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

In summary, the best diet for an insulin-requiring diabetic person is a diet that can be best integrated into the person's lifestyle, one that is best matched to an insulin regimen acceptable to that person, and one that leads to the best control of the 24-hour integrated blood glucose concentration. Should future research indicate that a very high-CHO, low-fat diet is of additional benefit to the patient, then the dietary recommendations to the patient should be altered accordingly. It should be understood that diabetes is a chronic disease that requires intensive effort by the patient if reasonable management is to be attained. We should not complicate this management unnecessarily by dietary intervention unless clear benefits can be observed. For the type II, noninsulin-requiring diabetic person, dietary recommendations are even less certain. Obese patients should be encouraged to lose weight and to maintain a more ideal body weight, but one should not be disappointed if the patient is unable to accomplish this. Medical indications for weight loss rarely have been sufficient motivation for patients to remain on a semistarvation diet. Should safe, effective anorexigenic drugs become available, they clearly would be the treatment of choice for these patients. The best weight-maintenance diet for type II diabetic persons remains to be determined. A high-CHO, low-fat diet would appear to be best, provided it results in a more normal average level of blood glucose. An increase in dietary soluble fiber also may be useful in reducing the serum cholesterol concentration. In such a diet, those CHO foods that raise the postprandial glucose concentration the least should be emphasized.
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PMID:The high-carbohydrate diet in diabetes management. 283 Jul 68

The San Luis Valley Diabetes Study was undertaken to determine the prevalence, risk factors, and complications of non-insulin-dependent diabetes mellitus in Hispanics and Anglos (non-Hispanic whites), using a geographically based case-control design. The study was conducted in two southern Colorado counties that include 43.6% Hispanic and 54.9% Anglo persons. Medical practice records were reviewed to identify medically diagnosed diabetics. Controls without diabetes were identified by a two-stage random sample of households. Diabetics (n = 343) and controls (n = 607) attended a clinic where an oral glucose tolerance test or current hypoglycemic therapy confirmed or diagnosed non-insulin-dependent diabetes mellitus. The age-adjusted prevalence of confirmed non-insulin-dependent diabetes mellitus was 21/1,000 in Anglo males and 44/1,000 in Hispanic males, accounting for non-response. For Anglo females, the prevalence was 13/1,000 compared with 62/1,000 for Hispanic females, accounting for nonresponse. Previously undiagnosed non-insulin-dependent diabetes mellitus was also higher among Hispanics. There was a 2.1-fold excess of confirmed non-insulin-dependent diabetes mellitus among Hispanic males and a 4.8-fold excess among Hispanic females, consistent with the excess non-insulin-dependent diabetes mellitus among Hispanics reported from comparable studies. Non-insulin-dependent diabetes mellitus is a major chronic disease problem for persons of Hispanic ethnicity.
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PMID:Methods and prevalence of non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. 291 42

Smoking habits in insulin-treated diabetics in Nottinghamshire (UK) and clinic-attending diabetics in Nottingham have been analysed. Compared with the general population, the prevalence of current cigarette smoking is significantly less (p less than 0.001) in both diabetic men and women older than 50 years. Fewer diabetic men over 60 years have ever smoked than in the general population (p less than 0.001) but this finding does not apply to diabetic women. While intervention probably plays some part in this lower prevalence, the most likely explanation is the multiplicative effect of both smoking and diabetes to produce high mortality risks. Actuarial analysis of insulin-treated clinic attenders diagnosed after 1970 showed that at most 14% (95% confidence interval [Cl] 9-18%) of the 183 who smoked at diagnosis had given up 5 years later while a minimum of 8% (95% Cl, 6-11%) of the 313 who were non-smokers had started smoking. Information about the patterns of smoking in patients with chronic disease is incomplete and it appears that too little is being done in clinical services which provide long-term management for these patients to either discourage smoking or determine why some patients give up smoking but others do not.
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PMID:Prevalence of smoking in a diabetic population: the need for action. 295 25

