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

Hemoglobin A1c (HbA1c) and the blood glucose concentrations were measured in 26 children with newly diagnosed diabetes mellitus from the start of insulin treatment and during the remission and post-remission phases. The results were analysed according to a biokinetic model which describes HbA1c as a function of the preceeding blood glucose level during the lifetime of the erythrocytes. The correlation between HbA1c and blood glucose at the start of treatment improved significantly when the model was modified to accomodate a change in the blood glucose level at the time when the first diabetic symptoms were noticed. The individual HbA1c values measured after 1, 2 and 3 weeks of insulin treatment were compared with values predicted from the biokinetic model and preceeding blood glucose measurements. There was a significant positive correlation between observed and predicted values, and the correlation increased with the length of the observation period. In all children the HbA1c level declined and reached a nadir 10 to 15 weeks after initiation of treatment. A significant negative correlation between the duration of remission and the HbA1c level was observed. It is concluded that the biokinetic model compares favourably with the observed variations in HbA1c and blood glucose levels which occur in newly diagnosed diabetes mellitus during the first weeks of insulin treatment.
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PMID:Variations in hemoglobin A1c and blood glucose in children with newly diagnosed diabetes mellitus described by a biokinetic model. 672 98

To evaluate the importance of dialysis in the determination of glycosylated hemoglobin (HbA1), we studied blood glucose and HbA1 in 38 insulin-dependent diabetic children during a morning fast and again 6 h postprandially. We used two methods to determine glycosylated hemoglobin: (1) the conventional macrocolumn method of Trivelli, which uses dialyzed hemolysate and (2) a commercially available microcolumn procedure, Isolab's Fast Hemoglobin Test System, which uses undialyzed blood samples. When the 6-h changes were assessed, the mean blood glucose had increased from 11.6 to 16.3 mmol/L (P less than 0.001). HbA1, determined by the microcolumn procedure simultaneously increased from 12.6% to 13.4% (P less than 0.001), and the increment in HbA1 correlated significantly with the increment in blood glucose (r = 0.62, P less than 0.001). HbA1 determined by the macrocolumn method increased slightly from 13.1% to 13.4% (P less than 0.01), and no correlation was present between the increment in blood glucose and HbA1 (r = -0.02, NS). When the microcolumn procedure was modified by employing dialyzed hemolysate, this method became unaffected by acute blood glucose variations. Therefore, dialysis in sample preparation appears to be important in minimizing the effect of acute changes in blood glucose on the level of glycohemoglobin. Methods in which dialyzed hemolysates are used may be more useful as an index of long-term glucose control.
Diabetes Care
PMID:Glycosylated hemoglobin in relation to rapid fluctuations in blood glucose in children with insulin-dependent diabetes: a comparison of methods with and without prior dialysis. 675 30

We studied 178 diabetic children and adolescents diagnosed during the period 1962-79 to find out the occurrence and duration of the postinitial remission, factors favoring a remission and the prognostic value of the remission. A postinitial remission occurred in 113 children (64%) being complete in only three boys (2%). The duration ranged from one month to 4.8 years, the mean being 8.4 months. The boys had a remission more often and of longer duration than the girls. The duration of diabetes was longer in the children without remission. The children with remission had lower blood glucose, milder hyperketonemia and ketonuria, higher pH and PCO2 at onset than those without remission. Hemoglobin A1 (HbA1) during 1979 were lower in the children with a positive remission history. The children with a remission lasting more than one year had a subsequently higher glucosuria index, lower HbA1 and higher C-peptide when compared to those without remission or to those with a short remission. The remission frequency increased from 1962 to 1979. Male sex and mild metabolic derangement at onset favor a postinitial remission, which results in a persisting residual beta-cell function and better metabolic control beyond the remission.
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PMID:Postinitial remission in diabetic children--an analysis of 178 cases. 676 Jun 64

