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

In this article we have focused on the evolving pattern of nutritional management of the person with diabetes. Before the advent of insulin in 1922, it was sufficient to identify a meal plan that would keep people alive until they could be rescued from mortality due to diabetic ketoacidosis (the major killer of the era) by pharmacologic means. Now, the life expectancy of people with diabetes is close to that of the general population and focus has turned to combating the new threats of macrovascular disease and kidney failure. Over recent years the susceptibility of NIDDM patients to macrovascular events has been established and the twofold increase in risk of a heart attack in diabetic men is outshadowed by the four- to fivefold risk in diabetic women and the 13- to 17-fold greater risk in diabetics under the age of 30 years compared with their nondiabetic counterparts. The mechanism behind the susceptibility to macrovascular disease has generated a veritable plethora of investigations focusing on the atherogenic profile of diabetic dyslipidemia. Hyperinsulinemia, insulin resistance, and overtreatment of the diabetic with insulin have been claimed as contributors to the development of premature atherosclerosis. The hallmark of the diabetic dyslipidemia is the tendency to elevated VLDL triglyceride levels and the closely linked reduction in HDL cholesterol. Although there is some controversy on the relationship between triglyceride levels and the incidence of CAD, there is no doubt that HDL is an independent risk factor. It can now be safely said that elevated triglycerides are a risk factor in women and that in men elevated triglycerides constitute a risk factor if accompanied by a reduced HDL level. For these reasons, any approach to nutritional management of the diabetic must attempt not only to normalize glycemia but to make every effort to reduce the atherogenic profile. In the accompanying algorithm (Fig. 4), we consider the risk factors conducive to a reduction in life expectancy and offer a meal plan that is appropriate for the individual with diabetes. For the 80% of NIDDM patients who are obese, a diet with a reduction of 500 to 1000 kcal is in order and this may be achieved by a periodic VLCD. We examined carefully the controversy related to yo-yo dieting and support the notion that its effects in humans are not all that harmful. Ingestion of simple sugars in the high carbohydrate diet has negative effects both on carbohydrate and lipid metabolism.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The good, the bad, and the ugly in diabetic diets. 131 32

Insulin resistance (prereceptor, receptor, postreceptor) is a complex phenomenon. It penetrates into the clinical picture via hyperinsulinism as impaired glucose tolerance, or NIDDM, as hyperlipoproteinaemia, arterial hypertension and hirsutism in women (syndrome 5H) associated with the polycystic ovary syndrome or the HAIR-AN syndrome. Based on a group of their 480 patients with NIDDM, 108 women with hirsutism, 320 patients with myocardial infarction and the results of the national cardiovascular programme the authors estimate the prevalence of the 5H syndrome as follows: in the general population 5-10%, in patients with arterial hypertension 15-30%, in NDDM 65-90%, in hirsutic women 10-20% and in patients with myocardial infarction 30-50%. These figures could be, however, substantially higher if as the criterion the IRI response was taken or that of C-peptide in OGTT or the results of the hyperinsulinaemic euglycaemic clamp. The clinical 5H syndrome is a phenomenon of latent insulin resistance perceived late by doctors and patients.
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PMID:[Clinical manifestations of insulin resistance. The hormonal-metabolic syndrome X (5H), its prevalence and impact on cardiovascular morbidity and mortality. I]. 150 12

The sudden death of a diabetic patient (NIDDM) during Holter monitoring is described. The patient was a 64-yr-old male with an 11-yr history of diabetic nephropathy, retinopathy, autonomic nervous dysfunction, and old myocardial infarction. In spite of all these complications, he remained asymptomatic and eventually resumed his normal activities, including a daily 1-h walk, until his sudden death. The cause of death was considered to be cardiac disease, but was not confirmed by autopsy. A detailed analysis of his Holter monitoring is given.
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PMID:Sudden death of a diabetic patient during Holter monitoring. 156 51

