Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic nephropathy is the only increasing cause of renal failure in the Western world. It affects a large proportion of both insulin-dependent (IDDM) and non-insulin-dependent diabetic (NIDDM) patients. A critical stage in the development of diabetic renal disease is the onset of microalbuminuria, defined as an albumin excretion rate of 30 to 300 mg/day. Microalbuminuria predicts progression to renal failure and early cardiovascular mortality in both IDDM and NIDDM patients. Microalbuminuria is associated with a constellation of other risk factors for small and large vessel damage which include raised blood pressure, poor glycemic control, plasma lipid and clotting factor abnormalities, left ventricular hypertrophy, and insulin resistance. Treatment with angiotensin-converting enzyme inhibitors corrects microalbuminuria and prevents progression to persistent proteinuria. Good blood glucose control significantly reduces the risk of progression from normoalbuminuria to microalbuminuria. The treatment of microalbuminuria appears highly cost-beneficial and substantially increases life expectancy. The development of microalbuminuria, for which all diabetic patients aged 12 to 70 years should be screened, should alert the physician to set in motion a program of assessment, monitoring, and correction of all risk factors for renal and cardiovascular disease.
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PMID:Prognostic significance of microalbuminuria. 781 38

It is well known that black Americans have a higher risk for low birth weight (LBW) than white Americans. In addition, blacks are at a higher risk for hypertension (HT), non-insulin dependent diabetes mellitus (NIDDM), and end-stage renal disease (ESRD), particularly ESRD attributed to HT (ESRD-HT) and NIDDM (ESRD-NIDDM). It has been shown that LBW is associated with postpartum anatomic and functional alterations in the kidney and pancreas as well as with progressive renal damage in animals and increased risk for HT and NIDDM during adulthood in humans. Based on these empirical findings, it is here proposed that a greater risk of HT, NIDDM, and ESRD, particularly ESRD-HT and ESRD-NIDDM, in black Americans during adulthood may be partly related to their higher risk of LBW. However, LBW is proposed here as a component factor rather than a sufficient cause or a necessary factor for the development of these diseases. The ultimate contribution of LBW to the black/white disparities regarding HT, NIDDM, and ESRD may depend not only on the black/white differences in LBW but also on the race-specific prevalences of other component factors, both environmental/behavioral and genetic, that may or may not require the presence of LBW to cause each of these diseases.
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PMID:The low birth weight hypothesis as a plausible explanation for the black/white differences in hypertension, non-insulin-dependent diabetes, and end-stage renal disease. 784 66

An increase in glomerular filtration rate (hyperfiltration) may be an important early event in the initiation of diabetic nephropathy but the prevalence of hyperfiltration appears to vary between different populations with type 2 diabetes. We have measured glomerular filtration rate using 51Cr EDTA clearance in 15 young Polynesians (mean age 32 years), 1-30 months after the initial diagnosis of type 2 diabetes and 15 control Polynesian subjects of comparable age and sex distribution. The mean glomerular filtration rate in the diabetic subjects (216 ml/min) was 57% greater than that of the controls (137.5 ml/min, P < 0.0001). About one-third of their excess in glomerular filtration rate could be accounted for by the marked obesity of the diabetic subjects, but even after correcting for body size the diabetic subjects still had a significantly higher mean glomerular filtration rate than controls (165.6 vs. 119.6 ml/min per 1.73 m2, P < 0.001); 73% of the diabetic subjects had hyperfiltration (> 140 ml/min per 1.73 m2). The diabetic subjects were normotensive but nonetheless had increased rates of albumin excretion (median 61 versus 9 mg/day, P < 0.001). We conclude that hyperfiltration is common in young Polynesians with recently diagnosed type 2 diabetes. Prospective studies are needed to determine whether this early abnormality of renal function heralds the later development of overt nephropathy.
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PMID:Glomerular hyperfiltration in young Polynesians with type 2 diabetes. 785 Dec 69

Proteinuria was estimated in 600 non-insulin dependent diabetes mellitus (NIDDM) patients in 24 hrs collection of urine. The test was repeated at least twice in a year to confirm the persistence of proteinuria. Mild proteinuria (200-500 mg/d) occurred in 94 (15.7%) and nephropathy (> 500 mg/d) in 112 (18.7%) patients. Nephropathy commonly occurred with long-standing diabetes (> 10 years). Development of proteinuria correlated directly with the duration of diabetes, diastolic and systolic blood pressure, age of the patients, serum creatinine and inversely with creatinine clearance. Retinopathy was seen in 75% of those with nephropathy. It is concluded that proteinuria occurs in one third of NIDDM patients and the risk of nephropathy increases with duration of disease.
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PMID:Prevalence of proteinuria in non-insulin dependent diabetes. 787 49

