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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the clinical profile of 296 non-insulin-dependent diabetic (NIDDM) patients with nephropathy and renal failure. Male preponderance was striking in this group and the age of onset of diabetes was between 30 and 50 years in 75%. Retinopathy was present in 86% with proliferative changes in 20% and coronary artery disease was evident in 40% of the patients. The incidence of retinopathy and coronary artery disease was significantly higher in this group than in a group of non-insulin-dependent diabetics without nephropathy (86% vs. 18.5%; 40% vs. 30% respectively, P less than 0.01). It is our observation that patients with NIDDM developing nephropathy and renal failure have had an early onset of disease and are significantly more often male. There is also a greater incidence of elevated blood pressure, coronary artery disease and retinopathy in this group.
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PMID:Clinical profile of Indian non-insulin-dependent diabetics with nephropathy and renal failure. 275 89

Little is known of the natural history of nephropathy in type 2 (non-insulin-dependent) diabetes, yet type 2 diabetes is a major cause of end-stage renal disease in the United States. The incidence rate of heavy proteinuria was determined in Pima Indians participating in a longitudinal population study of diabetes and its complications. Heavy proteinuria was defined by a urine protein (g/liter) to urine creatinine (g/liter) ratio greater than or equal to 1.0 (greater than or equal to 113 mg protein/nmol creatinine), a level which corresponds to a urine protein excretion rate of about 1 g/day. The incidence rates of proteinuria in diabetic Pimas were 4, 12, 37, and 106 cases/1,000 person-years at risk in the periods 0 to 5, 5 to 10, 10 to 15, and 15 to 20 years after the diagnosis of diabetes. The cumulative incidence rates were 2%, 8%, 23%, and 50% at 5, 10, 15, and 20 years, respectively. The duration of diabetes, severity of diabetes as determined by the degree of hyperglycemia and type of treatment, and blood pressure were risk factors for proteinuria. The presence of heavy proteinuria was strongly associated with the development of renal insufficiency, defined by serum creatinine greater than or equal to 2.0 mg/dl (greater than or equal to 177 mumol/liter). The incidence of proteinuria in type 2 diabetes in Pima Indians was as high as that reported in type 1 diabetes in other populations and represents a frequent, serious complication of the disease.
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PMID:Incidence of proteinuria in type 2 diabetes mellitus in the Pima Indians. 278 25

We studied the profile of nephropathy in 250 patients, 177 males and 73 females, with type 2 diabetes mellitus. The mean age was 55.9 +/- 8.8 years. Therapy for control of diabetes included diet alone in 1.6%, oral hypoglycaemic agents in 90.6% and insulin in 7.8%. Glycaemic control was satisfactory in 4.8%, fair in 41.2% and poor in 54.0%. Blood sugar values were normal without any therapy in 33 out of the 206 patients (16%) after the onset of renal insufficiency. The mean interval between the onset of diabetes and the appearance of proteinuria was 9.5 +/- 7.05 years. Proteinuria appeared within one year in 23 patients (9.2%), 1-5 years in 32 (12.8%), 6-10 years in 86 (34.4%) and more than 10 years in the remaining 109 patients (43.6%). Proteinuria was of nephrotic range in 17.6% of patients. Renal insufficiency was present in 206 (82.4%) patients and occurred 10.5 +/- 7.5 years after the detection of diabetes. Hypertension was present in 61.2% and was first detected 7.5 +/- 7.4 years after onset of diabetes. Endstage renal disease occurred 11.8 +/- 6.8 years after the onset of diabetes mellitus. Thus, clinical evidence of diabetic nephropathy is present in most patients with type 2 diabetes mellitus within a decade after the detection of diabetes. Subsequent progression to end-stage renal failure is rapid in the face of poorly controlled hypertension and hyperglycemia in the economically poor countries.
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PMID:Nephropathy in type 2 diabetes mellitus in Third World countries--Chandigarh study. 278 52

The prevalence of limited joint mobility (LJM) was studied in 110 insulin-dependent (IDDM) and 190 non-insulin-dependent (NIDDM) consecutive Ethiopian African diabetics and 300 age- and sex-matched controls at the Tikur Anbassa Teaching Hospital in Addis Ababa over a period of 18 months. Mean ages +/- S.D. of the IDDM, NIDDM, and controls were 35 +/- 9.9, 49.4 +/- 12.0, and 43.3 +/- 14.0 years, respectively. LJM was found in 44.5% of IDDM, 25.3% of NIDDM, and 6.7% of controls, being significantly commoner in IDDM than NIDDM (p less than 0.001) and in the diabetics than in controls (p less than 0.001). In IDDM those with LJM were significantly younger (p less than 0.05), had a higher prevalence of median fasting blood glucose (FBG) levels of 15 mmol/l and above (p less than 0.01), and retinopathy (p less than 0.05), but did not differ from those without LJM in duration of diabetes, or prevalence of neuropathy and nephropathy. In NIDDM those with LJM had a significantly longer duration of diabetes (p less than 0.005) and a higher prevalence of nephropathy (p less than 0.005), but did not differ from those without LJM in age at onset of diabetes, prevalence of neuropathy, and retinopathy or median FBG level.
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PMID:Limited finger joint mobility in insulin-dependent and non-insulin-dependent Ethiopian diabetics. 295 Oct 96

