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

This report considers the pathophysiologic significance of capillary basement-membrane thickening in diabetic nephropathy and retinopathy and the relationship of capillary basement-membrane thickening to increased susceptibility to infections and to increased vascular permeability in diabetes. The evidence available (1) indicates that basement-membrane thickening affects most if not all capillaries of the diabetic and may contribute to increased susceptibility to infection and (2) suggests that increased capillary permeability in diabetes need not be attributed to basement-membrane changes per se, but rather may be due to changes in the cellular elements of the capillary wall.
Diabetes 1976
PMID:Basement-membrane thickening and diabetic microangiopathy. 78 63

The hospital mortality of acute myocardial infarction amongst 285 known diabetics treated in the last decade was 39.7 per cent at one month and had increased to 51 per cent at 12 months. Treatment in a coronary care unit during the acute stage had little effect on the mortality amongst patients on insulin, but was beneficial for patients whose diabetes had been controlled by oral hypoglycaemic drugs. Female patients on oral hypoglycaemic drugs had the highest mortality. When considering age, duration of diabetes and presence of retinopathy, acute myocardial infarction in diabetics controlled on oral therapy appeared to have a worse outcome than in patients on insulin. Independently of whether patients were on insulin or on oral hypoglycaemic drugs 12 months after the acute episode, only about half of them were still alive.
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PMID:Myocardial infarction in diabetics. 80 45

The prevalence of diabetes due to chronic pancreatitis would appear to be increasing. In western countries this is associated with the known increase in alcohol consumption and AIP. Malnutrition may be etiologic in tropical areas. The incidence of diabetes in chronic pancreatitis is dependent on a number of factors. It is more common in alcohol-induced pancreatitis, rarely occurs after the first attack but tends to increase with time and rises markedly in calcific pancreatitis. Abnormal glucose tolerance occurred in 91% of patients with calcific pancreatitis and 70% of patients with noncalific AIP in our follow up of five to 12 years. This stresses the importance of serial regular glucose tolerance tests in these patients (Table I). The insulin-reserve is severely depleted in most patients who do not yet demonstrate abnormal glucose tolerance, indicating that pancreatitis regularly affects the islets and that nearly all patients are potential diabetics. The beta cells appear to respond better to oral glucose, glucagon or secretin than to i.v. glucose suggesting a selective glucose receptor loss or block to hyperglycemia in chronic pancreatitis. The alpha cells seem to be more resistant to the effects of chronic pancreatitis but true hypoglucagonemia was found in 16% of patients. In addition, stimulated growth hormone secretion may be deficient in pancreatic diabetes. These last two factors, among others, may be responsible for the protracted and even fatal hypoglycemia to which some patients with AIP on insulin therapy are liable. The danger of drug-induced hypoglycemia, coupled with the infrequency of vasculopathy, retinopathy and nephropathy in pancreatic diabetes has induced us to keep these patients hyperglycemic and glycosuric rather than in a sugar-free state, as long as symptoms are contained. Recurrent abdominal pain, marked weight loss and associated steatorrhea often raise special problems in the management of the pancreatic diabetic.
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PMID:Clinical and hormonal aspects of pancreatic diabetes. 80 21

The controversy as to the relationship between the degree of control of diabetes and the progression of the complications of the disease has not been solved. However, in this review, various studies suggesting a relationship between the metabolic abnormality and the diabetic complications are examined. The disadvantages of the uncontrolled diabetes mellitus can be divided into two major categories-short-term and long-term. The short-term disadvantages of controlled diabetes mellitus include the following: (1) ketoacidosis and hyperosmolar coma; (2) intracellular dehydration; (3) electrolyte imbalance; (4) decreased phagocytosis; (5) immunologic and lymphocyte activity; (6) impairment of wound healing; and (7) abnormality of lipids. The long-term disadvantages of uncontrolled diabetes melitus include the following: (1) nephropathy; (2) neuropathy; (3) retinopathy; (4) cataract formation; (5) effect on perinatal mortality; (6) complications of vascular disease; and (7) the evaluation of various clinical studies suggesting the relationship of elevated blood glucose levels and complications of diabetes mellitus. It is suggested that until the question of control can absolutely be resolved, the recommendation is that the blood glucose levels should be controlled as close to the normal as possible.
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PMID:Why control blood glucose levels? 81 31

