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Query: UMLS:C0011849 (diabetes)
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Still under debate is the prevalence of microalbuminuria in patients with recently diagnosed Type 2 (non-insulin-dependent) diabetes mellitus and its relation to existing macro-vascular disease and the major vascular risk markers. Hence, from a representative sample of 1512 patients with Type 2 diabetes of varied duration (recruited from 22 non-specialized medical practices of the Greater Munich Area) 68 (26 males, 42 females) of 71 eligible subjects with a known duration of diabetes of up to 17 weeks and not less than 4 weeks were examined in the present study. Median age was 61 (39 to 75) years, prevalence of ischaemic heart disease (case history plus ECG, Minnesota code, Whitehall criteria) 41.2%, and that of peripheral vascular and carotid artery disease (both assessed by ultrasound-Doppler) were 35.3 and 4.4%, respectively. Diabetes was well controlled (HbA1c: 6.9%, 5.6-8.3; fasting blood glucose: 7.7 mmol/l, 5.4-10.4; median +/- interquartile range IQ), the cardiovascular risk profile was most prominent in terms of triglycerides (3.1 mmol/l, 2.1-4.6, median +/- IQ range) and systolic blood pressure (164 mm Hg, 140-186, median +/- IQ range). 13.2% showed signs of urinary tract infection. Of the remainder, 19.0% exhibited microalbuminuria (RIA, > 30-200 mg/l), and 5.2% macroalbuminuria (> 200 mg/l). Significant correlations (p < 0.05) were found between urinary albumin concentration and beta 2-microglobulin in serum, systolic blood pressure, serum triglycerides, serum HDL-cholesterol (inversely), HbA1c, and peripheral vascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Microalbuminuria in a random cohort of recently diagnosed type 2 (non-insulin-dependent) diabetic patients living in the greater Munich area. 824 49

There are approximately 11 million people in the United States with diabetes, and the numbers are increasing by 6% annually. Still, the relationship between diabetes and job performance remains unclear and marked by bias. To help clarify this relationship, a multicriterion job-performance rating scale was developed to rate task behaviors, interpersonal behaviors, down-time behaviors, and hazardous behaviors. A volunteer sample of 53 subjects was selected from people with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). All subjects were rated individually by a supervisor, who also rated the norm for the work group. The norm rating was used to determine a norm-referenced control group. The subjects were rated better than the norm in all categories and on all criteria: composite job performance (P < .001), task behaviors (P < .01), interpersonal behaviors (P < .01), down-time behaviors (P < .05), and hazardous behaviors (P < .001).
Diabetes Educ
PMID:Diabetes and job performance: an empirical investigation. 837 Mar 32

Clinical goals in patients with non-insulin-dependent (type II) diabetes are to control glucose levels and prevent microvascular complications (eye, kidney, and nerve damage) while improving risk factors associated with cardiovascular disease (obesity, smoking, hyperlipidemia, hypertension, and hyperinsulinemia or insulin resistance). A wide array of medications and approaches is available to treat type II diabetes. Still, establishing an effective treatment regimen can be difficult, because patients have varying degrees of insulin secretory defects and insulin resistance and different conditions that must be factored in. Therefore, an individualized plan centered on self-management is the key to successful therapy in type II diabetes.
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PMID:Treatment of type II diabetes: what options have been added to traditional methods? 863 24

Diabetic nephropathy is one of the most frequent causes of chronic renal failure worldwide. Altogether, 35% of patients with insulin-dependent diabetes mellitus and a somewhat smaller percentage of patients with non-insulin-dependent diabetes mellitus ultimately develop diabetic kidney disease. Early diagnosis is of utmost importance since the development of diabetic nephropathy affects the general health, the carbohydrate metabolism of the patient, moreover it aggravates hypertension and accelerates atherosclerosis. Microalbuminuria is a sensitive but relatively late marker of diabetic kidney disease. Still, screening of diabetic patients for microalbuminuria is of great importance since there is no other screening test capable of diagnosing diabetic nephropathy at an earlier stage. The description of the genetic substrate of susceptibility to diabetic kidney disease would revolutionize the diagnosis and prevention of diabetic nephropathy. Until then, compliance with therapeutic guidelines outlined in milestone clinical studies of the last years may significantly decrease morbidity, the progression of, and the mortality associated with diabetic kidney disease.
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PMID:[Current issues in the diagnosis and therapy of diabetic nephropathy]. 907 51

