Diabete & metabolisme最新文献

Insulin-induced hypoglycaemia, the most frequent side-effect of insulin-therapy, is a potential source of considerable morbidity and has a recognised mortality. Acute hypoglycaemia produces an intense physiological stress with profound sympathoadrenal stimulation and widespread activation of hormonal counterregulatory systems, leading to secondary haemodynamic and haemorheological changes. The clinical effects of acute and recurrent severe hypoglycaemia are associated with significant morbidity including reversible, and permanent, abnormalities of cardiovascular, neurological and cognitive function, in addition to trauma and road traffic accidents. Comprehension of the morbidity of hypoglycaemia is important when designing insulin regimens and determining therapeutic goals for individual patients if the frequency and adverse effects of this dangerous side-effect of insulin therapy are to be limited.

Objective: The aim was to assess the presence of cardiomyopathic features in asymptomatic patients with Type 1 and Type 2 diabetes mellitus.

Research design and methods: Fifty-two (27 Type 1; mean duration: 10.2 +/- 7.4 yr; 25 Type 2, mean duration: 6.5 +/- 4.4 yr) diabetic patients with no signs of ischaemic heart disease or high blood pressure were studied by noninvasive techniques: Holter ECG; Filtered-Amplified ECG (FAECG); Exercise ECG; Echocardiography (BD, TM) and Doppler evaluation of diastolic parameters. Twenty-four healthy subjects matched for age were studied as controls.

Results: Holter ECG did not detect rhythm disturbances or features of silent ischaemia in either group of patients. With FAECG, at least one criterion of late ventricular potentials was found in 28% of Type 2 patients, vs 11% of Type 1 patients and 8.3% of control subjects. With exercise ECG, maximum oxygen uptake, anaerobic threshold, and workload performance were all significantly lower in Type 2 patients compared to control subjects. Echocardiography depicted a greater end diastolic interventricular septum thickness in Type 2 patients than in control subjects, with a trend toward left ventricular hypertrophy in 28% of Type 2 and 7.4% of Type 1 patients. Doppler echocardiography revealed a significant decrease in early diastolic peak filling rates (E) in diabetic patients as a whole group (Type 1 + Type 2) compared to controls. Late diastolic peak filling rates (A) were significantly higher in Type 2 patients than in their controls. The E/A ratio was significantly lower in diabetic patients (as a whole group) than in control subjects; this was accounted for mainly by a significant decrease of E/A in Type 2 patients compared to their controls.

Conclusions: Our major finding rests on the disclosure of abnormalities suggestive of cardiomyopathy in Type 2 diabetic patients with a relatively short duration of the known disease, while these alterations appeared in our study less prominent in Type 1 patients despite a longer duration of the disease. Among the various noninvasive techniques, FAECG and Doppler echocardiography used to detect late ventricular potentials and to assess left ventricular diastolic dysfunction, respectively, appear to be suitable tools.

The aims of this study were 1) to study the quality of life in diabetic patients receiving one of two different forms of insulin delivery and 2) to check in this disease, the reliability and responsiveness of a questionnaire (SQLP: subjective quality of life profile) which we have previously used and validated in other pathological states. A total of 743 Type 1 diabetic subjects, receiving two different forms of insulin injection completed this questionnaire twice, at a monthly interval. These patients stressed a certain number of somatic manifestations as well as their difficulty to move around or perform every-day life activities. The results from this trial show that the questionnaire was capable of demonstrating that the easiest mode of insulin injection was selectively and significantly related to a higher satisfaction with being able to move around.

