 51.3 +/- 18.7 after, group II 63.2 +/- 14.8 and 62.8 +/- 13.7 respectively). Reference group values were ADP 2.7 +/- 0.16, intensity 6.22 +/- 0.53, velocity 63.2 +/- 2.2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Clinical markers in endocrine-metabolic diseases].

We attempted to reevaluate the clinical significance of two parameters, 1,5-anhydroglucitol (AG) and type IV collagen, which are widely available in the fields of clinical activity. 1) 1,5 AG 1,5 AG was measured as a marker of glycemic control for diabetic patients by means of a column-enzymatic test (Nippon Kayaku Co., Ltd). Serum 1, 5 AG levels in diabetic patients (3.0 +/- 5.8 micrograms/ml, mean +/- SD) were significantly lower than in normal subjects (22.4 +/- 6.9 micrograms/ml). 75 g OGTT was performed on 428 subjects with urinary glucose detected on previous medical examination. According to the selectivity index (sensitivity value x specificity value) and the receiver operating characteristic curve (ROC) for diabetes, glycosylated hemoglobin (HbA1c) was slightly superior to 1,5 AG and fructosamine for diabetes screening. Furthermore, unexpectedly high levels of 1, 5 AG were obtained from the plasma of diabetic patients with this kit, when the patients were given a drip infusion containing maltose. We found that the maltose contained in the assay system interfered with measurement of 1, 5 AG. Nevertheless, 1, 5 AG measurements are thought to be useful in the diagnosis and screening of diabetes mellitus because of its wideranging fluctuations under relatively good glycemic control, as suggested by Yamanouchi, et al. 2) type IV collagen The type IV collagen peptide is known as a useful marker of progressive liver diseases and early stages of diabetic nephropathy. Type IV collagen was measured by one step sandwich enzyme immunoassay (EIA) using monoclonal antibodies (Panaassay IV CL; Fuji Chem. Ind., Ltd).(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers↗