Diabetes mellitus and candidiases

Patients in various clinical states of diabetes mellitus (according to the recommendation of the American Diabetes Association) as a primary diagnosis were examined for fungal infections by Candida species. Candida spp. were detected in urine, in the material taken from the mouth cavity, nails, skin lesions, ears and eyes, by cultivation on the Sabouraud agar, CHROMagar Candida, and by saccharide assimilation. In the group of diabetics with symptoms of oral candidiasis and denture stomatitis C. albicans was identified in 8 cases, C. tropicalis in 3, C. parapsilosis in 2; 1 strain of C. guilliermondii was also isolated. In patients with urinary tract infections the presence of C. albicans was shown in 12 cases; C. parapsilosis was detected in 6 cases and two strains of each C. tropicalis and C. krusei were also isolated. In patients with leg ulcers C. albicans (25 cases), C. parapsilosis (5), C. tropicalis (3) and one strain of each C. krusei and C. robusta were isolated. Otomycosis was associated with one strain of C. albicans, C. parapsilosis, C. tropicalis and C. guilliermondii. C. albicans was most frequently associated with onychomycosis, paronychia and endophthalmitis; C. parapsilosis was the second most rated yeast.     

Diabetes mellitus.

Developments on four fronts have contributed to an exciting year for the study of diabetes. These include advances in molecular genetic mapping, analysis of animal models of disease, understanding of disease phenotype, and the extension of statistical methods to the study of complex, non-Mendelian traits.     

Diabetes mellitus and cardiac function

Cardiovascular complications are the most common causes of morbidity and mortality in diabetic patients. Coronary atherosclerosis is enhanced in diabetics, whereas myocardial infarction represents 20% of deaths of diabetic subjects. Furthermore, re-infarction and heart failure are more common in the diabetics. Diabetic cardiomyopathy is characterized by an early diastolic dysfunction and a later systolic one, with intracellular retention of calcium and sodium and loss of potassium. In addition, diabetes mellitus accelerates the development of left ventricular hypertrophy in hypertensive patients and increases cardiovascular mortality and morbidity. Treating the cardiovascular problems in diabetics must be undertaken with caution. Special consideration must be given with respect to the ionic and metabolic changes associated with diabetes. For example, although ACE inhibitors and calcium channel blockers are suitable agents, potassium channel openers cause myocardial preconditioning and decrease the infarct size in animal models, but they inhibit the insulin release after glucose administration in healthy subjects. Furthermore, potassium channel blockers abolish myocardial preconditioning and increase infarct size in animal models, but they protect the heart from the fatal arrhytmias induced by ischemia and reperfusion which may be important in diabetes. For example, diabetic peripheral neuropathy usually presents with silent ischemia and infarction. Mechanistically, parasympathetic cardiac nerve dysfunction, expressed as increased resting heart rate and decreased respiratory variation in heart rate, is more frequent than the sympathetic cardiac nerve dysfunction expressed as a decrease in the heart rate rise during standing.     

Diabetes mellitus and the exocrine pancreas

Diabetes and carbohydrate intolerance can occur in pancreatitis. Although one-half of patients with acute pancreatitis will have some evidence of glucose intolerance during their acute illness, few will require insulin administration on either a short- or long-term basis. The diabetes seen in acute pancreatitis is likely due to a combination of factors, including alerted insulin secretion, increased glucagon release, and decreased glucose utilization by the liver and peripheral tissue. Chronic pancreatitis is often associated with diabetes mellitus, with the incidence as high as 70 percent when pancreatic calcification is present. These patients tend to be very sensitive to the effects of insulin and hypoglycemia. This is probably secondary to concurrent hepatic disease, malnutrition, and a relative decrease in glucagon reserves. The diabetes seen in chronic pancreatitis is associated with decreased insulin production. Finally, although the endocrine pancreas may influence the exocrine gland through a portal system, primary diabetes mellitus probably does not result in clinically significant alterations in pancreatic exocrine function.     

Diabetes mellitus and apoptosis: inflammatory cells

Since the early observation that similarities between thyroiditis and insulitis existed, the important role played by inflammation in the development of diabetes has been appreciated. More recently, experiments have shown that inflammation also plays a prominent role in the development of target organ damage arising as complications, with both elements of the innate and the adaptive immune system being involved, and that cytokines contributing to local tissue damage may arise from both infiltrating and resident cells. This review will discuss the experimental evidence that shows that inflammatory cell-mediated apoptosis contributes to target organ damage, from beta cell destruction to both micro- and macro-vascular disease complications, and also how alterations in leukocyte turnover affects immune function.     

Behandlung der Adipositas bei Diabetes mellitus

Visceral obesity represents a risk in the development of a metabolic syndrome and type 2 diabetes mellitus. An increase both in the prevalence of obesity and type 2 diabetes mellitus may be observed not only in Germany but worldwide. One important treatment element of obesity and the metabolic syndrome are psycho-educative measures to change the life style with the goal of inducing a change in nutritional intake (a reasonable energy-reduced, low-fat nutritional balance), weight reduction and an improvement in metabolic status. However, the mean and long-term results of conservative weight reduction programs especially in people with diabetes mellitus are inadequate. The adjuvant application of weight-reducing medication may be applied to support psycho-educative measures. If a distinct improvement of the metabolic status (HbA1c < 6.5%) can not be achieved, an oral application of antidiabetica is indicated. Obesity surgery is, as a rule, the method of choice for people with type 2 diabetes mellitus and obesity grade 2 3. In contrast to conservative measures, surgical procedures lead to an improvement of metabolic and cardiovascular parameters as well as the quality of life.     

Diabetes mellitus: Metabolic effects and oxidative stress

Diabetes mellitus is a complex polygenic pathology, which is characterized by numerous metabolic disorders. Progressive hyperglycemia developing during this disease causes clinically significant tissue damage and is considered as a main risk factor of micro- and macrovascular complications leading to retinopathy, nephropathy, and neuropathy. Hyperglycemia-depended oxidative stress and impairments in nitric oxide bioavailability play an essential role in the pathogenesis of diabetes and its complications. Homeostasis of glucose maintained by metabolic effects of insulin includes an increase of glucose uptake by skeletal muscles and suppression of glucose production by the liver. M. Brownlee (2005) put forward a hypothesis assuming that oxidative stress is the main mechanism of diabetic tissue damages. According to this hypothesis, mitochondrial dysfunction and superoxide anion radical hyperproduction by mitochondria is the principal mechanism of activation of four pathways of hyperglycemia-induced impairments under diabetes. Two cell signaling cascades regulate the glucose homeostasis: insulin-mediated glucose uptake (IMGU) in skeletal muscles, liver, and heart and glucose-stimulated insulin secretion (GSIS) in pancreatic β-cells. In addition to nonspecific irreversible oxidative damage of DNA, protein and lipid molecules reactive oxygen and nitrogen species induce cell and tissue damage, activating a number of cell stress-sensitive signaling cascades. Stress-dependent serine phosphorylation of insulin receptor substrate (IRS) proteins decreases its capacity for tyrosine phosphorylation and may accelerate degradation of IRS. This process underlies the molecular mechanism of oxidative stress-induced insulin resistance.