Experience of coronary care in diabetes.

During 1968-1973, 94 patients with diabetes were admitted to a coronary care unit (CCU) on 99 occasions with proved myocardial infarction. Altogether 24 of them (25-5%) died, giving an overall mortality at the time of discharge of 24% for the total admissions. This was just significantly higher than the 19% mortality recorded among non-diabetics treated in the same period but was much lower than that among diabetics treated for myocardial infarction before the advent of CCUs. No definite correlation was found between the type of anti-diabetic treatment and either mortality or the incidence of primary ventricular fibrillation. Patients with "poor" control of the diabetes before admission showed a significantly higher mortality than those with "good" control, but there was no significant difference in mortality between those with previous good control and non-diabetics.     

France Verus Wales

Assessment of roentgenographic measurements of cortical bone of the radius in 196 elderly females, including 63 diabetics, revealed that: (1) in the non-diabetic group there was a significant loss of cortical bone relative to the number of years after the menopause and to body weight; (2) although there was a significant loss of cortical bone relative to years postmenopausal in a group of diabetic patients the cortex in the diabetic group was better preserved than in those non-diabetic controls in whom no vertebral compressions were diagnosed in the roentgenograms; no correlation between bone loss and body weight was found among the diabetics; (3) the thinnest cortical bone and the lowest average body weight was found in the 34 non-diabetics with vertebral compression deformities. It thus appears that involutional osteoporosis will be less prevalent among old women suffering from diabetes mellitus than in comparable non-diabetic subjects, and more prevalent among non-diabetics of low body weight than in old women who are obese or of normal weight.     

Is there any association between GLY82 ser polymorphism of rage gene and Turkish diabetic and non diabetic patients with coronary artery disease?

This study was carried out in 52 non-diabetic, 62 diabetic patients with coronary artery disease (CAD) and 55 controls. A Gly to Ser change RAGE gene was analyzed by PCR-RFLP techniques. GlyGly genotype frequency is higher in non-diabetics versus controls (P < 0.001). GlySer frequency is higher in diabetics than controls and non-diabetics (P < 0.001). Ser allele frequency is respectively increased in the order of diabetics > Controls > non-diabetics. These results reveals none association between Gly82Ser and the development of disease in non-diabetic patients. In diabetics with Ser allele, higher prevalence of left-ventricule-hypertrophy was observed, but the significant difference between Gly82Ser and left-ventricule-hypertrophy only found in the whole patient group. As a result Ser allele has much more importance in the development of left-ventricule-hypertrophy than other cardiovascular risk factors. In this study we found the presence of Gly allele contributes to the CAD in non-diabetics and Ser allele may contribute to disease in diabetics.     

Why blind diabetics with renal failure should be offered treatment.

During May 1978 to April 1983 this renal dialysis unit treated 65 patients by continuous ambulatory peritoneal dialysis. Of these, 24 had type I (insulin dependent) diabetes, of whom 20 were blind; eight had type II (non-insulin dependent) diabetes, of whom three were blind; and 33 did not have diabetes and were not blind. The cumulative actuarial survival rates of these patients at five years were 60% for blind diabetics, 40% for sighted diabetics, and 46% for the non-diabetics. Of the 23 blind patients, 22 successfully achieved self care, including the self administration of insulin into the peritoneal dialysis solution. Blind patients had the least peritonitis and fewest complications of continuous ambulatory peritoneal dialysis, and none objected to the treatment or requested to be taken off it or be allowed to die. It was concluded that blind diabetic patients with renal failure showed both the will and the ability to stay alive and that their treatment was worth while.     

VDR gene polymorphisms are overrepresented in german patients with type 1 diabetes compared to healthy controls without effect on biochemical parameters of bone metabolism.

