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

Painful diabetic distal sensory neuropathy is a disabling and common complication of diabetes mellitus. There is evidence that microvascular changes resulting in ischemia to the vasa nervorum may contribute to this problem. Pentoxifylline has been shown to improve circulation through partially occluded peripheral vessels and has been postulated to be of potential benefit. Forty adult type II diabetics were enrolled in a double-blind, placebo-controlled study utilizing pentoxifylline for six months. Visual analog scores, nerve conduction studies, and physical examinations were used to evaluate response to treatment. At the end of the six-month trial, there was no significant difference in the patients' pain between the pentoxifylline- and placebo-treated groups. The authors conclude that pentoxifylline is not useful in the treatment of painful distal diabetic neuropathy.
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PMID:Pentoxifylline in the treatment of distal diabetic neuropathy. 192 15

Endoneurial microvascular abnormalities have been invoked in the pathogenesis of diabetic distal symmetric polyneuropathy. Detailed morphometric analysis of the endoneurial microvasculature was correlated with previously published data on nerve fiber morphometry and teased fiber analysis obtained from the same sural nerve biopsies. Biopsy specimens from neuropathic diabetic patients were obtained before and after 12 mo of aldose reductase inhibitor (ARI) treatment and compared to 15 carefully age-matched control subjects. Diabetic microvessels showed basement membrane thickening and loss of endothelial cell tight junctions. Microvascular density and the frequency of microvessels closed by endothelial cells increased with age in diabetic and control nerves and were unaffected by diabetes. The density of microvessels showing patent lumina did not differ between control and diabetic subjects and was not related to age or diabetes. Closed microvessels were composed of postcapillary venules that were otherwise devoid of ultrastructural abnormalities. We suggest that microvascular closure by endothelial cells may be a physiological condition and is unlikely to have any pathogenetic significance in diabetic neuropathy. Based on the current limited biopsy material, we conclude that 12 mo of ARI treatment that induced significant fiber repair and regeneration had no detectable effect on endoneurial microvascular abnormalities. These data suggest that endoneurial vascular pathology is not a rate-limiting factor in fiber damage or repair at this stage of diabetic neuropathy.
Diabetes 1991 Sep
PMID:Endoneurial microvessels in human diabetic neuropathy. Endothelial cell dysjunction and lack of treatment effect by aldose reductase inhibitor. 193 16

This study was designed to evaluate the involvement of airways innervation during diabetic autonomic neuropathy. Bronchial response to methacholine was assessed by inhalation of serially doubling doses in 22 insulin-dependent diabetes mellitus (IDDM) patients and 11 nondiabetic control subjects selected for their nonsmoking habits. Cardiovascular autonomic control was studied by four standardized tests, i.e., blood pressure and heart-rate variations during orthostatism, heart-rate variation during Valsalva maneuver, and deep breathing. Magnitude and time-course of response to methacholine were similar in nondiabetic subjects and IDDM patients without any abnormal result on cardiovascular tests. Conversely, bronchial response to methacholine was markedly reduced in IDDM patients with one or more abnormal results by cardiovascular assessment of autonomic control. In the IDDM patients, bronchial response to methacholine was significantly correlated to indexes of cardiovascular autonomic control. These results suggest that, during diabetic neuropathy, innervation of the airways likewise involves cardiac autonomic control and leads to impairment of defense reflexes of the airways.
Diabetes 1991 Sep
PMID:Decreased bronchial response to methacholine in IDDM patients with autonomic neuropathy. 193 17

We have studied the fate of diabetic neuropathy and autonomic function in 13 patients with long standing Type 1 (insulin-dependent) diabetes mellitus following combined pancreas and kidney transplantation. Fifteen diabetic patients with a kidney graft only served as controls. After initial improvement of the neuropathy in both groups, probably caused by the elimination of uraemia, a continuous improvement during the 48 months study was seen in the euglycaemic pancreas graft recipients only. Autonomic (parasympathetic) function improved only slightly and to a similar extent in both groups.
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PMID:Improvement in diabetic neuropathy 4 years after successful pancreatic and renal transplantation. 193 76

Contractility of the gall bladder (by ultrasound criteria) and pancreatic enzyme excretion were considerably decreased in patients with diabetes mellitus of noninsulin dependent type in the presence of atrophic duodenitis, confirmed by endoscopy and histology, as compared to diabetic patients without duodenitis or with non-atrophic duodenitis. The data obtained were discussed with relation to a decrease in the excretion in atrophic duodenitis of cholecystokinin-pancreozymin (the main physiological stimulator of motility of the gall bladder and pancreatic enzyme excretion). It turned out that contractility of the gall bladder in patients with diabetic neuropathy was much less than that in diabetic patients without neuropathy provided all other conditions were the same. All the results obtained permitted better understanding of the essence, mechanisms and clinical meaning of gastroenterological disorders in patients with diabetes mellitus.
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PMID:[Significance of duodenitis and disorders of gall bladder motility in patients with diabetes mellitus]. 194 3

Neuropathic (Charcot) arthropathy is a slowly progressive, chronic, destructive form of joint degeneration seen in patients with a neurosensory deficit. Attempts to produce neuropathic joint disease experimentally with a variety of deafferentation procedures have generally been unsuccessful. However, if the knee is rendered unstable by anterior cruciate ligament transection (ACLT), breakdown of the joint occurs rapidly in dogs that have previously undergone dorsal root ganglionectomy (DRG) for deafferentation of the ipsilateral limb. In contrast, ACLT in neurologically intact dogs produces not only nonprogressive changes that are characteristic of mild osteoarthritis. This report describes 3 patients with longstanding insulin-dependent diabetes mellitus in whom neuropathic arthropathy developed within weeks after minor trauma to the foot or ankle. In these patients, diabetic neuropathy served as the functional equivalent of dorsal root ganglionectomy, and the minor trauma served as the functional equivalent of ACLT. Together, they illustrate the phenomenon of neurogenic acceleration of joint degeneration in humans.
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PMID:Rapidly progressive Charcot arthropathy following minor joint trauma in patients with diabetic neuropathy. 196 68

