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PubMed1998

Insulin dose and cardiovascular risk factors in type 1 diabetic children and adolescents.

Associations between a high daily insulin dose and cardiovascular risk factors, including those of the insulin-resistance syndrome, were studied in 479 Type 1 diabetic children 6 to 18 years of age. Insulin dose increased over the first two years after diagnosis of diabetes (p = 0.0001) and was significantly higher in girls (p = 0.01). For those children with diabetes duration of more than 2 years, the insulin requirement increased up to 13-14 years of age (p < 0.05) and was higher in pubertal than pre-pubertal children (p < 0.05). For girls, the requirement was higher in puberty than in post-puberty (p < 0.05) and increased with diabetes duration (p < 0.05). Triglyceride concentrations were associated positively and significantly with the insulin dose of both boys and girls, after adjustment for age, pubertal stage, diabetes duration, and metabolic control (fructosamine levels). No other consistent associations were found between insulin dose and other cardiovascular risk factors: body mass index, central adiposity, arterial blood pressures, serum total cholesterol, apoA1, apoB, Lp(a), uric acid, or urinary albumin excretion. Parental obesity, hypertension and diabetes were not related to the insulin dose of children. The results did not differ when the population was limited to the 375 children with diabetes duration of more than 2 years. It is concluded that in these Type 1 diabetic children the insulin dose for a given level of metabolic control (our surrogate measure of insulin resistance) was related to a single cardiovascular risk factor: triglyceride concentrations.

Adolescent↗
PubMed1998

Short-term variations of serum glycated apolipoprotein B.

Serum glycated apolipoprotein B (apo B-G) levels were determined in 31 non-insulin-dependent diabetic patients and 13 control subjects by an enzyme-linked immunosorbent assay. Apo B-G was increased in diabetic patients compared to non-diabetic subjects, whether expressed as a serum concentration (57.7 vs 36.1 mg/l) or a percentage of total apolipoprotein B (4.42 vs 3.14%). Apo B-G, together with other markers (mean daily plasma glucose, serum fructosamines, triglycerides, total cholesterol, glycated haemoglobin), was measured before and after 5 days of therapeutic adjustment in diabetic patients. In 20 patients with a favourable course of glycaemic control, the mean decrease of apo B-G concentration reached nearly 16%. In 11 patients with an unfavourable course, the increase of apo B-G concentration was about 14%. Therefore, variation of serum apo B-G concentration could serve as an additional short-term marker for glycaemic control, although possible concomitant variations of serum triglycerides or total apolipoprotein B concentrations should also be considered.

Aged↗
PubMed1998

[Glucobay in the therapy of patients with non-insulin-dependent diabetes mellitus].

The article focuses on the action of a new sugar-lowering drug preparation glucobai (acarbose) in 47 patients with non-insulin-dependent diabetes mellitus (NIDM). The drug was prescribed at a dose of 150-300 mg daily with meal. A marked sugar-lowering effect was manifested by reduction of the level of postprandial hyperglycemia, glycosylated hemoglobin, fructosamine, body mass of the patients. The results obtained permit recommending glucobai (acarbose) as a sugar-lowering drug in NIDM patients.

Acarbose↗
PubMed1998

Improved metabolic control does not change plasma lipoprotein(a) levels in adolescents with type 1 diabetes mellitus.

BACKGROUND: It has been found that lipoprotein(a)[Lp(a)] is an independent risk factor for coronary heart disease. Studies on the influence of metabolic control on plasma Lp(a) levels in Type 1 diabetics have reported conflicting results. The aim of this study was to investigate Lp(a) levels in carefully selected adolescents with Type 1 diabetes mellitus before and after improved metabolic control achieved during a 2-week Juvenile Diabetes Training Camp. METHODS: Patients with conditions that affect plasma Lp(a) concentrations were not included. Metabolic variables were determined at the beginning and at the end of the camp. Diet was designed to supply 40-60 Kcal/Kg/day. Physical exercise was performed in two 60-minute daily sessions. Intermediate action insulin was given twice daily, and rapid acting insulin was also administered to some patients. RESULTS: On the last day of the camp, fructosamine declined from 430-362.7 mg/dL (p < 0.001), mean levels of total cholesterol, LDL-cholesterol, and triglycerides also declined significantly (p < 0.001), and HDL-C increased (p < 0.05). In contrast, no significant changes in plasma Lp(a) concentrations were observed. CONCLUSIONS: The findings of this study in this relatively large group of well-defined adolescents with Type 1 diabetes mellitus suggest that improved metabolic control does not reduce plasma Lp(a) levels.

