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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 has been reported to have controversial effects on left ventricular (LV) function in patients with no evidence of coronary artery disease. In this study, LV function at rest was evaluated in 2 groups of diabetic patients, with insulin-dependent (IDD; n = 16) and non-insulin-dependent (NIDD; n = 23) diabetes mellitus, with no evidence of coronary artery disease. All patients underwent an electrocardiographic stress test, and first-pass and equilibrium radionuclide angiography at rest and during supine exercise. Data in each group of diabetic patients were compared with those obtained from age- and sex-matched normal subjects. In both groups of diabetic patients plasma catecholamine levels were significantly greater than in control subjects. Ejection fraction at rest and during exercise did not differ between each group of diabetic patients and their respective control group. In patients with IDD, peak ejection rate (4 +/- 1 end-diastolic count/s) was significantly greater than in control subjects (2.6 +/- 0.1 end-diastolic count/s; p < 0.001); similarly, peak filling rate (4.3 +/- 1.0 end-diastolic count/s) was significantly greater than in controls (3.0 +/- 0.2 end-diastolic count/s; p < 0.001). Cardiac output and systemic vascular resistances did not differ between patients with IDD and control subjects. In contrast, patients with NIDD had significantly reduced cardiac output compared with that of control subjects (5.7 +/- 0.2 vs 5.9 +/- 0.2 liter/min; p < 0.01), and increased systemic vascular resistances (1,422 +/- 137 vs 1,314 +/- 68 dynes.s.cm-5; p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Am J Cardiol 1993 Feb 15
PMID:Comparison of left ventricular function in insulin- and non-insulin-dependent diabetes mellitus. 843 Jun 28

The report is a discussion of previously published and newly analyzed results concerning the association between heart diseases and alterations in the force-frequency relation (FFR). The optimum stimulation frequency of the FFR is measured and compared in isolated left ventricular myocardium from non-failing hearts with atrial septal defect, coronary artery disease (without and with insulin dependent diabetes mellitus) and from failing hearts with mitral regurgitation, or idiopathic dilated cardiomyopathy. Specifically, we examine the role of altered control of the excitation-contraction coupling system in blunting the force-frequency relation. We use the percent slope of the FFR as a measure of changes in the frequency sensitivity of this control. Our finding of a linear, direct relation between optimum stimulation frequency and % slope across all disease types suggests both parameters are coupled to the same underlying mechanism. To investigate the possible role of altered control of the calcium pump in this mechanism, we analyzed the detailed relation between isometric twitch relaxation kinetics and stimulation frequency in mitral regurgitation myocardium (MR). In the presence of 0.5 microM forskolin the depressed slope and optimum frequency of the FFR and the prolonged half-time of twitch relaxation were all restored to values found in non-failing myocardium. We use the kinetics of isometric twitch relaxation as an index of changes in pumping rate that occur in response to changes in stimulation frequency or in intracellular cyclic adenosine monophosphate concentration. A mathematical model based on the Hill relations for calcium pump uptake rate and for isometric tension as a function of intracellular pCa is developed to simulate isometric twitch relaxation in MR and non-failing myocardium. The success of this model in simulating non-failing and failing twitch relaxation supports a proposed mechanism for the prolonged relaxation time and depressed FFR in MR involving depressed protein kinase-A activity (due to lowered cAMP or to a defect in the Ser16 site of phospholamban) as a mechanism of altered control of the calcium pump in MR heart disease.
Basic Res Cardiol 1997
PMID:Role of cAMP in modulating relaxation kinetics and the force-frequency relation in mitral regurgitation heart failure. 920 49

Recent studies at our institution using positron emission tomography (PET) provide evidence that both myocardial blood flow (MBF) and glucose metabolism may be affected in patients with diabetes mellitus. A retrospective study revealed inadequate myocardial glucose uptake as assessed by 2-[18F]fluoro-2-deoxyglucose (18FDG) in 64% of type I (insulin-dependent diabetes mellitus, IDDM) and 36% of type II (non-insulin-dependent diabetes mellitus, NIDDM) patients. However, a study in 7 patients with IDDM and 9 controls showed that metabolic standardization using hyperinsulinemic-euglycemic clamp is associated with similar myocardial glucose uptake in both groups (0.43 +/- 0.16 vs 0.44 +/- 0.12 micromol/g per min; p = nonsignificant). Furthermore, we studied MBF as assessed by [13N]ammonia in 15 IDDM patients without coronary artery disease. We found an impairment in flow reserve in diabetic patients as compared with a control group of 13 healthy volunteers (2.6 +/- 1.3 vs 4.0 +/- 0.6; p <0.01), which was primarily due to a significantly higher resting MBF (95.3 +/- 27.7 vs 69.1 +/- 8.1 mL/100 g per min; p <0.01). Hyperemic flow during adenosine infusion tended to be lower in diabetics, but was not significantly different (236.3 +/- 105.7 vs 273.0 +/- 26.0 mL/100 g per min; p = nonsignificant). Morphologic and functional abnormalities of the coronary microcirculation have been reported in diabetic animals and humans. Furthermore, there is an ongoing controversy regarding the existence of a specific diabetic cardiomyopathy that is not related to epicardial coronary disease. However, few studies have explored the effect of diabetes, hyperinsulinemia, or hyperglycemia on MBF and glucose metabolism in humans. With PET it is possible to perform comprehensive noninvasive studies of various aspects of cardiac function in patients with diabetes mellitus.
Am J Cardiol 1997 Aug 04
PMID:Myocardial blood flow and glucose metabolism in diabetes mellitus. 929 61

