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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is a major scourge of the modern world and the complications of this disease are important causes of morbidity and mortality. It is expected that the prevalence of this disease will increase several fold in all regions of the world over the coming decades. The prevalence of type 2 diabetes (initial resistance to endogenous insulin, usually found in obese adults) is about nine times greater than that of type 1 diabetes (absence of insulin, usually found in children and young adults) and thus the burden of this disease is mainly of patients with type 2 diabetes. The many complications of diabetes mellitus include cardiovascular disease, retinopathy, nephropathy, peripheral neuropathy and peripheral vascular disease. These complications appear in patients with either type of diabetes. This monograph will be devoted to the discussion of diabetic nephropathy (DN).
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PMID:Management of diabetic nephropathy: epidemiology, pathogenesis of nephropathy and factors influencing progression. 1571 14

It is not known whether C-fiber functional subclasses are differentially affected by diabetes mellitus or whether the patterns of C-fiber dysfunction are different between type 1 and type 2 diabetes. We therefore examined efferent sympathetic sudomotor and primary afferent nociceptor C-fiber function in diabetic patients. Acetylcholine (10%) was used to evoke C-fiber (axon-reflex)-mediated responses. The nociceptor (flare) response was measured using a laser Doppler device. The sudomotor response was quantified with silastic imprints. The nociceptor C-fiber-mediated flare response was reduced in type 2 diabetic patients (P < 0.008) but was similar to controls in type 1 diabetic patients. The sympathetic C-fiber-mediated responses, including sweat volume (P < 0.05) and the number of activated sweat glands (P = 0.003), were increased in patients with type 1 diabetes. There also was a trend toward a larger axon-reflex sweat area in patients with type 1 diabetes (P = 0.09). No differences in these sweat responses were found in patients with type 2 diabetes compared to controls. These findings suggest that the functional abnormalities in diabetic peripheral neuropathy are not homogeneous and that C-fiber subclasses are differentially affected in type 1 and 2 diabetes mellitus.
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PMID:Differential impairment of the sudomotor and nociceptor axon-reflex in diabetic peripheral neuropathy. 1641 Nov 96

The aim of the article was to use prospectively collected data on people with type 1 diabetes to examine which routinely collected clinical measures predict the development of peripheral neuropathy in people with type 1 diabetes. Within the Newcastle Diabetes Services, structured data collection at an annual review has been collected since 1985. This includes metabolic measures, cardiovascular risk factors, and markers of complications. From 1990 data collection was standardized and computerized. For this study, all people with type 1 diabetes in the database in both 1992 and 2001 were ascertained. Data were extracted for a diagnosis of peripheral neuropathy (based on neuropathic symptoms, absence of pinprick sensation, and abnormal biothesiometer measurements and/or monofilament sensation) and for the other metabolic and cardiovascular risk measures, as well as markers of other microvascular complications. Associations with the development of neuropathy were sought. Eighteen of 404 people already had peripheral neuropathy in 1992, and 38 others developed neuropathy during follow-up. People who developed neuropathy were older (47 +/- 14 [SD] versus 36 +/- 11 years; P = 0.000), had longer-duration of diabetes (27 +/- 13 versus 18 +/- 10 years; P = 0.001), higher baseline serum cholesterol (5.8 +/- 1.3 versus 5.2 +/- 1.2 mmol/L, P = 0.017), and higher systolic (139 +/- 18 versus 129 +/- 20 mmHg; P = 0.003) and diastolic BP (82 +/- 12 versus 76 +/- 11 mmHg; P = 0.009) than those who remained free of neuropathy. We found no significant difference for BMI and glycated hemoglobin. The multivariate model showed that diastolic BP, duration of diabetes, serum cholesterol, and history of callus/ulcers on the feet predicted the development of peripheral neuropathy. Neuropathy developed in 11.4% of people with type 1 diabetes over a 9-year follow-up, and was predicted by factors normally associated with cardiovascular rather than microvascular disease.
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PMID:Cardiovascular risk factors predicting the development of distal symmetrical polyneuropathy in people with type 1 diabetes: A 9-year follow-up study. 1715 10

