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

The term "brittle diabetes" denotes the unstable course of an insulin-dependent diabetes characterised by frequent hypo- or hyperglycaemic crises. The aim of this study is to demonstrate empirically how psychosocial parameters interact with metabolic instability in a paradigmatic case of juvenile brittle diabetes. By means of a structured diary study, blood sugar values, moods (SAM), body symptoms (GBB), the daily hustle and hassle, helping therapeutic alliance (HAQ) and the aspects of setting were registered. Resulting time series (112 days each) were ARIMA-analysed by a multivariate approach. It could be shown that the mean variance of daily blood sugar values as an indicator of brittleness was predicted by moods, body complaints and by a family session as setting factor (p < 0.05, for corresponding predictors). Feelings of dominance preceded an increase of blood sugar variance, whereas depressive moods, anger and body symptoms were associated with metabolic instability. A family therapy session also resulted in an increase of the mean blood sugar variance. The model accounted for almost 30% of the total variance of the dependent variable (R-square-adjusted, p < 0.0001). The potential of multivariate time-series as a means to demonstrate psychosomatic interrelations is discussed. We believe that the results may also contribute to an empirically rooted understanding of psychodynamic processes in psychosomatoses.
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PMID:[Psychosocial predictors of metabolic instability in brittle diabetes--a multivariate time series analysis]. 1144 56

The evolution of enteric and portal venous drainage, better immunosuppression, and better patient care has elevated pancreas transplantation with dramatically improved results. At our center, long-term graft survival and rejection has significantly improved with portal venous drainage, which has become our gold standard. This improvement is exemplified by the excellent one-year patient and graft survival rates for SPLK transplants. SPLK has proven to be an ideal approach in uremic Type 1 diabetic patients with living donors and should become the procedure of choice for that population. Moreover, the improved monitoring of rejection has allowed a similar success of pancreas transplantation alone in non-uremic patients with brittle diabetes. The treatment of diabetes mellitus has room for great improvement, however, and there is no question that islet transplantation, xenotransplantation, and the pursuit of immunologic tolerance will play an extremely important role in that endeavor.
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PMID:Simultaneous pancreas-kidney (SPK) and pancreas living-donor kidney (SPLK) transplantation at the University of Maryland. 1151 15

Severely unstable, or brittle, diabetes can be disruptive to patients, carers and diabetes care teams. The peak age-group for brittle diabetes is 15-30, but there are reports of its occurrence in much older patients. To explore the characteristics and cause of brittle instability perceived by diabetologists in elderly patients we circulated a questionnaire to all UK hospital diabetic clinics for adults. 130 (56%) of 231 replied. Reports were obtained on 55 patients fulfilling our criteria for 'elderly brittle diabetes'--namely, age > or =60 years, on insulin treatment, and experiencing life-disrupting glycaemic instability of any kind associated with frequent or long admissions to hospital. Further information was obtained by a research nurse who visited the relevant clinics. The mean age of patients was 74 years (range 60-89) and 71% were female. The brittleness was classed as mixed glycaemic instability in 22 (44%), recurrent ketoacidosis in 16 (29%) and recurrent hypoglycaemia in 15 (27%). In 2 cases there was insufficient information for classification. The diabetes care team judged the brittleness to have multiple origins in two-thirds of the cases: problems with memory or behaviour were rare, and in only 4 cases was deliberate manipulation of therapy considered a possibility. 84% of the patients were living independently. In younger patients the principal manifestation of brittle diabetes is recurrent ketoacidosis. The present survey, though possibly subject to ascertainment bias, indicates that the patterns of instability and their causation may be different in elderly patients. With the growing use of insulin in the elderly, brittle diabetes is likely to be encountered increasingly often in this age-group.
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PMID:Brittle diabetes in the elderly. 1177 67

Modern diabetes therapy is positively introduced insulin administration including intensive insulin therapy to type 1 and type 2 diabetes to prevent or delay the development of long-term complications. However, conventional insulin derivatives could not mimic more closely physiological insulin secretion profiles, resulting in frequent hypoglycemia attacks and brittle diabetes. Recent advanced technologies have allowed to modify insulin molecules to obtain several insulin analogues. Lys.Pro insulin and insulin aspart, rapid-acting insulin analogues, have demonstrated improved post-prandial glucose control in comparison with regular insulin, even although they are usually administered immediately prior to the meal. Insulin glargine and SoLongln, long-acting insulin analogues, could preserve the stable basic insulin profiles during a day as compared with NPH insulin. These insulin analogues are very useful to supply the post-prandial and basic insulin secretions in type 1 and type 2 diabetics.
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PMID:[Recent trends of development of rapid-acting and long-acting human insulin analogues--its biological characteristics and clinical availability]. 1171 96

A 94-year-old man had with vascular dementia, visual disturbance, hearing difficulty and speech and motor disturbance. He had a history of diabetes mellitus over 50 years. He developed brittle type diabetes. On administration of mixed type insulin (30: 70.12-18 units in the morning and 6-8 units in the evening), his blood glucose concentrations fluctuated from almost zero to 500-600 mg/dl. After change to short acting regular insulin (4-5 units) before each meal and intermediate type insulin (2 units) before sleeping time, extreme hyperglycemia was not observed, but the brittleness with frequent hypoglycemia persisted. The hypoglycemic symptoms were absent at the time of striking hypoglycemia: it was thought that the patient was condition unaware of hypoglycemia. The cause of the brittle diabetes in the extremely elderly was thought to be depletion of endocrine insulin secretion due to marked beta-cell reduction and/or beta-cell exhaustion secondary to long term duration of diabetes. Daily detailed observation is required to care for such mentally deteriorated patient with brittle diabetes.
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PMID:[A case of brittle diabetes in a 94-year-old man with vascular dementia, visual disturbance and hearing difficulty]. 1270 50