The cardiovascular risk profile was assessed in all 208 diabetics accepted for dialysis in 28 German dialysis centres from 1985-1987 (104 men, 104 women, mean age 60 [22-82] years). 71 patients had type 1 and 128 type 2 diabetes, and 9 maturity onset diabetes of the young. Of 169 patients, 164 (97%) had hypertension (median systolic blood pressure at start of dialysis 200 [120-280] mm Hg). Only 74 patients (44%) were on continuing anti-hypertensive medication. Median serum cholesterol was 225 (66-424) mg/dl, LDL-cholesterol 158 (43-335) mg/dl and HDL-cholesterol 32 (10-67) mg/dl. In patients with a history of myocardial infarction (n = 26) the median cholesterol concentration was 269 (126-424) mg/dl, while in those with no history of myocardial infarction (n = 132) it was 221 (66-280) mg/dl (P less than 0.05). Only 5% of the patients had received lipid lowering therapy. Out of 175 patients, 65 (37%) had a history of smoking, and 25 (14%) were still smokers at the start of dialysis. There was a strong association between smoking history and amputations. Only 98 of 208 patients (47%) had had a specialist ophthalmological examination in the 12 months preceding the start of dialysis. Proliferative retinopathy was present in 33 out of 53 (62%) type 1 and 15 out of 98 (15%) type 2 diabetics. Out of 22 patients with unilateral or bilateral blindness, 2 (10%) had received no photocoagulation. - This investigation reveals a need for better medical care of diabetics with pre-end-stage renal failure.
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PMID:[Does the care of diabetic patients with renal failure in the predialysis phase need improvement?]. 191 32

Treatment of hypertension in patients with NIDDM should be administered with special attention not to increase insulin resistance nor to impair insulin secretion capacity. The coexisting risk for coronary artery disease and myocardial infarction should not be increased by undesired drug effects on the plasma lipoprotein profile. Late lesions of diabetes mellitus (nephropathy, neuropathy) have also to be taken into account. Consequently angiotensin converting enzyme inhibitors, if necessary combined with calcium channel blockers, should be administered first. If blood pressure is thus not sufficiently controlled, alpha-adrenergic blockers, vasodilating agents or sympatholytics may be added. Once insulin treatment is installed, or if required for other reasons (nephropathy, congestive heart failure, cardiac arrhythmia), also diuretics and beta-adrenergic blockers are indicated in antihypertensive treatment of diabetic patients.
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PMID:[Hypertension in type II diabetes mellitus]. 195 Mar 78

The association between fasting plasma insulin level and coronary heart disease (CHD) was studied in 909 non-insulin-dependent diabetic (NIDDM) patients, aged 45-64 years, and in 1,373 nondiabetic control subjects. Both diabetic and nondiabetic subjects with various manifestations of CHD had higher plasma insulin levels than did subjects free of CHD. By plasma insulin quintiles formed according to values in nondiabetic subjects, the age-adjusted prevalence of CHD defined by symptoms and/or electrocardiographic changes in diabetic men was 48.2% in quintiles I + II (lowest), 54.8% in quintiles III + IV, and 65.7% in quintile V (highest) (p = 0.006). The respective prevalences in diabetic women were 53.5%, 59.1%, and 73.3% (p = 0.004); in nondiabetic men, 28.1%, 33.7%, and 43.3%, respectively (p = 0.016); and in nondiabetic women, 28.1%, 34.9%, and 44.3%, respectively (p = 0.007). An essentially similar association was observed between plasma insulin level and definite or possible myocardial infarction (MI). In diabetic subjects, a positive association between plasma insulin level and CHD manifestations was also found when insulin strata were formed using quintile cutoff points determined separately from diabetic subjects. The association between plasma insulin level and the prevalence of CHD or MI disappeared or was weaker, especially in men, when adjustment was made for body mass index, hypertension, and triglyceride or high density lipoprotein (HDL) cholesterol level. The association between high plasma insulin level and CHD was significant in diabetic subjects with a body mass index greater than 27 kg/m2 but not in those diabetics with a body mass index less than or equal to 27 kg/m2. A significant clustering of hypertension, high triglyceride values, and low HDL cholesterol levels was observed in diabetic subjects in the highest insulin quintiles. The results suggest that hyperinsulinemia is an indicator of CHD in both NIDDM patients and nondiabetic subjects. Hyperinsulinemia may be directly atherogenic, but it is more probable that hyperinsulinemia reflects insulin resistance, which may be a factor enhancing atherogenesis by causing adverse changes in many CHD risk factors.
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PMID:High fasting plasma insulin is an indicator of coronary heart disease in non-insulin-dependent diabetic patients and nondiabetic subjects. 198 7

