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

A girl with typical clinical manifestations of neonatal diabetes was observed for 16 months with consecutive evaluations of pancreatic beta- and alpha-cell function and metabolic control. At the diagnosis both the plasma immunoreactive insulin (IRI) and C-peptide concentrations were inappropriate for the contemporaneous hyperglycemia. During the follow-up, the C-peptide fell twice below the detection limit but the beta-cell function recovered partially on both occasions. Based on 24-hour urinary C-peptide excretion, the endogenous insulin secretion was less than 10% of that in non-diabetic infants. When diagnosed the patient had plasma immunoreactive glucagon (IRG) and glucagon-like immunoreactivity (GLI) concentrations below the reference range for normal neonates. The IRG normalised within the first month, while the GLI increased to a level exceeding the reference range. Hemoglobin A1 had already risen at the time of diagnosis and subsequently rose to a level indicating poor metabolic control. The findings indicate an immature function of both beta- and alpha-cells at the diagnosis with the alpha-cells maturing within the first month. The recovery of the beta-cell function, after two failures in this patient with permanent neonatal diabetes, suggests that the beta-cell damage was at least partially reversible.
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PMID:Pancreatic islet cell function and metabolic control in an infant with permanent neonatal diabetes. 634 Apr 16

The medical and psychosocial findings concerning 15 adolescents with poorly controlled diabetes referred to a tertiary center are reviewed. While referring physicians usually attributed poor metabolic control to an unusual idiosyncratic pathophysiologic aspect of diabetes, all patients were managed by conventional treatment regimens. Psychosocial problems, including excessive school absence, depression, and social isolation were frequent in this population, and in eight families emotional factors appeared to contribute to the development and persistence of poor metabolic control. Eight patients accepted psychosocial intervention consisting of individual, family, and/or group counseling. Not one of the patients has been hospitalized for ketoacidosis in the subsequent 12-18-mo period, and their psychosocial functioning as adolescents is improved. Hemoglobin A1c levels remained elevated. Psychosocial factors in adolescents experiencing poor metabolic control should be addressed.
Diabetes Care
PMID:Characteristics of adolescents with poorly controlled diabetes referred to a tertiary care center. 634 21

Gastric bariatric operation has been advocated to ameliorate adult-onset diabetes mellitus in the morbidly obese patient. However, there are few data to support this. In this clinical study we report the cases of 23 insulin-treated, morbidly obese, adult-onset diabetes (type II) patients who underwent gastric bariatric operations for weight reduction. Preoperative insulin requirements ranged from 10 to 230 U/day (mean 74 U/day). After operation, 14 patients discontinued insulin, and seven patients decreased their insulin requirement by 72% (100 to 28 U/day). Two patients were lost to follow-up. Six patients were admitted to the Clinical Research Unit before and after operation to evaluate the effects of surgically induced weight loss on fasting blood glucose levels, hemoglobin A1C insulin resistance, and glucose tolerance. Weight loss at the time of postoperative studies ranged between 22.5 and 49.1 kg (mean 30.6 kg). Fasting blood glucose levels decreased 48% (mean 321 mg/dl before operation to 166 mg/dl after operation). Hemoglobin A1C levels improved from a mean of 11.8% to 7.9%. Insulin resistance assessed in four patients by measurement of glucose clearance during insulin and glucose infusion improved from a mean of 77 ml/min before operation to 228 ml/min after operation. Glucose tolerance was quantitated by determination of glucose disappearance during intravenous glucose tolerance test. The mean glucose disappearance improved from 0.176% to 0.385%/min following operation. This study provides clinical and laboratory evidence indicating significant improvement of insulin-treated diabetes mellitus in morbidly obese patients who have lost weight following gastric bariatric operation.
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PMID:Gastric bariatric operation in insulin-treated adults. 636 35

Seventeen diabetic subjects requiring insulin and who exhibited glycemic stability over a 9-12-mo control period received 5 g of pectin with each meal and at bedtime for 3 mo. Hemoglobin A1c (HbA1c) and glycosylated serum protein were measured in each patient on multiple occasions to assess glycemic control. No clear-cut change in these measurements occurred during the period of pectin ingestion. These data are not consistent with a beneficial effect of high-pectin diets in people with diabetes.
Diabetes Care
PMID:Dietary pectin and glycemic control in diabetes. 637 10

