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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is the second most prevalent chronic disease in children in the U.S. It is associated with severe manifestations which include blindness and circulation deficiencies as well as markedly increased risk of death. The etiology of diabetes mellitus remains a mystery although both genetic and environmental factors have been implicated. The geneticist is confronted with a number of obstacles in his attempts to unravel this problem, including differences in the definition of affected individuals. This matter was certainly clarified by the separation of noninsulin-dependent diabetes (NIDDM) and insulin-dependent diabetes mellitus (IDDM) into two separate disease entities. Twin studies, however, show that IDDM cannot be entirely due to genetic causes as concordance is no more than about 50%. Although the disease is then clearly not inherited per se, the "susceptibility" to diabetes seems almost surely inherited and, provided this susceptibility, the disease can be brought on by environmental factors. Until the underlying mechanism causing IDDM is completely ascertained, we have to rely on genetic markers to approach the study of the inheritance thereof. Since, in the early 1970s, research by Nerup's and Cudworth's groups revealed associations between the HLA-B locus and IDDM, the HLA markers are considered the classical genetic markers for IDDM susceptibility. In this paper, we review the nature of the genetic susceptibility to IDDM and the possible environmental factors which can bring on the disease.
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PMID:Immunogenetics of insulin-dependent diabetes mellitus in humans. 257 May 96

Lists of patients receiving repeat prescriptions for epilepsy, diabetes, thyroid disease and asthma were compared with chronic disease registers stored on seven practice computers. Diabetes was the most accurately recorded disease: the names of 72% of patients receiving medication for this condition appeared on the relevant disease registers. Agreement between the two data sources was 68% for thyroid disease, 58% for asthma and 49% for epilepsy. The levels of accuracy are not yet high enough for the computerised chronic disease registers to provide an accurate estimate of the prevalence of these conditions, but new system developments suggest a more optimistic outlook for the future.
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PMID:Computer held chronic disease registers in general practice: a validation study. 259 87

The subject of varied acceptance of clinical trial results is discussed in the context of review of trials with which I have been involved and my subjective evaluation of their impact on the practice of clinical medicine. My experience goes back to 1949 and a World Health Organization trial of hyperimmune gamma globulin against rabies. This was followed by a large trial of secondary prevention of poliomyelitis. I participated in the planning and initiation of the first chronic disease trial, the University Group Diabetes Program (UGDP). The latter lasted for 15 years and its ramifications continue to this day. My next trial was the Coronary Drug Project (CDP), a complex trial with more than 8,000 patients. The trials of aspirin and aspirin combined with persantine (the CDPA, AMIS, PARIS I, and PARIS II) followed. My last three trials were a trial of photocoagulation in diabetic retinopathy (DRS), a six-country trial of the antiarrhythmic drug mexiletine (IMPACT), and a study involving two diagnostic procedures for pulmonary embolism (PIOPED). When one considers, in retrospect, the plethora of trials one is struck by the uniform absence of a priori considerations of the impact on medical practice, or likely lack thereof, of possible outcomes.
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PMID:Varied acceptance of clinical trial results. 260 62

Biochemical evidence of glucose toxicity was found in the retinal and corneal layers of diabetic rabbits. It can be reasonably assumed that the observed changes are causally related to the morphological and physiological diabetic pathologies of the retinal and corneal cells. Intracellular glucose is greatly increased, and the polyol pathway activity appears to be enhanced, resulting in an accumulation of intracellular sorbitol, which can be assumed to be oxidized to fructose. Accompanying the alterations of glucose metabolism are disturbances in myoinositol and Na+ handling by the affected structures. The detailed relationship of the observed metabolic effects of hyperglycemia to changes in cellular ion handling and the observed morphological and functional disturbances has yet to be elucidated. The morphologically and functionally discrete populations of RPE and CEN cells, which are readily amenable to experimental manipulation in situ and in cell culture may serve as unique models for systematic examination of the causes and the consequences of diabetes leading to ocular complications in particular and to the complications of other more complex tissues such as nerve and kidney. The present data show that the findings in one population of cells may not be completely reproducible in another as can be seen in the diverse myoinositol responses of the retinal and corneal layers to diabetes mellitus. The diverse responses perhaps reflect unique adaptive capabilities of individual tissues to the diabetic condition. It is a challenge for complications research to fully appreciate diverse responses of various tissues to persistent glucose intoxication and to delineate meticulously the time courses of such heterogeneous responses, which might result in debilitating pathology in certain cases but in a compensated chronic disease state in others. The corneal endothelium and the RPE are relatively resilient structures compared with the mural and endothelial cells of the retinal microvessels which are destroyed by the diabetic condition. Factors and components that protect tissues against the persistent effects of hyperglycemia need to be uncovered. Success in such an endeavor could be of benefit in the management of diabetic complications.
Diabetes Metab Rev 1989 Feb
PMID:Biochemical manifestations of diabetes mellitus in microscopic layers of the cornea and retina. 264 33

