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At least 1,567 records · Page 87Linked to original sources
PubMed1991

Post-prandial glycaemic reduction by an alpha-glucosidase inhibitor in type 2 diabetic patients with therapeutically attained basal normoglycaemia.

Post-prandial glucose excursions remain elevated in most patients with diabetes even when normal fasting plasma glucose levels have been achieved. In 39 patients with type 2 diabetes who had attained basal normoglycaemia by therapy with diet alone, a sulphonylurea, a basal insulin supplement or basal plus prandial insulin the mean glycosylated haemoglobin (HbA1) values were at the upper end (mean +/- 1SD, 8.1 +/- 1.1%) of the normal range (5.0-8.2%). Miglitol, an alpha-glucosidase inhibitor, given in a dose of 50 mg three times a day was studied in a double blind randomized crossover study. In diet and sulphonylurea treated patients, a mean 25% reduction of the post-prandial plasma glucose excursions was obtained whereas in ultralente treated patients miglitol appeared to reduce basal plasma glucose levels (p < 0.006). Side effects were limited to minor gastrointestinal disturbances, usually ameliorating after the first week of therapy. Alpha-glucosidase inhibition to prevent post-prandial glycaemia may have a role in patients in whom sulphonylurea or diet therapy has been used to obtain normal basal glucose concentrations.

1-Deoxynojirimycin↗
PubMedDate not supplied

Premixed insulin at ratio 3/7 and regular + isophane insulins at mixing ratios from 2/8 to 4/6 achieve the same metabolic control.

The insulin regimen with two daily injections is still that more frequently used. Often regular and NPH insulins are mixed at different ratios according to the patient's need; however, the mixture preparation can involve several errors. Efficacy, safety and compliance were evaluated comparing a premixture 3/7 (Actraphane HM) with extemporary mixtures of regular + NPH at mixing ratios ranging from 2/8 to 4/6, in a cross-over study of 8 weeks involving 20 insulin dependent diabetics. Metabolic control, hypoglycaemic episodes, insulin dose and proportions were similar with both treatments while a higher compliance was achieved with the premixture. In conclusion, premixture 3/7 and extemporary mixture (from 2/8 to 4/6) obtain the same efficacy and safety but the former shows a higher acceptability.

Adult↗
PubMed1990

Analysis of glycosylated serum protein changes using a computer model.

UNLABELLED: The authors devised a computer model of albumin glycosylation based on irreversible glycosylation reaction of first-order kinetics. The dynamism of glycosylated albumin changes in relation to glycaemic profiles was compared with an earlier model of haemoglobin glycosylation. A non-linear regression analysis was employed to calculate the parameters of the model in three groups of patients. CONCLUSIONS: 1. Erythrocyte pool stratification accounts for the smaller clinical difference between glycosylated protein and haemoglobin than would correspond to their respective half-life values. 2. Glycosylated proteins are probably eliminated more rapidly than non-glycosylated proteins. 3. Higher levels of glycosylated proteins are occasionally at variance with model calculations, a fact which is probably due to other factors.

Computer Simulation↗
PubMed1990

Kinetic behaviour of liver glucokinase in diabetes. II. Possible role of non-enzymatic protein glycation.

The phosphorylation of D-glucose, as catalyzed by liver postmicrosomal supernatants, prepared from diabetic rats, under conditions aiming at the characterization of gluco-kinase activity, indicates, in addition to the classical fall in enzyme activity, an altered kinetic behaviour, the affinity for D-glucose and the apparent energy of activation being both lower in diabetic than normal rats. These kinetic anomalies persist after separation of cytosolic proteins from low molecular weight metabolites by gel filtration chromatography. They are simulated, to a limited extent, when liver cytosolic proteins from normal rats are glycated in vitro through prolonged exposure to a high concentration of D-glucose. Diabetes causes an increased non-enzymatic glycation of liver cytosolic proteins, including lactate dehydrogenase, as judged by either the ketoamine test, a back-titration procedure or the separation of glycated proteins by affinity chromatography. These findings suggest that chronic hyperglycemia might alter the intrinsic properties of liver glucokinase through a process of non-enzymatic glycation.

Animals↗
PubMed1990

[Platelet alpha 2 adrenergic receptors, plasma catecholamines and orthostatic hypotension in insulin-dependent diabetic patients].