The benefits of self-monitoring of blood glucose (SMBG) in diabetic children have been assessed in an 18-mo prospective study by comparison of two groups, one receiving intensive education (N = 20) and the other, education combined with SMBG (N = 19). Regular home visits were made with all children during which attempts were made to optimize diabetes control. Mean blood glucose levels in the SMBG group showed a downward trend throughout the study; however, values at baseline (11.7 mmol/L) were not significantly different from those at completion of the study (10.8 mmol/L). Hemoglobin A1c levels showed a seasonal fluctuation, but values at the beginning and end of the study were nearly identical to each other in both groups. The SMBG group showed a reduction in the number of hospital admissions for stabilization of control and for ketoacidosis (P less than 0.04).
Diabetes Care
PMID:A prospective study to evaluate the benefits of long-term self-monitoring of blood glucose in diabetic children. 638 Oct 4

Seven type I (insulin-dependent) diabetic patients previously treated with continuous subcutaneous insulin infusion therapy participated in a 6-wk training program consisting of cycle ergometer exercise 1 h/day 4 times a week. Six nontraining pump-treated type I diabetic patients and 19 healthy subjects were studied as controls. The training improved maximal aerobic power (VO2 max) by 8% (P less than 0.05). Hemoglobin A1 was in the high normal range before training (8.6 +/- 0.4%) and remained unchanged. The ratio of HDL cholesterol to total cholesterol rose by 16% in the training group (P less than 0.01) but remained unchanged in the sedentary diabetic patients. Mean daily insulin requirements fell by 6% in the training group (P less than 0.01). This reduction occurred in the lunch and dinner boluses whereas the basal infusion rate remained unchanged. Insulin sensitivity as determined by the euglycemic clamp technique was 25-40% lower in the training group (5.24 +/- 0.48 mg/kg/min) and sedentary diabetic group (6.55 +/- 0.82 mg/kg/min) as compared with controls (8.69 +/- 0.77 mg/kg/min, P less than 0.025). After the training, the rate of glucose uptake rose by 60% (P less than 0.001) to 8.48 +/- 0.77 mg/kg/min, which was comparable to that in the controls, but remained unaltered in the sedentary diabetic group. Insulin binding to erythrocytes was comparable in the diabetic and healthy subjects, and remained unchanged. Basal hepatic glucose production was elevated in both groups of diabetic patients (P less than 0.05), whereas the suppression by insulin was normal, and both of these were unaltered by training.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes Care
PMID:Normalization of insulin sensitivity in type I diabetic subjects by physical training during insulin pump therapy. 639 76

Despite the well-known hyperglycemic effect of thiazide diuretics, these agents are often administered to diabetic patients. This study compared 89 insulin-treated diabetic patients receiving hydrochlorothiazide, 57 receiving furosemide, and 255 receiving no diuretic. Hemoglobin A1c level was 7.2 +/- 1.8 percent (mean +/- SD) with hydrochlorothiazide, significantly higher than the levels of 5.9 +/- 2.3 percent with furosemide and 6.4 +/- 2.0 percent with no diuretic. Low-density lipoprotein cholesterol level was 154 +/- 43 mg/dl with hydrochlorothiazide, but 134 +/- 42 mg/dl with furosemide and 130 +/- 42 mg/dl with no diuretic. Multivariate analysis showed that the associations remained significant after adjustment for age, sex, race, type and duration of diabetes, body mass index, blood pressure, serum potassium level, insulin dose, and treatment with other medications. These findings suggest that treatment with thiazide diuretics in the diabetic population may increase low-density lipoprotein cholesterol and hemoglobin A1c levels.
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PMID:Elevated hemoglobin A1c and low-density lipoprotein cholesterol levels in thiazide-treated diabetic patients. 649 35

