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

Therapeutic considerations regarding the treatment of hypertension in patients with diabetes mellitus are reviewed. Good blood pressure control is essential in diabetic patients to prevent morbidity and mortality associated with cardiovascular diseases. Hypertension may also accelerate complications of diabetic microvascular disease, nephropathy, and retinopathy. Diuretics (e.g., thiazides, furosemide, ethacrynic acid, bumetanide) and beta blockers have traditionally been used as initial therapy for most patients with hypertension; however, these agents may not be the best choice for diabetics. Adverse metabolic consequences include alteration of glucose metabolism and plasma lipids. Beta blockers may also blunt the ability of patients to recognize symptoms of hypoglycemia. Both diuretics and beta blockers can cause sexual dysfunction in men. Adrenergic agents and vasodilators are associated with a high prevalence of orthostatic hypotension in diabetic patients. The calcium-channel blockers are considered safe and well tolerated when given at low and moderate doses. The angiotensin-converting-enzyme (ACE) inhibitors are able to slow the progression of diabetic nephropathy by reducing the glomerular hypertension that causes it. For the treatment of mild hypertension in diabetic patients, the drugs of choice should include (in descending order) ACE inhibitors, calcium-channel blockers, diuretics, and beta blockers. Severe or resistant hypertension usually requires treatment with combinations of drugs, including a diuretic. Tailoring therapy to individual complications and close monitoring of the patient are essential for safe, effective treatment of hypertension in the diabetic patient.
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PMID:Management of hypertension in the diabetic patient. 227 52

Diabetes mellitus (DM), associated with very subtle disorders, affects, either directly or indirectly, various functions of the reproductive system. Adequate, regular, and timely therapy may prevent or delay these disorders. The T synthesis disorder is caused by molecular changes at the level of Leydig cells and may lead to other disorders in all target organs and tissues. The close correlation between Leydig and Sertoli cells function, i.e., between spermatogenesis and second sex glands function, results in certain anomalies in diabetic patients' spermiograms. Parallel lesions associated with DM, through CNS (hypothalamus-hypophysis), and endocrine profile are indirectly intensified or induced by these disorders, which reflect dysfunction of homeostatic balance in carbohydrate metabolism. Sexual dysfunction in all its forms (reduced erection, impotence, and other libido dissociations) is an accompanying phenomenon of the diabetic disease. However, manifestations of these disorders are related to the regulation of carbohydrate metabolism and to the duration of disease. The duration of disease is not necessarily correlated with sexual dysfunction. Even carbohydrate metabolism remains within normal range in addition to other lesions, diabetes leads gradually but progressively to premature aging of body cells.
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PMID:Diabetes mellitus/male infertility. 228 51

The aetiology and management of diabetic impotence is well-documented; the effects of diabetes on female sexuality are not so clear. In this study, 48 diabetic women were assessed clinically and answered detailed sexual questionnaires during a semistructured interview with a sexual counsellor. Twenty-four of the women reported one-or-more sexual dysfunctions: decreased libido, slow arousal, inadequate lubrication, anorgasmia or dyspareunia. There was no significant relationship between the presence of dysfunction and recent glycaemic control, the duration of diabetes, the presence of clinical complications or of neuropathy alone, or the attitude to sexuality. The sexual dysfunction(s) were present at the onset of diabetes in the majority of those so affected (17 of 24 patients), or were attributed to other causes in the remainder. It is suggested that sexual dysfunction in diabetic women should be treated actively as in "normal" women, since diabetes is not the major aetiological factor.
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PMID:Factors in sexual dysfunction in diabetic female volunteer subjects. 259 88

