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

ASHP supports strict glycemic control in selected patients with IDDM on the basis of studies demonstrating that strict glycemic control delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy. Because of the increased risk of hypoglycemia, intensive treatment regimens may not be appropriate in patients with poor perception of hypoglycemic symptoms and those with a history of frequent, severe hypoglycemic episodes. The pharmacist can play a key role in implementing and monitoring this therapy by collaborating with other members of the health care team and by counseling patients.
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PMID:ASHP therapeutic position statement on strict glycemic control in selected patients with insulin-dependent diabetes mellitus. 860 Dec 69

The isokinetic muscle strength in 56 IDDM patients with > 20 years of diabetes duration and in their individually sex-, age-, weight-, and height-matched control subjects was assessed. Peak torque of foot dorsal and plantar flexion and knee and wrist extension and flexion was measured. The neuropathic condition was assessed by a neurological disability score, a neuropathy symptom score, nerve conduction studies, and quantitative sensory examination. All results were summed to obtain a neuropathy rank-sum score for each patient. According to their renal albumin excretion, the patients were classified to have normo-, micro-, or macroalbuminuria. In addition, according to their retinal status, patients were classified as having no, simple, or proliferative retinopathy. The IDDM patients had a 21% reduction of muscle strength of both ankle dorsal (P < 1 x 10(-4)) and plantar flexors (P < 0.01), compared with control subjects. A 16% reduction of knee extensors (P < 0.005) and a 17% reduction of knee flexors (P < 0.01) was found. In contrast, muscle strength in wrist flexors and extensors was not significantly reduced (10 and 11%, respectively [NS]). In patients with the most severe weakness, muscle strength of the calf muscles was only 50% of the expected performance. Correlations were found between the neuropathy rank-sum score and the muscle strength of ankle dorsal (r = -0.66, P < 1 x 10(-7)) and plantar flexors (r = -0.51, P < 0.0005), knee extensors (r = -0.51, P < 0.0005) and flexors (r = -0.44, P < 0.005), and wrist flexors (r = -0.41, P < 0.005). No correlation was found for wrist extensors (r = 0). Neither were there any relationships between muscle strength at the ankle and knee and the degree of albuminuria or retinopathy. In conclusion, motor performance is substantially impaired in long-term IDDM patients, and the weakness is related to the presence of neuropathy but not to albuminuria or retinopathy per se.
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PMID:Isokinetic muscle strength in long-term IDDM patients in relation to diabetic complications. 860 65

Elevated serum sialic acid (SSA) predicts cardiovascular disease in the non-diabetic population and is also associated with the presence of microalbuminuria and clinical proteinuria in patients with insulin-dependent diabetes (IDDM). We have studied 121 patients with IDDM of long duration (mean duration 25.2 years) to investigate the relationship of SSA concentrations to the presence of retinopathy, nephropathy, and neuropathy. SSA levels were elevated in patients with retinopathy (0.578 +/- 0.161 gl-1, n = 98) when compared with those without retinopathy (0.468 +/- 0.145 gl-1, n = 23, p = 0.002). Patients with nephropathy (urinary albumin:creatinine ratio of > 3 mg mmol-1 in all of three early morning specimens of urine) also had raised SSA levels (0.625 +/- 0.169 gl-1, n = 30) compared with those without nephropathy (0.533 +/- 0.160 gl-1, n = 91, p = 0.006). There was a significant correlation of SSA with urinary albumin:creatinine ratio (correlation coefficient 0.33, p < 0.001). SSA levels were not related to the presence or absence of neuropathy (0.567 +/- 0.181 gl-1, n = 28, vs 0.533 +/- 0.160 gl-1, n = 93, p = 0.92, respectively). In conclusion, retinopathy and nephropathy but not neuropathy are associated with increased SSA levels in patients with IDDM. The significance of this is not yet clear but it is possible that sialic acid is involved in the pathophysiology of microvascular disease in IDDM.
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PMID:Serum sialic acid and the long-term complications of insulin-dependent diabetes mellitus. 868 44

Central motor pathways were studied in 17 normoalbuminuric insulin-dependent diabetic (IDDM) patients who had been diabetic for more than 20 years, and compared with findings in 17 age-, sex-, and height-matched control subjects. The central motor conduction time was calculated from recordings of the compound muscle action potentials of the abductor pollicis brevis muscle after single transcranial and spinal root magnetic stimulation. The central motor conduction time from motor cortex to cervical spinal roots was 9.8 +/- 1.65 ms in diabetic patients and 10.1 +/- 1.48 ms in control subjects. In diabetic patients with neuropathy the central motor conduction time was 9.5 +/- 1.76 ms vs 10.1 +/- 1.56 ms in patients without neuropathy. The excitability of the motor pathways was studied by paired transcranial magnetic stimulation at interstimulation intervals of 30-1000 ms. In normal control subjects, an early facilitation of the amplitude of the compound muscle action potential at an interstimulation interval of 30 ms was found, while no facilitation was present in diabetic patients. In addition the compound muscle action potential latencies were prolonged at interstimulation intervals of 30-50 ms in diabetic patients. The changes of excitability did not correlate with the presence of peripheral neuropathy, metabolic control or diabetes duration. It is concluded that long-term normoalbuminuric IDDM patients have imparied excitability but normal central conduction time of the motor pathways.
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PMID:Motor pathway function in normoalbuminuric IDDM patients. 869 Jan 71