Adolescent↗
PubMed1996

Peripheral somatic nerve function in relation to glucose tolerance in an elderly Caucasian population: the Hoorn study.

Only sparse and contradictory data are available on peripheral somatic nerve function in relation to the total range of glucose tolerance. A random sample (n = 708) of people, stratified by age, sex, and glucose tolerance, from a Caucasian population aged 50 to 74 years was invited to undergo an examination including measures of large-fibre nerve function (ankle and knee reflexes, vibration sense, vibratory perception threshold (VPT) at the foot) and one measure of small-fibre function (thermal discrimination threshold (TDT) at the foot). A total of 267 subjects with a normal glucose tolerance (NGT), 167 with impaired glucose tolerance (IGT), 90 with newly diagnosed diabetes mellitus (NDM), and 73 with previously known diabetes (KDM) were included. KDM was associated with the highest prevalence of large-fibre nerve dysfunction. Within the range from NGT to NDM, most large-fibre function measures showed a decline with decreasing glucose tolerance. The TDT showed a decrease with an increase in fasting and post-load insulin levels (p < 0.05). We conclude that glucose intolerance is associated with impaired peripheral large-fibre nerve function, an association which seems to apply even in the non-diabetic range. Higher insulin levels were associated with a better small-fibre nerve function.

Aged↗
PubMed1997

Formation of plasma advanced glycosylation end products (AGEs) has no influence on plasma viscosity.

Plasma viscosity is mainly determined by large non-spherical proteins. In Type 1 diabetes mellitus, plasma viscosity increases with deterioration of diabetic control. Since protein glycation and formation of advanced glycosylation end products (AGEs) alter the structural and functional properties of proteins, AGEs might influence the rheological properties of plasma proteins. Therefore, we investigated the influence of plasma-AGEs on plasma viscosity in 34 normoalbuminuric diabetic patients (17 Type 1, 17 Type 2) with normal renal and liver function. In an additional experiment, 6 ml plasma of 9 healthy volunteers were incubated under sterile conditions for 14 days at 37.5 degrees C in the presence of 5.2 and 32.9 mmol l(-1) glucose. In diabetic patients, plasma-AGE levels were not correlated with plasma viscosity. Plasma-AGE levels in healthy controls (246 +/- 37 U ml[-1], mean +/- SD) were raised significantly (p<0.001) after the incubation at 37.5 degrees C (392 +/- 57 U ml[-1] and 552 +/- 58 U ml[-1], respectively). However, no difference was found in plasma viscosity pre- and post-incubation (pre-incubation: 1.25 +/- 0.04 mPas, post-incubation: 1.23 +/- 0.03 and 1.24 +/- 0.03, respectively). We conclude that there is no influence of plasma-AGEs on plasma viscosity.

Adult↗
PubMed1998

Effects of different glycaemic index foods and dietary fibre intake on glycaemic control in type 1 diabetic patients on intensive insulin therapy.

To evaluate the influence of a low glycaemic index (GI), high GI and high fibre diet on glycaemic control and insulin requirement in Type 1 diabetic patients on intensive insulin therapy, nine well-controlled, highly-motivated Type 1 diabetic patients were put on a control diet for 12 days and then randomized in a consecutive manner to 12 days of each diet, in a crossover design. During each experimental diet, the study subjects adjusted their premeal insulin (soluble) dose to maintain their 1-h postprandial capillary glucose at or below 10 mmol l(-1). At the end of each experimental diet, they were submitted to a standardized breakfast of the diet under study, using the same premeal insulin dose as that required for the control diet. The control diet contained 16.0+/-3.0 g of fibre day(-1) with a GI of 77.4+/-2.7 compared to 15.3+/-6.3 and 66.2+/-1.2 for the low GI diet, 17.1+/-7.2 and 92.9+/-3.6 for the high GI diet, and 56.1+/-3.6 (including 15 g of guar) and 73.5+/-2.1 for the high fibre diet. Prebreakfast capillary blood glucose (6.2+/-1.2 mmol l(-1)) on the low GI diet and postbreakfast capillary blood glucose (8.7+/-1.8 mmol l(-1)) on the high fibre diet were significantly lower than the values obtained with the control diet (8.0+/-1.8 and 10.6+/-2.4, respectively; p<0.05). No change in premeal or basal insulin dose was required. During the standardized breakfasts, the incremental area under the curve was 1.6+/-1.5 mmol l(-1) min(-1) for the control diet compared to 1.1+/-1.8 for the low GI diet, 3.2+/-1.4 for the high GI diet (p<0.05 versus low GI and high fibre; p=0.08 versus control), and 1.0+/-0.9 for the high fibre diet. These observations indicate that in well-controlled Type 1 diabetic subjects on intensive insulin therapy, major alterations in the GI and fibre content of meals induce small but significant changes in glucose profile. In everyday life, however, these differences are blunted, and plasma glucose remains within the target range for optimal metabolic control.