Type 1 diabetic individuals are known to develop disorders of bone metabolism resulting in osteopenia. Previous studies have suggested an influence of vitamin D receptor alleles on bone metabolism and susceptibility for type 1 diabetes mellitus. The present study was initiated to investigate the distribution of vitamin D receptor alleles in Caucasian type 1 diabetic patients and their relation to bone turnover parameters. 75 patients were included and compared to 57 healthy controls. Three vitamin D receptor alleles were examined (BsmI, TaqI and FokI); serum levels of intact osteocalcin, parathyroid hormone, bone specific alkaline phosphatase, the carboxy terminal extension peptide of type I procollagen, 25-OH-vitamin D levels, HbA1c and urinary deoxypyridinoline excretion were measured. We observed a higher frequency of the TT genotype in diabetic patients, but no difference in markers of bone turnover between diabetics and non-diabetics in either sex. Bone turnover was different in men and in women without any association with vitamin D receptor genotype. No association was found between diabetes duration, age of onset or metabolic control and bone turnover parameters. In summary, our results show an association between the TT genotype and diabetes in Germans, but no difference in bone turnover markers between diabetics and non-diabetics.     

Deoxyribonucleic acid polymorphism of the apoprotein AI-CIII-AIV gene cluster and coronary heart disease in non-insulin-dependent diabetes.

The prevalence of an uncommon allelic variant (S2) of the apoprotein AI-CIII-AIV gene cluster was determined in non-insulin-dependent diabetics with or without evidence of coronary heart disease and in controls. Frequencies of the S2 allele were 14% for diabetics with coronary heart disease compared with 2% for non-diabetics with no clinical evidence of occlusive vascular disease. No subject with the S2 allele was detected among a further group of matched diabetics without clinical features of macrovascular disease. The results suggest that a genetic component contributes to the susceptibility to coronary heart disease in non-insulin-dependent diabetics. Whether the observed deoxyribonucleic acid variant is aetiological for atherosclerosis or in linkage disequilibrium with other atherogenic loci on chromosome 11 remains to be clarified.     

Diabetic impotence: studies of nocturnal erection during REM sleep.

Nocturnal erections were studied in 30 diabetic patients who complained of impotence and in 11 healthy volunteers. The maximum increase in penile circumference was measured by a penile strain-gauge and recorded on a portable tape-recorder; an external oculogram was recorded simultaneously to identify periods of rapid-eye-movement sleep. The technique gave reproducible results, was acceptable to patients, and was suitable for use in an oridnary hospital ward. Only six diabetics showed a maximum increase in penile circumference of under 15 mm, whereas all but one of the healthy subjects showed maximum increases above this value. Of the six diabetics, five complained of total impotence and had other features of autonomic neuropathy that suggested an organic basis for their impotence. The other patient complained of partial importence, which was probably caused by psychological factors. These findings suggest that the prevalence of organic impotence among diabetics has been overestimated.     

Fasting plasma magnesium concentrations and glucose disposal in diabetes.

Fasting plasma concentrations of magnesium were measured by neutron activation analysis in 30 non-diabetics and 87 diabetics (55 non-insulin-treated, 32 insulin treated). Plasma concentrations of magnesium were lowest in the insulin treated group (mean 0.84 (SEM 0.01) mmol/1; 2.0 (0.02) mg/100 ml), intermediate in the non-diabetics (mean 0.89 (SEM 0.01) mmol/1; 2.2 (0.02) mg/100 ml), and highest in the non-insulin-treated diabetics (mean 0.95 (SEM 0.02) mmol/1; 2.3 (0.05) mg/100 ml). In all diabetics plasma magnesium concentrations were inversely related to plasma glucose values (rs = -0.33; p less than 0.01) and in non-insulin-treated patients to plasma insulin concentrations (rs = -0.28; p less than 0.05), the former confirming previous observations. In 67 of the diabetics the KG constant for disposal rate of glucose during a standard intravenous glucose tolerance test was directly related to fasting plasma magnesium concentrations, and this relation persisted after controlling for age, sex, body mass index, type of treatment, and glucose and insulin values. This direct relation of plasma magnesium concentration with glucose disposal was unexplained by its influence on insulin secretion but was related to insulin sensitivity; hence magnesium may be an important determinant of insulin sensitivity in maturity onset diabetes.     