This investigation examines whether serum lipoprotein levels in patients with diabetes mellitus and in those with coronary artery disease are associated with lower heart rate variability (HRV). The study group consisted of 58 subjects divided into 3 groups: normal subjects, chronic stable angina, and type 1 diabetes. Twenty-four-hour ambulatory electrocardiographic recordings were analyzed in the time and frequency domains; standard instantaneous autonomic testing was also performed. On 24-hour ambulatory recordings, patients with chronic stable angina had significantly lower HRV than normals, and diabetics had a more marked reduction in HRV than both normals and anginal patients. When anginal patients and diabetics were stratified by total serum and low-density lipoprotein (LDL) cholesterol levels, diabetics with elevated total and LDL cholesterol had an additional, significant decrease in HRV parameters. No such difference was demonstrated in patients with stable angina. No significant correlations were noted for high-density lipoprotein (HDL) cholesterol, triglycerides, or total cholesterol/HDL ratio and HRV in diabetics or patient with angina. Diabetics with markedly abnormal peripheral reflexes had significantly higher triglycerides and total cholesterol/HDL ratios. Finally, standard tests of autonomic function did not correlate with total, LDL, HDL cholesterol levels, total cholesterol/HDL ratio, or triglycerides. Thus, we found a relation between atherogenic lipid levels and reduced HRV in diabetic patients that has not been previously identified.
Am J Cardiol 1998 Apr 15
PMID:Relation of heart rate variability and serum lipoproteins in type 1 diabetes mellitus and chronic stable angina pectoris. 957 51

Cardiac arrhythmias and markedly increased mortality rate have been demonstrated in patients with diabetic autonomic neuropathy. Abnormal prolonged QT dispersion interval (QTd) is associated with a higher risk of ventricular arrhythmias. The aim of this study was to evaluate the relationship between autonomic dysfunction, QT and JT interval dispersion parameters and ventricular arrhythmias. Twenty-six patients with type 1 diabetes mellitus and 20 healthy subjects as controls were enrolled in the study. Resting 12-lead electrocardiograms were recorded for measurement of QTd, corrected QTd (QTcd), JT dispersion (JTd) and corrected JT dispersion (JTcd). After taking ECG, all patients underwent autonomic function tests. Patients and control group were also evaluated by 24-h Holter monitoring. Fourteen patients were identified who had autonomic dysfunction. QTd, QTcd, JTd, and JTcd values were significantly higher in patients with autonomic dysfunction than both patients without autonomic dysfunction and the control group (QTd: 78+/-16 vs. 51+/-13 ms, P=0.002; 78+/-16 vs. 48+/-9 ms, P<0.001; QTcd: 91+/-14 vs. 66+/-12 ms, P=0.001; 91+/-14 vs. 61+/-11 ms, P<0.001; JTd: 81+/-12 vs. 58+/-13 ms, P=0.001; 81+/-12 vs. 49+/-7, P<0.001; JTcd: 96+/-15 vs. 73+/-11 ms, P<0.001; 96+/-15 vs. 67+/-8 ms, P=0.001). There was no significant difference between the dispersion parameters in diabetic patients without autonomic dysfunction and the control subjects (P>0.05). Also, patients with autonomic dysfunction had higher Lown classes of ventricular arrhythmias and patients with higher Lown classes of ventricular arrhythmias had more prolonged QTd and QTcd values. The data suggest that diabetic patients with autonomic dysfunction have increased dispersion of ventricular refractoriness, which may be one of the factors contributing to the increased incidence of arrhythmias and sudden death observed in these patients.
Int J Cardiol 1998 Jun 01
PMID:QT dispersion and autonomic nervous system function in patients with type 1 diabetes. 969 30

Several observational studies document a considerably increased risk of advanced renal disease, cardiovascular disease, and early mortality in persons with diabetes. Both epidemiologic and observational studies indicate that progression of cardiovascular disease and renal disease is associated not only with high blood glucose levels, but also with hypertension and dyslipidemia. In persons with type 1 diabetes, hypoglycemic and antihypertensive therapy are important in the prevention of cardiovascular and renal disease. In those with type 2 diabetes, hypoglycemic therapy can help to prevent microvascular disease in the retina and in the kidney, and recent studies show that antihypertensive treatment is important in preventing cardiovascular disease. Thus, a multifactorial intervention program is key to preventing complications of hyperglycemia and, equally important, elevated blood pressure and dyslipidemia.
Am J Cardiol 1998 Nov 12
PMID:Natural history of cardiovascular and renal disease in patients with type 2 diabetes: effect of therapeutic interventions and risk modification. 982 36