For some time it has been recognized that postovulatory exacerbation of hyperglycemia contributes to the instability of diabetes in many women of reproductive age. It has been suggested that increasing plasma levels of progesterone and estrogen may induce insulin resistance and consequently lead to increased hyperglycemia during the luteal phase of the menstrual cycle. Due to the fact that menstrual cycles in a given woman may vary in length and that it takes patients several days on intermediate or long-acting insulin to achieve a steady state with regard to any dosage adjustment, it is difficult to design an insulin regimen that maintains euglycemia throughout the menstrual cycle in these labile patients. Recognition of this problem led to trying a nonsequential low estrogen contraceptive as adjunctive therapy in a 20-year old woman with insulin dependent diabetes mellitus. The patient consistently suffered an exacerbation of hyperglycemia after ovulation in each cycle, lasting until the onset of menses. On 1 occasion the patient developed frank diabetic ketoacidosis. For the first 2 cycles on Lo Ovral, the hyperglycemia was postponed from the 1st postovulatory day until day 18-19 of the cycle. It was reasoned that the serum estrogen and/or progestin level might be building cumulatively, and the oral contraceptives (OCs) were subsequently withdrawn at day 19 of the cycle rather than day 21. A maximum blood glucose level of 400 mg/dl was attained at day 19 and was treated with additional regular insulin. Levels in excess of 240 mg/dl did not recur during that cycle. The following cycle OC therapy was interrupted at day 18; no blood glucose level in excess of 240 mg/dl occurred that month. Hemoglobin A1c fell from a pre-OC treatment value of 12.4% to the current A1c of 9.7%. A modest increase in blood pressure has occurred, but this is easily managed with a 2 g sodium diet and 25 mg of hydrochlorothiazide daily. On the basis of this experience, a controlled trial is warranted of low dose estrogen nonsequential OCs in lean, nonsmoking, 18-30 year old women with insulin dependent diabetes mellitus with postovulatory hyperglycemia.
Diabetes Care
PMID:Oral contraceptives abolish luteal phase exacerbation of hyperglycemia in type I diabetes. 676 14

Hemoglobin A1c concentrations were measured in 107 out patients with non insulin treated diabetes. A good correlation was observed between Hb A1c and random post-prandial plasma glucose levels. Mean Hb A1c concentrations were slightly higher in these diabetics than in controls but markedly lower than values observed in insulin treated patients. Sixty three per cent of the patients had Hb a1c levels below three standard deviations above our normal mean value. Random post-prandial plasma insulin levels were correlated to the degree of overweight but not other parameters. The best results were observed in patients treated by diet alone (31 % of the whole population) and in those on diet and sulfonylureas (30 %) who were also the less older and the less overweight subjects.
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PMID:[Metabolic control in 107 maturity onset diabetic out patients (author's transl)]. 698 21

Hemoglobin A Ic is produced when glucose reacts nonenzymatically with the NH2-termini of Hb A beta chains and then undergoes an Amadori rearrangement. The concentration of Hb A Ic measured at any given time reflects a patient's mean blood glucose level for the preceding weeks to months. Infrequent measurements of Hb A Ic can therefore be used to assess long-term carbohydrate control in outpatient diabetics. In addition, the synthesis of Hb A Ic may represent a model reaction to explain the pathogenesis of many of the sequelae of chronic diabetes. Nonenzymatic glycosylation reactions may also underlie some of the changes ascribed to normal aging.
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PMID:Hemoglobin A Ic and diabetes mellitus. 699 14

Thirteen patients were instructed in a technique of self-management of insulin-dependent diabetes mellitus, using multiple home-monitored blood glucose determinations and multiple injections of regular insulin in conjunction with once-daily Ultra Lente insulin. Hemoglobin A1c and quantitative fluorescein fluorophotometry were used to assess blood glucose control and retinal permeability, respectively. In those patients achieving normal blood glucose control, retinal vascular leakage was statistically identical to that of a nondiabetic control population. In those patients less well controlled, retinal permeability did not differ statistically from values observed in a population of insulin-dependent diabetic patients under "standard" control. It is concluded that with "tight" control of blood sugar and normalized A1c hemoglobin, retinal permeability similarly is normalized.
Diabetes Care
PMID:Effect of blood glucose control on retinal vascular permeability in insulin-dependent diabetes mellitus. 699 63

