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

Blood serum activity of ACE, alfa2-macroglobulin as well as triglycerides concentration was determined in 90 patients with diabetes and in 40 healthy persons. Taking into account criteria established by WHO the patients with diabetes were divided into two groups. The first group consisted of 32 patients with diabetes of type I (juvenile one); the second group consisted of 58 patients with diabetes of type II (adult one). It was found that blood serum level of all tested parameters is statistically increased (p < or = 0.001) in comparison with control group. In patients with diabetes of type I the level of alfa2-macroglobulin and ACE was higher than in those with diabetes of type II. The serum contents of triglycerides in both groups of patients was comparable. No correlation between parameters determined in patients with diabetes was found.
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PMID:Blood serum angiotensin-converting enzyme, alfa2-macroglobulin and triglycerides in patients with diabetes. 128 70

Diabetes mellitus (DM)-linked metabolic alterations and hypertension concomitantly accelerate or precipitate cerebrovascular and coronary heart disease, nephropathy, retinopathy and widespread macroangiopathy, thereby conferring to diabetic patients a very high risk of morbidity, disability and early death. Therefore, the long-term care for diabetic patients should be aimed at concomitant metabolic and blood pressure (BP) control. Dietary measures are indispensable; a high fibre, low fat, low salt diet is recommended, complemented with caloric restriction and physical exercise when body weight is above the ideal. Antidiabetic pharmacotherapy involves an unresolved dilemma. The desired achievement of euglycemia necessitates effective levels of insulin, but hyperinsulinemia (due to parenteral [over]treatment in insulin-dependent DM) is suspected to promote atherogenesis and represents a coronary risk factor and perhaps even facilitates hypertension. Considering antihypertensive pharmacotherapy, thiazide-type or loop diuretics are problematic drugs in DM because they can aggravate metabolic alterations. These agents also seem to exert only a limited preventive or regressive effect on left ventricular hypertrophy (LVH); beta-blockers are also not considered ideal, since they decrease the awareness of hypoglycemia and tend to promote glucose intolerance. Unselective beta-blockers in particular promote peripheral ischemia and insulin-induced hypoglycemia, while beta-blockers without intrinsic sympathomimetic activity lower serum HDL-cholesterol. Calcium antagonists and ACE inhibitors have equivalent antihypertensive efficacy, do not impair carbohydrate and lipid homeostasis or peripheral perfusion and can effectively improve LVH. Certain ACE inhibitors may even slightly ameliorate abnormal insulin sensitivity and plasma glucose levels. While alpha-blockers share most of these desirable properties, these agents are more prone to precipitate orthostatic hypotension in the diabetic patient. The non-thiazide diuretic indapamide and the serotonin2-antagonist ketanserin also combine antihypertensive efficacy with metabolic neutrality. The ultimate goal of therapy is to improve life prognosis. In essential hypertension, conventional drug treatment based on diuretics in high dosage satisfactorily reduced cerebrovascular but not coronary complications or sudden death. In diabetic patients, the influence of antihypertensive therapy on prognosis has not been assessed prospectively. Based on retrospective analyses, Warram et al reported a 3.8 times higher mortality in diabetics treated with diuretics alone, than in diabetics with untreated hypertension (Arch Intern Med. 1991;151:1350). H. H. Parving calculated that effective BP control in patients with diabetic nephropathy might reduce 10 year-mortality from about 65 to 20 percent (J Hypertension. 1990; 8[Suppl 7]:187).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Antihypertensive therapy in diabetic patients. 128 10

ACE inhibitors are used on a large scale basis in hypertensive diabetics, while the association between diabetes and hypertension is frequent and harmful. This is due to their excellent tolerance and efficacity. No specific advantage has been reported in their use regarding tolerance, i.e., they may not alter insulin sensitivity consistently. Conversely, ACE inhibitors may offer the specific advantage of protecting kidney function against diabetic microangiopathy, since their effects on glomerular haemodynamics seem independent from their hypotensive effect.
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PMID:[Converting enzyme inhibitors in diabetes]. 129 43

Glucose intolerance and noninsulin-dependent diabetes are commonly associated with hypertension. Epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. When hypertensive patients whether obese or of normal weight are compared with matched normotensive control subjects, an increased plasma insulin response to a glucose challenge is consistently observed. Studies using insulin glucose clamp techniques in combination with tracer glucose infusion and indirect calorimetry have demonstrated that the insulin resistance in hypertensive subjects is located in muscles and restricted to glycogen synthesis. The relations between hyperinsulinemia and blood pressure do not prove that the relationship is a causal one. However, at least four mechanisms may link hyperinsulinemia with hypertension: Na+ retention, sympathetic nervous system overactivity, disturbed membrane ion transport and proliferation of vascular smooth muscle cells. Diuretics and beta-blockers may enhance insulin resistance, which is not affected by calcium antagonists, but decreased by the ACE inhibitor captopril. Weight reduction and regular physical exercise can improve insulin sensitivity and decrease blood pressure values. These nonpharmacological interventions should be more strongly recommended to diabetic and nondiabetic hypertensive patients.
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PMID:Hyperinsulinemia, insulin resistance and essential hypertension. 130 12