Poor metabolic control of diabetes mellitus has often been associated with the severity of periodontal disease. This case report describes the diagnosis, therapeutic concept, treatment steps, and long-term monitoring of a 22-year-old female with generalized aggressive periodontitis who had a history of type 1 brittle diabetes mellitus. The main objective was to treat the patient with periodontal surgery despite the difficult baseline situation to avoid tooth loss that would have been accompanied by a need for prosthodontic treatment. The mean of glycosylated hemoglobin [figure: see text] measurement (HbA1c) was used to indicate the long-term control of diabetes mellitus. This report proves the efficiency of periodontal therapy in the prevention of future periodontal breakdown and improvement of the HbA1c level in a systemically compromised patient.
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PMID:[Aggressive generalized severe periodontitis and brittle diabetes mellitus Type I. Diagnosis, treatment and report of a case]. 1285 54

Salient aspects of prolonged metabolic studies on seven excessively labile diabetic patients and a review of the literature concerning causation and therapy of brittle diabetes are presented. Brittleness is redefined as "a syndrome of excessive insulin-sensitivity and ketosis-proneness manifested by extreme and unexplainable short-term and long-term fluctuations in the parameters of the disease". Evidence on the causation of hyperlability points to dysfunction of plasma-protein transport and of hepatic and peripheral tissue metabolism of insulin. No objectively demonstrable complete and lasting stabilization was possible by means of any antidiabetic or adjunctive therapeutic measures. However, achievement of quantitative improvement in the accuracy of regulation of diabetes and moderation in deviations from the acceptable range of parameters were feasible. To this end, therapy recommended for everyday use incorporates the following principles found to be most helpful in following the oscillations of the disease on the research ward: flexibility in the plan of therapy; accuracy, especially in timing of therapeutic events; and employment of an insulin program best suited to the patient's needs and comfort.
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PMID:OBSERVATIONS ON THE ETIOLOGY AND THERAPY OF "BRITTLE" DIABETES. 1413 95

Since its introduction in 1966, pancreas transplantation has undergone considerable progress. Refinements in surgical technique, better organ preservation solutions, and more potent immunosuppressive therapies have improved patient and graft-survival rates dramatically. Survival rates for patient and pancreas at 1 year approach 95 and 83 %, resp., for simultaneous pancreas and kidney transplantation, and 97 and 78 %, resp., for pancreas alone. US pancreas graft and patient survival rates do not significantly differ from the results of the European centers. However, there is still a hesitant acceptance of combined pancreas-kidney transplantation in Germany. Combined pancreas-kidney transplantation is nowadays the treatment of choice in carefully selected patients with type 1 insulin-dependent diabetes mellitus and end-stage renal failure. Many US centers even advocate combined transplantation in diabetic patients at a pre-uremic stage. Pancreas transplantation significantly improves quality of life and provides excellent long-term glycemic control which halts or even ameliorates secondary diabetic complications such as microangiopathy and neuropathy. In addition, there is increasing evidence that successful pancreas transplantation significantly prolongs patient survival mainly by a reduction of cardiovascular-related mortality. Current 10-year patient survival rate after SPK exceeds 70 %. For diabetics with end-stage renal disease there is no alternative treatment available with comparable live expectancy. However, morbidity and mortality after SPK is still higher than for kidney transplantation alone in the first year. Outcome of isolated pancreas transplantation is also improving but this technique is still restricted to non-uremic patients with severe diabetic complications or with brittle diabetes and severe impairment of quality of life.
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PMID:[Pancreas transplantation: a survey on indications, surgical techniques, immunosuppression, complications and outcome]. 1462 31

The term "brittle diabetes" describes a subtype of instable type-I diabetes, characterized by high variations of blood sugar without any evident cause and despite careful clinical management. Clear guidelines for a precise definition of the condition are still lacking; this fosters insecurities concerning diagnosis and therapy of the disease. Psychosocial influences, triggering these conditions, were discussed. The patient-doctor-relationship appears to be tensed due to an often missing compliance. Using a paradigmatic case study as background, the specific diagnostic and therapeutic problems in brittle diabetes were presented. Brittle diabetes advocates a close cooperation between internal and psychosomatic medicine units and a combination of patient education and psychotherapy. Seen under a psychosomatic paradigm, brittle diabetes can be detected early and effective treatment may avoid further complications in these young patients.
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PMID:[Integrative treatment of instable diabetes mellitus: education or psychotherapy?]. 1521 65

Rising demand for islet transplantation will lead to severe donor shortage in the near future, especially in countries where cadaveric organ donation is scarce. We undertook a successful transplantation of living-donor islets for unstable diabetes. The recipient was a 27-year-old woman who had had brittle, insulin-dependent diabetes mellitus for 12 years. The donor, who was a healthy 56-year-old woman and mother of the recipient, underwent a distal pancreatectomy. After isolation, 408 114 islet equivalents were transplanted immediately. The transplants functioned immediately and the recipient became insulin-independent 22 days after the operation. The donor had no complications and both women showed healthy glucose tolerance. Transplantation of living-donor islets from the distal pancreas can be sufficient to reverse brittle diabetes.
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PMID:Insulin independence after living-donor distal pancreatectomy and islet allotransplantation. 1588 82


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