RESUMEN
NIDDM appears to be an inherited condition. Our aim was to identify early metabolic abnormalities in non-diabetic offspring with one NIDDM parent and with a strongly positive (n = 58, age 27.8 +/- 7.0 years) or a negative family history (n = 38, age 27.4 +/- 6.7 years) of diabetes. These were compared with 31 offspring of non-diabetic parents (age 26.9 +/- 5.5 years). After an overnight fast, blood was taken for glucose, insulin, C-peptide, insulin receptors, and lipids. All the subjects underwent a 75 g oral glucose tolerance test. The positive family history group had significantly higher fasting levels of triglycerides (1.09 +/- 0.24 vs control subjects: CS: 0.93 +/- 0.16 mmol l-1, p < 0.001), insulin (102.8 +/- 46.4 vs CS: 77.5 +/- 32.4 pmol l-1, p < 0.01) and C-peptide (0.69 +/- 0.22 vs CS: 0.61 +/- 0.19 nmol l-1, p < 0.05) and lower numbers of insulin receptors per red cell (9.1 x 10(3) (4.5-18.1, 95% confidence intervals) vs CS: (11.2 x 10(3) (6.3-19.9)), p < 0.01, despite similar blood glucose levels. After a glucose challenge (120 min), the increases in both insulin and C-peptide concentrations were significantly greater in the positive family history group (289.2 +/- 214.1 pmol l-1, 2.23 +/- 1.48 nmol l-1), respectively, than in CS (192.4 +/- 170.3 pmol l-1, p < 0.05) (1.54 +/- 0.99 nmol l-1 p < 0.01), respectively. No significant differences were found in fasting and post-challenge glucose levels. The negative family history group had significantly lower numbers of insulin receptors 9.4 x 10(3) (4.1-15.2) compared with CS (p < 0.05). Insulin sensitivity was significantly reduced in the positive family history group (41.6%) compared with control subjects (51.9%), p < 0.01. The results strongly support the familial basis of the disease.
Asunto(s)
Glucemia/metabolismo , Péptido C/sangre , Diabetes Mellitus Tipo 2/genética , Insulina/sangre , Lípidos/sangre , Adolescente , Adulto , Análisis de Varianza , Presión Sanguínea , Colesterol/sangre , HDL-Colesterol/sangre , Intervalos de Confianza , Diabetes Mellitus Tipo 2/sangre , Eritrocitos/metabolismo , Ayuno , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Núcleo Familiar , Receptor de Insulina/análisis , Valores de Referencia , Triglicéridos/sangreRESUMEN
Since a number of animal studies have shown that insulin-like growth I (IGF-I) stimulates nerve regeneration, the aim of our study was to evaluate the possible relationship between IGF-I and IGF-I receptors in diabetic patients with peripheral neuropathy. One hundred and four patients with Type 2 diabetes (57 with peripheral neuropathy and 47 non-neuropathic) were studied. Controls were 17 non-diabetic persons. After an overnight fast, blood was taken for IGF-I, IGF-I receptors, glucose, HbA1, C-peptide, and insulin. The neuropathy study group had significantly lower levels of IGF-I:144.5 ng ml-1 (57.5-363.0, 95% confidence limits) compared to controls: 186.2 ng ml-1 (93.3-371.5), p < 0.01, and to diabetic patients without neuropathy: 173.7 ng ml-1 (83.1-363.0), p < 0.01. The study group also had a lower number of IGF-I receptors per red cell: 22.9 x 10(3) (13.08-38.01) vs control subjects: 28.1 x 10(3) (18.62-42.65), p < 0.01, and non-neuropathic diabetic patients: 26.3 x 10(3) (16.59-41.68), p < 0.01. In diabetic subjects there was a positive correlation (r = 0.20, p < 0.05) between IGF-I and HbA1, while in the neuropathy group there was a negative correlation between the score for nerve dysfunction with the IGF-I (r = -0.39, p < 0.01) and with IGF-I receptors (r = -0.34, p < 0.01). We conclude that in diabetic patients with peripheral neuropathy there are abnormalities of IGF-I and IGF-I receptors which may contribute to impaired neuronal regeneration.