1. The effect of administration of the angiotensin converting enzyme inhibitor (ACEI), lisinopril (Carace; 10-40 mg twice daily) and the calcium channel blocker, nifedipine (Adalat Retard; 20-40 mg twice daily) on ex vivo [45Ca2+] uptake by platelets from hypertensive diabetic (type 1 and 2) patients was investigated. 2. At the end of at least 3 months treatment, blood was collected prior to the patient taking the morning dose of medication and washed platelets prepared. [45Ca2+] uptake was monitored following the addition of adrenaline, isoprenaline and dibutyryl cAMP (dbcAMP), as well as in unstimulated (zero) platelets. 3. Both nifedipine and lisinopril significantly inhibited the ex vivo uptake of [45Ca2+] by platelets when this process was stimulated by adrenaline, isoprenaline and dibutyryl cAMP. Basal uptake was also inhibited in both groups. 4. These data consolidate the hypothesis that ACE inhibitors may possess calcium channel/calcium mobilisation blocking properties. Apart from its hypertensive action, lisinopril may also reduce platelet activity via modulation of calcium dynamics, thereby reducing the incidence of vascular complications associated with diabetes mellitus.
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PMID:Lisinopril and nifedipine administration inhibits the ex vivo uptake of [45Ca2+] by platelets from hypertensive diabetic patients. 131 54

We report here the alterations of serum angiotensin-converting enzyme activity (S-ACE) and of active renin plasma concentrations (ARPC) in 41 insulin-dependent diabetes mellitus (IDDM) patients compared with those of 26 control subjects. The IDDM patients had S-ACE activity (54 +/- 16 I.E.) in the upper normal range (controls, 39 +/- 7). When the patients were subclassified according to their diabetic complications, a significant increase of S-ACE within the IDDM group compared to the controls was observed in patients with nephropathy (68 +/- 13, P less than 0.001) with persistent proteinuria and with retinopathy (63 +/- 14, P less than 0.001). A significant correlation was found between proteinuria and S-ACE (r = 0.98, P less than 0.001) and between retinopathy and S-ACE levels (r = 64, P less than 0.001). No correlation between blood pressure and S-ACE or between blood glucose and S-ACE was observed. The ARPC were within the normal range in the IDDM (21 +/- 9 ng/l) and in control (19 +/- 3) groups. No correlations between ARPC and blood pressure or blood glucose or the degree of diabetic complications were registered. These data show that S-ACE activity is elevated in IDDM patients with nephropathy-proteinuria and/or with retinopathy and the circulating renin may not represent the renal renin-angiotensin vascular system.
Diabetes Res Clin Pract 1992 Jun
PMID:Serum angiotensin-converting enzyme activity and active renin plasma concentrations in insulin-dependent diabetes mellitus. 133 Apr 63

Disturbances of neurovascular function in the extremities may occur in patients with diabetes mellitus, exposure to toxic substances and chronic exposure to vibrating hand tools, as well as in Raynaud's phenomena. In these conditions symptoms of paraesthesia, finger numbness and blanching occur, so nerve conduction studies, vibration and temperature threshold measurements and neurovascular function tests are used for objective assessment of neurological dysfunction. The aim of the present study was to examine some factors which may confound quantitative neuro-vascular function measurements if used to assess neuropathy in diabetics. All subjects were consenting volunteers without exposure to known neurotoxic chemicals. The 5 groups were (a) healthy non-diabetic subjects not exposed to vibration (n = 10, mean age 52.3 yrs) (b) 2 insulin dependent and 8 non-insulin dependent diabetic subjects with a mean of 6 years treatment (n = 10, mean age 55.7 yrs) (c) maintenance employees exposed to high frequency pneumatic hand tools (n = 10, mean age 52.2 yrs) (d) subjects who were not diabetic or exposed to vibrating tools, but were being treated with the ACE-inhibitor enalapril 20 mg daily for hypertension (n = 5, mean age 54 yrs) (e) subjects who had smoked more than 10 cigarettes daily for at least 15 yrs (n = 10, mean age 51 yrs). Neurovascular tests included axon reflex responses measured by laser Doppler velocimeter evoked on the dorsum of the finger by iontophoresis of acetylcholine 16 mC in a circumferential chamber: cutaneous microvascular dilator responses to endothelial stimulation by iontophoretic application of the muscarinic agonist pilocarpine 16 mC and to direct nitrodilator sodium nitroprusside 16 mC. The skin temperature of the digits was held between 33 degrees and 34 degrees C during testing and dilator responses were measured as flux change by on-line computer analysis using 'Perisoft'. There was a significant reduction (P < 0.05) in the neurovascular responses of both diabetics and vibration--exposed subjects to acetylcholine and, in the case of vibration-exposed subjects, to pilocarpine, but nitroprusside responses were not significantly different. Our findings of reductions in neurovascular responses in diabetics and in subjects exposed to higher frequency vibration is consistent with recent epidemiological findings. Furthermore, subjects treated with an ACE-inhibitor (enalapril) showed significant reduction in acetylcholine-evoked axon reflex responses, while the test group of smokers showed a significant reduction in their dilator response to pilocarpine.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Confounding factors in non-invasive tests of neurovascular function in diabetes mellitus. 134 58