Persistent increased urinary albumin excretion rate (UAER) is associated with increased cardiovascular mortality in type-2 diabetes, however, there are no conclusive data about the progression of advanced UAER in these patients. The present study has investigated the effect of metabolic intervention on the progression in UAER in relation to initial UAER levels. A total of 20 patients with type-2 diabetes and secondary failure to sulfonylurea were observed during 1 year (age, 60 +/- 8 years; HbA1c, 10.8 +/- 1.4%; and duration of diabetes, 17 +/- 10 years) and divided into two groups: group 1 (n = 10; UAER: 51 +/- 35 mg/24 h); and group 2 (n = 10; UAER: 191 +/- 175 mg/24 h). Despite a significant improvement of metabolic control by insulin treatment in both groups (HbA1c: group 1: 11 +/- 1.5 vs. 7.9 +/- 1.2%; group 2: 10.6 +/- 0.9 vs. 9.1 +/- 1.3%, P < 0.001), a progression of UAER was observed in group 2 (191 +/- 175 vs. 331 +/- 237 mg/24 h, P < 0.02), but not in group 1 (51 +/- 35 vs. 41 +/- 24 mg/24 h). Still serum creatinine levels remained normal in all patients during the observation period. The 24 h blood pressure (RR) values in the two groups remained normal under antihypertensive therapy throughout the study (group 1: RR syst: 130 vs. 136 mmHg; RR diast: 80 vs. 81 mmHg, mean arterial pressure (MAD): 89 vs. 93 mmHg; group 2: RR syst: 139 vs. 134 mmHg; RR diast: 78 vs. 75 mmHg, MAD: 97 vs. 90 mmHg). The data shows that in type-2 diabetic patients with normotensive blood pressure values the initial urinary albumin excretion levels determine the progression of UAER. When metabolic control is improved incipient UAER remains constant, but advanced UAER shows progression.
Diabetes Res Clin Pract 1998 Jan
PMID:Initial urinary albumin excretion determines the progression of microalbuminuria in patients with type-2 diabetes and normotensive blood pressure values despite improved metabolic control. 959 73

The study was performed to reassess the prevalence of gestational diabetes mellitus (GDM) in south Indians and to study the foetal outcome in women with GDM in comparison with normal pregnancies. In 1036 pregnant women, glucose tolerance was tested with 75-g oral glucose load, in the second or third trimester. Those with 2-h plasma glucose of > or = 200 mg/dl were considered as diabetic (WHO Criteria). Those with 2-h values of 140-199 underwent a 3-h glucose tolerance test (GTT) with 100-g glucose load (O'Sullivan and Mahan criteria). GDM was diagnosed in nine women (0.87%) by this criteria. Foetal outcome in 211 GDM referred to the diabetes centre was compared with the outcome in 853 normal pregnancies. There were no cases of aborted pregnancy among the GDM, while six cases were reported among the normal glucose tolerance (NGT). Still birth and the number of premature babies were higher in GDM. Babies with birth weight > or = 3.5 kg were more among the GDM (P < 0.001). There was no difference in the occurrence of congenital anomalies in the two groups. It was noted that congenital abnormalities in the foetus were more common among those born of mothers with higher plasma glucose (9 versus 1.1%). Multiple linear regression analyses in NGT and GDM showed that the birth weight of the baby was dependent on the plasma glucose and the body mass index of the mothers. The results of the present study show that the prevalence of GDM in urban south India was low, when the NDDG criteria was used. It also indicated that the WHO criteria may be more appropriate as the foetal outcome was determined by even a small rise in maternal plasma glucose. With good metabolic control in GDM, the foetal risks are very much reduced.
Diabetes Res Clin Pract 1998 Sep
PMID:Foetal outcome in gestational diabetes in south Indians. 982 47

In Type Diabetes mellitus (DM), the two primary defects that occur are insulin resistance and impaired insulin secretion. Currently, no data exist showing improved outcomes or reduced macrovascular complications with tight glycemic control in Type II DM, and only minimal data shows a reduction of microvascular complications. Still, the current standard of practice is to attempt to attain glycemic goals in patients with Type II DM. As an attempt to resolve this issue, the United Kingdom Prospective Diabetes Study (UKPDS) was initiated. This 11-year study is comparing conventional therapy to intensive therapy in patients with Type II DM. The American Diabetes Association's (ADA) guidelines state that either sulfonylureas, metformin, acarbose, or insulin can be used as first-line treatment for Type II DM; however, oral agents can be attempted first in most patients. Until results from the ongoing UKPDS trials are available, the guidelines for glycemic control from the ADA should be followed.
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PMID:Strategies of the treatment of type II diabetes mellitus. 1016 73

