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

The study aim was to assess the relationship between homocyst(e)inemia and microalbuminuria in non-insulin-dependent diabetes mellitus (NIDDM) patients. The study was performed on 33 NIDDM patients (16 males and 17 females), and 16 healthy control subjects (seven males and nine females). Plasma fasting and post-methionine load homocyst(e)ine (tHcy), together with other parameters that could modify tHcy levels, were assessed. There were no significant differences between NIDDM patients and controls for fasting tHcy (8.12 +/- 3.17 v 7.19 +/- 2.40 micromol/L) and post-methionine load tHcy (26.51 +/- 11.50 v 25.06 +/- 10.76 micromol/L). Moreover, there was a significant correlation between urinary albumin excretion (UAE) and fasting tHcy (r = .340, P = .05) and post-methionine load tHcy (r = .502, P = .004) in NIDDM patients. Fasting tHcy was correlated both with post-methionine load tHcy (r = .429, P = .01) and with vitamin B12 (r = -.349, P = .04) in NIDDM patients. Microalbuminuric NIDDM patients had higher fasting tHcy (9.05 +/- 3.83 micromol/L) than normoalbuminurics (7.12 +/- 1.95 micromol/L). In addition, NIDDM patients with complications presented higher fasting tHcy values than the group without complications (9.61 +/- 3.34 v 6.53 +/- 2.09 micromol/L, Kolmogorov-Smirnov two-sample test for nonparametric data [KS] = 1.794, P = .003), without any other significant differences in the parameters considered. tHcy could be an important risk factor worsening the prognosis in NIDDM patients, especially microalbuminuric patients. Microalbuminuric NIDDM patients could be particularly prone to hyperhomocyst(e)inemia, probably due to endothelial or renal dysfunction with a reduction in the scavenging of tHcy.
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PMID:Fasting and post-methionine load homocyst(e)ine values are correlated with microalbuminuria and could contribute to worsening vascular damage in non-insulin-dependent diabetes mellitus patients. 971 85

The aim of this study was to assess the relationship between homocysteine (tHcy), folate and vitamin B12 levels, urinary albumin excretion, and arterial blood pressure in patients with non-insulin-dependent diabetes mellitus (NIDDM). Our study was carried out in 33 NIDDM patients (16 men, 17 women) and 16 healthy volunteers as controls (seven men, nine women). Fasting and postmethionine load plasma tHcy levels were assessed, together with folate, vitamin B12, and urinary albumin excretion levels. In NIDDM patients, there were correlations between folate and mean arterial pressure (r = -0.352, P = .046), folate and systolic blood pressure (r = -0.437, P = .013), folate and vitamin B12 (r = 0.499, P = .004), tHcy and vitamin B12 (r = -0.348, P = .04), ln tHcy and ln folate (r = -0.404, P = .01), and, lastly, between tHcy, either fasting or postload, and urinary albumin excretion. Patients with elevated tHcy levels had significantly higher diastolic blood pressure (P = .04) and mean arterial pressure (P = .03). Otherwise, higher folate values were associated with lower systolic blood pressure (P = .004) and mean arterial pressure (P = .02). In addition, NIDDM patients with complications presented higher tHcy basal values than the group without complications (P = .003). A particular propensity of such patients towards endothelial dysfunction could explain the presence of correlations between these metabolic parameters and arterial blood pressure.
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PMID:Plasma homocysteine and folate are related to arterial blood pressure in type 2 diabetes mellitus. 975 96

Weaning is the cause of much concern among first-time mothers. A milk-only diet is advised until 3-4 months of age. Health professionals should ensure the baby receives a sufficient and balanced diet during the weaning period, to meet the needs for energy and growth. Breast milk or infant formula should continue up to the age of at least one year. The weaning period is a good time to educate parents in good nutrition. A wide variety of foods should be the aim in child nutrition, but each different type needs to be started separately during weaning. Care is needed to ensure vegetarian babies receive enough proteins, vitamins and minerals (especially iron). Failure to thrive has a multitude of causes, and treatment must be that of the cause. Strictly vegan children who eat no dairy products will need added synthetic vitamin B12. Failure to thrive may be due to physical problems (eg choanal atresia), infection, vomiting, diarrhoea, anorexia, parental ignorance or poverty. Other causes include coeliac disease, cow's milk protein allergy, cystic fibrosis, severe eczema or asthma, or diabetes.
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PMID:Common feeding problems in babies and children: 2. 981 53