Diabetic nephropathy has become the single most important cause of endstage renal failure in most countries of the Western world. Against this background, the role of the renin-angiotensin system (RAS) and its blockade command considerable interest. In diabetic patients and in diabetic animals, the circulating components of the RAS are suppressed. Although the evidence is not completely uniform, there are indirect arguments (renal hemodynamic response to RAS blockade, AT1 receptor expression), however, which would be consistent with increased intrarenal action of angiotensin (ANG) II. There is solid evidence that ACE inhibitors effectively interfere with progression of micro-albuminuria both in IDDM and NIDDM. They also prevent progression of advanced renal failure in IDDM, while there is only preliminary evidence in this respect for NIDDM. ACE inhibitors are superior to conventional antihypertensive agents (with the possible exception of some calcium channel blockers), but such superiority is seen only when the levels of blood pressure are relatively high. In diabetic animals, treatment with ANG II receptor blockers interferes with the development of glomerular lesions. In acute and subacute studies on diabetic patients, ANG II receptor blockers reduced albuminuria (or proteinuria) more than beta-blockers. Head-on comparison of equipotent doses ACE inhibitors and ANG II receptor blockers in non-diabetic patients produced equal reductions in proteinuria. The long-term effects of ANG II receptor blockers on progression of advanced diabetic nephropathy is the object of two large international studies. The results will not be available before the year 2000.
Basic Res Cardiol 1998
PMID:Diabetes--renal function--what are the special problems? 983 74

Individuals with diabetes have a two to four times higher risk of cardiovascular morbidity and mortality than nondiabetics. Patients with both type 1 and type 2 diabetes share a similar risk. Studies in individuals with type 1 diabetes have shown a decreased clearance of postprandial triglyceride-rich lipoprotein particles of abnormal composition. Particles isolated from diabetic individuals show abnormal composition and an increased tendency to cause cholesteryl ester accumulation in macrophages and are therefore potentially atherogenic. Various interventions may alter these abnormalities and improve the atherosclerotic risk. These include adopting a high-carbohydrate diet over a high monounsaturated diet, improving glycemic control, infusing insulin intraperitoneally, and using pharmacologic therapies such as the statins.
Clin Cardiol 1999 Jun
PMID:Postprandial triglyceride metabolism in diabetes mellitus. 1037 94

The purpose of our investigation was to compare circadian patterns of heart rate variability as assessed by 24-h ambulatory electrocardiographic (ECG) recordings in normal subjects, chronic stable angina, and Type 1 diabetes mellitus. The study population consisted of three groups: 12 normal subjects, 23 chronic angina patients, and 23 Type 1 diabetics. For purposes of analyzing circadian variation, the ECG recordings were divided into daytime (08:00-00.00 h) and night-time (00:00-08:00 h) periods. Analysis was performed for all time and frequency domain measures of heart rate variability, attempting to identify differences in day-to-night variability among these three groups. All time domain parameters except standard deviation of all 5-min mean RR intervals, and all frequency domain indices maintain significant circadian variations (P<0.0001), with the greatest day to night variation seen in normals, the least in diabetics, and intermediate values in chronic angina. These changes in heart rate variability circadian rhythms reflect significant reductions in cardiac parasympathetic activity with the most marked reduction in nocturnal vagal activity. Given the circadian pattern of myocardial ischemia and infarction, these data suggest that quantification of the magnitude of circadian variation in heart rate variability may have the potential to further risk stratify chronic angina and diabetes for future cardiac events.
Int J Cardiol 1999 Sep 30
PMID:Circadian patterns of heart rate variability in normals, chronic stable angina and diabetes mellitus. 1052 63

The treatment of hypertension and heart failure has evolved in recent years. It may no longer be sufficient to lower blood pressure per se or correct hemodynamics alone in these conditions to achieve optimal long-term outcomes; rather, the effects of drugs on the cellular events and structural alterations that occur in the vasculature, heart, and kidney must be considered. Drugs that target angiotensin II, which include the angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), may protect target organs from damage and thereby improve outcomes. Nevertheless, it remains to be demonstrated whether these agents are more effective in reducing cardiovascular morbidity and mortality in hypertensive patients than conventional treatment with diuretics and beta blockers. In certain subgroups of hypertensive patients, including those with heart failure, type 1 diabetes with proteinuria, or after myocardial infarction with systolic dysfunction, there is compelling evidence for use of ACE inhibitors. The results from animal models and initial clinical studies suggest that ARBs are also highly effective in these patients. Several large-scale clinical studies, comparing the effect of ARBs and other drug classes on morbidity and mortality outcomes, have been initiated to better define the long-term benefit of ARBs in the treatment of hypertension and heart failure.
Am J Cardiol 1999 Nov 18
PMID:Long-term benefits of angiotensin II blockade: is the consensus changing? 1058 90


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