A double-blind, partial crossover study on the therapeutic effect of yohimbine hydrochloride on erectile dysfunction was done in 82 sexually impotent patients. All patients underwent a multifactorial evaluation, including determination of penile brachial blood pressure index, cavernosography, sacral evoked response, testosterone and prolactin determination, Derogatis sexual dysfunction inventory and daytime arousal test. After 1 month of treatment with a maximum of 42.0 mg. oral yohimbine hydrochloride daily 14 per cent of the patients experienced restoration of full and sustained erections, 20 per cent reported a partial response to the therapy and 65 per cent reported no improvement. Three patients reported a positive placebo effect. Maximum effect takes 2 to 3 weeks to manifest itself. Yohimbine was active in some patients with arterial insufficiency and a unilateral sacral reflex arc lesion, and in 1 with low serum testosterone levels. The 34 per cent response is encouraging, particularly in a Veterans Administration population presenting with a high incidence of diabetes and vascular pathological conditions not found in regular office patients. Only few and benign side effects were recorded, which makes this medication worth an attempt, often as a first line of treatment even at a dose of 8 tablets.
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PMID:Effect of yohimbine hydrochloride on erectile impotence: a double-blind study. 265 5

The authors present the results from a retrospective study conducted on 42 patients with Peyronie's disease. For each case, all possible etiological factors were investigated, such as family history, history of trauma, history of other collagenoses, of diabetes, and so on. These studies yielded results comparable to published data. Calcifications within the plaques were found on simple X-ray films in 10.8% of cases. Out of 20 radiological examinations of the corpora cavernosa that were performed, 80% demonstrated pathological processes. It was possible, in some of the cases, to measure echographically the plaque widths, while autophotography was useful in a small number of cases. We were more particularly concerned with sexual dysfunction, impotence, and premature ejaculation, which could be observed in 14 patients.
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PMID:[Etiologic and diagnostic aspects of Peyronie's disease. Apropos of 42 cases]. 267 50

The contribution of diabetes and cirrhosis to sexual dysfunction and hypogonadism was evaluated by two-way analysis of variance in a group of 30 men with idiopathic hemochromatosis. The prevalence of severe sexual dysfunction was significantly higher in men with hemochromatosis than in a control group matched for prevalence of diabetes and age (P less than 0.001). In both controls and hemochromatosis patients the presence of diabetes was significantly associated with sexual dysfunction (P less than 0.005), but the more severe symptoms in the hemochromatosis patients were related to the additive effects of hypoandrogenism (P less than 0.01). Sexual dysfunction was a common early complaint in hemochromatosis patients, but these symptoms were frequently overlooked, leading to diagnostic delay. Mean testicular volume was a useful measure of gonadal status, being significantly correlated with indices of serum free testosterone (rs = 0.83; P less than 0.01) and LH (rs = 0.71; P less than 0.001). The presence of cirrhosis did not contribute significantly to symptomatology, but had an effect independent of and additive to hypogonadotropic hypogonadism in reducing serum free testosterone (P less than 0.02) and estradiol (P less than 0.002), an effect apparently mediated through central rather than testicular mechanisms. Hypoandrogenism was associated with an increase in serum sex hormone-binding globulin (SHBG) concentrations (P less than 0.005), but cirrhosis also had an independent effect in raising SHBG (P less than 0.005), which could not be accounted for by changes in circulating sex hormone concentrations. Thus, the evaluation of sexual dysfunction or hypogonadism in men with hemochromatosis requires consideration of the effects of both diabetes and cirrhosis. Because of the greater variance in SHBG some estimate of free testosterone rather than total testosterone is preferable.
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PMID:Hypogonadism and sexual dysfunction in hemochromatosis: the effects of cirrhosis and diabetes. 273 93