50 Patients of diabetes mellitus (both IDDM and NIDDM) were selected with typical symptoms, signs and positive bed side tests of autonomic neuropathy. All the patients were followed for three months during which strict metabolic control was achieved by routine treatment with oral hypoglycaemic agents and/or insulin, simply by change in their previous treatment dosages and better attention to diet and physical activity. 22% patients showed significant improvement in symptoms of autonomic neuropathy. 42% showed partial improvement and 36% patients did not show any improvement. Improvement in objective test score was significant in 18%, partial in 46% and insignificant in 36%. Improvement in neuropathy did not correlate with HbA1C levels. 36% patients did not show any subjective or objective improvement in autonomic neuropathy inspite of good glycaemic control as indicated by normal HbA1C levels in them.
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PMID:A study of autonomic neuropathy in diabetes mellitus in relation to its metabolic control. 871 18

Insulin-dependent diabetes mellitus (type 1) is accompanied by long-term complications: retinopathy, nephropathy, neuropathy, as well as macrovascular complications. We compared the direct cost of standard insulin treatment in type 1 patients with that of intensified treatment as well as the direct cost of their complications during the two treatment modes for 35 years' duration of disease. According to our model calculations, the direct cost of basic intensified insulin treatment is $3300 per year, about three times more than that of the standard insulin treatment. However, for the period of 35 years, the cost of complications associated with intensified insulin treatment is lower, while the total cost of intensified treatment, over 35 years, is higher than that of the standard treatment. Thus, looking from the health provider point of view and relating only to economic analysis, intensified insulin treatment encompassing all type 1 patients is not cost-beneficial. Therefore, the decision to adopt this type of therapy should be based on the combination of medical, ethical, political, and economical principles, and applied to selected, well motivated, and prepared patient groups, in whom compliance to intensified treatment would be expected to prevent or delay the onset of complications. According to cost analysis, nephropathy is the most common and severest complication, and intensive treatment promises to be most effective in this group of patients.
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PMID:Analysis of direct cost of standard compared with intensive insulin treatment of insulin-dependent diabetes mellitus and cost of complications. 877 85

The presence of opioid peptides within pancreatic islets in several animal species and in humans suggests that these peptides could play a role in pancreatic endocrine secretion, influencing glucose metabolism. We measured plasma met-enkephalin (met-Enk) levels in eight neuropathic (four with insulin-dependent diabetes mellitus [IDDM] and four with non-insulin-dependent diabetes mellitus [NIDDM]) and eight nonneuropathic (four IDDM and four NIDDM) diabetic patients to study met-Enk secretion in diabetic patients with asymptomatic autonomic neuropathy. Plasma met-Enk levels were significantly lower in neuropathic compared with nonneuropathic patients both in the IDDM group (28.7 +/- 4.8 v 61.6 +/- 4.1 pg/mL, P < .0025) and in the NIDDM group (26.5 +/- 3.6 v 44.3 +/- 4.6 pg/mL, P < .0125). This study suggests that the presence of neuropathy in diabetic patients, even if asymptomatic, is associated with a significant decrease of plasma met-Enk levels, thus contributing to a worsening of metabolic control under stress conditions.
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PMID:Plasma met-enkephalin levels in diabetic patients: influence of autonomic neuropathy. 878 Dec 92

Specially designed Thor-Lo footwear has been shown to reduce the in-shoe foot pressures in diabetic patients at risk of foot ulceration when compared to their own footwear. Fifty at high risk patients 32 (64%) males, 17 (34%) type 1 diabetes) have been provided with this foot wear and have been followed up for 6 months. Mean age was 57.6 (range, 34-78) years, duration of diabetes 22.4 (range, 4-50) years, Neuropathy Symptom Score 3.36 +/- 2.96 (mean +/- S.D.), Neuropathy Disability Score 16.8 +/- 6.83, VPT 43.4 +/- 11.8 Volts while 43 (86%) could not feel a 5.07 or smaller Semmes-Weinstein monofilament. Forty-two (84%) patients were re-examined at an interim visit 3 months after baseline, while 37 (74%) completed the study. In-shoe peak forces and pressures were measured using the F-Scan system. No difference was found among the peak force among baseline (95.5 +/- 26 kg), interim (96.5 +/- 33) and final visit (97.7 +/- 25.2, P + NS). There was no difference in peak pressures at the baseline (3.98 +/- 1.42 kg.cm-2), second visit (4.13 +/- 2.30) and the final visit (4.25 +/- 1.51). Nine (18%) patients developed foot problems and one died during the study. We conclude that no changes in foot pressures were found over a period of 6 months of continuous usage of the specially designed footwear in a group of diabetic patients at risk of foot ulceration. Further prospective studies are required to evaluate the impact of specially designed footwear in reducing the rate of foot ulceration.
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PMID:Longitudinal in-shoe foot pressure relief achieved by specially designed footwear in high risk diabetic patients. 879 9

