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

Ulceration of the foot is a major cause of morbidity in patients with diabetes, and its treatment has become a significant part of general surgical practice. It is, therefore, important to develop an efficient and effective approach to the care of this complication. We established a clinic dedicated to the care and prevention of foot ulcers in diabetic patients and since its inception in 1985, 343 patients have been seen. We provide regular prophylactic care and education to patients without ulcers, as well as treating those with ulcers. To assess the effectiveness of the clinic, we compared two groups of patients. Group 1 contained those who had ulcers while attending our prophylactic care program. Group 2 comprised those who were referred to us with lesions already present. There were 21 patients in group 1 and 150 in group 2. There were no statistical differences between the two groups with respect to age, sex, type and duration of diabetes, smoking history, prevalence of peripheral neuropathy, peripheral vascular disease, renal impairment and retinopathy. The sites and sizes of lesions were also no different between the groups. In spite of these similarities, however, patients in group 1 had a significantly better prognosis than those in group 2. The over-all number of lesions per patient was lower (1.52 +/- 0.98, compared with 2.06 +/- 1.33, p less than 0.05), the mean time required for lesions to heal was shorter (111.9 +/- 80.5 days compared with 160.5 +/- 151.3 days, p less than 0.05). The major amputation rate was lower and fewer patients required partial foot amputation. Prior to the opening of the clinic, the mean length of inpatient treatment was 30 days. This now has been reduced to 12.9 +/- 12.8 days. We conclude that the improved prognosis for those in group 1 can be attributed to the earlier detection and treatment of both potential and actual foot lesions. These results support the contention that the establishment of a dedicated diabetic foot care clinic and regular patient review can reduce the morbidity associated with diabetic foot ulceration.
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PMID:Meticulous attention to foot care improves the prognosis in diabetic ulceration of the foot. 172 50

To determine whether diabetic patients without known cardiovascular disease have exercise-induced perfusion abnormalities without symptoms, we performed thallium-201 exercise tolerance testing (ETT) on 16 subjects with diabetes mellitus (8 men and 8 women; mean age = 51 +/- 2 years). To compare these patients to another group at risk for coronary disease and painless myocardial infarction, 13 hypertensive (7 men and 6 women; mean age = 50 +/- 2 years) patients without symptoms of atherosclerotic disease served as controls. Diabetic and hypertensive patients were similar with regard to age, sex, years since diagnosis and other cardiac risk factors. Abnormal exercise thallium testing was more common among diabetic patients (11/16 = 69%; p less than 0.05) as compared to hypertensive patients (4/13 = 31%). None of the patients reported chest pain or its equivalent. There was no difference between diabetic and hypertensive subjects in the number of minutes exercised, percentage of maximal heart rate attained or final heart rate achieved. Diabetic subjects as a group had greater evidence of peripheral neuropathy but no abnormality of autonomic nerve function. Using ETT with thallium scintigraphy, diabetic patients without known cardiovascular disease were more likely to have transient myocardial perfusion defects than were hypertensive patients.
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PMID:Transient myocardial perfusion abnormalities in diabetic patients: a prospective study using thallium exercise tolerance testing. 176 34

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection/cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.
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PMID:Left ventricular dysfunction and blood glycohemoglobin levels in young diabetics. 180 Sep 43

Life expectancy and physical fitness of patients with neurogenic bladder dysfunctions is highly dependent on the urine status of the patient, and on the integrity and function of the upper urinary tract. Residual urine and urine incontinence give rise to infections, a vicious circle which ends with uraemia. Following nerve disorders can be the cause of a bladder dysfunction with outflow obstruction thus bearing the risk of ascending urine infection: 1) complete or incomplete spinal cord lesion, 2) myelomeningocele, 3) diseases of the CNS, 4) peripheral neuropathy (diabetes, chronic alcoholism, infectious diseases), 5) effect or side-effect of medications. An infravesical obstruction can occur at the alpha-adrenergic receptor site, at the level of the bladder neck or at the level of the striated external sphincter. The latter condition was termed detrusor-sphincter-dyssynergia. Instrumental bladder emptying for prevention of UTI can be achieved by: 1) catheterisation, 2) intermittent self catheterisation, 3) indwelling catheter--should be avoided for long term drainage, 4) suprapubic bladder drainage (cystocath)--the best treatment option for emptying the bladder and to avoid infections.
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PMID:[Neurogenic bladder as a cause of urinary tract infection]. 181 97