The microvascular complications of retinopathy, nephropathy, and neuropathy are less prevalent, and not as severe, in NIDDM as compared with IDDM for unknown reasons. Macrovascular disease is the greatest challenge in the management of NIDDM because it is the cause of death in 50% to 60% of this patient population. Control of the hyperglycemia is the most important because the prevention of complications is more effective than the treatment of them. Blood glucose control through diet, exercise, and medication is the key to reducing the previously identified complications. Lifestyle modifications of diet and exercise are the most effective treatment to reduce hyperglycemia. It is important to emphasize during the asymptomatic period the serious consequences of the complications and to set goals using the glycosylated hemoglobin. If these goals are not met, treatment should be intensified by more frequent visits or referral for the team approach. The time for intervention is before the complications are present, not after they occur. It is certainly reasonable to reduce as many risk factors as possible that adversely affect the complications of NIDDM. Hypertension can affect the course of coronary artery disease, retinopathy, nephropathy, and neuropathy and should be treated. The avoidance of tobacco is a must for the prevention of vascular disease and is associated with painful neuropathy. Dyslipidemia is seen frequently in NIDDM and should be assessed by fasting lipid panel and treated to lower the LDL cholesterol below 130 mg/dL. Reduction of individual risk factors is the most effective approach to this complex clinical syndrome until such time as a better understanding of the pathophysiology provides a more specific and effective intervention.
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PMID:Noninsulin-dependent diabetes mellitus. The prevention of complications. 787 91

A 62-year-old patient with non-insulin dependent diabetes (NIDDM) was admitted to our hospital for blood pressure control. He had been treated with angiotensin converting enzyme inhibitor (ACEI) for 7 years and showed marked hypokalemia with increased urinary potassium excretion. Hormonal examination revealed a normal plasma aldosterone concentration and increased plasma renin activity (PRA, 13.4 ng/ml/h), so potassium losing nephropathy was suspected. After discontinuation of the ACEI, PRA decreased to normal. An adrenal adenoma was found on abdominal magnetic resonance imaging (MRI) and adrenalectomy was performed to confirm aldosterone producing adenoma (APA). Although ACEIs are said not to alter PRA in APA, this drug was primarily responsible for the increased PRA in this case. This is a rare case of APA, which showed markedly increased PRA during ACEI treatment.
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PMID:A case of aldosterone producing adenoma associated with high PRA after long-term angiotensin converting enzyme inhibitor treatment. 795 96

In mid-1990 we evaluated blood pressure and its associations in 366 nondiabetic adult Navajos and 400 Navajos with type 2 diabetes attending Indian Health Service outpatient clinics in Tuba City, Arizona. In nondiabetics, systolic blood pressure (SBP) rose with increasing age while diastolic blood pressure (DBP) fell; 13.4% had hypertension by diagnosis or treatment. Female nondiabetics had lower blood pressures than males. SBP and DBP correlated with age, body mass index (BMI), and urinary albumin excretion (UAE). Hypertension was associated with a sixfold increase in nephropathy, a threefold increase in renal insufficiency, and an almost sixfold increase in cardiovascular disease. Diabetics had higher blood pressures than age- and sex-matched nondiabetics; 58.4% had hypertension by diagnosis or treatment, and, in spite of widespread antihypertensive treatment, blood pressures in almost 50% were suboptimal from the perspectives of cardiovascular and renal protection. Blood pressures of female diabetics were similar to those of males. Blood pressures correlated with age, BMI, and increasing UAE. Rates of nephropathy and cardiovascular disease were much higher in diabetics than nondiabetics, and within the diabetic population hypertension was associated with a greater than threefold increase in nephropathy, an eightfold increase in renal insufficiency, a five-fold increase in peripheral and cerebrovascular disease, and more than doubling of the rate of heart disease. The relationship of blood pressure to renal and cardiovascular disease suggest similar mechanisms in nondiabetics and diabetics, with diabetes contributing an accentuated susceptibility. Albuminuria and cardiac disease are generated at "subhypertensive" blood pressures, while established hypertension appears to drive overt renal, cerebrovascular, and peripheral vascular disease, and to further increase heart disease risk.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Blood pressure in Navajo Indians and its association with type 2 diabetes and renal and cardiovascular disease. 803 47