Asunto(s)
Diabetes Mellitus Tipo 2/metabolismo , Neuropatías Diabéticas/metabolismo , Factor I del Crecimiento Similar a la Insulina/metabolismo , Receptor IGF Tipo 1/metabolismo , Anciano , Estudios de Casos y Controles , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
It has been reported that albumin excretion rate may reflect not only an indication of renal disease but also a widespread vascular damage. We studied the relationship between overnight albumin excretion rate (AER) and peripheral vascular disease (PVD), using Doppler ultrasound, and its major risk factors in 80 Type 2 (non-insulin-dependent) diabetic patients. Thirty-eight of these patients had normoalbuminuria (AER < 30 micrograms/min), 22 had microalbuminuria (30-200 micrograms/min) and 20 had macroalbuminuria (> 200 micrograms/min). Patients with macroalbuminuria were older than those with normoalbuminuria (p < 0.01) and they also had a longer duration of diabetes (p < 0.05). Patients with elevated albumin excretion rates had elevated prevalence of PVD (macroalbuminuric 40%, p < 0.01; microalbuminuric 27.2%, p < 0.05; vs normoalbuminuric 7.8%). Among the risk factors analysed, hypertension and triglyceride concentrations were higher in the proteinuric diabetics (macroalbuminuric p < 0.001, p < 0.01; microalbuminuric p = NS, p < 0.01 respectively), while HDL-C levels were found to be significantly lower in this group (p < 0.05). In the diabetic group as a whole, raised AER was correlated with PVD (p < 0.05), duration of diabetes and systolic blood pressure (p < 0.01). We conclude that the prevalence of PVD was significantly higher in Type 2 diabetic patients with elevated albumin excretion rate. Furthermore, these patients had higher blood pressure and low HDL-C.
Asunto(s)
Albuminuria/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Enfermedades Vasculares Periféricas/etiología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/epidemiología , Prevalencia , Factores de RiesgoRESUMEN
The aim of this study was to assess the possible relationship between serum levels of Type III procollagen peptide (PIIINP) and peripheral vascular disease (PVD) in diabetic patients. Ninety Type 2 diabetic patients being treated with sulfonylureas, and 37 non-diabetic subjects were studied using Doppler ultrasound. After an overnight fast, blood was taken for PIIINP, glucose, glucosylated hemoglobin (HbA1), C-peptide, and lipids. Data were analysed according to the non-paired Student's t-test and the correlation coefficient, after log transformation. PIIINP levels were significantly elevated in diabetics with PVD (n = 44), 4.3 micrograms/l (2.4-7.6, 95% confidence limits) compared with controls 3.1 micrograms/l (1.9-4.9), P < 0.001, and with diabetics without PVD (n = 46), 3.1 micrograms/l (1.9-5.0), P < 0.001. No correlation was found between PIIINP and HbA1, glucose, C-peptide, age or duration of diabetes. We conclude that PIIINP levels are elevated in Type 2 diabetics with PVD. It may reflect an increase in collagen deposition in the large arteries that accompanies the development of macroangiopathy.