Diabetes mellitus is a common chronic disorder the primary therapeutic principles of which have long been based on the combination of physical activity with appropriate diet. Although exercise in insulin-dependent diabetes mellitus (IDDM) may be associated with metabolic deterioration in the case of lack of adequate provision of insulin and carbohydrate in balanced amounts, the beneficial effects of exercise in diabetes are numerous. Exercise facilitates the utilization of glucose as the main source of energy for contracting muscles and decreases peripheral insulin resistance. Limited epidemiological studies have demonstrated that lack of physical activity may be involved in the epidemic outburst of non-insulin-dependent diabetes mellitus (NIDDM) in some unusual populations. Long-term studies are still needed to show that lifelong physical training and exercise reduce morbidity and mortality in diabetes.
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PMID:Overview of diabetes mellitus and exercise. 267 85

Diabetes mellitus is a chronic disease with early and late complications. In the clinical care provided to diabetics, prevention of late complications is as important as good metabolic control. To achieve these goals education of the diabetic subject is essential. Eye and nervous system complications are particularly highlighted.
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PMID:[Long-term complications in diabetes mellitus]. 269 75

Chronic diseases (diabetes mellitus, end stage renal failure on hemodialysis, post-hepatitic liver cirrhosis) caused autonomic neuropathy in 34 of 65 cases. The frequency of autonomic neuropathy was 14 of 30 diabetics (typ I and typ II), twelve of 19 patients on dialysis, and eight of 16 non-alcoholic liver cirrhotics. We did not find a correlation between the tests of the cardiovascular and of the gastrointestinal system. The distribution of the neuropathic changes was undependent of the underlying disorder. Using appropriate tests, alterations of the autonomic functions can be discovered frequently even in asymptomatic patients. At least two pathological test results are necessary to reach a significant difference between patients and healthy controls. This indicates that the diagnosis of autonomic neuropathy should rely on two or more pathological test results. The evidence of autonomic neuropathy identifies a population of high risk patients.
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PMID:[Autonomic neuropathy in diabetes mellitus, chronic renal failure and liver cirrhosis]. 271 53

The Eysenck Personality Inventory and Hospital Anxiety and Depression scale were administered to 80 patients undergoing medical treatment for long standing inflammatory bowel disease: 22 patients were studied before the diagnosis was established and 40 patients with diabetes mellitus served as controls. High neuroticism and introversion scores were more prevalent in the patients with inflammatory bowel disease than controls (p less than 0.05) and these characteristics were as prominent in patients before diagnosis as in established cases. Introversion scores increased with the duration of disease (r = 0.51). Depression was uncommon, occurring only in patients with active chronic disease. Patients believed there was a close link between personality, stress and disease activity. Fifty six of the patients recognised factors that initiated the disease and in 42 this was thought to be a stressful life event or a 'nervous personality'.
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PMID:Personality profile and affective state of patients with inflammatory bowel disease. 273 54

Although evidence suggests that adolescents with chronic illness are at a greater risk for psychosocial disability, little is known about the adolescent's perception of the impact of the disease on his or her day-to-day life. Standardized measures of coping strategies, mastery, self-efficacy, social support, depression, and a semistructured interview on everyday difficulties were administered to matched groups (sex and age) of 31 adolescents with cystic fibrosis, 31 adolescents with diabetes, and 31 healthy controls. No differences were found between control and adolescents with a chronic disease responses on the standardized measures. The semistructured interview, however, revealed that the adolescent's perception of his or her physical health and the reaction of other family members to the illness were important sources of stress. These findings suggest that, in general, adolescents with a chronic illness cope effectively with their disability but that parents and clinicians must be sensitive to the adolescents' feelings and concerns regarding their health and its impact on the family.
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PMID:Chronic disease and its impact. The adolescent's perspective. 273 7

Insulin-dependent diabetes mellitus (IDDM) is a complex, chronic disease that is difficult to control during adolescence. This study evaluated the effects of a 6-week, family-oriented, group intervention on adolescents' metabolic control and psychosocial and family functioning. Thirty-two families were randomly assigned to one of three groups: multifamily (MF), multifamily plus parent simulation of diabetes (MF + S), and control (C). Outcome measures included glycosylated hemoglobin (Hb Al); perceptions of diabetes; estimates of youngsters' self-care; and family functioning. Adolescents in the MF + S group displayed significant decrements in Hb Al, and adolescents in both intervention groups reported more positive perceptions of a "teen-ager with diabetes" at posttreatment, relative to controls. Adolescents participating in smaller family groups demonstrated clinically significant improvements in Hb Al that were maintained at 6-month follow-up. Parent reports suggested that adolescents in the intervention groups improved their diabetes care. Findings support the use of multifamily groups plus parent simulation of diabetes as an intervention strategy for adolescents with IDDM.
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PMID:Diabetes in adolescence: effects of multifamily group intervention and parent simulation of diabetes. 275 76


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