Plasma catecholamine levels, total platelet alpha 2-adrenoceptor number and affinity state (using [3H]-yohimbine binding) have been investigated in insulin-dependent diabetic patients with (n = 12) or without (n = 10) orthostatic hypotension as well as in normal control subjects (n = 6). Mean resting basal catecholamine values were similar in the three groups. One min standing elicited an increase in norepinephrine plasma level (but not in epinephrine plasma levels) in control group but not in diabetic patients (with or without orthostatic hypotension). The maximal number of platelet alpha 2-adrenoceptors (and Kd) calculated by [3H]-yohimbine saturation experiments was similar in the three groups. The percentage of platelet alpha 2-adrenoceptors in high affinity state determined by inhibition experiments of [3H]-yohimbine binding by UK14,304 (a specific alpha 2-adrenergic full agonist) was significantly lower in diabetic patients with orthostatic hypotension (29.2 +/- 5.3%) than in the other two groups. No significant difference was found between the control group (60.0 +/- 2.0%) and diabetic patients without orthostatic hypotension (64.3 +/- 3.1%). These results indicate that orthostatic hypotension in insulin-dependent diabetic patients is marked by a lack of noradrenaline increase in standing position and by a decrease in platelet alpha 2-adrenoceptors in high affinity state. Thus we suggest that orthostatic hypotension of diabetes mellitus is the result of sympathetic nerves injuries and of abnormalities in alpha 2-adrenoceptors coupling.

Autonomic Nervous System Diseases↗
PubMedDate not supplied

Long term reduction of microalbuminuria after 1 year of angiotensin converting enzyme inhibition by perindopril in hypertensive insulin-treated diabetic patients.

We studied the effects of perindopril, an angiotensin converting enzyme (ACE) inhibitor administered during 12 months, on creatinine clearance, albuminuria and glycaemic control in diabetic subjects with mild to moderate hypertension. After 1 month placebo, 40 insulin-treated patients were divided into 3 groups based upon their urinary albumin excretion rate (AER). Group I had a normoalbuminuria (AER less than 15 mg/24 h), group II had a microalbuminuria (AER : 15-150 mg/24 h) and group III had a macroproteinuria (AER greater than 150 mg/24 h and Albustix (+)). They were given perindopril, 4 to 8 mg orally once daily, and received a stable diet. Diastolic blood pressure was normalized within the first 3 months in 80% of the patients. From these, 28 (14.7 and 7 from groups I, II and III respectively) were followed during a total active treatment period of 12 months. They were matched for age, duration of diabetes and hypertension, systolic and diastolic blood pressures, daily insulin dose, postprandial plasma C-peptide and quality of glycaemic control. Mean supine diastolic blood pressure was decreased by 15 and 18% at 1 and 12 months respectively. Heart rate was not significantly modified. At 3 months, plasma ACE activity was nearly totally inhibited while plasma renin activity was markedly increased. In patients of group II, microalbuminuria was reduced from 66 +/- 13 (mean +/- SEM after placebo) to 39 +/- 6 mg/24 h after 1 month perindopril and this effect was maintained at 12 months. In group I, albuminuria remained within the normal range. In group III, macroproteinuria was not consistently modified by perindopril.(ABSTRACT TRUNCATED AT 250 WORDS)

Albuminuria↗
PubMed1990

Unique aspects of diabetes mellitus in the elderly.

Diabetes mellitus is a common condition in the geriatric population. In older subjects it may present in unusual ways and may be associated with unusual conditions. Hyperglycemia produces a variety of effects, including osmotic diuresis and cognitive dysfunction, which seriously impair the quality of life of the older individual. Older diabetics need to have their diabetes well controlled. The approach to diabetic control in older individuals is similar to that in younger individuals, with some notable exceptions.

Age Factors↗
PubMed1990

[Analysis of dynamic changes in glycosylated blood proteins using a computer model].

UNLABELLED: The authors elaborated a computer model of albumin glycosylation based on the irreversible glycosylation reaction with first order kinetics. The dynamics of changes of glycosylated albumin in relation to the glycaemic profile was confirmed with an older model of haemoglobin glycosylation. By means of regression analysis parameters of the model in three groups of patients were calculated. CONCLUSION: 1. Stratification of the red cell pool is the reason why there is a smaller clinical difference between glycosylated protein and haemoglobin than corresponds to their half-times. 2. Glycosylated proteins are probably eliminated more rapidly than non-glycosylated ones. 3. Higher levels of glycosylated proteins sometimes do not correspond to model calculations are probably due to other factors.

Computer Simulation↗
PubMed1989

D-lysine effectively decreases the non-enzymic glycation of proteins in vitro.