Blood Glucose↗
PubMed1999

Classification to ordinal categories using a search partition methodology with an application in diabetes screening.

A method is proposed for classification to ordinal categories by applying the search partition analysis (SPAN) approach. It is suggested that SPAN be repeatedly applied to binary outcomes formed by collapsing adjacent categories of the ordinal scale. By a simple device, whereby successive binary partitions are constrained to be nested, a partition for classification to the ordinal states is obtained. The approach is applied to ordinal categories of glucose tolerance to discriminate between diabetes, impaired glucose tolerance and normal states. The results are compared with analysis by ordinal logistic regression and by classification trees.

Age Factors↗
PubMed1999

Distribution of antioxidants among blood components and lipoproteins: significance of lipids/CoQ10 ratio as a possible marker of increased risk for atherosclerosis.

Total CoQ10 levels were evaluated in whole blood and in plasma obtained from a group of 83 healthy donors. Extraction with light petroleum ether/methanol was more efficient, for whole blood, than the extraction which is often used for plasma and serum, i.e., ethanol hexane. An excellent correlation was present between plasma CoQ10 and whole blood CoQ10. CoQ10 is mainly associated with plasma rather than with cellular components. Positive, significant correlations were found between the LDL-chol/CoQ10 ratio and the total-chol/HDL-chol ratio, which is usually considered a risk factor for atherosclerosis. The proportion of CoQ10 carried by LDL was 58 +/- 10%, while the amount carried by HDL was 26 +/- 8%. In VLDL + IDL CoQ10 was 16 +/- 8%. The content of CoQ10 in single classes of lipoproteins is strictly correlated with CoQ10 plasma concentration. In a parallel study conducted on a population of diabetic patients (one IDDM group and one NIDDM) CoQ10 plasma levels were generally higher compared to the control group, also when normalised to total cholesterol. In particular the LDL fraction showed a CoQ10/chol ratio higher in NIDDM but not in IDDM patients, compared to controls. The CoQ10/triglycerides ratio was lower in NIDDM respect to controls and even lower in IDDM patients.

Aged↗
PubMed1995

Vanadate enhances insulin-receptor binding in gestational diabetic human placenta.

Although vanadium is found abundantly in animal and plant kingdoms its biological effects are not clear. Vanadate compounds have been shown to normalize blood glucose levels in streptozotocin treated rats, enhance glucose oxidation and improve the sensitivity to insulin by enhanced receptor binding in rat adipocytes. The aim of the present study was to investigate the effect of vanadate, at high (0-8 mmol l-1) and low (0-1.0 mmol l-1) physiological concentrations, on [125I]-insulin binding in the placenta of three groups of patients, namely from normal (N) controls, gestational diabetics (GDM) and women with risk factors in their medical history for developing diabetes mellitus (RF). Vanadate at low concentrations (0.2-0.6 mmol l-1) enhanced the maximal binding 2-fold in GDM placenta but only increased (up to 1.2-fold) the binding slightly at high concentrations (5 mmol l-1). However with placenta from normal or women at risk, vanadate increased the [125I]-insulin binding up to 1.2-fold both at low and high concentrations. Thus it appears that vanadate augments insulin binding in the placenta from women with gestational diabetes mellitus.

Adult↗
PubMed1995

Histones from diabetic rats contain increased levels of advanced glycation end products.

In a recent report we have demonstrated the in vitro formation of advanced glycation end products (AGEs) on histones in a time and sugar concentration dependent fashion. In the present work we examined histone advanced glycation in vivo. Diabetes was induced in rats by streptozotocin injection and the hyperglycemic state was maintained and surveyed for up to 24 weeks. Diabetic rats showed accumulation of early glycation products in plasma proteins and in hemoglobin. Histones from the liver of diabetic rats showed AGEs levels three-fold higher than those of their age-matched controls. Histone AGEs increased with the duration of diabetes and tended to increase with the age as well. Similar tendencies were apparent in skin collagen. Our data demonstrate that diabetes induces an increase in the accumulation of AGE products on histones. This reinforces the concept that advanced glycation occurs in intracellular proteins and suggests a possible role for intracellular glycation in the increased theratogeny associated with diabetes mellitus.