Asunto(s)
Angiopatías Diabéticas/sangre , Fragmentos de Péptidos/sangre , Enfermedades Vasculares Periféricas/sangre , Procolágeno/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/etiologíaRESUMEN
The aim of this study was to assess the prevalence of peripheral vascular disease (PVD) in newly diagnosed diabetic patients and the possible relationship to various risk factors. One hundred and twenty non-insulin-dependent diabetics (NIDDs) aged 50-70 years and 93 non-diabetic subjects, matched for age and sex, were studied using Doppler ultrasound. None had a history of alcoholic abuse, while 12 diabetic and 8 non-diabetic subjects were smokers. There were 6 male subjects with PVD (5 NIDDs, 1 control subject) and 2 female diabetic subjects with PVD (p: No SD). In group of male diabetics with PVD, HDL-C levels were found to be lower and triglyceride levels higher, than in those without diabetes, but the difference was not significant. Hypertension, body mass index and smoking were not associated with the presence of PVD in either female or male diabetic subjects. It is concluded that, although PVD tended to be more common in men with newly diagnosed diabetes, the overall findings support the view that macrovascular disease is related to duration of diabetes.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/epidemiología , Enfermedades Vasculares Periféricas/epidemiología , Factores de Edad , Angiopatías Diabéticas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Prevalencia , Factores de Riesgo , Factores Sexuales , UltrasonografíaRESUMEN
To evaluate the role of calcium and the parathyroid gland in the pathophysiology of essential hypertension, creatinine clearance, urinary excretion of sodium, calcium and nephrogenous cyclic adenosine monophosphate (NcAMP) and serum parathyroid hormone (PTH) levels were measured in 25 newly diagnosed essentially hypertensive patients before institution of any treatment and in 25 age- and sex-matched normal volunteers. While no significant differences in creatinine clearance, serum total calcium levels or 24-hour sodium excretion existed between the two groups, hypertensives had a higher mean (+/- SD) 24-hour calcium excretion rate (199.0 +/- 44.7 vs. 152.8 +/- 33.6 mg, p less than 0.001), a higher mean NcAMP excretion rate (2.54 +/- 0.8 vs. 1.87 +/- 0.5 nmol/100 ml glomerular filtrate, p less than 0.001) and a higher mean serum PTH concentration (1.87 +/- 0.6 vs. 1.53 +/- 0.4 ng/ml, p less than 0.001) than the normotensives. A significant positive correlation existed between calcium and sodium excretion in both hypertensives (r = 0.66, p less than 0.001)) and normotensives (r = 0.67, p less than 0.001), but given the same levels of creatinine clearance and sodium excretion, hypertensives excreted more calcium than normotensives (p less than 0.001)). In both hypertensives and normotensives, serum PTH levels were positively correlated with NcAMP excretion (r = 0.42, p less than 0.05, and r = 0.41, p less than 0.05, respectively) and the ratio of urinary sodium to urinary calcium excretion (r = 0.59, p less than 0.001, and r = 0.75, p less than 0.001), respectively). The above results suggest that in essential hypertension, increased activity of parathyroid glands may occur as a consequence of increased urinary calcium losses which are presumably due to an intrinsic defect in renal calcium handling.
Asunto(s)
Calcio/orina , AMP Cíclico/orina , Hipertensión/fisiopatología , Hormona Paratiroidea/sangre , Adulto , Presión Sanguínea , Creatinina/metabolismo , Femenino , Humanos , Hipertensión/sangre , Hipertensión/orina , Masculino , Fosfatos/sangre , Valores de Referencia , Análisis de Regresión , Sodio/orinaRESUMEN
We investigated the relationship between the size of the pancreas in non-insulin-dependent diabetic patients (NIDDs) and normal subjects, and also the possible correlation between pancreatic size in diabetics and basal C-peptide concentrations. Eighty-four non-insulin-dependent diabetics and eighty control subjects matched for age, sex and body mass index (BMI) were studied, using a realtime sector system, with which we measured the head and body of the pancreas in cm2. Scans were performed twice in 50 subjects with no significant difference. Both the head and the body of the pancreas were significantly smaller in diabetics (4.60 +/- 1.10 cm2, 5.92 +/- 1.53 cm2, respectively) than in normal subjects (6.09 +/- 1.62 cm2, 7.43 +/- 2.14 cm2) (p less than 0.001). The mean total area of the pancreas for the diabetics was 10.53 +/- 2.45 cm2, and for the controls 13.53 +/- 3.60 cm2 (p less than 0.001). No correlation was found between the total area of the pancreas and the BMI in the two groups. In the diabetic group, there was a positive correlation between C-peptide and the total area of the pancreas (r = 0.30, p less than 0.01). We concluded that the size of the pancreas is smaller in NIDDs than in healthy controls, and there is a positive correlation with the basal C-peptide concentration.