The reduction of oxygen by the ene-diol tautomer of simple monosaccharides produces hydrogen peroxide and alpha-oxoaldehydes. This process, termed monosaccharide autoxidation, occurs at physiological pH and temperature and may contribute to the development of several pathological processes. Enolization of the monosaccharide to an ene-diol tautomer is a prerequisite for the reaction of the monosaccharides with oxygen. The reaction kinetics suggest a two step process: the enolization of the monosaccharide to the ene-diol followed by the reaction of the ene-diol with oxygen. Free-radical reactive intermediates are formed by the reaction of the ene-diol with oxygen: superoxide, semidione, and 1-hydroxyalkyl radicals are formed under physiological conditions (hydroxyl radicals are also detected at high pH). The autoxidation of monosaccharides stimulates the oxidation of oxyhemoglobin in erythrocytes, producing methemoglobin and hydrogen peroxide, and the oxidation of reduced pyridine nucleotides NAD(P)H to the oxidized congener NAD(P)+ and enzymatically inactive nucleotide. This stimulates oxidative metabolism (via the hexose monophosphate shunt) and alpha-oxoaldehyde metabolism (via the glyoxalase system) in erythrocytes in vitro. The oxidative challenge is relatively mild even with very high concentrations (50 mM) of monosaccharide. However, crosslinking of membrane proteins by alpha-oxoaldehydes is enhanced; this effect may exacerbate ageing and decrease the lifetime of erythrocytes in circulation. In vivo, the autoxidation of monosaccharides is expected to be a chronic oxidative process occurring in biological tissue which utilises simple monosaccharides, e.g., in glycolysis and gluconeogenesis. Monosaccharide autoxidation is suggested to be a determinant in the control of cellular mitosis and ageing, providing physiological substrates for the glyoxalase system, and may contribute to the chronic disease processes associated with diabetes mellitus and the smoking of tobacco.
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PMID:Monosaccharide autoxidation in health and disease. 300 96

The completeness of chronic disease registration in four general practices was assessed by referring to the Hospital Activity Analysis. Overall, just over half (56%) of the 695 patients who had been discharged from hospital with a diagnosis of diabetes, cancer, myocardial infarction, epilepsy, hypertension, or thyroid disease were identified on the practice disease registers. Patients with diabetes were most likely to be identified (72%), and those who had had a myocardial infarct least likely (43%). If the standard of registration is to be improved general practitioners must be convinced of its value. The Hospital Activity Analysis might be used widely to audit and improve practice registers.
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PMID:Completeness of chronic disease registration in general practice. 310 20

Recent advances in cellular and molecular biology have enormous implications for clinical medicine. Of particular interest is the ability to diagnose genetic diseases. Although enormous advances have been made in the diagnosis of monogenic disorders, these diseases account for a relatively small percentage of patients seen in adult medicine. Of more interest in terms of clinical impact are the chronic diseases with a genetic component which occur in about 10% of the population e.g. diabetes mellitus, heart disease, malignancy. If a subgroup of patients with a chronic disease such as diabetes mellitus, who are at particular risk to develop complications, can be identified, the physician will have to convince them to alter their lifestyle. The transfer of basic science to clinical medicine may ultimately lead to a greater emphasis on the art of medicine.
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PMID:From bench to bedside--the impact of the transfer of the new biology to clinical medicine. 316 54

As public health measures decrease the number of deaths due to infectious diseases, life expectancy will increase and chronic and degenerative diseases will claim a greater part of the public health resources. Moreover, many of these diseases are directly related to certain preventable risk factors, which it would be advantageous to identify and eliminate before they become major problems in developing countries. First, demographic analyses, using multiple decrement life tables, were performed to show 1) the survival experience of persons in the population who would die of a disease, given the current cause-specific mortality rates, 2) the life expectancy at any age in the table for a given cause of death, and 3) the gain in life expectancy among persons expected to die of the disease. Second, models were constructed for assessing the effects of risk factors and their change over time. The 1st part of this analysis used hazard functions to relate the risk of disease or death to the values of the risk factor; the 2nd part used linear regression equations to project future values of the risk factors as a function of their past values. Data for the life tables were drawn from World Health Organization cause-specific mortality profiles for cancer, diabetes, cirrhosis, stroke, and heart disease in highly developed, moderately developed, and less developed nations. Data for assessing the effects of various risk factor interventions were drawn from the Framingham Study of cardiovascular disease. Risk factors used were serum cholesterol, blood pressure, smoking, Quetelet index, blood sugar, hemoglobin, vital capacity and age. Demographic analysis showed that the effects of major noncommunicable diseases on life expectancy was not significantly different in developed and developing countries; there were differences in the proportions of deaths from the 5 diseases analyzed but not in the distribution of age at death. Moreover, numerically there are currently more chronic disease deaths in developing than in developed countries, and as life expectancy increases and fertility declines, the impact of noncommunicable diseases will rapidly increase in those countries. Analysis of risk-factor reduction by intervention, such as nonsmoking campaigns and low cholesterol diets, showed that such interventions would be cost-effective, but less so at some ages than at others. Nevertheless, such interventions would be worthwhile if they prevented unhealthful life styles from gaining a foothold in these countries.
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PMID:The global impact of noncommunicable diseases: estimates and projections. 323 13