Fasting hyperhomocysteinemia is an independent risk factor for coronary artery disease, stroke, peripheral vascular atherosclerosis, and for arterial and venous thromboembolism. The risk for cardiovascular disease with homocysteine is similar to conventional risk factors. The interaction of hyperhomocysteinemia with hypertension and smoking is strong and the combined effect is more than multiplicative. The combined effect of homocysteine and cholesterol is additive. Homocysteine produces atherosclerosis, thromboembolism, and vascular endothelial cell injury. Vascular dysfunction produced by homocysteine may be due to endothelial cell damage. Homocysteinemia-induced atherosclerosis is probably due to various factors including endothelial cell injury, inability to sustain S-nitroso-homocysteine formation because of imbalance between production of nitric oxide by dysfunctional endothelium and homocysteine, smooth muscle cell proliferation, and thromboembolism. There is strong evidence that endothelial cell injury is associated with oxidative stress produced by homocysteine. Hyperhomocysteinemia is associated with numerous conditions, including coronary disease, stroke, peripheral vascular disease (carotid artery and cerebrovascular atherosclerosis), venous thrombosis, renal disease, diabetes mellitus, and organ transplant. Folic acid, vitamin B12 and B6 have been shown to be beneficial in reducing plasma homocysteine levels. Folic acid is specifically very effective, safe and inexpensive.
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PMID:Homocysteine, a Risk Factor for Cardiovascular Disease. 982 15

Many patients suffer from vitamin B12 deficiency and are thus exposed to irreversible sequelae if diagnosis occurs at a late stage. This prospective study undertaken by eight practitioners over a period of 12 months concerns early diagnosis. Blood vitamin B12 levels were measured in 152 patients presenting macrocytosis detected by systematic MCV analysis at the time of a blood test, a neuropathy or a recent cognitive, affective and behavioural problem, and were found to be lowered (< or = 175 pmol/l) in 54 patients of whom 43 had undergone vitamin B12 test treatment for 6 months. Haematological, neurological and psychiatric evaluation was carried out before and after treatment, and a diagnosis of deficiency was recorded in 24 patients based on unequivocal response to therapy. Improvement was greatest haematologically in 12 patients, neurologically in 6 patients and psychiatrically in 6 other patients, with 4 patients showing a combination of all modes. These 24 patients (mean age 69 years) suffered from numerous pathologies which were liable to complicate diagnosis in some of them: neurological (46%), psychiatric (37%), chronic alcoholism (33%), folic acid deficiency (29%), and diabetes (17%). The only diagnostic element used as a criterion of deficiency was an extremely low level of vitamin B12 (< or = 75 pmol/l). Marked macrocytosis or a combination of haematological and neuropsychiatric signs are strong indicators, but only improvement under treatment allowed a diagnosis to be made in the majority of patients. Macrocytosis was, however, not present in 6 of the 12 neuropsychiatric patients. The study thus identified a high proportion of patients with vitamin B12 deficiency who additionally presented, in equal proportions, both haematological and neuropsychiatric symptoms. Neither the clinical examination nor the vitamin B12 level in general permit early diagnosis based on a high probability index and long-term follow-up. Simpler methods for early diagnosis are therefore needed.
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PMID:[Vitamin B 12 deficiency: early diagnosis in ambulatory care medicine]. 985 89