A procedure was developed in the laboratory for pancreatic allotransplantation in pancreatectomized dogs. Dogs with such grafts have survived for many months when treated with azathioprene and prednisone to prevent rejection. Contrary to usual beliefs, the pancreas is not unduly sensitive to total ischemia since it has been possible to successfully preserve a canine pancreas in vitro with hypothermia for periods up to 24 hours. Such preserved pancreas' have then been allotransplanted into pancreatectomized dogs with survival of the dogs for long periods. We have now done pancreaticoduodenal allotransplantation in 13 patients with juvenile onset diabetes mellitus. Nine of these patients also had renal failure and received simultaneously a renal allograft taken from the same cadaver. In all but one of these patients the pancreas functioned immediately. Two patients with juvenile onset diabetes mellitus and severe retinopathy but without terminal renal failure have received pancreaticoduodenal allografts alone. In both of these patients the pancreas functioned immediately but problems with the duodenum necessitated the removal of the pancreaticoduodenal allograft which did not show signs of rejection. As a result of the findings of increased sensitivity of the kidney and duodenum to rejection we have now modified our technique to transplant the pancreas alone. This technique was used in one patient with juvenile onset diabetes mellitus and severe retinopathy. Her renal function was only moderately reduced. The pancreatic allograft initially functioned normally but then was removed at 28 days because of clinical signs of rejection of the pancreas which were confirmed by the microscopic findings. Despite the promise of islet-cell transplantation, no long term functioning allografts have resulted in animals or man. Thus we need to continue with whole organ pancreatic allografts by various techniques if diabetes mellitus is to be controlled.
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PMID:Transplantation of the pancreas. 82 66

A sample of 181 diabetics with diabetic retinopathy was statistically investigated with regard to association of smoking with proliferative retinopathy. The numbers of patients with proliferative retinopathy rose with increasing tobacco consumption. In non-smokers no association existed between diabetes duration and proliferative retinopathy, but in smokers the number with proliferative retinopathy rose with increasing diabetes duration.
Diabetes 1977 Jan
PMID:Cigarette smoking and diabetic retinopathy. 83 May 64

In order to ascertain the first vascular lesions responsible for infantile diabetic retinopathy, 300 angiofluorographies were performed in 87 children and adolescents whose diabetes became clinically apparent before the age of 14. Compared with normal ophtalmoscopy, the angiofluorography enabled to double the frequency of the diagnosis of incipient retinopathy. In addition to the classical diabetic lesions, the authors describe modifications of vascular permeability noted by leakage of fluorescein and observed in 75% of initial retinopathies. These leakages must be considered to be the first lesions of infantile diabetic retinopathy. They appear before microaneurysms: they seem to be reversible. Highly significant correlation between degree of control, duration of diabetes and frequency of retinopathy were demonstrated.
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PMID:[Diagnosis of juvenile diabetic retinopathy using fluorescein angiography. Description of initial lesions]. 83 69

In patients with idiopathic hemochromatosis, retinopathy was investigated by ophthalmoscopy and fluorescein angiography and was present in eight out of 23; this prevalence is similar to that reported in patients with diabetes aged between 30 and 60 years at onset of diabetes and with the same duration of the disease; in these eight patients retinopathy was of mild degree, with no impairment of visual acuity, fewer than 10 microaneurysms in each fundus, and no other retinal abnormatic islets directly. These studies confirm that anticholinergic drugs may be useful adjuvants in treating these patients.
Diabetes 1977 Feb
PMID:Retinopathy and plasma growth hormone levels in idiopathic hemochromatosis with diabetes. 83 64

Seven patients had sickle cell trait (hemoglobin AS) and vasoproliferative retinopathy. The retinal abnormalities in these seven patients were indistinguishable from those seen in patients with clinically significant sickling hemoglobinopathies (sickle cell-hemoglobin C disease, hemoglobin S-thalassemia disease, and sickle cell anemia). All seven patients also had some evidence of associated systemic disease such as diabetes, syphilis, tuberculosis, or sarcoidosis. In the presence of an associated systemic disease, marked retinopathy can occur in the ordinarily benign condition of sickle cell trait.
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PMID:Proliferative retinopathy in sickle cell trait. Report of seven cases. 84 50

Left ventricular function was assessed by measuring sytolic time intervals in insulin-requiring diabetics with and without significant microangiopathy. The results were compared with those in normal controls. Significant microangiopathy was defined as proteinuria over 3 g/24 h or proliferative retinopathy. Left ventricular function was also assessed one and a half years later by echocardiography in four patients with microangiopathy. Patients with angina, previous myocardial infarction, hypertension, and alcoholism were excluded. All had normal electrocardiograms and chest radiographs. Diabetics with microangiopathy had impaired left ventricular function, whereas those with uncomplicated diabetes had normal function. This finding supports the existence of a specific diabetic cardiomyopathy due to microangiopathy rather than the metabolic defect. The association of microangiopathy and impaired left ventricular function may explain the high immediate mortality and the high incidence of cardiogenic shock and congestive heart failure after myocardial infarction in diabetics.
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PMID:Diabetic cardiomyopathy: the preclinical phase. 86 81


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