Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

ANTIPSYCHOTICS AND DIABETES: After 50 years' use of antipsychotics, it is pertinent to draw-up a circumspect review of the side effects of these psychotropic agents. Moreover, few articles have attempted to elucidate the relationship between the monitoring of carbohydrate metabolism and the prescription of this type of medication. SEVERAL MECHANISMS AT THE ORIGIN OF AN IMBALANCE IN GLYCAEMIA: Antipsychotics, notably the atypical forms, represent an additional factor of risk for developing diabetes. The weight gain secondary to this treatment plays an important part in this imbalance, but other mechanisms may also contribute. DEPENDING ON THE TYPE OF ANTIPSYCHOTIC: Our present knowledge is insufficient to be able to quantify the effect of each atypical antipsychotic on diabetes. The only tendency that has been reproduced in several studies concerns the increased risk associated with dibenzodiazepine antipsychotics (clozapine and olanzapine), compared with the other antipsychotics.
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PMID:[Antipsychotic drugs. Risk factors for diabetes]. 1457 87

MODALITIES FOR THE DIAGNOSIS OF VENOUS THROMBOEMBOLISM: Currently rely on the confrontation of the initial clinical data and the results of D-dimer measurements, a venous Doppler, although reliable, is not a first-line exploration. REGARDING TREATMENT: Indications for thrombolysis are currently limited to massive pulmonary oedema with shock. Alteplase added to heparin improves the progression of severe embolism; it spares the patients from heavy interventions of resuscitation but the mortality remains the same. Concerning anticoagulant treatments, prolonged antivitamin K at classical doses is more effective than low doses and for limited duration if phlebitis is an idiopathic one. FOR HEART FAILURE WITH PRESERVED EJECTION FRACTION: Treatment of these heart failures, formerly know as 'diastolic' is similar to that of the acute phase of systolic heart failure. However, care should be taken with vasodilatators. CONCERNING HEART FAILURE IN GENERAL: The brain natriuretic peptide (BNP) represents a remarkable progress for the aetiological diagnosis of dyspnoea (inferior to 80 pg/ml in the case of pulmonary origin, superior to 300 pg/ml in the case of cardiac origin or severe pulmonary embolism). Regarding treatment, for acute heart failure, it is still the association of nitrates and diuretics, with oxygen therapy and eventually inotropics. Beta-blockers, which have revolutionized the treatment of chronic heart failure, must be maintained whenever possible in the case of the onset of acute pulmonary oedema. Multisite pacing is increasingly used in refractory chronic heart failure. Implantable defibrillation has become common practice. Non-invasive ventilation (Bi or C-PAP) is interesting in acute cardiogenic pulmonary oedema. THE PREVENTIVE ROLE OF N ACETYL-CYSTEINE: N acetyl cysteine reduces the incidence of nephropathies induced by the radio contrast products in patients with chronic kidney failure. Combined with hydratation, it must be proposed the day before and on the day of the procedure in any patient with diabetes or kidney failure.
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PMID:[Diagnostic and therapeutic progress. Venous thromboembolism, cardiac insufficiency and radio contrast agents]. 1522 98

THREE DEFINITIONS: The metabolic or X syndrome is defined by an association of metabolic anomalies leading to an increased risk of cardiovascular complications. Today, there are at least 3 definitions of X syndrome: those of WHO, EGIR and NCEP. To varying degrees they associate increased abdominal fat, hypertension, glucose tolerance abnormality (ranging from hyperinsulinism to diabetes), and hypertriglyceridemia with low HDL cholesterol. FROM AN EPIDEMIOLOGICAL POINT OF VIEW: The prevalence of metabolic syndrome depends on the definition used and varies with the country or ethnic group considered. About 25% of the US and 10% of the French adult populations are concerned. THE RISK OF COMPLICATIONS: According to clinical trials, people with metabolic syndrome have a 2 to 4-fold increase in risk for coronary heart disease. Some of them have a particularly high risk (association of most features of the syndrome, association of an increased waist circumference and hypertriglyceridemia, presence of biological markers such as elevated C-reactive protein or microalbuminuria). Metabolic syndrome is also associated with a 4-fold increase in risk for developing diabetes.
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PMID:[Epidemiological data and screening criteria of the metabolic syndrome]. 1525 40