The ever-increasing incidence of diabetes mellitus is a cause for growing public health concern in both developed and developing countries. In this study, we aim to explore the special demographic and clinical features of diabetes, as seen in a large sample of Yemeni patients, and to compare these features with those reported in other countries. All patients referred to our diabetic clinic over a five-year period were investigated according to a standardized protocol. Data was collected and fed into a personal computer with a software statistical package for analysis. The relative frequencies of clinical classes of diabetes were 10.5% for IDD, 58.6% for non-obese NIDDM; 26.2% for obese NIDDM, and 4.7% for IGT. In the IDDM class, the age-specific relative frequency rate showed a higher and earlier onset peak frequency in females than in males. Among NIDDM class, about 31% of patients were diagnosed under the age of 45 years, and only 12% were first diagnosed after the age of 65 years. Most NIDDM patients came from social classes I and II (professionals and intermediate professionals) and most IDDM patients came from social class IIIM (skilled manual). A positive family history of diabetes among first-degree relatives of index patients was observed in 33.7% of IDDM patients, in 30% of non-obese NIDDM patients, in 39.2% of obese NIDDM patients and 32% of IGT patients. Female NIDDM patients had a significantly higher mean body mass index (BMI) than males (P<0.0001). Hypertension was recognized in 24.2% of the diabetic population aged 20 to A(3) 65 years. Large vessel disease (LVD) was observed in 28% of patients, small vessel disease (SVD) in 45%, and peripheral neuropathy in 40.7%. Inadequate glycemic control was noticed during follow-up in the majority of patients. Diabetes mellitus in Yemen, especially NIDDM, is characterized by an earlier age at onset, and predominance of males and non-obese NIDM subclass. Other characteristics include moderate genetic susceptibility, inadequate glycemic control and high prevalence of chronic complications.
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PMID:Demographic and clinical features of diabetes mellitus in 1095 Yemeni patients. 1735 90

Data from 1294 patients with diabetes mellitus admitted to the Endocrinology Department of the Institute of Medical Sciences, Srinagar, Kashmir, from 1986 to 1994, were analyzed for frequency of various neurological problems. Of 1294 patients, 46.29% had clinical evidence of one or more neurological problems. The frequency of neurological problems was significantly more in patients with type II diabetes mellitus (P<0.001). Predominant neurological problems included peripheral neuropathy (96.66%), stroke (5.51%), Parkinsonism (1.50%), seizure disorder (1.17%) and dementia (1%). Mean (+/- SD) age of patients with neurological problems was significantly more (P<0.001) than those without neurological problems (52.07+/- 9.52 versus 47.45+/- 12.87 years for type II diabetes mellitus; 26.73+/- 8.40 versus 18.0+/- 3.62 for type I diabetes mellitus). Mean duration of diabetes in patients with neurological problems was significantly more than those without neurological problems (6.70+/- 6.04 versus 3.95+/- 4.22 years for type II diabetes mellitus; 5.63+/- 3.67 versus 1.89+/- 2.57 for type I diabetes mellitus). At the time of admission, fasting blood glucose was lower in patients without neurological problems as compared to patients with problems (9.08+/- 2.22 versus 11.05+/- 4.91 mmol/L for type II diabetes mellitus; 9.44+/- 2.80 versus 13.01+/- 5.01 mmol/L for type I diabetes mellitus; P7lt;0.001).
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PMID:Profile of neurological problems in diabetes mellitus retrospective analysis of data from 1294 patients. 1737 58

Our previous work demonstrated that the sterol response element binding proteins (SREBP)-1 and SREBP-2, which are the key regulators of storage lipid and cholesterol metabolism respectively, are highly expressed in Schwann cells of adult peripheral nerves. In order to evaluate the role of Schwann cell SREBPs in myelination and functioning of peripheral nerves we have determined their expression during development, after fasting and refeeding, and in a rodent model of diabetes. Our results show that SREBP-1c and SREBP-2, unlike SREBP-1a, are the major forms of SREBPs present in peripheral nerves. The expression profile of SREBP-2 follows the expression of genes involved in cholesterol biosynthesis, while SREBP-1c is co-expressed with genes involved in storage lipid metabolism. In addition, the expression of SREBP-1c in the endoneurial compartment of peripheral nerves depends on nutritional status and is disturbed in type 1 diabetes. In line with this, insulin elevates the expression of SREBP-1c in primary cultured Schwann cells by activating the SREBP-1c promoter. Taken together, these findings reveal that SREBP-1c expression in Schwann cells responds to metabolic stimuli including insulin and that this response is affected in type 1 diabetes mellitus. This suggests that disturbed SREBP-1c regulated lipid metabolism may contribute to the pathophysiology of diabetic peripheral neuropathy.
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PMID:SREBP-1c expression in Schwann cells is affected by diabetes and nutritional status. 1763 11