GAD65 (glutamic acid decarboxylase) is an important autoantigen in both type 1 (insulin-dependent) diabetes mellitus (IDDM) and the neurological autoimmune disease stiff-man syndrome (SMS), and is expressed in pancreatic islets as well as the nervous system. Still, only 30% of SMS patients also have type 1 diabetes. To study regulation of T cell responsiveness to GAD65, we investigated a non-diabetic SMS patient with HLA-DR3/7 (predisposing to type 1 diabetes) and high levels of type 1 diabetes-associated autoantibodies against GAD65 and islet cells, and compared the results with those of her diabetic son and two other SMS patients. T cell responses to GAD65 were repeatedly absent in primary stimulation, whereas IA-2, islet antigen and tetanus toxoid induced significant T cell proliferation. However, after in vitro restimulation, GAD65 reactive T cell lines and clones were obtained that were HLA-DR3 restricted, and cross-reactive with a homogenate of purified human pancreatic islets. These T cells produced the immunoregulatory cytokine IL-10 in combination with IFN-gamma and IL-4 (Th0). The dominant T cell epitope was mapped to the central region of GAD65. Although no primary response to whole GAD65 was detectable, the naturally processed GAD65 peptide epitope was recognized vigorously in the primary stimulation assay. The lack of detectable primary T cell responses to GAD65, together with the GAD65-specific cytokine production of restimulated T cells, suggest that GAD65-specific cellular autoimmunity in this patient is suppressed and may be related to the absence of diabetes despite humoral autoreactivity and genetic predisposition.
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PMID:GAD65-Reactive T cells in a non-diabetic stiff-man syndrome patient. 1033 Mar

The Diabetes Control and Complications Trial has conclusively demonstrated that improved metabolic control leads to reduction in the rate of microvascular complications of diabetes. In order to allow patients to achieve improved metabolic control, much research has focused on improved methods of glucose monitoring and more physiologic ways of insulin delivery. The 2 most promising methods of minimally invasive blood glucose monitoring are the Glucowatch, using the technique of reverse iontophoresis to measure interstitial fluid glucose levels every twenty minutes and an implantable sensor, in which a catheter resembling that used for insulin delivery through a pump is impregnated with glucose oxidase at the tip. This device monitors blood sugars every few minutes, but like a holter monitor, must be downloaded in the physician's office. Still under development are (1) implantable subcutaneous sensors with a high and low blood glucose alarm and (2) sensors in which the patient will be able to download the data using a home PC. Advances in insulin delivery have included the availability of new insulin analogs which more closely simulate endogenous insulin release, with rapid acting analogs simulating the increase in insulin production that normally occurs after meals. Phase III clinical trials are in progress of a long-acting basal insulin without peak actions to simulate the low dose continuous production of the insulin which normally inhibits hepatic glucose production. In addition, use of the insulin pump has increased markedly since publication of the DCCT with the greatest increase being among adolescents. In addition to advances in treatment of diabetes, research has continued on curing the disease using islet cell transplantation and preventing the disease with agents such as insulin (DPT-1 Trial) and nicotinamide (ENDIT). This article provides an overview of recent advances in diabetes management and prevention.
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PMID:New developments in type 1 (insulin-dependent) diabetes. 1082 72

Nurses deliver care to people with various forms of chronic illnesses and conditions. Some chronic conditions, such as paraplegia, are visible while others, such as diabetes, are invisible. Still others, such as multiple sclerosis, are both visible and invisible. Having a chronic illness or condition and being different from the general population subjects a person to possible stigmatization by those who do not have the illness. Coping with stigma involves a variety of strategies including the decision about whether to disclose the condition and suffer further stigma, or attempt to conceal the condition or aspects of the condition and pass for normal. We present a beginning framework that describes the relationship between the elements of stigma and the decision to disclose or hide a chronic condition based on its visibility or invisibility. The specific aims were to combine the results from a meta-study on qualitative research with a review of the quantitative literature, then develop a theoretical framework. Although an understanding of how patients cope with stigmatizing conditions is essential for nurses who aim to deliver comprehensive individualized patient care, there is little current literature on this subject. The relationship between visibility and invisibility and disclosure and non-disclosure remains poorly understood. A framework to facilitate a deeper understanding of the dynamics of chronic illnesses and conditions may prove useful for practice.
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PMID:Stigma of visible and invisible chronic conditions. 1088 57


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