Excessive non-enzymic glycation of proteins alters their physicochemical properties, with possible pathological effects. We investigated the in vitro inhibition of protein glycation by D-lysine--an isomer not incorporated into mammalian proteins but possessing the same chemical characteristics as L-lysine. Glucose incorporation was studied as follows: (a) human albumin, IgG, collagen, and isolated glomerular basement membrane were incubated for 20 days with D-glucose (5.0, 10.0, and 20.0 mmol/L) in the presence of D-lysine at 1/10 the sugar concentration; (b) albumin was incubated in similar glucose concentrations but with a constant amount (2.0 mmol/L) of D-lysine; (c) albumin and IgG were incubated for 10 days in buffer containing glucose (10 mmol/L) and increasing concentrations of D-lysine (0.25, 0.5, 1.0, 2.0, and 4.0 mmol/L); (d) inhibition specificity was tested by treating albumin as in c but with glycerol present rather than D-lysine. In addition, we measured ketoamine after incubating albumin (50 g/L) in 10 mmol/L glucose for 10 days in the presence of D-lysine (0.25, 0.5, 1.0, and 2.0 mmol/L). The results show that (a) the amount of glucose bound to the four proteins was significantly (P less than 0.05) decreased in the presence of D-lysine at the higher concentrations of glucose; (b) the lower the glucose concentration, the higher was the inhibitory effect of D-lysine; (c) the inhibition of glucose incorporation into proteins correlated directly with the concentration of D-lysine; (d) no inhibition was observed with glycerol. Ketoamine decreased with increase in D-lysine (P less than 0.01). The effective diminution of non-enzymatic glycation by D-lysine highlights its potential use in vivo.

Basement Membrane↗
PubMed1989

Lipoprotein subfraction composition in non-obese newly diagnosed non-insulin dependent diabetes after treatment with diet and glibenclamide.

The composition and concentrations of fasting plasma lipoproteins were determined in a prospective study of 11 +/- 2 (mean +/- 1 SD) months in 16 non-obese (body mass index less than or equal to 30) patients with Type 2 (non-insulin dependent) diabetes mellitus at diagnosis, treated by diet alone or diet plus glibenclamide (2.5-7.5 mg/day). Compared with normal subjects matched for sex, age, body mass index, exercise, alcohol consumption and smoking, Type 2 patients at diagnosis showed increased concentrations of non-esterified and esterified cholesterol, triglyceride, phospholipid and protein in the very low density lipoprotein (VLDL) fraction. The apolipoprotein (apo) B concentrations was also raised, but low density lipoprotein (LDL) cholesterol concentrations were not significantly altered in Type 2 patients at diagnosis. Plasma concentrations of high density lipoprotein (HDL) non-esterified and esterified cholesterol, HDL phospholipid and apo AI were lower in Type 2 patients at diagnosis. This was largely accounted for by a reduced number of HDL2 molecules of normal composition. After treatment of Type 2 patients with diet alone, there was a marginal increase in plasma HDL cholesterol and phospholipid, and in plasma HDL2 cholesterol, phospholipid, protein and apo AI concentrations, in association with reductions of VLDL component concentrations, body mass index and glycaemia. Type 2 patients treated with diet plus glibenclamide exhibited similar abnormalities of plasma lipoprotein concentrations before and after treatment, except for a small reduction in VLDL component concentrations and a slight increase in the apo AI:B ratio. Institution of diet alone and diet plus glibenclamide generally failed to restore VLDL, HDL and HDL2 component concentrations and the apo AI:B ratio to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMed1989

Effect of glycation of low-density lipoprotein on the immunological determination of apolipoprotein B.

Non-enzymatic glycation of low-density lipoprotein (LDL) may contribute to the premature atherogenesis of patients with diabetes mellitus. To assess whether glycation of apolipoprotein B, the predominant protein of LDL, interferes with the ability to immunologically quantify this protein, we prepared and purified glycated LDL by incubating normal plasma samples with high concentrations of glucose. Although both the plasma and the LDL specimens incubated with glucose contained significantly more glycated protein than control specimens, the quantitative interaction of an apolipoprotein B-specific antibody with glycated vs nonglycated LDL was not significantly different. We conclude that apolipoprotein B can be accurately quantified immunologically despite the presence of clinically excessive degrees of LDL glycation.

Apolipoproteins B↗
PubMed1989

[Pregnancy and diabetes mellitus].

The dynamics of the placental lactogenic hormone level, insulin requirements, and glycaemia during pregnancy was studied in diabetes I and II patients and diabetic pregnancies. Fructose amine and C-peptide levels in maternal and neonatal blood were measured in different diabetes types. The risk of diabetes I development in relation to the incidence of the HLA-system antigens was assessed. The need for a functional insulin therapy prior to and during pregnancy was substantiated.

C-Peptide↗