To assess early stage autonomic nerve dysfunction, power spectral analyses were conducted on the consecutive RR records of healthy subjects (N/C, n = 21) and age-matched diabetic patients without neuropathy (DNN, n = 11), with peripheral neuropathy alone (DPN, n = 14), and with autonomic neuropathy (DAN, n = 13) during resting, deep breathing, and tilting. From the analyses, power spectral densities of low frequency (0.05-0.1 Hz) component (LF; msec2) and of high frequency (0.2-0.35 Hz) component (HF; msec2) were calculated as expressing sympathetic activity and parasympathetic activity, respectively. In N/C, LF and HF were 466 +/- 332 and 251 +/- 151, respectively. Deep breathing significantly (p less than 0.05 by paired t-test) increased HF to 403 +/- 305 and tilting increased LF significantly to 593 +/- 375. In diabetics as a group, both LF and HF were significantly smaller than those in N/C. DNN showed significantly smaller HFs than N/C. DPN showed a significantly smaller HF during deep breathing (135 +/- 93) and a significant smaller LF during tilting (122 +/- 119) than N/C. DAN showed a significantly smaller HF during deep breathing (49 +/- 49) and a significantly smaller LF during tilting (54 +/- 52) than DPN. Tilting increased LF significantly (p less than 0.001) in N/C but not in diabetics. Deep breathing increased HF significantly (p less than 0.001) in N/C and DNN. HF in diabetics highly correlated with known duration of diabetes. LF in diabetics did not correlate with known duration of diabetes nor level of hemoglobin A1c.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes Res 1991 Jun
PMID:Assessment of early stage autonomic nerve dysfunction in diabetic subjects--application of power spectral analysis of heart rate variability. 181 14

The responses in heart rate, blood pressure and blood flow in the resting forearm during contralateral isometric handgrip were investigated together with the respiratory sinus arrhythmia (measured during standardized breathing frequency and depth), and the heart rate response to a Valsalva manoeuvre in 20 patients with insulin-dependent diabetes and clinical signs of a peripheral neuropathy. The respiratory sinus arrhythmia and the Valsalva ratio were attenuated in the patients compared to age-matched controls, indicating reduced vagal function. Also the responses to handgrip were reduced. The blood flow increase in the resting forearm upon handgrip was correlated with both the respiratory sinus arrhythmia and the Valsalva ratio, supporting neurogenic mediation of the flow response and indicating a reduction in sympathetic as well as vagal function in diabetes autonomic neuropathy.
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PMID:Neurogenic forearm vasodilatation during contralateral isometric exercise is attenuated in diabetes mellitus. 182 57

Auditory brain stem responses were recorded in 20 normoacoustic long-duration Type 1 diabetic patients (duration of diabetes 26 (range 13-46) years, age 44 (25-66) years) with peripheral neuropathy and retinopathy and in 19 sex-matched normoacoustic short-duration Type 1 diabetic patients (duration of diabetes 2 (0-6) years, age 23 (18-50) years) without clinical signs of neuropathy or microangiopathy. Abnormal brain stem auditory evoked responses were demonstrated in 40% of the long-duration and in 5.3% of the short-duration diabetic patients (p less than 0.01). Interpeak latencies Jv-JI and JIII-JI were significantly prolonged in both patient groups compared with the non-diabetic control group (p less than 0.01). Magnetic resonance imaging was performed in 16 of the long-duration patients and in 40 age-matched healthy volunteers on a whole body MR-scanner. Subcortical and/or brain stem lesions with abnormally high signals were seen in 69% of the long-duration Type 1 patients and in 12% of the healthy volunteers (p less than 0.02). Neuropsychological examination including 17 tests for intelligence and cognition were performed in the 20 long-duration Type 1 diabetic patients. The results indicated a performance close to that seen in a control group of healthy age-matched control subjects. Our study demonstrates that a considerable proportion of long-duration Type 1 diabetic patients suffering from retinopathy and peripheral neuropathy additionally have signs but no symptoms of central nervous system affection, diabetic encephalopathy.
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PMID:Evidence for diabetic encephalopathy. 182 3