Hemoglobin A1c (HbA1c) was measured as an indicator of glucose control in 180 children and adolescents with diabetes mellitus who received two daily injections of insulin as part of a highly structured treatment program. A total of 426 HbA1c determinations was made in the group of 180 patients. HbA1c values were elevated in most patients despite the aggressive treatment. The HbA1c level was very elevated at diagnosis, fell to near normal after 60-90 days of insulin therapy, increased gradually, and reached a plateau after approximately 4 yr duration (at about twice the level in normal subjects) (mean +/- SEM, 10.0 +/- 0.2% and 5.34 +/- 0.07%, respectively). Mean insulin dose (U/kg/24 h) paralleled both HbA1c and duration of diabetes. The relationship between endogenous insulin secretion and glucose control was examined in those patients with diabetes for longer than 5 yr. Patients were separated into three groups based on HbA1c levels: those with HbA1c less than 9% (N = 22), between 9 and 11% (N = 26), and greater than 11% (N = 28). Serum C-peptide and glucose concentrations were measured 2 h after a standard breakfast in those patients in the "low" and "high" HbA1c groups (mean HbA1c values 8.2% and 12.7%, respectively). C-peptide was detectable in all patients and the mean C-peptide levels did not differ significantly in the two groups, although postprandial glucose concentrations were significantly lower in the "low" HbA1c group (means +/- SEM, 96 +/- 11 and 211 +/- 21 mg/dl, respectively; P less than 0.001).
Diabetes Care
PMID:Hemoglobin A1c levels in children and adolescents with diabetes mellitus. 700 43

We have measured fasting C-peptide reactivity (CPR) as well as CPR responses to a test meal in 83 diabetic patients and 41 non diabetic controls. In comparison to controls, basal CPR was decreased in lean insulin-treated diabetics with stable or brittle diabetes and in obese patients with brittle diabetes. Lean and obese maturity-onset diabetics had increased CPR levels and so had obese insulin-treated patients. Nevertheless, the CPR response to the test meal was clearly inadequate in all diabetics. In control patients, there was a positive correlation between fasting blood glucose and CPR levels. On the contrary, lean diabetics demonstrated a negative correlation between these parameters. Hemoglobin A1 levels were negatively correlated to fasting CPR levels in lean diabetics, indicating the importance of residual B-cell function for diabetes control. These correlations were obscured in obese diabetics. In our patients, circulating insulin antibodies had apparently no deleterious effect on metabolic control.
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PMID:Pancreatic B-cell response to a test-meal in lean and obese diabetic patients: relation to metabolic control. 701 99

Twelve ambulatory patients (six women and six men; mean age, 29 years) with type I diabetes were treated with a continuous subcutaneous open-loop insulin pump in an attempt to effect better glucose control. Hemoglobin A1, mean blood glucose, total cholesterol, total triglycerides, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and the cholesterol/HDL-C ratio were assessed monthly before and after glucoregulation from five to 14 months (mean, nine months). Mean HDL-C levels increased significantly (52 +/- 4 to 60 +/- 5 mg/dL); mean cholesterol/HDL-C ratios decreased significantly (4.46 +/- 0.43 to 3.89 +/- 0.39). Mean values for triglycerides, total cholesterol, and LDL-C, all initially normal, did not change. Both mean Hb A1 levels and glucose levels fell from 11.2% +/- 0.5% to 9.8% +/- 0.5% and 177 +/- 15 mg/dL to 128 +/- 12 mg/dL, respectively. Insulin requirements decreased from 0.80 +/- 0.08 to 0.61 +/- 0.05 units/kg/24 hr. These results may favorably alter the prediction for development of accelerated atherosclerosis in type I diabetics.
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PMID:Improvement of high-density lipoprotein-cholesterol levels. Ambulatory type I diabetics treated with the subcutaneous insulin pump. 703 Dec 87


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