A MAJOR RISK RECURRENCE: The sparcity of data in the absence of treatment renders assessment of the natural course of depressive disorders difficult. Naturalist studies have identified various elements that characterise the evolution. After an episode of depression, usually lasting 6 to 8 months, the disorder is marked by a high risk of recurrence. Fifty to 85% of the patients having exhibited an episode of major depression will relapse at least once in their life. A CHRONIC DISEASE: The propensity in the repetition of depression and the socio-professional and family impact that results has led to an increasing number of authors to consider the problem as a chronic disease, like asthma or diabetes. IN TERMS OF MANAGEMENT: It is important to replace depression in the progressive perspective of a chronic disease and to avoid, after the first episode, the risk of relapses and recurrences. During treatment of the acute phase, we recommend treatment to be continued up to 12 months after complete remission, so as to reduce the risk of relapse. Regarding prevention of recurrences, treatment should be continued for more than 12 months in patients who have had 3 episodes of depression or, in certain cases, only two. THE CONSEQUENCES OF A LACK OF INFORMATION: Research work has shown that depressive disorders have been insufficiently treated: either the doses are too low or the prescription is withdrawn too quickly, or the patient does not fully comply. In the majority of cases, insufficient management stems from a lack of knowledge on the course of depressive disorders and on treatment modalities, as far as not only the practitioner but also the patient are concerned.
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PMID:[Evolution of depressive disorders]. 1561 83

Sicker adults in Germany suffer many of the same issues and concerns as do sicker adults in Australia, Canada, New Zealand, the United Kingdom, and the USA. However, quality of care in sicker adults in Germany stands out from the other countries in a few key areas: 1. DISSATISFACTION WITH THE HEALTH CARE SYSTEM: Almost one in three sicker adults in Germany feels that their health care system should be completely rebuilt. This is comparable to the USA and Australia and higher than in New Zealand, Canada, and the UK. 2. STRENGTHS AND WEAKNESSES IN COORDINATION OF CARE: On the plus side, Germany is doing better than most countries to insure that needed information is available at the time of a patient''s scheduled appointment. Also, sicker adults in Germany are more likely than in other countries to have a long-term relationship with their primary care physician and receive less often conflicting informations. However, Germany stands out in the proportion of sicker adults who feel that their doctors have ordered a medical test that they thought was unnecessary because it had already been done. 3. COMPARATIVELY EASY ACCESS TO OUTPATIENT, SPECIALTY AND EMERGENCY CARE: Though substantial minorities of sicker adults in Germany struggle with access to care as compared to other countries, they find it easier to get after hours care and have the shortest waits to see a doctor, to see a specialist, to have nonemergency surgery, and to be seen in the emergency room. Along with the USA, German respondents are most satisfied with the amount of choice they have in a surgeon 4. COMMUNICATION ABOUT RISKS DURING HOSPITALIZATIONS: Hospitalized sicker adults in Germany are more likely than those in other countries to have the risks of their treatment explained to some extent prior to the procedure. However, German patients are less likely to have the risks of their treatment fully explained than those in other countries. German patients who were given new medications were more likely than patients in other countries to report that they did not have a clear understanding of the purpose of these medications. Further, German patients are more likely than those in other countries to report that their regular doctor rarely or never explains the possible side effects of their medications. 5. FAILURES IN HOSPITAL DISCHARGE PLANNING: Overall, hospitalized sicker adults in Germany face more failures in discharge management than in other countries. Of particular note is that Germany is less likely than all other countries to ensure that hospitalized patients have appointments for follow-up care upon discharge from hospital. 6. HOSPITAL-BASED INFECTIONS ARE RARE.: Hospitalized patients in Germany are less likely than in other surveyed countries to report that they developed an infection while in the hospital. 7. LAB NOTIFICATION DELAYS ARE INFREQUENT: Sicker adults in Germany are less likely than in other surveyed countries to report that they have experienced delays in being notified about abnormal lab test results. 8. GERMAN DOCTORS ARE LESS LIKELY TO INFORM PATIENTS ABOUT AN ERROR: When German patients experience medical and medication errors, they are less likely than are patients in other countries to be told by a doctor or other health care professional that an error had been made. 9. BETTER QUALITY OF CARE IN CHRONICALLY ILL PATIENTS: Generally , Germany is doing a better job than other countries at providing patients with chronic conditions some basic standards of preventive care. These patients are more likely to have a nurse in their doctor's office who is regularly involved in the management of their care. Patients from the old Bundeslaender seem to receive a better quality of diabetes care compared to those from the new Bundeslaender. 10. HAVING PRIVATE INSURANCE IS ASSOCIATED WITH INCREASED USE OF HEALTH CARE: German respondents who have private health insurance are more likely to see a specialist, to be hospitalized, and to have nonemergency surgery than those without private insurance. They are also more likely than those without such supplemental insurance to report that doctors ordered an unnecessarily duplicative test. Wait times are shorter for those with private insurance, both to see a specialist and for nonemergency surgery. There is no difference in the overall quality of care for chronic diseases between patients having private or statutory insurance. 11. GERMAN FEMALE RESPONDENTS REPORT MORE COMMUNICATION AND COORDINATION FAILURES THAN DO MALES: German female patients are more likely than males to report failures by their doctors to communicate with them about treatment choices, the specific goals and treatment, symptoms to watch for and when to seek further care, and possible medication side effects. Women are also more likely to report coordination problems in unnecessarily duplicative tests or information not being available at the time of their appointment. Females are less likely than males to rate their overall care as excellent or very good.
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PMID:[Quality of health care in Germany. A six-country comparison]. 1632 86