Debate: PCI or CABG for multivessel disease? Viewpoint: No clear winner in an unfair fight

The Arterial Revascularization Therapy Study (ARTS) and the Stent or Surgery (SoS) trial each randomized patients with multivessel disease to either stenting or bypass surgery. The ARTS showed no difference in mortality between the two strategies, other than in diabetic patients, who fared better with surgery. The SoS trial demonstrated increased mortality in the stent arm, a difference that was not attributable to diabetes. Both trials found that the rates of repeat revascularization were lower with surgery, although the rate with stenting was much lower than had been seen in previous trials of angioplasty. Use of antiplatelet therapy such as intravenous glycoprotein IIb/IIIa inhibitors, especially with their pronounced effects in diabetics and in those with multivessel disease, could potentially equalize the playing field or perhaps even tip the balance in favor of percutaneous intervention     

Relation between blood plasma viscosity and presence of vascular and neurological complications in diabetic Africans

The relation between changes in plasma and serum viscosity and the presence of diabetic vascular and neurological complications was investigated in 50 diabetic Africans. Diabetics with complications had significantly elevated plasma and serum viscosity compared with those of both diabetics without complications and healthy non-diabetics. Hypertension also contributed to the elevation of plasma and serum viscosity in diabetics with complications. Plasma and serum viscosity of diabetics significantly correlated with the number of vascular and neurological complications. Diabetics with cerebrovascular disease had the highest plasma and serum viscosity due to the presence of many complications. The results of this study suggest that changes in plasma and serum viscosity may be associated with abnormalities of vascular and neurological function present in diabetic Africans.     

Insulin modulates early-phase noradrenaline response to glucose ingestion in humans

To clarify the relationship between the early-phase insulin response and the early-phase noradrenaline (NA) response to glucose ingestion in humans, serum NA, adrenaline, immunoreactive insulin (IRI), C-peptide immunoreactivity, potassium, nonesterified fatty acid and plasma glucose levels were measured in 8 non-diabetics and 10 diabetics without autonomic disturbance after oral 75 g glucose load. Following results were obtained: 1) In non-diabetics, the maximal NA response was observed at 30 min after glucose ingestion, but in diabetics, mean serum NA levels remained unchanged. The effect of glucose ingestion on the NA response was significantly different between non-diabetics and diabetics by the repeated measurements analysis of variance (F ratio = 5.72, P less than 0.05). 2) In total group (n = 18), at early-phase after glucose ingestion (at 30 min), positive correlation was found between dIRI level and dNA level (r = 0.52, P less than 0.05), between dIRI level and %dNA level (r = 0.56, P less than 0.05), between dIRI/dglucose ratio (insulinogenic index) and dNA level (r = 0.70, P less than 0.01). 3) In four diabetics, NA responses to glucose ingestion were studied again after mild energy restriction for 2 wk. In three of them, both early-phase IRI response and early-phase NA response to glucose ingestion improved after diet therapy, but in the remainder, early-phase NA response to glucose ingestion remained unchanged in accordance with sustained impaired early-phase insulin response to glucose ingestion.(ABSTRACT TRUNCATED AT 250 WORDS)     

Glycosylation of hair: possible measure of chronic hyperglycaemia.

To determine whether hair is excessively glycosylated in diabetes mellitus 4 cm hair samples were taken proximally from behind the ear in 50 white non-diabetics and 46 diabetics. Hair glycosylation was assayed by a modification of the thiobarbituric acid reaction. Blood was taken from the diabetics at the same time for measurement of glycosylated haemoglobin concentration. The mean (1 SD) concentration of fructosamine (mumol/100 mg hair) was 0.054 (0.011) for normal hair. Glycosylation was not related to sex, age, or hair colour. The diabetics'' hair was more heavily glycosylated (0.097 (0.045] than normal (p less than 0.01) and there was a correlation between hair glycosylation and the concentration of glycosylated haemoglobin in the diabetics (r = 0.71; p less than 0.01). Hair from non-diabetics showed a stable time related increase in glycosylation when incubated with glucose. Glycosylation of hair might provide a stable long term measure of tissue glycosylation, useful in the investigation of microvascular complications of diabetes mellitus.     