Reports of renal replacement therapy in diabetes usually refer to patients with insulin-dependent diabetes mellitus (IDDM) only, and little is known about renal failure in non-insulin-dependent diabetics (NIDDM). A high proportion, 46/141 (32%), of the diabetics treated at our unit since 1974 had NIDDM. They were older at treatment (56 +/- 9 years, mean +/- SD) compared to the IDDM patients (39 +/- 10 years, p less than 0.001), and had a shorter duration of diabetes (13 +/- 8 years versus 23 +/- 8 years, p less than 0.001). Asians and Afro-Caribbeans accounted for 48% of the NIDDM patients (22/46) compared to only 7% of those having IDDM (6/95, p less than 0.0001). Non-diabetic renal disease accounted for the renal failure in 32% (15/46) of the NIDDM patients but only in 10.5% (10/95) of the IDDMs (p less than 0.001). Despite these differences the prevalence of other diabetic complications (retinopathy, neuropathy, and cardiovascular disease) was similar. Patient survival after transplantation was poorer in NIDDM than IDDM (23% and 57%, respectively, at 2 years). Survival on dialysis was equally poor in NIDDM and IDDM. Thus, NIDDM patients treated for renal failure are more commonly non-European and more often have non-diabetic renal disease. Yet other diabetic complications occur to the same extent in both IDDM and NIDDM patients with diabetic nephropathy.
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PMID:Non-insulin-dependent diabetes and renal replacement therapy. 296 85

Hypertension is more frequently found in patients with diabetes mellitus than in subjects with normal glucose tolerance. On the other hand, concomitant hypertension accelerates the progression of diabetic nephropathy. To examine whether human atrial natriuretic peptide (human ANF-[99-126], hANP) is involved into the pathogenesis of hypertension and nephropathy of diabetic patients and to find out whether the detection of increased hANP levels can serve as an early marker, helping to identify diabetic patients at increased risk of developing these diabetes complications, we studied 107 randomly selected patients with Type 1 or Type 2 diabetes mellitus (53 women, 54 men). There were no differences between patients with normal hANP levels and patients with hANP levels above normal range regarding age, diabetes duration, metabolic control, kidney function (creatinine clearance and proteinuria), electrolytes, and in plasma renin activity, aldosterone, epinephrine and norepinephrine levels in plasma. However, higher blood pressure was measured and antihypertensive therapy was found more frequently in patients with increased hANP levels (p less than 0.05). This was confirmed by analyzing the subgroup of patients with normal blood pressure without antihypertensive therapy: Again, diastolic blood pressure was found to be higher (p less than 0.05) in patients with elevated hANP than in patients with normal hANP levels. In this subgroup, increased creatinine clearance tended to be found more frequently among patients with increased hANP levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[What pathophysiologic significance does increased plasma levels of human atrial natriuretic peptide have in patients with diabetes mellitus?]. 297 Jan 66

Hyperfiltration is a very characteristic feature in insulin-dependent diabetes. Hyperfiltration is to some extent associated with long-term glycemic control but the correlation is not very strong. Long-term hyperfiltration may play a role in the genesis of late diabetic nephropathy, but it is difficult to distinguish effects of hyperfiltration per se from effects of poor metabolic control. Long-term hyperfiltration without diabetes does not produce nephropathy. It is hypothesized that IDDM patients who do not show considerable hyperfiltration in spite of poor metabolic control may be those who are to some extent protected against late diabetic nephropathy, but other mechanisms may also be involved in the renal protection of these patients, who survive long-term diabetes without nephropathy. On the other hand, those with poor metabolic control combined with hyperfiltration are likely to develop nephropathy. In addition, it is suggested that the metabolic aberrations in diabetes, with the subsequent changes in the biochemistry of the glomerular wall, are permissive and absolutely required for the development of diabetic nephropathy. Of note, diabetic glomerulopathy in NIDDM occurs without significant hyperfiltration and extreme hyperfiltration in the one-kidney-model (without diabetes) does not produce nephropathy. Nonglycemic modalities of intervention, resulting in reduced hyperfiltration, e.g., low-protein diet or administration of somatostatin analogues, deserves interest as new potential ways of preventing or postponing diabetic nephropathy. Also intervention with aldose-reductase inhibitors may be an important therapeutic modality for those patients in whom good metabolic control is not obtainable. It is now well-established that antihypertensive treatment, including ACE-inhibition, reduces rate of decline in GFR in patients with already established nephropathy. In addition, protein excretion is diminished in IDDM patients with incipient diabetic nephropathy by antihypertensive treatment where GFR is well-preserved during treatment. No data are available for NIDDM.
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PMID:Comparative renal pathophysiology relevant to IDDM and NIDDM patients. 306 56