Hypertension in patients with diabetes mellitus increases the risk of both macrovascular and microvascular complications. Such microvascular complications as diabetic nephropathy and retinopathy are accelerated in the presence of arterial hypertension. Evidence suggests that the complications of diabetes mellitus begin early in the course of the disorder as manifested by microalbuminuria and increased vascular reactivity. These findings are accompanied by changes in the renin-angiotensin-aldosterone system including reductions in plasma renin activity. These changes could be secondary to volume expansion that may be a direct consequence of elevated blood glucose, suggesting that the metabolic disorder in diabetes contributes to the etiology of hypertension in these patients. Adequate treatment of hypertension is crucial to the prevention of complications; however, many antihypertensive agents have limited usefulness in diabetes mainly because of their unfavorable side effects. Diuretics lower blood pressure in hypertensive diabetics, but their metabolic effects are especially undesirable in this population. beta-Blockers alter glucose and lipid metabolism in diabetic patients and reduce regional blood flow. Central acting agents and alpha-blockers are often associated with orthostatic hypotension, sexual dysfunction, and central nervous system side effects. Angiotensin-converting enzyme inhibitors (ACEIs) such as captopril effectively lower blood pressure in diabetic patients and have few unwanted effects. They may improve metabolic control and have favorable effects on glucose metabolism. The ACEIs also produce improved regional hemodynamics which may lead to the improvement in or prevention of the progression of diabetic nephropathy.
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PMID:Management of hypertension in the patient with diabetes mellitus. Focus on the use of angiotensin-converting enzyme inhibitors. 305 49

To examine the prevalence of psychiatric disorders in patients with long-standing type I diabetes mellitus, we assessed a series of candidates for pancreas transplantation. Using the Diagnostic Interview Schedule, six-month and lifetime prevalences of psychiatric disorders were established for the candidates and their potential donors (first-degree relatives). Excluding tobacco use disorder and psychosexual dysfunction, 38 diabetic subjects (51%) received one or more psychiatric diagnoses. The lifetime prevalence of major depression was comparable for female (11 of 48 [22.9%]) and male (seven of 27 [25.9%]) diabetics; both rates were significantly higher than rates in first-degree relatives and the general population. Among female diabetics, the six-month and lifetime prevalences of simple phobia were increased vs donors and the general population; among male diabetics, the lifetime prevalence of antisocial personality disorder was greater than that in the general population. None of these disorders was found to be related to the duration of diabetes or the presence of various complications. The data suggest that increased rates of psychiatric disorder in type I diabetics have both gender-independent and gender-related components.
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PMID:Prevalence of major depression, simple phobia, and other psychiatric disorders in patients with long-standing type I diabetes mellitus. 325 79

The incidence of sexual dysfunction increases with age and in the presence of systemic hypertension. An interplay between endocrine, neurologic and vascular systems mediates normal male sexual function. Androgens primarily regulate libido and maintenance of genital tissue, while the autonomic nervous system and arterial blood flow play key roles in the physiology of the male sexual response, particularly penile erection. Vascular disease related to hypertension, diabetes mellitus and atherosclerosis may be the main factor contributing to the sexual dysfunction that occurs with aging. Hormonal alterations probably play less of a role. The importance of neurologic abnormalities remains to be determined. Although specific diagnostic testing can be useful in defining abnormalities in each of these systems, treatment of sexual dysfunction in the setting of hypertension in the elderly patient remains a challenge.
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PMID:Sexual dysfunction with aging and systemic hypertension. 328 46

The prevalence of diabetes mellitus and hypertension in the United States is increasing partly because of the incidence of these diseases in the growing geriatric population. Diabetes and hypertension have been associated with sexual dysfunction in both men and women. Neuropathy, vascular insufficiency and psychological problems have been implicated in impotence, impaired ejaculation and decreased libido in men and in decreased vaginal lubrication, orgasmic dysfunction and decreased libido in women. Several investigations of women with diabetes suggest fewer reports of sexual dysfunction than have been reported by diabetic men. However, there have been few evaluations of sexual dysfunction in women and no standard methods for assessment. Antihypertensive agents, especially diuretics, sympathetic inhibitors and beta-blocking agents have been associated with sexual dysfunction due to autonomic and hormonal effects. An estimated 40 to 80% of diabetic hypertensives have reported sexual dysfunction in several investigations. Clearly, the diabetic hypertensive patient should be evaluated for sexual dysfunction, and appropriate therapy, including changes in medication or referral for sex counseling, should become routine in clinical care.
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PMID:Sexual dysfunction in the diabetic patient with hypertension. 328 48


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