This study was undertaken to examine the effects of aldose reductase inhibitor (ARI) and vitamin B12 (VB12) on myocardial uptake of iodine-123 metaiodobenzylguanidine (MIBG) in patients with diabetic autonomic disorder. Myocardial scintigraphy using 123I-MIBG was performed on 20 healthy volunteers (controls) and 56 patients with non-insulin-dependent diabetes mellitus (NIDDM), in order to obtain the heart/mediastinum ratio in the initial (HMi) and the delayed images (HMd), and the washout rate (%WR). Thirty-four of the 56 NIDDM patients could be diagnosed as having diabetic autonomic disorder by evaluating their scintigraphic findings in comparison with the controls. Seventeen of these 34 patients received 150 mg/day of doses before meals, and the other 17 received 1.5 mg/day of mecobalamin (VB12 group) in three divided doses after meals, for 3-5 months. According to the presence or absence of clinical symptoms of autonomic or peripheral somatic nerve disorder, the patients were subclassified into four groups. group 1=patients, with autonomic symptoms or somatosensory disorder in the ARI group; group 2=patients without autonomic symptoms or somatosensory disorder in the ARI group; group 3=patients with autonomic symptoms or somatosensory disorder in the VB12 group; and group 4=patients without autonomic symptoms or somatosensory disorder in the VB12 group. After completion of the treatment, myocardial scintigraphy was performed again. Comparing the results obtained before and after the treatment, it was seen that ARI improved only the HMi in group 1 (P=0.046), whereas VB12 significantly improved HMi in the group 3 (P=0.018) and HMi, HMd and %WR in group 4 (P=0.043, P=0.018 and P=0.043, respectively). We conclude that VB12 is more efficacious than ARI in the treatment of diabetic cardiovascular autonomic disorder.
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PMID:Effects of aldose reductase inhibitor and vitamin B12 on myocardial uptake of iodine-123 metaiodobenzylguanidine in patients with non-insulin-dependent diabetes mellitus. 987 Oct 96

Diet and exercise are basic measures of treatment of diabetes mellitus. To prevent the development and progression of atherosclerotic disease as well as microangiopathy, diet management should be focused on the reductions of conventional risk factors for atherosclerosis such as hyperglycemia, dyslipidemia, and hypertension. To control the these risk factors, both total energy and fat intake should be reduced. A diet high in mono- and poly-unsaturated fatty acids, and dietary fibers are recommended to diabetic patients, but the ideal ratio of saturated, monounsaturated, and polyunsaturated fatty acids should be determined from clinical and epidemiological studies in the future. A high concentration of plasma homocysteine is a new risk factor for atherosclerotic disease in diabetic patients. To reduce plasma homocysteine, diet enriched in folate and vitamin B12 may be recommended. A high intake of flavonoid, one of antioxidants, may be also recommended in diabetic patients because of its counteraction against increased oxidative stress in diabetes mellitus. Exercise therapy is an effective measure for improving glycemic control in Type 2 diabetic patients. However, the most appropriate kinds and strength of exercise in diabetic patients with complications or elderly diabetic patients still remain unknown. The dietary regimen or exercise of diabetic patients should be determined individually according to the risk factors, complications, and psychological and socioeconomic conditions.
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PMID:[Perspective of dietary management and exercise therapy in diabetes mellitus]. 1019 49

Medical myths occur for many different reasons. A common thread is that they all make some pathophysiologic sense. A good example is the concern about using oral cobalamin when treating pernicious anemia. The difficulty in absorbing vitamin B12 when intrinsic factor is not available does not make oral replacement impossible; the dose just needs to be higher. Pathophysiologic concerns have also been a key reason why physicians have avoided using beta-blockers in patients with diabetes. They fear that beta-blockers will block adrenergic symptoms, and patients will not know when they are hypoglycemic. In studies addressing this issue, there appears to be no real problem with increased severe episodes of hypoglycemia in patients on beta-blockers or increased hypoglycemic unawareness. Several studies commented on the unanticipated symptom of increased sweating associated with hypoglycemia in diabetic patients who are taking beta-blockers. Another important concept behind some medical myths is the overreliance on case reports or authoritative text. The concern about depression associated with beta-blocker use grew out of one widely referenced case report. Subsequent studies have not shown convincing evidence for a strong association with beta-blocker use and depression. The strong position taken against narcotic use in Cope's Early Diagnosis of the Acute Abdomen is probably the reason for the perpetuation of the myth of avoiding narcotics for pain relief in patients with undiagnosed acute abdominal conditions. The only two studies addressing this issue showed no problems with diagnosis caused by providing narcotic pain relief. Newer therapies usually undergo closer scrutiny before being accepted, often including placebo-controlled trials to show the efficacy of a medication. Such might not be the case with newer technologies. It is harder to evaluate the benefit of a new technology in the face of noncomparable previous technologies. Catheterization of the right side of the heart (Swan-Ganz catheter) was a technology that became widely used before any outcome studies became available. Multiple reports in the last decade have shown increased mortality and increased utilization of resources in patients who received catheterization of the right side of the heart. Most new drug therapies require randomized data to show effects before widespread use and acceptance occur. Older therapies that have been widely accepted for a long time might not have had controlled trial data behind recommendations for their use, and once practice patterns become widespread, it is hard to change. It is always good to ask the question, "Will this help my patient live better or longer?" when prescribing a therapy. These myths underscore the importance and utility of outcome-based research to help guide physicians in their practices.
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PMID:Did we learn evidence-based medicine in medical school? Some common medical mythology. 1022 Feb 38

