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Query: UMLS:C0011849 (diabetes)
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Biochemical and bone scintigraphic studies were performed in nondiabetic and diabetic patients receiving hemodialysis at the time of kidney transplantation to assess the degree of secondary hyperparathyroidism. Despite lower serum calcium concentrations, diabetic patients had significantly lower parathyroid hormone (PTH) levels than nondiabetic patients. In addition, diabetic patients had lower graded total-skeletal scintigraphic scores than nondiabetic patients. The PTH levels showed positive correlations with bone scan scores and with alkaline phosphatase in nondiabetic patients but not in diabetic patients. Avascular necrosis occurred in 17% of nondiabetic patients and in only 2% of diabetic patients. Patients with avascular necrosis had significantly higher PTH levels than patients without avascular necrosis. Diabetes mellitus seems to confer a protective effect from the skeletal manifestations of secondary hyperparathyroidism, including avascular necrosis.
JAMA 1981 Mar 06
PMID:Decreased secondary hyperparathyroidism in diabetic patients receiving hemodialysis. 700 80

Twelve ambulatory patients (six women and six men; mean age, 29 years) with type I diabetes were treated with a continuous subcutaneous open-loop insulin pump in an attempt to effect better glucose control. Hemoglobin A1, mean blood glucose, total cholesterol, total triglycerides, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and the cholesterol/HDL-C ratio were assessed monthly before and after glucoregulation from five to 14 months (mean, nine months). Mean HDL-C levels increased significantly (52 +/- 4 to 60 +/- 5 mg/dL); mean cholesterol/HDL-C ratios decreased significantly (4.46 +/- 0.43 to 3.89 +/- 0.39). Mean values for triglycerides, total cholesterol, and LDL-C, all initially normal, did not change. Both mean Hb A1 levels and glucose levels fell from 11.2% +/- 0.5% to 9.8% +/- 0.5% and 177 +/- 15 mg/dL to 128 +/- 12 mg/dL, respectively. Insulin requirements decreased from 0.80 +/- 0.08 to 0.61 +/- 0.05 units/kg/24 hr. These results may favorably alter the prediction for development of accelerated atherosclerosis in type I diabetics.
JAMA 1982 Jan 01
PMID:Improvement of high-density lipoprotein-cholesterol levels. Ambulatory type I diabetics treated with the subcutaneous insulin pump. 703 Dec 87

Infections of the head and neck were identified in 12 (9%) of 128 consecutive patients undergoing renal transplantation. The infections included sinusitis, otitis media, dental abscess, Ludwig's angina, parotitis, and nasal abscess. A significant correlation was found between the development of infection and juvenile-onset diabetes but not with previous splenectomy. None of the infections occurred during treatment of rejection episodes with corticosteroids. The clinical presentations and microbiologic agents causing the infections were similar to those found in nonimmunosuppressed patients.
JAMA 1982 Jun 25
PMID:Head and neck infection after renal transplantation. 704 19

The occurrence of both hypertension and diabetes in patients at a general medical clinic at a university center and within a work-site community has been determined. In addition, the course of such patients for four years following presentation has been observed. The combination of hypertension and diabetes appeared more frequently, was expressed by greater severity, and coincided with a higher observed morbidity among the hospital clinic patients than among the work-site population. These findings regarding the prevalence and natural history of these coexistent diseases reaffirm that the source of a selected population can significantly affect the pattern of disease expression observed and, therefore, limit the capacity to extrapolate results from one population to another.
JAMA 1982 Jan 01
PMID:Effects of sample selection on the coincidence of hypertension and diabetes. 705 40

Two patients with long-standing diabetes mellitus and diabetic retinopathy were evaluated for declining renal function and heavy albuminuria. Initially, diabetic glomerulosclerosis was suspected as the cause of progressive glomerulopathy. However, in both patients the rate of loss of glomerular filtration rate was greater than that usually seen in diabetic glomerulosclerosis, and the urine sediment contained many RBC casts. These findings led to renal biopsy, which demonstrated crescentic glomerulonephritis superimposed on diabetic glomerulopathy. Both patients were treated with prednisone and cyclophosphamide and both experienced substantial improvement in renal function. These experiences demonstrate the importance of searching for evidence of a superimposed treatable glomerulopathy in the diabetic patient with glomerulopathy and advancing renal insufficiency.
JAMA 1982 Mar 12
PMID:Rapidly progressive glomerulonephritis superimposed on diabetic glomerulosclerosis. Recognition and treatment. 705 37

