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Query: UMLS:C0011849 (diabetes)
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Home blood glucose monitoring has been introduced as a means to achieve good control in patients with diabetes mellitus. Many patients use color-reagent strips and color comparisons to determine blood glucose levels. Intact color vision in the blue-yellow range is necessary for accurately interpreting these strips.Blue-yellow vision deficits occur as a consequence of eye disease and are not genetic or sex-linked. We evaluated blue-yellow vision acuity in 70 diabetic patients and in 19 age-matched control subjects. The patients with diabetes were subdivided according to their degree of retinopathy as follows: no disease (N = 14), nonproliferative diabetic retinopathy (N = 16), proliferative diabetic retinopathy (N = 14) and postlaser-treated (N = 26). None of the control group had deficits. Each group of diabetic patients had a statistically significant increase in color vision deficits compared with the controls. In the laser-treated group, deficits occurred in most patients, were more severe and were significantly increased over all other diabetic subgroups. These deficits may impair visual interpretation of home blood glucose monitoring strips.
West J Med 1987 Apr
PMID:Blue-yellow vision deficits in patients with diabetes. 349 70

Access to health insurance and protection against expenditures for medical care are of special concern to diabetic patients in the United States. This study examines some information on the extent and breadth of public and private health insurance for individuals with diabetes, as well as some estimates of their use of health-care services and their mean expenses for this care. About 12% of all diabetic patients less than 65 yr old (approximately 311,000 individuals) were uninsured throughout 1977, a rate not much different from that for the rest of the United States population. Those with diabetes who are uninsured tend to be younger, Black or Hispanic, in excellent or good health, and live outside of metropolitan areas and in the South or West. As expected, diabetic patients use more medical care than others of their age and sex, and their medical expenses are also much higher, particularly in younger age groups. In 1977, average total medical-care expenses for people with diabetes were $1514 compared with $548 for the rest of the population. They and their families paid approximately 20% out of pocket (approximately $355). Their health insurance premiums were not much different from those without diabetes, averaging approximately $1000 in 1977 for those under age 65. The private insurance coverage for diabetic patients was similar to that for others, although slightly fewer had major medical coverage than the general population.
Diabetes Care
PMID:Medical expenditures and insurance coverage for people with diabetes: estimates from the National Medical Care Expenditure Survey. 355 17

Type I diabetes mellitus appears to result from an insidious immunologic destruction of pancreatic beta-cells in genetically susceptible persons exposed to one or a series of environmental insults. This genetic susceptibility is related to alleles located on the sixth chromosome in the HLA-DR or an adjacent region. With superimposition of a viral or other environmental triggering event, cell-and antibody-mediated events are activated that lead to the specific autorejection of beta-cells and consequent insulin deficiency. Immunosuppressive strategies to impede or halt complete destruction of beta-cells, using cyclosporine, have already been initiated in both animals and humans with diabetes mellitus. Because of the potential toxicity of all current immunosuppressive regimens, such therapies cannot, at this time, be considered for wide-scale use in persons with type I diabetes. Reported inductions, however, of insulin independence in patients with newly diagnosed type I diabetes using cyclosporine or other agents underscore the role of the immune system in the pathogenesis of the disease and highlight the need to develop safer, more specific immunomodulation designed to avoid complete beta-cell destruction.
West J Med 1987 Mar
PMID:The role of immunotherapy in type I diabetes mellitus. 355 59

This study was designed to compare the prevalence of obesity, high blood pressure, diabetic vascular disease, and risk factors in Black West Indians who had emigrated to Britain (WIB) with those in Whites in England and among diabetic Jamaicans in Jamaica. Seventy-seven consecutive WIB patients were matched for age, sex, known duration of diabetes, and type of treatment of diabetes with 74 Whites from the same diabetes clinic in England. In Jamaica, a systematic random sample (95 women, 36 men) was studied. There was no difference in age at diagnosis between WIBs and Jamaicans. Effort chest pain (possible angina) was less frequent in WIBs (9%) or Jamaicans (3%) than in Whites (25%). Cigarette smoking was more common in WIBs than in Whites but still low in Jamaicans. Body mass index was greatest in WIB women (85%), significantly more than in matched White (52%) or Jamaican women (45%); 40% of White men and WIB men were obese, significantly more than Jamaicans (15% obese). Systolic blood pressure was similar, but diastolic blood pressure was significantly greater in WIBs than in matched White subjects. The prevalence of casual hypertension was high (greater than 40%) in all groups, often despite treatment. Cataracts were significantly more frequent in WIB and Jamaican groups than in Whites. Total background retinopathy after correcting for duration of diabetes did not differ between groups, and there were no significant differences in other complication rates. Levels of HbA1 were lower in Whites than in the other groups. Regression analysis showed that systolic blood pressure was most consistently related to complications, particularly retinopathy, independent of ethnic group and duration.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes Care
PMID:Black West Indian and matched white diabetics in Britain compared with diabetics in Jamaica: body mass, blood pressure, and vascular disease. 358 77