Aging↗
PubMed1986

Glycosylated proteins in normal and diabetic pregnancy.

The methods available for and the clinical usefulness of measuring glycosylated proteins in pregnancy complicated by diabetes is reviewed. The need for standardization of reference ranges for pregnancy and for highly accurate and precise methods of measurement is emphasized. Measurement of glycosylated proteins is useful in patients with established diabetes to identify pregnancies at risk for complications known to be associated with significant hyperglycaemia. These include spontaneous abortion and malformations, foetal loss due to premature labour or intrauterine death, and macrosomia and other neonatal morbidities. The use of glycosylated protein measurements as a diagnostic test for gestational diabetes appears limited.

Abortion, Spontaneous↗
PubMed1989

The course and determinants of insulin action in type 1 (insulin-dependent) diabetes mellitus.

The course and determinants of insulin action were investigated in 8 newly diagnosed Type 1 (insulin-dependent) diabetic patients, who were studied every 3 months for one year, and in three groups of 8 patients each with 5, 10 and 20 years diabetes, studied once. Fifteen healthy subjects matched for age, sex and body weight served as control subjects. Dose-response curves were constructed using sequential euglycaemic (5.0 mmol/l) clamps (insulin infusion rates: 0.5, 1.0, 2.0 and 5.0 mU.kg-1.min-1 in periods of 2h). After 1/2 month of insulin treatment, insulin responsiveness was normal, but sensitivity was decreased (ED50 70 +/- 7 mU/l (SEM) vs 54 +/- 4 mU/l in control subjects, p less than 0.05). After 6 months, insulin sensitivity was improved (ED50 57 +/- 4 mU/l, p less than 0.01 vs 1/2 month and not significant (NS) vs control subjects); but after 9 and 12 months, it was reduced again, similarly to 0.5 month. Insulin responsiveness remained normal at all time-points. In the three groups of patients with longstanding diabetes, impaired insulin sensitivity with normal responsiveness was noted also (ED50 73 +/- 9 mU/l, p less than 0.02 vs control subjects). At 6, 9 and 12 months, glycaemic control (HbA1) and insulin dose were inverse correlates for insulin action; in patients with longstanding disease, this was noted for HbA1 and body weight, in control subjects for body weight. In conclusion, decreased insulin sensitivity re-develops in Type 1 diabetes within the first year following an initial improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Impairment of monocyte "lectin-like" receptor activity in type 1 (insulin-dependent) diabetic patients.

In order to investigate whether the ability of peripheral blood monocytes to bind bacteria is impaired in diabetes, we studied carbohydrate-binding ("lectin-like") receptors and the receptor for the Fc portion of immunoglobulin on monocytes from 25 male Type 1 (insulin-dependent) diabetic patients and 10 age-matched healthy control subjects. Peripheral blood monocytes from the diabetic patients expressed lower levels of "lectin-like" receptors compared to the control subjects, whereas the expression of the receptor for the Fc portion of immunoglobulin was similar in both populations. There was no correlation between the degree of "lectin-like" binding activity and plasma glucose concentration or glycaemic control. Recognition of unopsonized bacteria by the "lectin-like" receptor is impaired in Type 1 diabetes; this may affect the efficient elimination of potential pathogens.

Adult↗
PubMed1993

Plasma lipoprotein (a) concentration and phenotypes in diabetes mellitus.

Patients with Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus are at increased risk of developing atherosclerotic vascular diseases. A variety of lipoprotein abnormalities have been described as being associated with this increased risk. In this study, apo(a) isoform frequencies and lipoprotein(a) [Lp(a)] concentrations were determined in Type 1 and Type 2 diabetic patients in order to investigate a possible contribution of Lp(a) to the increased risk for atherosclerosis in diabetes. No significant differences in plasma Lp(a) concentrations were found in two ethnically different populations (Austrians from the province of Tyrol and Hungarians from Budapest) in either type of diabetes when compared to respective control groups (91 Type 1 and 112 Type 2 diabetic patients vs 202 control subjects in the Hungarian study and 44 Type 1 diabetic and 44 Type 2 diabetic vs 125 control subjects in the Austrian study). There were also no significant apo(a) isoform frequency differences between both patient groups and control subjects in the two study groups. These data, obtained from two large ethnically different populations, provide no evidence of a contribution of Lp(a) to the increased risk for atherosclerosis in diabetes.

Adult↗