Obesity is considered to be a major nutritional disorder in the U.S. and in many parts of the industrialized world. The physiology of the obese and their propensity for chronic disease has been of growing interest over the past few years, and an extensive literature has begun to accumulate. Obesity is a heterogeneous disorder. When viewed in the broadest sense, it has been considered a disorder of energy balance. The development of obesity in humans is of complex etiology, involving genetic and environmental components that affect regulatory and metabolic events. The prevalence of overweight and obesity in a population depends on the particular reference or standard of desirable weight selected for use. A trend toward increasing height and weight has been evident among adults for several centuries, and among children as early as the 7th year of life in developed countries. Overweight persons are at increased risk for coronary artery disease, high blood pressure, diabetes mellitus, and cancer. The degree of overweight that carries additional risk without affecting mortality needs to be defined. Overweight most likely contributes in varying degrees to morbidity in different societies, because the risk for most common chronic diseases is multifactorial. In defining overweight and obesity, morbidity, in addition to mortality, ought to be taken into consideration. The multidisciplinary approach to the study of obesity--borrowing concepts and techniques from endocrinology, neurobiology, genetics, and nutrition--should yield new insights into how environmental factors such as diet and physical expenditure interact to influence energy metabolism and body composition.
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PMID:Characteristics of obesity: an overview. 330 Apr 91

Data on five Polynesian populations, obtained by standardized population surveys conducted during the years 1978-1980, were examined for associations between glucose tolerance and both obesity and island of residence. In both sexes, after allowing for the influence of age and obesity, there was a significant difference in glucose tolerance between the three populations considered, subjectively, to be the less traditional and the two considered as retaining a more traditional lifestyle. Regression models predicting diabetic status were weaker than those using glucose tolerance as the dependent variable, probably due to the small number of diabetic subjects in the samples. As all subjects were of Polynesian ancestry, and the results could not be explained by knowledge of ancestral affiliations between the five populations, environmental, rather than genetic factors may have been the determinants of the observed differences in glucose tolerance. This finding highlights the need for a more sophisticated approach to the study of the association between socio-cultural modernization and chronic disease in the Pacific.
Diabetes Res Clin Pract 1988 Jan 07
PMID:Glucose tolerance in Polynesia: association with obesity and island of residence. 334 33

Quality of life is an important consideration in medical decisions involving elderly patients and a clinical outcome measure of health care. Elderly outpatients (N = 126) with five common chronic diseases (arthritis, ischemic heart disease, chronic pulmonary disease, diabetes mellitus, and cancer) and their physicians were interviewed to better characterize patient quality of life. Patients generally perceived their quality of life to be slightly worse than "good, no major complaints" in each chronic disease. Physicians' ratings were generally worse than and only weakly associated with the patients' ratings of quality of life in each chronic disease. Significant independent correlates of patients' ratings of quality of life included the patients' perceptions of their health, interpersonal relationships, and finances. These results suggest that quality of life in elderly outpatients with chronic disease is a multidimensional construct involving health, as well as social and other factors. Physicians may misunderstand patients' perceptions of their quality of life.
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PMID:Quality of life in chronic diseases: perceptions of elderly patients. 334 21


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