Vascular complications such as atheroma, hypertension and macroangiopathy are the leading causes of morbidity and mortality in diabetic patients. Epidemiological and clinical data linking hyperinsulinaemia to both hypertension and atherosclerosis are inconsistent. Hyperglycaemia is the distinguishing feature of diabetes and it seems a likely candidate for the poor cardiovascular outlook of diabetic patients. High blood glucose levels cause selective impairment of endothelium-dependent relaxation and delay cell replication time of cultured human endothelial cells. These effects of hyperglycaemia are reversed by a number of antioxidants, including superoxide dismutase, catalase and glutathione. Impaired endothelium-dependent vasodilation has been reported both in Type 1 and Type 2 diabetic patient. The evidence for a role of oxygen-derived free radicals in the pathogenesis of vascular diabetic complications can be summarized as follows: 1) glucose can auto-oxidize generating oxygen derived free radicals; 2) elevated levels of oxygen derived free radicals are found in red blood cells, plasma and retina of diabetic animals and patients, and correlate with metabolic control; 3) endogenous antioxidants are all decreased in diabetic tissues and blood; and 4) treatment with different antioxidants may improve many of the metabolic abnormalities reported to occur in diabetic patients. The use of antioxidants to reduce the risk of coronary heart disease in diabetes should await the results of randomized trials with these drugs in the primary and secondary prevention of coronary disease.

High Homocyst(e)ine levels (H) have been recently recognized as a risk factor for atherosclerosis. Patients with Diabetes Mellitus (DM) are prone to atherosclerosis. Therefore, this study was designed to search for the effect of DM on H and their relationship. Forty-one Type 1 diabetic subjects (DS, age 34.8 +/- 12 yr, DM duration: 10.7 +/- 11.1 yr) were compared to 40 age-matched control subject (CS, age 34.2 +/- 9.1 yr). H (measured by ion-exchange chromatography, units: mumol/l) and several parameters (creatininemia; triglycerides; total, HDL, LDL cholesterol; Lp(a); HbA1c; vitamins B9 and B12) were determined after an overnight fast. H were significantly (p = 0.0001) lower in DS (6.8 +/- 2.2) than in CS (9.5 +/- 2.9). This difference was still apparent in male and female subgroups compared to matched CS (p = 0.003 for each). No correlation was found between H and: lipids, vitamins, renal or retinal status. But H seemed to increase with age, especially in women (p = 0.03; r = 0.32). While there is, at this time, no explanation for the lower H observed in DS, it appears that H cannot directly account for accelerated atherosclerosis in DM. Nevertheless, it remains to be established if high, or even normal, H could identify a subgroup of DS at higher risk of precocious and severe atherosclerosis.

Aims: To study serum Lp (a) levels and other metabolic cardiovascular risk factors in children with type 1 diabetes mellitus (DM) as compared to sex and age matched nondiabetic children. The correlation of Lp (a) serum levels and other lipid parameters with HbA1c concentration in diabetic children was investigated.

Design: Transversal observational study.

Target population: 36 C-peptide negative Type 1 diabetic children without microalbuminuria and no macromicrovascular nor neurological complications, aged 8 to 15 years; 17 boys, 19 girls. Mean duration of Type 1 diabetes was 4.99 +/- 3.04 years, daily insulin needs 32.79 +/- 12.64 Units. 41 healthy children with no family history of diabetes mellitus, aged 8 to 15 years, 26 boys, 15 girls, were studied in parallel as the control group.

Methods: Serum total cholesterol and triglycerides were assayed by enzymatic methods, High-density lipoprotein (HDL) cholesterol by enzymatic method after precipitation of very-low-density (VLDL) and low-density lipoprotein (LDL) fractions. The LDL fraction was estimated after serum precipitation as the difference between total cholesterol and supernatant cholesterol concentrations. Apo-AI, apoA-II and apo-B were measured by radial immunodiffusion assays. Serum Lp(a) was measured by a monoclonal anti-Lp(a) antibody (ELISA) method and whole blood glycosylated hemoglobin A1c (HbA1c) by high resolution liquid chromatography.

Results: HbA1c concentration in diabetic children was 7.51 +/- 1.54% vs 4.16 +/- 0.35% in nondiabetic children. Lp(a) serum levels did not significantly differ among both groups (25 +/- 22 mg/dl in diabetics; 22 +/- 22 mg/dl in controls). Significant correlation was found between HbA1c levels and each of TC, LDL and TG serum concentrations in the diabetic group. Lp (a) levels were only correlated with glycated hemoglobin in the two patients showing the highest levels of HbA1c; in the diabetic group: HbA1c 10.9 and 11.5%.

Conclusions: In 36 children aged 8-15 years with uncomplicated Type 1 diabetes for less than 15 years duration, Lp (a) serum levels were positively correlated with HbA1c only in two of them showing the poorest metabolic control.