The Diabetes Control and Complications Trial (DCCT) demonstrated a reduction in the development and progression of the long-term complications of IDDM with intensive therapy aimed at achieving glycemic control as close to the nondiabetic range as possible. The DCCT subsequently showed that the total lifetime exposure to glycemia was the principal determinant of the risk of retinopathy and that there was a continuous nonlinear relationship between this risk and the mean level of HbA1c (DCCT Research Group, Diabetes 44:968-993, 1995). In contrast, other authors, based on a retrospective study (Krolewski et al., N Engl J Med 332:1251-1255, 1995), have suggested that a glycemic threshold for microabuminuria and for retinopathy exists at an HbA1c level of approximately 8%, below which there is no further appreciable reduction in risk. In this perspective, we examine whether the DCCT data demonstrate such a glycemic threshold for the development of retinopathy, nephropathy, or neuropathy. In the DCCT, 1,441 patients with IDDM were randomly assigned to intensive (n = 711) or conventional (n = 730) therapy and followed for a mean of 6.5 years. Retinopathy was assessed every 6 months by stereoscopic fundus photography; albumin excretion was measured annually in a 4-h collection; and neuropathy was assessed with a standardized protocol performed at baseline and at 5 years. Glycosylated hemoglobin was measured quarterly. Episodes of severe hypoglycemia were ascertained using standardized procedures. The risks (hazard rates) of retinopathy progression and of developing microalbuminuria and neuropathy were found to be continuous but nonlinear over the entire range of glycosylated hemoglobin values in the intensive, conventional, and combined treatment groups. These nonlinear relationships describe a constant relative risk gradient in which proportional reductions in HbA1c are accompanied by proportional reductions in the risk of complications. Although the magnitude of the absolute risk reduction declines with continuing proportional reductions in HbA1c, there are still meaningful further reductions in risk as the HbA1c is reduced toward the normal range. When the instantaneous risks for different complications associated with different HbA1c values are compounded over time, there are substantial differences in the cumulative incidence of patients experiencing a complication for patients with HbA1c values of 6 vs. 7 vs. 8% or higher. In fact, no HbA1c threshold could be identified, short of normal glycemia, below which there was no risk of the development or progression of these complications. Furthermore, as the HbA1c was reduced proportionately, the proportional rate of decline in the relative risk for each of these complications was similar for HbA1c levels < or = 8.0% and for levels > 8%. In contrast, although the absolute risk of severe hypoglycemia in the intensive treatment group increased as the HbA1c decreased, the relative risk gradients were significantly less for HbA1c levels < or = 8.0% than for levels > 8%. These extensive prospective DCCT data do not support the conjecture that a glycemic threshold for the development of complications exists at an HbA1c of 8% or that an HbA1c goal of 8% is maximally beneficial. In the DCCT, as HbA1c was reduced below 8% there were continuing relative reductions in the risk of complications, whereas there was a slower rate of increase in the risk of hypoglycemia. Therefore, the DCCT continues to recommend implementation of intensive therapy with the goal of achieving normal glycemia as early as possible in as many IDDM patients as is safely possible.
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PMID:The absence of a glycemic threshold for the development of long-term complications: the perspective of the Diabetes Control and Complications Trial. 882 62

A 76 years old patient suffering from insulin dependent diabetes presents a multiple, bilateral and asymmetric cranial neuropathy involving on the left side the cranial nerves VIII, IX with a participation of the efferent autonomic fibers of the nerves VII and IX (xerostomia) and the nerve XII, and involving on both sides the nerves VII and X. Like it is known from literature the nerve XI was spared, probably because of the more caudal emergence from the brainstem. The disease was preceded by a violent otalgia on the left side which was initially interpretated as a malignant external otitis. This affection was associated with an inflammatory syndrome that was easily monitored by the blood sedimentation rate. The course was favorable but marked by fluctuations of the neurological deficits. The MRI shows a pachymeningitis localised at the beginning in the medial fossa and on the cerebellar tentorium, later on the left parieto-occipital convexity. The diagnosis of a focal idiopathic pachymeningitis was confirmed by excluding different other affections like inflammatory, tumoral and infectious diseases, by using MRI examinations, CSF analysis and especially meningeal biopsy. It is a rare inflammatory disease of unknown origin with potentially persistent neurological deficits. We discuss the differential diagnosis and the therapeutical possibilities, which consist in a long term immunosuppression with corticosteroids and azathioprine.
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PMID:[Neuritis of multiple cranial nerves in idiopathic focal pachymeningitis]. 886 57


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