A decline in cognitive function has been reported in type 1 diabetes, but its relation to different disease factors such as hypoglycemic events and peripheral neuropathy is controversial. The objective of the present study was to identify factors that are important for cognitive impairment in type 1 diabetes. A cross-sectional study was performed in adult patients (N=150) with type 1 diabetes (duration 26.6+/-11.4 years). Function in different cognitive domains was evaluated by the same trained examiner, in order to eliminate inter-rater variability. Peripheral nerve function was tested quantitatively. Predictors of cognitive impairment were identified using multiple regression analysis. The major finding was that long diabetes duration and young age of diabetes onset were the strongest predictors of low scores in psychomotor speed, memory, processing speed, attention, working memory, verbal ability, general intelligence, executive functions and a low global score. The number of previous hypoglycemic events had no defined effect upon cognitive functioning. Other significant predictors were low compound muscle action potential (CMAP) (for visual perception-organization), old age (for visual-spatial ability), short stature, high BMI and hypertension. Presence of retinopathy and long-term metabolic control correlated with nerve conduction defects, but not with cognitive impairment. Although a history of hypoglycemic events was not a predictor of cognitive impairment, we cannot exclude the possibility that the influence of young age of diabetes onset depends on the effect of hypoglycemic events early in life. The clinical relationships of cognitive impairment differ from those of peripheral neuropathy, indicating a different pathogenesis. The influence of diabetes duration, BMI, height, age and CMAP may suggest that loss of the neuroprotective effects of insulin or insulin-like growth factors plays a role.
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PMID:Predictors of cognitive impairment in type 1 diabetes. 1788

Type 1 diabetes mellitus (T1DM) is associated with a peripheral neuropathy that reduces nerve conduction velocity. This may impair high motor-unit discharge frequencies (MUDF), decrease muscle activation, and curtail the ability to sustain repetitive contractile tasks. We examined (1) whether MUDF, the contractile properties of the knee extensors, and the conduction velocity of persons with T1DM differed from controls; (2) whether persons with T1DM can maintain adequate MUDF during a fatigue protocol; and (3) the relationship between these parameters and impaired glycemic control. We studied male and female subjects with T1DM and controls matched for age, height, weight, and gender. Single motor unit recordings were made from vastus lateralis during maximal and submaximal contractions and during a fatigue protocol. Glycemic control was assessed from blood glucose concentration and glycosylated hemoglobin (HbA1c). Control femoral conduction velocities were comparable to literature values and those of the T1DM subjects were slower. These values correlated with plasma glucose and HbA1c. T1DM subjects fatigued 45% sooner than controls, and time to fatigue and conduction velocity were correlated (r = 0.54, P < 0.05). Discharge frequencies tended to be slower during 50% maximal voluntary contractile force in the T1DM subjects at task failure. Persons with T1DM had slower conduction velocities and lower MUDF than their controls, which apparently leads to impaired activation of muscle and decreased endurance during isometric fatigue.
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PMID:Slower conduction velocity and motor unit discharge frequency are associated with muscle fatigue during isometric exercise in type 1 diabetes mellitus. 1804 Oct 50

A common complication associated with diabetes is painful or painless diabetic peripheral neuropathy (DPN). The mechanisms and determinants responsible for these peripheral neuropathies are poorly understood. Using both streptozotocin (STZ)-induced and transgene-mediated murine models of type 1 diabetes (T1D), we demonstrate that Transient Receptor Potential Vanilloid 1 (TRPV1) expression varies with the neuropathic phenotype. We have found that both STZ- and transgene-mediated T1D are associated with two distinct phases of thermal pain sensitivity that parallel changes in TRPV1 as determined by paw withdrawal latency (PWL). An early phase of hyperalgesia and a late phase of hypoalgesia are evident. TRPV1-mediated whole cell currents are larger and smaller in dorsal root ganglion (DRG) neurons collected from hyperalgesic and hypoalgesic mice. Resiniferatoxin (RTX) binding, a measure of TRPV1 expression is increased and decreased in DRG and paw skin of hyperalgesic and hypoalgesic mice, respectively. Immunohistochemical labeling of spinal cord lamina I and II, dorsal root ganglion (DRG), and paw skin from hyperalgesic and hypoalgesic mice reveal increased and decreased TRPV1 expression, respectively. A role for TRPV1 in thermal DPN is further suggested by the failure of STZ treatment to influence thermal nociception in TRPV1 deficient mice. These findings demonstrate that altered TRPV1 expression and function contribute to diabetes-induced changes in thermal perception.
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PMID:Influence of TRPV1 on diabetes-induced alterations in thermal pain sensitivity. 1831 87

Foot pain and lower-limb neuroischemia in diabetes mellitus is common and can be debilitating and difficult to treat. We report a comparison of orthotic materials to manage foot pain in a 59-year-old man with type 1 diabetes mellitus, peripheral neuropathy, peripheral arterial disease, and a history of foot ulceration. We investigated a range of in-shoe foot orthoses for comfort and plantar pressure reduction in a cross-sectional study. The most comfortable and most effective pressure-reducing orthoses were subsequently evaluated for pain relief in a single system alternating-treatment design. After 9 weeks, foot pain was completely resolved with customized multidensity foot orthoses. The outcome of this case study suggests that customized multidensity foot orthoses may be a useful intervention to reduce foot pain and maintain function in the neuroischemic diabetic foot.
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PMID:Comparison of orthotic materials on foot pain, comfort, and plantar pressure in the neuroischemic diabetic foot: a case report. 1834 25


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