Familial aggregation of coronary heart disease (CHD) and specific major risk factors were determined among 639 first-degree relatives of 73 women with confirmed coronary death before age 55. They were compared with 1,151 persons in 141 control families. Of women with early coronary death, 62% had first-degree relatives with early coronary disease compared with 12% of affected control family members. In the proband families, coronary incidence rates were 2.7 times the control population rates for women (P<.001) and 1.6 times the control population rates for men (P<.05). An excess incidence of coronary disease was observed for ages 45 to 74 in both men and women.Smoking, hypertension, diagnosed hyperlipidemia and diabetes were all two to three times more common in the female probands with early coronary death than in healthy controls. Hypertension was more common in all proband relatives (both sexes with and without coronary disease). Smoking was more common among female relatives of probands when compared with the controls. These data suggest that early coronary disease in women is often familial and associated with smoking and hypertension. The familial aggregation seems to be stronger in female relatives of female probands with early CHD than in male relatives. Genetic factors or shared family life-style or both likely account for these observations.
West J Med 1986 Sep
PMID:Coronary disease and risk factors in close relatives of Utah women with early coronary death. 376 12

An analysis is presented of data on all 30 129 inpatient admissions to a mission hospital in the West Nile District of Uganda in the 27 year period from July 1951 to August 1978. For most of this period the hospital was staffed by the same two doctors. For each patient admitted, a record was made of their age (adult or child), sex, place of residence, duration of stay in hospital, diagnosis and vital status at discharge. The annual number of admissions increased steadily from around 300 in 1952 to over 1600 in 1966 and subsequently declined to about 900 in 1977. Sixty-five per cent of admissions were medical, 12% surgical, 11% obstetric and 9% gynaecological. Thirty per cent of admissions were children (aged 0-9 years). Forty-five per cent of admissions were from those resident in the same county as the hospital and another 20% were from an immediately adjacent county. Infective and parasitic conditions (including respiratory diseases) accounted for over 60% of admissions among children and over 38% of admissions among adults (excluding obstetric patients). The six most common causes of admission were: uncomplicated delivery (2308 admissions), pneumonia (2020), hookworm (1999), malaria (1806), schistosomiasis (1742) and diarrhoea (1041). In total 1960 deaths were recorded (6.5% of all admissions). High case fatality rates were observed for tetanus (61%), immaturity (54%), meningitis (38%), kwashiorkor (21%), other malnutrition (19%) and anaemia (19%). A striking increase in the number of admissions for measles was observed in the period 1976 to 1978. Admission rates for schistosomiasis (S. mansoni) appeared to be highest from counties adjacent to the Nile and 104 deaths were recorded among the 1742 patients with this as the primary diagnosis. Admissions for diabetes, as a percentage of all admissions increased from 0.2% in 1951-54 to 1.5% at the end of the study period. Marked seasonal variations in admission patterns were found for diarrhoea, measles, meningitis and respiratory infections, the last two, but not diarrhoea, being most common in the wettest months. Admissions for malaria showed no strong seasonal associations. Despite the limitations of hospital-based data, it is argued that the data analysed provide a reasonable indication of the important causes of severe morbidity and mortality in the district. Furthermore, some of the changes in admission patterns over time are likely to represent true changes in disease rates rather than artefacts of diagnosis or referral. The analyses presented indicate the value of simple record systems, carefully maintained.
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PMID:Admissions to a rural hospital in the West Nile District of Uganda over a 27 year period. 378 13

