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

The permeability of the blood-retinal barrier and retinal blood flow were evaluated by two new fluorophotometric methods in a series of patients with proliferative retinopathy, due either to retinal vein occlusion or to diabetes. A breakdown of the blood-retinal barrier and a decrease in retinal blood flow were observed in these patients. The breakdown of the blood-retinal barrier could be quantitated by vitreous fluorophotometry, which revealed very high concentrations of fluorescein in the vitreous after intravenous administration. The decrease in retinal blood flow appeared to be due mainly to appreciable narrowing of the retinal arteriolar vessels.
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PMID:Vitreous fluorophotometry and retinal blood flow studies in proliferative retinopathy. 30 82

Pancreatic islet cell, thyroid, and gastric antibodies were studied in 116 young insulin-dependent diabetics and 257 relatives. Seventy-four per cent of the diabetics studied within three months of diagnosis had islet-cell antibodies but only 20% of those studied three years or more after diagnosis. Persistence of these antibodies was associated with a high prevalence of thyrogastric autoimmunity, which suggests that some cases have an aetiology similar to that of "polyendocrine" autoimmune disease. Retinopathy or nephropathy, or both, was present in 10 diabetics, who were all members of "autoimmune" families, in which one or more members had organ-specific antibodies. Nine of the 10 healthy relatives with islet-cell antibodies and all families with more than one diabetic were also in this autoimmune group. These data suggest that an autoimmune factor may contribute to juvenile diabetes and that such autoimmune diabetes has a tendency to run in families and may be more likely to cause complications.
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PMID:Autoimmunity in juvenile diabetics and their families. 35 41

The only methods of treatment for severe diabetic retinopathy that have been proved effective by controlled clinical trials are photocoagulation and pituitary ablation. It must be noted that photocoagulation and pituitary ablation impede but do not cure diabetic retinopathy. Pars plana vitrectomy can be highly effective for removing blood from the vitreous of the eye, allowing better vision, particularly if the retina has been shown to be functional by electrophysiologic testing and ultrasonography. In addition, vitrectomy allows the ophthalmologist to visualize, evaluate, and treat the diabetic retina by photocoagulation or other methods. Attempts at better regulation of blood sugar have reduced the development of microangiopathy in experimental animals and recently in man. The benefits of rigorous regulation of the blood sugar has been noted in a policy statement by the American Diabetes Association. The development of a practical, beneficial pancreas has been undertaken, and may be required in order to reap the full benefits of rigorous blood sugar control. It has been recommended that all patients be evaluated by an ophthalmologist as soon as they have been found to have diabetes, that all diabetics be examined ophthalmologically on an annual basis, and that patients with significant retinopathy be seen at 6 month or shorter intervals by their ophthalmologist. The evaluation and treatment of diabetic retinopathy has progressed enormously during the past decade. It is hoped that the cause of diabetic microangiopathy and retinopathy will be discovered in the near future so that treatment will ultimately cure rather than control the process of diabetic retinopathy.
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PMID:Diabetic retinopathy. 35 41

In order to investigate whether patients with long-standing juvenile diabetes mellitus (onset of diabetes before the age of 30) and a low daily insulin requirement (less than 0.50 units/kg body weight) still have functioning B-cells, plasma C-peptide was determined after stimulation (OGTT and glucagon/tolbutamide) in 64 patients with diabetes of more than 18 years' duration (mean 31 years). Measurable endogenous insulin production was found in 24% of the patients. The prevalence of severe retinopathy was lower in the secretors than in the non-secretor group. There was no difference in insulin antibody concentration between the two groups. Furthermore, the insulin requirement in the secretor group was relatively constant during the course of diabetes. Metabolic control was similar in both groups. It is concluded that a persisting but low activity of endogenous insulin production can be found in many long-term juvenile diabetics with a low insulin requirement, while others without any residual beta-cell function develop a low insulin requirement for unknown reasons.
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PMID:Persistent insulin secretion, assessed by plasma C-peptide estimation in long-term juvenile diabetics with a low insulin requirement. 35 94

Twenty-one insulin-dependent diabetics with azotemic nephropathy were evaluated for renal transplantation by selective coronary angiography and cine left ventriculography. All had hypertension, retinopathy, neuropathy, and required salt restriction plus diuretics for volume overload. There was no clinical or electrocardiographic evidence of ischemic coronary artery disease in twenty. Ten patients (five males, five females, mean age 29.3 years; mean duration of diabetes 21.9 years; mean serum cholesterol 239 mg%) had significant coronary artery disease, seven demonstrating focal abnormalities in left ventricular wall motion. Two patients (one male, one female; mean age 36.5 years; mean duration of diabetes 28.5 years; mean serum cholesterol 250 mg%) had no significant coronary artery disease, but demonstrated diffusely abnormal left ventricular wall motion with diminished ejection fraction. Thirty-eight percent had significant coronary artery disease unpredictable by electrocardiographic or clinical data. The finding of no significant coronary artery disease in 52% of a group with severe renal-hypertensive complications of diabetes is surprising. Two patients may have a demonstrated cardiomyopathy.
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PMID:Asymptomatic coronary artery disease: angiographic assessment of diabetics evaluated for renal transplantation. 36 Dec 77