A total of 263 diabetic patients and 129 normal controls were enrolled in a study of vibratory perception threshold (VPT) using an electromagnetic vibrometer at two sites, the dorsum of the metacarpal bone of the index finger (IF) and the dorsomedial aspect of the metatarsal bone of the great toe (GT). The results showed that the mean values of VPT for both IF and GT were significantly higher in diabetics than in normal subjects. In both control and diabetic groups, the VPT values at GT only were elevated with increasing age. Furthermore, the mean VPTs at both IF and GT were related to the duration of illness and the severity of diabetes mellitus in the patient group. Eighty cases of diabetes mellitus received nerve stimulation tests including motor and sensory nerve conduction velocities of the upper and lower limbs. The results from these cases demonstrated good correlation between VPT and motor conduction velocity (MCV), but not between VPT and sensory conduction velocity (SCV). There was a negative correlation between VPT at IF and median MCV (p less than 0.0005) in the upper limbs, as well as VPT at GT and tibial MCV (p less than 0.0005) in the lower limbs. For clinical applications, VPT values seemed to be more sensitive than MCV in detecting neuropathic change in diabetic patients. Hence, impairment of vibratory perception can be taken as a subtle clinical sign of diabetic neuropathy, and measurement of VPT can be used as an index of a patient's current subclinical state.
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PMID:Vibratory perception threshold in diabetic neuropathy. 197 6

The Authors examine the possibilities of instrumental diagnosis in patients with the "diabetic foot" syndrome. The lack of clinical relevance of the so called "microangiopathy" is stressed, because. Indeed, either the "macroangiopathy" or the diabetic neuropathy are responsible for almost all the symptoms of this syndrome. In the differential diagnosis between these two major sequelae of diabetes, with consequently wide differences in the therapeutic choices, the Doppler ultrasound examination has been of paramount usefulness, because it is very sensitive and specific in detecting and localizing any lesion suggestive of macroangiopathy.
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PMID:[Role of non-invasive vascular diagnosis in the study of "diabetic foot"]. 200 30

Effects of essential fatty acids on nerve conduction, hypoxic resistance, skeletal muscle contractile properties, and capillary density were examined in streptozocin-induced diabetic rats. Nondiabetic and diabetic controls and three diabetic groups treated with 10% supplements of corn oil, evening primrose oil (Efamol), or a mixture of 80% evening primrose oil and 20% fish oil (Efamol Marine) for 2 mo were used. Efamol and Efamol Marine increased plasma gamma-linolenic acid levels, but arachidonic acid was elevated only with Efamol. Diabetes resulted in 15-29% reductions in sciatic motor and sensory saphenous nerve conduction velocity. Efamol prevented conduction deficits more effectively than Efamol Marine, and corn oil had no effect. In vitro measurement of sciatic nerve hypoxic resistance revealed a 49% increase in the time taken for action potential amplitude to decline by 50% with diabetes. Corn oil had no significant effect. With Efamol, hypoxic resistance was within the nondiabetic range. Efamol Marine produced intermediate results. Functional improvements may relate to enhanced vasa nervorum perfusion, because endoneurial capillary density increased by 22% with Efamol, angiogenesis perhaps resulting from eicosanoid production from arachidonic acid. Soleus muscle contractions were prolonged by diabetes. This was partially corrected by treatment, Efamol being most effective. Extensor digitorum longus muscle had reduced tetanic tension with diabetes, and this was prevented by all treatments. Soleus showed a modest increase in capillarization with Efamol, which may have contributed to reduced susceptibility to fatigue. The data suggest involvement of abnormal fatty acid metabolism in the etiology of diabetic neuropathy and myopathy.
Diabetes 1991 May
PMID:Essential fatty acid diet supplementation. Effects on peripheral nerve and skeletal muscle function and capillarization in streptozocin-induced diabetic rats. 202 1

The prevalence of silent myocardial ischemia and its relation to autonomic dysfunction and pain threshold was studied in 58 men with diabetes mellitus and without cardiac symptoms. All patients underwent 48-hour ambulatory electrocardiographic monitoring and exercise testing after assessment of their autonomic function and pain threshold. Silent myocardial ischemia, defined as greater than or equal to 1 mm of ST-segment depression on either exercise testing or ambulatory electrocardiographic monitoring, was corroborated by exercise-induced reversible defect(s) on tomographic thallium scintigraphy. Autonomic function was assessed by heart rate response to: (1) Valsalva maneuver, (2) deep breathing, and (3) upright posture, as well as by diastolic blood pressure response to sustained handgrip and systolic blood pressure response to upright posture. Autonomic dysfunction was defined as greater than or equal to 2 abnormal responses. Pain threshold measurements were performed using electrical cutaneous stimulation of both forearms. Of the 58 diabetic patients, 21 were found to have autonomic dysfunction (36%). Silent myocardial ischemia was detected in 10 patients (17%), and was significantly more frequent in patients with than without autonomic dysfunction (38 vs 5%, p = 0.003). There was no difference in the electrical pain threshold or tolerance in subjects with and without silent myocardial ischemia. It is concluded that silent myocardial ischemia in asymptomatic diabetic men occurs frequently and in association with autonomic dysfunction, suggesting that diabetic neuropathy may be implicated in the mechanism of silent myocardial ischemia.
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PMID:Detection of silent myocardial ischemia in diabetes mellitus. 173 30


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