The present pilot study investigated the effect of long-term treatment with picotamide on baseline and exercise-induced urinary albumin excretion levels in normotensive patients with type II diabetes mellitus. Six patients with type II diabetes were studied: four patients (two men and two women; mean age, 52 +/- 11 years) were treated for 9 months with picotamide (300 mg, TID) and two patients who did not receive the study medication served as controls. Three of the picotamide-treated patients were given a cycloergometric exercise test at baseline and after 3 and 6 months of therapy to evaluate the effects of the drug on exercise-induced microalbuminuria. Microalbuminuria at rest was measured in all patients at baseline and after 3, 6, and 9 months. At the end of the study, all the picotamide-treated patients demonstrated a significant decrease in microalbuminuria at rest (from 41.7 +/- 12.7 micrograms/min at baseline to 11.8 +/- 3 micrograms/min after 9 months) and after exercise (peak at baseline 103 +/- 36 micrograms/min vs 65.8 +/- 11 micrograms/min after 6 months). Conversely, in the two controls, microalbuminuria at rest increased from 45.1 +/- 0.9 micrograms/min at baseline to 151 +/- 59 micrograms/min at the end of the 9-month study period. (All values given as mean +/- SEM.) In conclusion, long-term administration of picotamide was effective in reducing abnormal exercise-induced microalbuminuria and albuminuria at rest. These findings suggest that long-term treatment with picotamide of normotensive patients with type II diabetes mellitus and incipient nephropathy may slow the progression of the nephropathy in its early stages.
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PMID:Effect of long-term administration of picotamide on baseline and exercise-induced urinary albumin excretion in patients with type II diabetes mellitus and incipient nephropathy. 806 15

Non-insulin-dependent diabetes mellitus (NIDDM) is a major health problem which occurs predominantly in the older population; 16.8% of persons over age 65 years have NIDDM. The total health costs of NIDDM are in excess of $US20 billion annually. The primary objective in the treatment of NIDDM is to achieve normoglycaemia, without aggravating coexisting abnormalities. Common abnormalities include obesity, hypertension, retinopathy, nephropathy and neuropathies. Diet, and consequent bodyweight reduction, is the cornerstone of therapy for NIDDM. Total calorie intake should be limited, while the percentage of calories from carbohydrates should be increased and that from fats and cholesterol should be decreased. Exercise may also help to reduce bodyweight. Sulphonylurea drugs stimulate insulin secretion from beta-cells, and may be a useful adjunct to nonpharmacological therapy. Failure to respond to sulphonylurea drugs may be primary (25 to 30% of initially treated patients) or secondary (5 to 10% per year). It is not clear which is the most effective pharmacological intervention in such cases. Options include switching to or combining therapy with insulin, a biguanide, or other insulin-sparing antihyperglycaemic agents, e.g. alpha-glucosidase inhibitors, thiazolidinediones, chloroquine or hydroxychloroquine, or fibric acid derivatives such as clofibrate. Other experimental agents include the fatty acid oxidation inhibitors and dichloroacetate. Specific agents, such as antihypertensives, lipid lowering agents and sorbitol inhibitors, may be needed to prevent the complications arising from the spectrum of clinical and metabolic abnormalities which arise from insulin resistance.
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PMID:Treatment of non-insulin-dependent diabetes mellitus and its complications. A state of the art review. 807 74

We investigated both sodium-lithium countertransport (Na-Li CT) and ouabain-sensitive sodium transport (Na pump) of erythrocytes in healthy subjects (group A), patients with non-insulin-dependent diabetes (NIDDM) without nephropathy (group B), patients in the proteinuric stage (group C), and those in the renal insufficiency stage (group D). Erythrocytes from all four groups had a similar initial water and ionic content and were loaded with similar degrees of Li and Na for efflux studies. There were no significant differences in erythrocyte Na-Li CT or Na pump among the four groups. However, the maximal rate of Na-Li CT was significantly higher in a group of subjects with essential hypertension when compared with groups A, B and C, consistent with the view that there is a genetic marker for essential hypertension. Ouabain-insensitive Na efflux (Na leak) of erythrocytes was found to be significantly higher in group D than in groups A or B. Also, a significant positive correlation existed between Na leak and urine protein levels of the subjects studied. Our results thus indicate that in contrast with insulin-dependent diabetic patients (IDDM) where an elevated Na-Li CT is observed, with diabetic nephropathy, Na-Li CT in NIDDM is apparently not associated with nephropathy; rather the ouabain-insensitive Na efflux appears to be correlated with the stages of nephropathy in NIDDM. The association suggests that the rate of ouabain-insensitive Na efflux may provide an index for assessing the degree of nephropathy in NIDDM patients.
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PMID:Abnormalities of sodium transport in non-insulin-dependent diabetes: association with renal disease. 810 99


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