Bladder dysfunction is a common complication of diabetes mellitus and is attributed in part to peripheral neuropathy. Voiding function is mainly controlled by muscarinic receptor function. Therefore, I investigated first the biochemical and functional characteristics of urinary bladder muscarinic receptors and then the effects of experimental diabetes on them. Experimental diabetes was induced in 2 month-old male rats by intravenous injection of 65 mg/kg of streptozotocin (STZ). Effects of diabetes mellitus were investigated 2, 4 and 8 weeks after injection of STZ. The amount of muscarinic receptors labelled with 3H-quinuclidinyl benzylate (QNB) was higher in the bladder dome of diabetic animals than control animals, while the affinity for its binding sites was similar in both groups. Muscarinic agonists and antagonists inhibited 3H-QNB binding with similar inhibitory constants (Ki) in control and diabetic domes. The rank order of inhibition of 3H-QNB binding by muscarinic agonists and antagonists: bethanechol greater than pirenzepine greater than carbamylcholine greater than acetylcholine greater than atropine, is consistent with the absence of M1 receptors in the bladder dome. In functional studies muscarinic agonists induced a larger contractile response in bladder dome muscle strips from 8 week-old diabetic animal than those from controls. The rank order of ED50s were similar in the control and treated groups, being in good agreement with the Ki values obtained from receptor binding studies. These data show a direct correlation between the diabetes-induced biochemical and functional alterations in muscarinic receptor properties of the rat bladder.
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PMID:[Biochemical and functional characteristics of bladder muscarinic receptors and effects of experimental diabetes in rats]. 182 10

Type II (noninsulin-dependent) diabetes (NIDDM) can be preceded by a relatively long period of disturbed glucose metabolism. Therefore, the prevalence of neuropathy and its possible relationship to metabolic abnormalities were investigated in 95 newly diagnosed type II diabetics (upper age limit was set at 55 years) with a mean age of 49.7 years (men/women ratio 1:1). The study program was as follows: Detailed history, clinical investigation of peripheral nerves, sensory assessment to touch and pain (pinprick), vibration sensation using established techniques, and motor nerve conduction velocities (MNCV) of the fibular (peroneal) and ulnar nerves. Three cardiovascular autonomic function tests were performed: the Valsalva maneuver, standing (ratio between RR-intervalmax: RR-intervalmin), and deep breathing (maximum/minimum heart rate). Vascular diseases were diagnosed using a conventional 12-lead resting electrocardiogram (ECG) and impedance measurement of the lower extremities. The results were as follows: abnormal vibration sensation in 80.0%, abnormalities of MNCV in 15.7%, abnormal sensations to touch or pinprick in 14.7%, and loss of reflexes in 13.6%. If peripheral neuropathy was defined as having at least three of the four abnormalities plus neuropathic symptoms, the prevalence was 6.3% (6 of 95 patients). Abnormalities of the three cardiovascular autonomic function tests were much less prevalent in type II diabetic patients (2.1-7.3%). In conclusion, the study showed that peripheral and autonomic neuropathy is not common at diagnosis in middle-aged type II diabetic patients without signs of microvascular or macrovascular complications.
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PMID:Prevalence of peripheral and autonomic neuropathy in newly diagnosed type II (noninsulin-dependent) diabetes. 183 Mar 12

The prevalence of late complications was determined in four general practices in a representative group of 137 patients with Type 2 diabetes and a control group of 128 non-diabetic individuals. Retinopathy was found in 35% of all diabetic patients, with the same prevalence below and above the age of 70 years. Microalbuminuria was found in 42% of diabetic patients and in 22% of the control group (p less than 0.001). Above 70 years of age microalbuminuria was found with increasing frequency in the control group and was not significantly higher in the diabetes group. Serum creatinine was the same in the diabetic patients and the control group. Peripheral neuropathy was found frequently in the diabetes group, but was not uncommon in the control group (abnormal temperature sensation 63 vs 49% (p less than 0.05), abnormal vibration perception 53 vs 33% (p less than 0.001), absent tendon reflex 62 vs 21% (p less than 0.001]. Above age 70 years there was again a reduction in the difference in prevalence of neuropathy between the diabetes and control groups. Ischaemic heart disease was found more frequently in the diabetes group, but only below 70 years of age (32% of diabetic patients and 14% of the control group with ischaemic changes on ECG (p less than 0.01]. Above that age 46% of the diabetes group and 45% of the control group had ECG signs of ischaemic heart disease.
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PMID:Impact of late complications in type 2 diabetes in a Dutch population. 183 May 27


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