Asunto(s)
Diabetes Mellitus Tipo 2/patología , Páncreas/patología , Péptido C/análisis , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The aim of this study was to assess the prevalence and the possible risk-factors for the development of peripheral vascular disease (PVD) in sulfonylurea-treated diabetic patients with proteinuria. Fifty non-insulin-dependent diabetics (NIDDs) with proteinuria (greater than 500 mg/24 h), with age less than or equal to 75 years and duration of diabetes greater than or equal to 5 years, and forty-eight NIDDs without proteinuria, matched for age, sex, body mass index (BMI), duration of diabetes and glycaemic control, were studied using Doppler ultrasound. Risk factors analysed included smoking, hypertension and metabolic indices (cholesterol, HDL-C, triglycerides). The prevalence of PVD was 44% in the proteinuric disease group compared to 14.6% in those without proteinuria (p less than 0.01). Among the risk factors analysed, hypertension and triglyceride concentration were significantly higher in the proteinuric diabetics (p less than 0.01), while HDL-C levels were found to be significantly lower in this group (p less than 0.05). We conclude that the prevalence of PVD was significantly higher in NIDDs with proteinuria. Furthermore, proteinuric patients had higher blood pressure and low HDL-C.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Angiopatías Diabéticas/epidemiología , Proteinuria/etiología , Compuestos de Sulfonilurea/uso terapéutico , Anciano , Colesterol/sangre , HDL-Colesterol/sangre , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Triglicéridos/sangreRESUMEN
Serum levels of angiotensin-converting enzyme (ACE) were measured in 53 patients with type II (non-insulin-dependent) diabetes (25 without ophthalmologic complications, 20 with background retinopathy, and eight with proliferative retinopathy) and in 33 healthy nondiabetic subjects. Diabetic subjects were excluded if they had hypertension, ischemic heart disease, peripheral vascular disease, or an elevated urine albumin level. After an overnight fast, blood was taken for determination of ACE, blood glucose, glycosylated hemoglobin (HbA1), and C peptide levels. Data were analyzed according to the nonpaired Student's t test and linear regression analysis. Levels of ACE were significantly elevated in the whole diabetic group as compared with control subjects (334.0 U/L +/- 97.0 vs 250.5 U/L +/- 85.5, P less than .001). This elevation was more marked in those diabetics with background retinopathy (344.6 U/L +/- 96.8, P less than .001) and proliferative retinopathy (357.3 U/L +/- 93.2, P less than .01); no significant difference was found between ACE levels of diabetics without complications and those of control subjects. No correlation was found between ACE levels and HbA1, blood glucose, or C peptide values. We conclude that ACE levels are elevated in type II diabetes, chiefly in patients with retinopathy. This finding may reflect microvascular damage caused by secretion of ACE by the vascular endothelial cells.
Asunto(s)
Retinopatía Diabética/enzimología , Peptidil-Dipeptidasa A/sangre , Glucemia/análisis , Péptido C/sangre , Colorimetría , Retinopatía Diabética/sangre , Estudios de Evaluación como Asunto , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , Análisis de RegresiónRESUMEN
The aim of this study was to assess the possible relationship between high density lipoprotein cholesterol (HDL-C) concentrations and endogenous insulin secretion, as measured by basal serum C-peptide secretion. Eighty-nine non-insulin-dependent diabetic patients (NIDDs) being treated with sulfonylureas were studied. There were 47 men and 42 women matched for age, body mass index (BMI), duration of diabetes and glycemic control. Blood samples were taken after an overnight fast. HDL-C concentrations were significantly lower in males (45.9 +/- 11.2 mg/dl) than in females (52.9 +/- 13.1 mg/dl) (p less than 0.01). There was a negative correlation between C-peptide and HDL-C (males r = -0.40, p less than 0.01; females r = -0.42, p less than 0.01), and a positive correlation between C-peptide and serum triglyceride (Tg) (males r = +0.36, p less than 0.05; females r = +0.31, p less than 0.05).