EURODIAB ACE is a collaborative European study that was set up to assess incidence of childhood insulin-dependent diabetes mellitus (IDDM) in Europe, test the proposal of a south-north gradient, and to gather information to determine the causes and pathogenesis of the disease. Here, the basic epidemiological results are reported. Newly diagnosed cases of IDDM in children aged up to 15 years were identified prospectively in twenty-four geographically well-defined study regions in Europe and Israel (a total of 16.8 million children) during 1989 and 1990. 3060 cases were identified with estimated ascertainment rates exceeding 90% in all study regions. Age-standardised and sex-standardised incidence rates varied widely, ranging from 4.6 (northern Greece) to 42.9 (two regions in Finland) cases per 100,000 per year. Rates in southern Europe were generally higher than previously assumed, and there was an unexpectedly high incidence in Sardinia, which had the second highest rate (30.2 cases per 100,000 per year) recorded in Europe. Eastern European regions had generally low rates. The collaborative network now established provides a framework for further studies to examine the complex interaction between genetic and environmental factors in the cause and pathogenesis of IDDM.
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PMID:Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE Study. 134 6

Felodipine is a vascular-selective, dihydropyridine calcium antagonist previously investigated as a conventional tablet formulation administered twice daily. More recently considerable experience has been gained with an extended release (ER) formulation which has the convenience of once daily administration. Felodipine ER has been well studied in patients with essential hypertension. As monotherapy in mild to moderate essential hypertension, felodipine ER is at least as effective in reducing blood pressure as other calcium antagonists, beta-blockers, diuretics and ACE inhibitors, with some results favouring felodipine ER at a statistically significant level at the dosages used. It is also effective combined with controlled release metoprolol or enalapril in patients with mild to moderate essential hypertension. In patients with more severe forms of essential hypertension uncontrolled by beta-blocker and/or diuretic therapy, felodipine ER was effective as an 'add-on' therapy in placebo-controlled trials, and, at the dosages used, more effective than either sustained release nifedipine or nitrendipine. Felodipine produces effective control of blood pressure without negative effects on cardiac performance. In addition to its antihypertensive action, results suggest that felodipine therapy is associated with significant regression of left ventricular hypertrophy. Furthermore, it appears suitable for use in patients with concomitant diabetes, renal dysfunction or asthma, and is also being investigated for use in patients with congestive heart failure or angina pectoris. Felodipine ER is an effective drug for the treatment of all grades of essential hypertension, and can be used both as monotherapy and in combination with other antihypertensive agents. Further clinical experience should fully establish the long term tolerability of felodipine ER and consequently its place in therapy relative to other accepted antihypertensive drugs. However, with the convenience of once daily administration, felodipine ER is a worthwhile innovation in the treatment of hypertension.
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PMID:Felodipine. A review of the pharmacology and therapeutic use of the extended release formulation in cardiovascular disorders. 138 18

Hypertension and diabetes mellitus are strongly associated conditions from epidemiologic, genetic, and pathophysiologic points of view. The prevalence of hypertension is high in patients with diabetes, and, conversely, many patients with essential hypertension are glucose intolerant. Proteinuria appears in 40-50% of patients with insulin-dependent diabetes mellitus and 20-30% of patients with non-insulin-dependent diabetes mellitus. Progressive renal failure occurs in 30-40 and 3-8% of patients, respectively, hypertension being a leading factor in its rate of progression. In various animal experiments, ACE inhibitors are able to prevent proteinuria and glomerular sclerosis, presumably by lowering transglomerular capillary pressure. In the diabetic human, ACE inhibitors are powerful antihypertensive drugs, devoid of metabolic side effects. Clinical studies indicate that ACE inhibitors reduce proteinuria and possibly slow the rate of decline in renal function. Such an effect is not observed with beta-blockers. Large-scale studies are needed to confirm this very important hypothesis.
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PMID:Angiotensin-converting enzyme inhibition and diabetic nephropathy. 138 63


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