Sex-specific outcomes of diabetic patients with acute myocardial infarction who have undergone percutaneous coronary intervention: a register linkage study

ABSTRACT: BACKGROUND: The presence of diabetes mellitus poses a challenge in the treatment of patients with acute myocardial infarction (AMI). We aimed to evaluate the sex-specific outcomes of diabetic and non-diabetic patients with AMI who have undergone percutaneous coronary intervention (PCI). METHODS: Data of the Estonian Myocardial Infarction Registry for years 2006[EN DASH]2009 were linked with the Health Insurance Fund database and the Population Registry. Hazard ratios (HRs) with the 95 % confidence intervals (CIs) for the primary composite outcome (non-fatal AMI, revascularization, or death whichever occurred first) and for the secondary outcome (all cause mortality) were calculated comparing diabetic with non-diabetic patients by sex. RESULTS: In the final study population (n = 1652), 14.6 % of the men and 24.0 % of the women had diabetes. Overall, the diabetics had higher rates of cardiovascular risk factors, co-morbidities, and 3[EN DASH]4 vessel disease among both men and women (p < 0.01). Among women, the diabetic patients were younger, they presented later and less often with typical symptoms of chest pain than the non-diabetics (p < 0.01). Women with diabetes received aspirin and reperfusion for ST-segment elevation AMI less often than those without diabetes (p < 0.01). During a follow-up of over two years, in multivariate analysis, diabetes was associated with worse outcomes only in women: the adjusted HR for the primary outcome 1.44 (95 % CI 1.05 [MINUS SIGN] 1.96) and for the secondary outcome 1.83 (95 % CI 1.17 [MINUS SIGN] 2.89). These results were largely driven by a high (12.0 %) mortality during hospitalization of diabetic women. CONCLUSIONS: Diabetic women with AMI who have undergone PCI are a high-risk group warranting special attention in treatment strategies, especially during hospitalization. There is a need to improve the expertise to detect AMI earlier, decrease disparities in management, and find targeted PCI strategies with adjunctive antithrombotic regimes in women with diabetes.     

Ten-year follow-up report on Birmingham Diabetes Survey of 1961. Report by the Birmingham Diabetes Survey Working Party.

In a diabetes survey in 1960-1, 808 patients from a whole-practice population who either had glycosuria or were used as age- and sex-matched controls were given a 50-g oral glucose tolerance test (GTT). Ten years later the test was repeated in 382 cases. Of the original group, 126 had died and a similar number refused the second test. The original GTT results were classed as normal or as showing GTT diabetes, lag storage, renal glycosuria, or miscellaneous abnormalities. Most of those who converted to florid diabetes came from the GTT diabetes group, all the remainder having shown another minor degree of abnormality in the test; 23% with GTT diabetes, however, remained unchanged, while 32% returned to normal or had only minor anomalies. Of the original lag-storage group 57% remained unchanged or became normal, though 24% had converted to a diabetic abnormality. Renal glycosuria was an innocent peculiarity. The various miscellaneous abnormalities tended to change and showed an excessive conversion to diabetes. There was no accelerating trend towards diabetes in the second five years of follow-up. Those who developed florid diabetes showed an excess mortality comparable to that of clinical diabetics in general. Those who remained normal had the lowest mortality, while those with minor abnormalities occupied an intermediate position.     

Effect of intravenous infusion of insulin in diabetics with acute myocardial infarction.

Diabetes mellitus is associated with a high mortality after myocardial infarction. To see whether this may be decreased by improved diabetic control the effect of an insulin infusion regimen was studied in patients with acute myocardial infarction. From April 1982 to April 1983, 33 diabetics were admitted with acute myocardial infarction. Those being treated with diet alone or oral hypoglycaemic drugs continued with this unless control was poor, when they were changed to a "sliding scale" regimen of subcutaneous insulin injections thrice daily. Those already receiving insulin were maintained on thrice daily subcutaneous injections. From April 1983 to April 1984, 29 diabetics had acute myocardial infarction. Those receiving treatment with oral hypoglycaemic drugs or insulin were changed to continuous intravenous infusion of insulin, the aim being to maintain the blood glucose concentration at 4-7 mmol/I (72-126 mg/100 ml). Those being treated with diet alone continued with this if blood glucose concentrations were acceptable. Total mortality fell from 42% in the first year to 17% in the second (p less than 0.05). Over the same period mortality among non-diabetic patients with myocardial infarction did not change significantly. There was a significant fall in cardiac arrhythmias (expressed as the percentage of patients in whom arrhythmias were recorded) from 42% to 17% (p less than 0.05). The most significant fall in the incidence of complications occurred in those who had been receiving oral hypoglycaemic drugs on entry to the study (87% to 50%, p less than 0.05).     