Using questionnaire and physical screening examination data for a general population of 4,962 adults aged 18 to 61 years enrolled in the Rand Health Insurance Experiment, we calculated the prevalence of 13 chronic illnesses and assessed disease impact. Low-income men had a significantly higher prevalence of anemia, chronic airway disease and hearing impairment than their high-income counterparts, low-income women a higher prevalence of congestive heart failure, diabetes mellitus, hypertension, hearing impairment and vision impairment. Of our sample, 30% had one chronic condition and 16% had two or more. Several significant pairs or "clusters" of chronic illnesses were found. With few exceptions (diabetes, hypertension), the use of physician care in the previous year for a specific condition tended to be low. Disease impact (worry, activity restriction) was widespread but mild. Persons with angina, congestive heart failure, mild chronic joint disorders and peptic ulcer disease reported a greater impact than persons with other illnesses.
West J Med 1986 Oct
PMID:Chronic disease in a general adult population. Findings from the Rand Health Insurance Experiment. 378 41

A total of 222 cases of septicaemia was recorded at the University Hospital of the West Indies between June 1982 and June 1983. This gave an overall incidence of 16.1 per 1000 admissions. The 233 bacterial strains isolated comprised 100 Gram-positive and 133 Gram-negative organisms with Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus being the most frequent. Highest rates of septicaemia were recorded in patients less than 1 year and over 50 years of age. Septicaemia caused by Gram-positive organisms was predominantly a disease of children whereas that caused by Gram-negative organisms arose more often in neonates and in patients over 50 years of age. A predisposing factor was noted in 104 patients of whom 42 had neoplastic disease. The most frequently identified initial sites of infection were the respiratory tract, the gastro-intestinal tract and the meninges. Most blood stream infections were community-acquired, three quarters of all septicaemic patients being admitted to the departments of medicine or paediatrics. There were 11 cases of polymicrobial septicaemia caused predominantly by Gram-negative organisms in patients with underlying disease. Appropriate antimicrobial drugs were administered to 57% of septicaemic patients whereas 17% received superfluous antimicrobial therapy. In those patients who received inappropriate antimicrobial therapy there was a marked increase in mortality. Forty of 61 deaths were attributed to septicaemia. Mortality from septicaemia caused by Gram-negative organisms was 21% compared with 13% for that caused by Gram-positive organisms. The organisms associated with the highest case fatality rates were Escherichia coli, 53%; Enterobacter sp., 27%; and beta-haemolytic streptococci 24%. There were no deaths from septicaemia caused by Haemophilus influenzae, Salmonella sp. or Serratia sp. The highest mortality rates were associated with neoplastic disease, diabetes, polymicrobial septicaemia, urinary tract infections and old age.
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PMID:Bacteraemia at the University Hospital of the West Indies--a report of 222 cases. 389 69

The insulin response to glucose taken orally is increased in patients with impaired glucose tolerance (IGT) but decreased in those with type II diabetes mellitus. The insulin response to meals, however, is normal in patients with type II diabetes, although the glucose concentrations are obviously elevated. The acute insulin response to intravenously administered glucose is absent in cases of both IGT and type II diabetes when the fasting plasma glucose level exceeds 115 mg per dl. On the other hand, the response to other intravenously given secretagogues is either normal or nearly so. The absent acute insulin response to intravenously administered glucose can be restored by alpha-adrenergic blockade, prostaglandin synthesis inhibition, dopaminergic blockade and euglycemia. Insulin antagonism characterizes patients with both IGT and type II diabetes. Those with IGT and mild diabetes mellitus (untreated fasting plasma glucose concentrations < 180 mg per dI) have a receptor defect probably due to down regulation. Diabetic patients with more severe type II diabetes show a postreceptor defect. The relation (if any) between receptor and postreceptor defects is unclear.
West J Med 1985 Feb
PMID:Pathogenesis of impaired glucose tolerance and type II diabetes mellitus--current status. 389 14

Cerasee, a wild variety of Momordica charantia is traditionally prepared as a tea for the treatment of diabetes mellitus in the West Indies and Central America. To investigate a possible hypoglycaemic effect, concentrated aqueous extracts of cerasee were administered to normal and streptozotocin diabetic mice. In normal mice, intraperitoneal administration of cerasee improved glucose tolerance after 8 hr, and in streptozotocin diabetic mice the level of hyperglycaemia was reduced by 50% after 5 hr. Chronic oral administration of cerasee to normal mice for 13 days improved glucose tolerance. The cerasee extracts did not significantly alter plasma insulin concentrations, suggesting that cerasee may exert an extrapancreatic effect to promote glucose disposal.
Diabetes Res 1985 Mar
PMID:Cerasee, a traditional treatment for diabetes. Studies in normal and streptozotocin diabetic mice. 389 64


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