The controversy over the whether strict blood glucose control prevents or attenuates the complications of diabetes is still unresolved, but the available data support the value of good blood glucose control. The resolution of the controversy is not feasible at present because of the complexity and financial cost of a definitive prospective study and because we may not presently possess pharmacological agents which can accomplish the goal of long term strict control of the blood glucose. Finally, whereas we regard retinopathy, nephropathy and neuropathy as valid pathological endpoints, we are not secure in assuming that blood glucose represents the critical measurement for longitudinal assessment of metabolic control. Studies evaluating control based on blood and urine glucose assessments are complicated by the failure of the data to reflect changes in minute to minute regulation. Thus, the relative insensitivity of some of these parameters of control could account for failures to demonstrate a correlation between adequacy of therapy and diabetic complications.
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PMID:Control of the blood glucose in diabetes mellitus is it valuable? Is it feasible. 38 Sep 57

Insulin dependent (IDD) and non-insulin dependent diabetes (NIDD) are separate disorders. Twin studies show that IDD cannot be entirely due to genetic causes as concordance is no more than about 50%, but there is some inherited predisposition to it as shown by HLA patterns. NIDD, on the other hand, is predominantly due to genetic causes since identical twins are nearly always concordant. Many cases of NIDD show chlorpropamide alcohol flushing (CPAF), a dominantly inherited feature which may precede the appearance of diabetes and thus act as a genetic marker for this type of diabetes. Diabetics who show chlorpropamide acohol flushing are less likely to develop retinopathy than those who do not. Genetic factors must therefore affect the incidence and severity of diabetic retinopathy. Chlorpropamide alcohol flushing is due to sensitivity to enkephalin. Enkephalin and other opioids affect carbohydrate metabolism and insulin release. It is possible therefore that they act as neurotransmitters and cause NIDD by a sympathetically mediated effect on the liver and pancreas--in other words, that as far as NIDD is concerned Claude Bernard's views on the cause of diabetes may have been right.
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PMID:Diabetes: the genetic connections. 39

Present methods of management of juvenile-onset diabetes mellitus do not prevent serious and debilitating complications affecting multiple organ systems. In an effort to reverse advanced forms of these complications, segmental transplantation of the pancreas has been performed on 10 patients, seven of whom simultaneously or subsequently received renal transplants. Long periods of normoglycemia (two to four and one-half years) were achieved in two patients who also maintained transplant kidney function. The course of these two patients is described to illustrate the possible value and limitations of the procedure. These patients had normal blood glucose levels, exhibited repeated normal intravenous glucose tolerance curves, and had repeated normal endogenous insulin levels. Their courses were characterized by (1) absence of problems related to pancreatic exocrine secretions into the bladder; (2) stable eye changes despite some episodes of hemorrhage from preexisting retinopathy; (3) vascular complications, including stroke and gangrene of extremities necessitating amputation despite successful femoropopliteal bypass grafting; (4) peripheral neuropathy; and (5) repeated infections. Both patients succumbed to vascular complications. Thus, pancreatic transplantation can maintain blood glucose and insulin at normal levels for extended periods of time. However, it does not reverse such complications as advanced retinopathy or atherosclerosis. Since the procedure may have value in preventing progression of these complications, it should be evaluated in patients with less advanced complications of diabetes.
Diabetes Care
PMID:Long-term effects of pancreatic transplant function in patients with advanced juvenile-onset diabetes. 40 Jan 24

The fate of the diabetic today is essentially determined by the late complications of diabetes. Of the forms of clinical expression of diabetic microangiopathy, nephropathy and retinopathy are the most significant. Findings are presented which suggest that diabetic microangiopathy is not of genetic or immunologic origin, but is to be considered a consequence of insulin deficiency. More recently, some studies have been carried out which which strongly support the concept that metabolic control of the diabetic prevents or at least delays the development of late complications of diabetes. For this reason an optimal for control of diabetes, if at all possible with aglycosuria, should be aimed at.
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PMID:[The effect of metabolic control on the development of late complications of diabetes (author's transl)]. 40 63

Submaximal bicycle ergometry was used in the evaluation of cardiac function in 22 patients with juvenile diabetes and 21 age-matched control subjects. Six patients had moderate to severe retinopathy and 2 had peripheral neuropathy. Half of the patients, but only 3 of the controls, were smokers. No differences were found in BP, serum cholesterol, triglycerides and serum creatinine levels between diabetics and controls. None had proteinuria. Patients with juvenile diabetes had higher heart rates (HR) at rest as well as during and after exercise than the healthy controls. Diabetics also had a reduced HR response to postural changes compared with the controls. Five diabetics and one control had a pathological exercise ECG (0.05 less than P less than 0.1) that may indicate early non-symptomatic coronary heart disease. The observed changes in HR may be due to autonomic neuropathy.
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PMID:Response to bicycle exercise testing in long-standing juvenile diabetes. 42 49


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