Preserved function of the plasma membrane calcium pump of red blood cells from diabetic subjects with high levels of glycated haemoglobin

The activity of the plasma membrane Ca²⁺-pump decreases steeply throughout the 120 days lifespan of normal human red blood cells. Experiments with isolated membrane preparations showed that glycation of a lysine residue near the catalytic site of the pump ATPase had a powerful inhibitory effect. This prompted the question of whether glycation is the mechanism of age-related decline in pump activity in vivo. It is important to investigate this mechanism because the Ca²⁺ pump is a major regulator of Ca²⁺ homeostasis in all cells. Its impaired activity in diabetic patients, continuously exposed to high glycation rates, may thus contribute to varied tissue pathology in this disease. We measured Ca²⁺-pump activity as a function of red cell age in red cells from diabetics continuously exposed to high glucose concentrations, as documented by their high mean levels of glycated haemoglobin. The distribution of Ca²⁺-pump activities was indistinguishable from that in non-diabetics, and the pattern of activity decline with cell age in the diabetics’ red cells was identical to that observed in red cells from non-diabetics. These results indicate that in intact cells the Ca²⁺ pump is protected from glycation-induced inactivation.     

Distribution of pancreatic endocrine cells including IAPP-expressing cells in non-diabetic and type 2 diabetic cases.

There is a lack of agreement on the distribution of islet amyloid polypeptide (IAPP) in the pancreases of healthy and diabetic subjects. Therefore, a detailed morphometrical and immunohistochemical study was performed to obtain information on the distribution of cells expressing insulin, glucagon, somatostatin, pancreatic polypeptide (PP), and IAPP in the pancreases of non-diabetic (n=4) and diabetic individuals (n=6). In the non-diabetic cases, beta-cells contributed to approximately 64%, alpha-cells to 26%, delta-cells to 8%, PP cells to 0.3%, and IAPP cells to 34% of the islet cell population. The ratio of IAPP/insulin was approximately 1:2. In diabetic cases, beta-cells were decreased by 24%, and IAPP was decreased by 57%. The alpha- and delta-cells were increased by 40% and 58%, respectively. IAPP/insulin ratio was decreased by 41%. Thus, only 50% of the beta-cells in non-diabetics and only 30% in diabetics coexpressed IAPP. In diabetics, more delta-cells coexpressed IAPP than in non-diabetics. The results seem to argue against the notion that the secretion of IAPP is increased in diabetics. It is possible that an increase in somatostatin and glucagon plays a greater role in diabetes than IAPP.     

A comparison of the PAS-reaction in the dermis of diabetic and non-diabetic humans

Dermopathy is a part of the diabetic syndrome that decreases the solubility of dermal collagen. In the present study, the PAS-reactive component of collagen has been analysed in diabetic and non-diabetic human dermis by photographic densitometry. The PAS-reaction was significantly lower in diabetics than non-diabetics, and age seemed to be of no consequence. The results are interpreted to indicate a decrease in collagen-associated sugar residues in diabetics.     

The importance of defining serum MMP-9 concentration in diabetics as an early marker of the rupture of atheromatous plaque in acute coronary syndrome

Acute coronary syndrome (ACS) is the main cause of mortality in diabetics. Acute myocardial infarction (AMI) in diabetics is much more often than in non-diabetics. MMP-9 activity could ease the formation of atherosclerosis, destabilization and plaque rupture as well as thrombocyte aggregation. THE AIM OF THIS STUDY IS TO EXAMINE: MMP-9 defining in serum in diabetics; the impact of diabetes mellitus on atherosclerosis and MMP-9 level; relation between serum values of MMP-9 and markers of glycoregulation and lipid status, respectively. RESULTS: The greatest concentration of both total and active MMP-9 serum has been noted in diabetics group with ACS. Both total and active MMP-9 values, in group with diabetes and ACS showed significantly important difference regarding the values in control group. Total and active MMP-9 showed statistically important correlation between the values of glycated hemoglobine A1c (HbA1c) and inverse correlations with values of subfraction HDL3.Active MMP-9 showed statistically important inverse correlation with value of HDL cholesterol. IN CONCLUSION: According to the results, it has been thought that active MMP-9 shows a certain degree of atherosclerotic changes on blood vessels better than total MMP-9. MMP-9, active one, could present an early marker of atherosclerosis, especially on coronary blood vessels, in diabetics with type 2.