Non-insulin-dependent diabetes mellitus (NIDDM) and hyperhomocysteinemia are both associated with premature vascular disease. We tested the hypothesis that homocysteine is associated with vascular disease and other diabetic complications in patients with NIDDM. The current investigation is a cross-sectional analysis of baseline variables for participants in the Appropriate Blood Pressure Control in Diabetes (ABCD) Trial. Men and women aged 40 to 74 years with NIDDM and a mean diastolic blood pressure (BP) of 80 mm Hg or higher were eligible. We measured serum levels of total homocysteine (tHcy), cystathionine, and methylmalonic acid (MMA) and correlated these values with clinical and other laboratory measures of the complications of diabetes mellitus in 452 subjects. tHcy was higher in males than in females and correlated with the duration of hypertension and systolic BP. tHcy was significantly correlated with MMA (r = .35, P < .0001) and cystathionine (r = .53, P < .0001) levels and inversely correlated with serum B12 (r = -.23, P < .0001) and folate (r = -.18, P < .0001). It was significantly correlated with serum creatinine (r = .28, P < .0001 for males and r = .39, P < .0001 for females) and inversely correlated with creatinine clearance (r = -.19, P < .005 for males and r = -.30, P < .0001 for females). tHcy was not increased in subjects with cardiovascular disease or retinopathy, but it was increased in those with neuropathy (10.3 v 9.3 micromol/L, P < .05) and macroalbuminuria (11.0 v 9.2 micromol/L, P < .005). Of these subjects, 2.2% met the criteria for vitamin B12 deficiency and 1% met the criteria for folate deficiency. We conclude that elevations of tHcy in this population appear to be the result of a combination of vitamin deficiency and decreased renal function and do not appear to be a predictor of cardiovascular disease.
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PMID:Total homocysteine is associated with nephropathy in non-insulin-dependent diabetes mellitus. 1048 47

The atherogenicity of homocyst(e)ine--H(e) --emerged from many studies showing an association between moderately elevated levels and vascular occlusive disease. The aim of this study was to evaluate whether high homocyst(e)ine levels were associated with carotid atherosclerosis. Carotid atherosclerosis was defined as an intimal media thickness of internal and carotid bifurcation of at least 2 mm on the near and far walls as determined by B-mode ultrasonography. The study population included 91 patients: group 1 (61% males, mean age 64+/-10 years, 57% with history of hypertension) with ultrasound evidence of carotid atherosclerosis and 100 with normal carotid walls--group 2 (36% males, mean age 52+/-15 years, 27% with history of hypertension). Homocyst(e)ine levels (mol/L) were determined by high-performance liquid chromatography with a fluorescent detector. Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasma folic acid and vitamin B12 were not significantly different in the two groups. Homocyst(e)ine levels (micromol/L) were significantly higher in patients with carotid ather osclerosis than in those with normal arteries (11.7+/-6.5 micromol/L, 95% CI 10.4-13.1 vs 8.07+/-4.4 micromol/L, 95% CI 7.2-8.9, p<0.0001). By multiple regression analysis H(e) levels were positively correlated with male gender (p<0.02), age (p<0.001), and negatively with folic acid (p<0.0001). By logistic regression the independent predictors of carotid atherosclerosis were male gender (OR 2.65), hypertension (OR 2.55), age (x10 years, OR 2.15) and H(e) levels (x1 micromol/L, OR 1.11). This study confirmed homocyst(e)ine is associated with carotid atherosclerosis. Consequently the authors recommend H(e) levels be screened in all patients at risk for atherosclerosis.
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PMID:Hyperhomocyst(e)inemia is associated with carotid atherosclerosis. 1053 21


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