THE RETINAL VESSELS HAVE TWO BARRIERS: the retinal pigment epithelium and the retinal vascular endothelium. Each barrier exhibits increased permeability under various pathological conditions. This condition is referred to as blood retinal barrier (BRB) breakdown. Clinically, the most frequently encountered condition causing BRB breakdown is diabetic retinopathy. In recent studies, inflammation has been linked to BRB breakdown and vascular leakage in diabetic retinopathy. Biological support for the role of inflammation in early diabetes is the adhesion of leukocytes to the retinal vasculature (leukostasis) observed in diabetic retinopathy. PPARgamma is a member of a ligand-activated nuclear receptor superfamily and plays a critical role in a variety of biological processes, including adipogenesis, glucose metabolism, angiogenesis, and inflammation. There is now strong experimental evidence to support the theory that PPARgamma inhibits diabetes-induced retinal leukostasis and leakage, playing an important role in the pathogenesis of diabetic retinopathy. Therapeutic targeting of PPARgamma may be beneficial to diabetic retinopathy.
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PMID:Role of Peoxisome Proliferator Activator Receptor gamma on Blood Retinal Barrier Breakdown. 1830 74

As the prevalence of obesity and diabetes are continually increasing, the use of "false sugars" otherwise known as sweeteners, and their associated health issues are being more and more discussed. A higher sugared power, less calories as well as a moderated or non-existent effect on blood sugar would lead to believe that sweeteners are helpful. However, we CANNOT say that they are THE solution as they can contain calories, may have some undesired effects, and moreover they ease the conscience without actually allowing a weight loss with their sole use. They are to be used with judgment, wittingly and especially when comparing sweetened products. The sweetener myth is often far from reality. It is therefore important to give our patients the means to analyze their dietary intake with regard to their sweeteners ingestion.
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PMID:[Sweeteners: between myth and reality]. 1946 12

DURING THE PASSAGE FROM ADOLESCENCE TO ADULTHOOD, INDIVIDUALS ARE EXPECTED TO GO THROUGH THREE PSYCHOLOGICAL STAGES: identity formation (finding out who they are), intimacy (establishment of stable intimate relationships) and generativity (productive lifestyle, career or vocational realization). Having diabetes may complicate this process. Further, the period of late adolescence and early adulthood coincides with the transition of care from paediatric to adult care services. This transition is a time when the individual is particularly at risk for loss of medical follow-up and medical complications. The present article reviews the current state of knowledge on psychosocial maturation in youth with diabetes and the process of transition of care from paediatric to adult care services.
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PMID:Exploring a black hole: Transition from paediatric to adult care services for youth with diabetes. 1965 43