The ten- to 16-year predictive value of body weight for diabetes mellitus was evaluated prospectively in two groups of women with initially normal results of glucose tolerance tests. The incidence of diabetes in 602 high-risk (previous transient gestational glucose intolerance) participants was significantly higher for overweight subjects (46.7%) than for those of normal weight (25.6%). In 328 concurrently selected negative control subjects (without previous intolerance), the difference was not significant (4.5% v 1.9%). Another definition of diabetes, indicating further deterioration, gave similar results, although high-risk overweight women had disproportionately higher incidence rates. Being overweight had no substantial predictive value for diabetes mellitus during this period unless the additional evidence for a high-risk classification was present. Among such persons at high risk, excess weight also predicted the severity of the subsequent diabetic condition.
JAMA 1982 Aug 27
PMID:Body weight and subsequent diabetes mellitus. 709 63

Carotid bruit was routinely sought in the Framingham cohort and during eight years appeared in 66 men and 105 women, all of whom were asymptomatic. The incidence increased with age equally in the two sexes from 3.5% at 44 to 54 years, to 7.0% at 65 to 79 years. The eight-year incidence was greater in diabetes and hypertensive subjects. Transient ischemic attacks appeared in eight (two alone) and stroke in 21 of the 171, a stroke rate more than twice expected for age and sex. More often than not, cerebral infarction occurred in a vascular territory different from that of the carotid bruit, often in the posterior circulation, and ruptured aneurysm, embolism from the heart, and lacunar infarction was the mechanism of stroke in nearly half the cases. Incidence of myocardial infarction was also increased twofold in those with asymptomatic carotid bruit. General mortality were also increased; 1.7-fold with men, and 1.9-fold in women, with 79% of the deaths owing to cardiovascular disease, including stroke. Carotid bruit is clearly an indicator of increased stroke risk but chiefly as a general and nonfocal sign of advanced atherosclerotic disease and not necessarily as an indicator of local arterial stenosis preceding cerebral infarction.
JAMA 1981 Apr 10
PMID:Asymptomatic carotid bruit and risk of stroke. The Framingham study. 720 46

All nondiabetic patients admitted to a coronary care unit with suspected myocardial infarction (MI) had glycosylated hemoglobin (Hb A1) determinations to aid in the interpretation of hyperglycemia. Hyperglycemia was frequent among patients with a confirmed MI, whereas an elevated Hb A1 level was less common and affected patients with and without MI equally. With the use of a fasting plasma glucose level of 140 mg/dL and an Hb A1 level of more than 8.5% as combined diagnostic criteria, 9% of patients (8/93) with MI and 12% of patients (8/68) without MI had previously unrecognized diabetes. Follow-up studies three months after the acute episode supported these results. The Hb A1 measurements provide a practical method to separate hyperglycemia due to stress from that due to diabetes mellitus. Marked hyperglycemia with a normal Hb A1 level indicates a severe MI.
JAMA 1981 Oct 09
PMID:Value of glycosylated hemoglobin measurements after acute myocardial infarction. 727 44

We describe three patients in whom severe, life-threatening hyperkalemia and renal insufficiency developed after treatment of acute gouty arthritis with indomethacin. This complication may result from an inhibition of prostaglandin synthesis and consequent hyporeninemic hypoaidosteronism. Careful attention to renal function and potassium balance in patients receiving indomethacin or other nonsteroidal anti-inflammatory agents, particularly in those patients with diabetes mellitus or preexisting renal disease, will help prevent this potentially serious complication.
JAMA 1980 Sep 05
PMID:Indomethacin-induced hyperkalemia in three patients with gouty arthritis. 741 69

To test their immune responsiveness to pneumococcal polysaccharide antigens, eight azotemic patients, ten dialysis patients, and five insulin-dependent diabetics were vaccinated with a 14-valent vaccine. When compared with nonazotemic, nondiabetic control subjects, both diabetics and uremic patients responded with normal antibody titers to each antigen type. Therefore, we are advising immunization with commercially available vaccine in our patients with diabetes, renal failure, or both, although long-term efficacy has yet to be proved.
JAMA 1980 Nov 21
PMID:Intact antibody response to pneumococcal capsular polysaccharides in uremia and diabetes. 743 55


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