The awareness of hypertension as one of the major risk factors for mortality and morbidity in NIDDM has increased greatly in the past few years. It is now accepted practice to measure BP at least yearly in all such patients. Unfortunately, one cannot yet be sure to what extent diabetics benefit from anti-hypertensive therapy, and the simple assumption that treatment of the increased risk reduces that risk must be constantly questioned. No specific data are yet available for NIDDM, though it would be remarkable if the benefits of decreased cerebrovascular mortality and probable reduced total mortality (Sleight, 1987) did not apply to the higher-risk diabetic subject, at least at the higher levels of diastolic pressure (greater than 105 mm Hg). There is, though, no evidence that mortality or morbidity of coronary artery disease, the major killer in NIDDM, is reduced even in non-diabetics and the present author does not consider there to be any evidence suggesting that thresholds for treatment of hypertension in uncomplicated patients with NIDDM should be lower than those for non-diabetics, unless progressive nephropathy is present. Current advice in the non-diabetic is that levels of blood pressure in adults consistently above 95 mm Hg warrant therapy, aiming to reduce it below 90 mm Hg (World Health Organization, 1986). While the importance of hypertension should not be underestimated, it should not deflect attention from the other risk factors. Cessation of smoking, and by implication its reduction, will, for all smoking patients but the most hypertensive, produce a greater reduction in cardiovascular and total mortality risk than will anti-hypertensive therapy. There are also early signs that effective dietary and/or drug treatment of significant hyperlipidaemia lowers cardiovascular mortality. Choice of anti-hypertensive therapy is especially important, not only for efficacy but also for quality of life, in patients who already suffer major restrictions on diet, freedom and life expectancy. While controlled trials in the subject are of immense importance in determining optimum therapy, there is currently no evidence to favour any particular group of drugs, and an individual patient's therapy should be decided on the basis of their own circumstances.
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PMID:Hypertension. 307 98

Genetic markers would be useful to study the transmission of type 2 diabetes and to identify patients with enhanced risk of development of late diabetic complications. The aim of this study was to evaluate the influence of selected possible genetic markers on the development of diabetic complications. One hundred and eighty patients with type 2 diabetes (79 males, 101 females) were therefore studied with respect to ABO and Rh blood grouping and chlorpropamide alcohol flush (CPAF) and acetylator phenotype status, in addition to life style (smoking, dietary, alcohol and drug taking habits) and metabolic indexes (HbA1, M-value, serum cholesterol, serum triglycerides), with regard to late complications coronary heart disease (CHD), arterial hypertension (AH), peripheral vascular disorders (PVD), retinopathy and nephropathy. None of the genetic markers considered appeared to be associated with diabetic complications. Multiple logistic analysis identified different risk-factors for each complication: AH and age for CHD; hyperlipidaemia for AH; age of patients for PVD; duration of diabetes for retinopathy; AH for nephropathy. It is concluded that the possible genetic markers evaluated in this study do not identify a higher or lower risk for late complications. On the contrary, most of the risk factors identified support previous studies. Active correction of these risk-factors might improve the overall prognosis of patients with type 2 diabetes.
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PMID:Risk factors for micro- and macroangiopathic complications in type 2 diabetes: lack of association with acetylator phenotype, chlorpropamide alcohol flush and ABO and Rh blood groups. 311 87

Non-insulin-dependent diabetes mellitus is strikingly common in British Indians, but their susceptibility to diabetic complications is unknown. The ratio of albumin to creatinine concentrations was measured in samples of the first urine voided in the morning in 154 Indian and 82 Europid patients with non-insulin-dependent diabetes and in a control group of 129 non-diabetic Indians. The ratio was significantly higher in the Indian patients than in the Europid patients and the Indian controls. There were no significant correlations between the logarithm of the albumin: creatinine ratio and age, known duration of diabetes, haemoglobin A1 concentration, or body mass index within either diabetic group. Hypertension and raised albumin:creatinine ratio were significantly associated, and significant correlations were seen between the logarithm of the albumin:creatinine ratio and systolic and diastolic blood pressures in the Indian but not the Europid diabetics. Because of the high prevalence of diabetes at a relatively early age in Indians, nephropathy may emerge as an important clinical problem.
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PMID:Microalbuminuria in non-insulin-dependent diabetes: its prevalence in Indian compared with Europid patients. 312 60


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