Ensuring the diagnosis of diabetes mellitus by morphological findings is very difficult. Postmortem determination of blood glucose is of no value because of the influence of glycolysis. In clinical studies, Hb A1 determination is used for long-time therapy control of diabetes. Values of less than 10% Hb A1 show that assimilation of glucose is in order. This study is based on the investigation of blood from 174 cadavers (125 men aged between 17 and 84 years; 49 women aged between 27 and 89 years) with many different causes of death, including some cases of coma diabeticum. Blood was frozen immediately; in 48 cases it was stored at +4 degrees C, too. Besides, we took cerebrospinal fluid and urine from each corpse (frozen at -80 degrees C) for determination of glucose, lactic acid, and acetone. Hemoglobin A1 was analyzed by a chromatographic method: the concentrations of Hb A1 ranged from 7.5% to 20% independent of the actual amount of total hemoglobin in our samples (total Hb from 5 to 32 g/dl). Obviously, there is very little influence of autolysis or prefinal glucose fluctuations in blood on its quantity. There is a positive correlation to the concentration of glucose and lactic acid in cerebrospinal fluid (according to the formula of Traub) and also to the presence of acetone in case of diabetic coma. According to our experience, Hemoglobin A1 is a very useful marker to ensure the diagnosis of diabetes mellitus post mortem. As Hb A1 seems to be very constant and stable vs. autolysis, it may help to clear up cases of unexpected death.
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PMID:[Initial results of postmortem diagnosis of diabetes mellitus by Hb A1 determination]. 663 56

To suppress the progression of diabetic microangiopathies, good control of blood glucose levels must be maintained. We examined the usefulness of glycosylated hemoglobin as an index of control of diabetes using the Markov process for the analysis of the prognosis of retinopathy. Two hundred and ninety-nine diabetics who were followed for over 3 years period in our clinic and whose control states were steady during the observation period were selected for this study. Grade of retinopathy was classified into 4 stages according to Scott's criteria (Stage 1: no retinopathy, Stage 2: Scott Ia and IIa, Stage 3: Scott IIIa and IIIb, Stage 4: Scott IV and V). Glycosylated hemoglobin was measured as Hemoglobin A1 (HbA1), and patients were divided into 4 groups according to their levels of HbA1: Group A: HbA1 less than or equal to 8%, Group B: 8% less than HbA1 less than or equal to 10%, Group C: 10% less than HbA1 less than or equal to 12% and Group D: 12% less than HbA1. We estimated the transitional probability for the course of retinopathy from Stage 1 to Stage 4. After 10 years, Group A was expected to distribute to Stage 1 67%, Stage 2 29%, Stage 3 3% and Stage 41%, Group B to Stage 1 49%, Stage 2 45%, Stage 3 5% and Stage 4 1%, Group C to Stage 1 53%, Stage 2 30%, Stage 3 12% and Stage 4 4%, and Group D to Stage 1 24%, Stage 2 36%, Stage 3 23% and Stage 4 16% respectively (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:An investigation of the usefulness of HbA1 as an index of control of diabetes: from the viewpoint of progress of diabetic retinopathy. 668 May 13

The purpose of this investigation was to determine the effects of a regular vigorous physical activity program on children aged 5-11 yr with insulin-dependent diabetes mellitus (IDDM). The experimental group of children (N = 9) took part in a 30-min vigorous exercise program three times a week for 12 wk; the control group (N = 10) did not. Hemoglobin A1 (HbA1) and fasting blood glucose (FBG) were used to determine metabolic control. Oxygen consumption was evaluated by treadmill testing and analyses of expired air. The experimental group significantly (P less than 0.05) decreased their HbA1 and FBG while the control group showed no change. The experimental group significantly (P less than 0.05) increased their peak aerobic capacity (ml/kg . min) when compared with baseline values (47.14 +/- 1.94 versus 50.69 +/- 1.30). It was concluded that a carefully applied program of regular vigorous physical activity can beneficially influence metabolic control and cardiovascular fitness in young children with IDDM.
Diabetes Care
PMID:Effects of a physical activity program on metabolic control and cardiovascular fitness in children with insulin-dependent diabetes mellitus. 670 66


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