IT SEEMS DESIRABLE TO EMPHASIZE THE FOLLOWING CONCLUSIONS: 1. A careful balancing of the normal acids and bases of the urine makes it possible not merely to detect the presence of organic acids in the urine, but also to determine approximately the amount of such acids. The method recently described by Herter and Wakeman can be recommended as securing a greater degree of accuracy, for the amount of labor involved, than any other procedure. 2. The determination of the N of NH(3) is a useful procedure for clinical purposes, since it is probably true that a considerable excretion of organic acid (say 15 gm. oxybutyric or more in 24 hours) is always attended by an increased excretion of NH(3). As much organic acid as corresponds to 10 gm. oxybutyric acid may be excreted in 24 hours without causing an increased excretion of NH(3) (Case IX). We cannot therefore rely on the ammonia output to detect moderate quantities of organic acid. 3. Where organic acids are removed in considerable amount without increasing the excretion of NH(3), the acid takes out other alkalies, probably in some instances chiefly K. 4. In cases of diabetic coma the urine always contains a large excess of organic acids and the N of NH(3) is usually increased to 18 to 25 per cent of the total N. 5. Crotonic acid can regularly be obtained from the urines of patients in diabetic coma. 6. The condition of diabetic coma is preceded by a period of days, weeks or months, in which there is a large excretion of beta-oxybutyric acid (20 gm. or more in 24 hours), and in which the N of NH(3) is largely increased. 7. Patients whose urines show or have shown a large excretion of organic acids are in danger of developing diabetic coma, but the N of NH(3) may temporarily rise as high as 16 per cent and yet coma may be delayed for more than 7 months (Case VII). The persistent excretion of more than 25 gm. of beta-oxybutyric acid indicates impending coma. 8. A patient passing 30 gm. of beta-oxybutyric acid in 24 hours may still have enough energy and strength to be about all day and perform considerable muscular work (Case X). 9. A patient who has been excreting very little organic acid and has gained weight may within a few months show the presence of considerable quantities of organic acid, and die in typical diabetic coma (Case VII). 10. When the urine contains little or no organic acid there is no immediate prospect of diabetic coma, but patients with such urine are probably liable to most of the other dangers that threaten diabetic patients. The relation between the degree of acid intoxication and the susceptibility to infection seems worthy of special experimental study. 11. Where the urine regularly contains more than 200 gm. of sugar per day there is usually considerable organic acid in the urine and large amounts of acid, indicative of coma, are invariably accompanied by considerable or great glycosuria. 12. Sometimes there is much sugar and little or no acid in the urine, and sometimes there is considerable acid and little sugar. These facts render it desirable to examine the urine of diabetic patients at least once a month with reference to the amount of acid excreted, for the element of acid intoxication must be clearly separated from the element of glycosuria in our study of the progress of a case. In other words, we must recognize the acid intoxication as an important and sometimes as a dominant factor in the prognosis, and this element should be regarded even in those cases of diabetes which have the clinical indications of a mild type of the disease. We may thus hope to prolong life in many instances by taking precautions, as to diet and out-of-door life, which might not otherwise be deemed necessary. 13. The withdrawal of carbohydrate food frequently leads to a considerable reduction in the quantity of organic acids excreted. The reason for this is not yet clear and the phenomenon deserves careful study.
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PMID:THE ACID INTOXICATION OF DIABETES IN ITS RELATION TO PROGNOSIS. 1986 59

THE dysglycemia of diabetes includes two components: (1) sustained chronic hyperglycemia that exerts its effects through both excessive protein glycation and activation of oxidative stress and (2) acute glucose fluctuations. Glycemic variability seems to have more deleterious effects than sustained hyperglycemia in the development of diabetic complications as both upward (postprandial glucose increments) and downward (interprandial glucose decrements) changes activate the oxidative stress. For instance, the urinary excretion rate of 8-iso-PGF2alpha, a reliable marker of oxidative stress, was found to be strongly, positively correlated (r = 0.86, p < .001) with glycemic variability assessed from the mean amplitude of glycemic excursions (MAGE) as estimated by continuous glucose monitoring systems (CGMS). These observations therefore raise the question of whether we have the appropriate tools for assessing glycemic variability in clinical practice. From a statistical point of view, the standard deviation (SD) around the mean glucose value appears as the "gold standard." By contrast, the MAGE index is probably more appropriate for selecting the major glucose swings that are calculated as the arithmetic mean of differences between consecutive peaks and nadirs, provided that the differences be greater than the SD around the mean values. Furthermore, calculating the MAGE index requires continuous glucose monitoring, which has the advantage to detect all isolated upward and downward acute glucose fluctuations. In conclusion, the increasing use of CGMSs will certainly promote better assessment and management of glycemic variability.
J Diabetes Sci Technol 2008 Nov
PMID:Glycemic variability: the third component of the dysglycemia in diabetes. Is it important? How to measure it? 1988 98


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