A number of reports on dialysis and transplantation for diabetic patients in the UK and USA are available. The aim of the present survey was to assess the prevalence, main characteristics and complications of diabetic patients treated by dialysis and transplantation in Italy. On 31 December 1987 in Italy, 1605 diabetic patients were being treated by dialysis or transplantation. The prevalence was 28 per million compared with the UK and the USA where the corresponding figures were 17 and 78 per million respectively. The annual incidence in 1987 was 9 per million (UK: 4 per million; USA: 33 per million). The mean age of the Italian diabetic patients was 59 years whereas that for British diabetic patients similarly evaluated was 48 years. Of the Italian diabetic patients 67% had NIDDM (UK: 22%; USA: 50%). Haemodialysis was used in 81% of the Italian patients, peritoneal dialysis in 14%, and only 5% were transplanted. This is in contrast to the UK where only 18% of the patients were treated by haemodialysis and 39% were transplanted. Amongst Italian patients who started RRT in 1987, 9% died within the year, and of the remainder 38% had severe bilateral visual impairment (UK 35%), 3% had had amputations (UK 6%), 7% had suffered from disabling strokes (UK 6%) and 7% had had a myocardial infarction (UK 17%). Before 31 December 1987 another 2.2% developed severe bilateral visual impairment, 0.6% underwent amputations, 1.0% had a disabling stroke and 0.6% suffered from a myocardial infarction. The proportion of diabetic patients treated by RRT in Italy is twice that of the UK but only half that of the USA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diabetes mellitus and renal replacement therapy in Italy: prevalence, main characteristics and complications. 212 52

The relative importance and behaviour of plasma and platelet plasminogen activator inhibitor (PAI-1) in disease has not hitherto been examined. In this study the concentration of PAI-1 in the plasma and platelets of patients with a variety of disorders was examined using a specific ELISA and a functional assay. Mean plasma PAI-1 was elevated in groups of patients with diabetes mellitus, hypertension, alcoholic cirrhosis, angina and myocardial infarction. Plasma PAI-1 was raised in the post-operative phase and the PAI-1 released after surgery was not derived from platelets. In all groups PAI-1 in the platelet pool reflected the platelet count, except in type II diabetes mellitus and chronic renal failure, where a reduced quantity of PAI-1 antigen per platelet was found. In severe chronic renal failure, abnormal platelets and diminished platelet PAI-1 may contribute to the haemorrhagic tendency sometimes seen in this disorder. Plasma PAI-1 represents a larger proportion of total circulating PAI-1 in disease than it does in healthy individuals; PAI-1 per platelet is abnormal only in a minority of disorders. Plasma and platelet pools of PAI-1 vary independently in disease and both merit consideration in evaluating the importance, if any, of PAI-1 in thrombosis or haemorrhage.
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PMID:The platelet and plasma pools of plasminogen activator inhibitor (PAI-1) vary independently in disease. 220 5

In the longitudinal Schwabing study, unselected insulin-treated diabetic patients were followed for major vascular complication (MVC) (stroke, myocardial infarction, gangrene) and asymptomatic, early detectable peripheral vascular disease (PVD). In the group of insulin-treated NIDDM multiple logistic regression analysis revealed the number of daily injected insulin units as a significant predictor for MVC and PVD (t = 1.98; p less than 0.04; x +/- S.D.: PVD yes 57.6 +/- 21.4 U/d; PVD no 44.3 +/- 17.7; age-adjusted univariate p less than 0.001). Daily insulin dose correlated highly significantly with serum triglycerides (r = 0.40, p less than 0.001) as well as with blood glucose (r = 0.33, p less than 0.001). These data suggest that insulin resistance is characteristic for atherosclerotic disease in NIDDM and the hyperinsulinemia-hypertriglyceridemia-syndrome might be a powerful cardiovascular risk factor in diabetes mellitus.
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PMID:Daily insulin dose as a predictor of macrovascular disease in insulin treated non-insulin-dependent diabetics. 330 65

Newly diagnosed hypertensive patients, and patients with hypertension which was not controlled by their existing therapy, were studied in a single-blind, placebo-controlled trial. Criteria for inclusion in the study were a systolic blood pressure less than 160 mmHg and a diastolic blood pressure greater than 95 mmHg. The study group was composed of 15 non-diabetic patients, 14 patients with non-insulin dependent diabetes mellitus (NIDDM) and 13 patients with insulin-dependent diabetes mellitus (IDDM). Mean supine and erect, systolic and diastolic blood pressure were reduced in all three groups after 2 and 14-16 weeks of nifedipine therapy (P less than 0.001). Mean fasting blood glucose, mean haemoglobin A1, mean total serum cholesterol, mean high density lipoprotein (HDL) cholesterol and mean serum triglycerides were not affected by nifedipine in any of the three groups over the 14-16 weeks' treatment. Forty out of the 42 patients entering, completed the study. One patient with NIDDM and angina died from a myocardial infarction in the final 4 weeks of the study, and one non-diabetic patient was unable to tolerate nifedipine after two weeks of treatment and was withdrawn from the study. No patients were withdrawn due to treatment failure.
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PMID:Effect of nifedipine on carbohydrate metabolism and serum lipoproteins in hypertensive patients with and without diabetes mellitus. 345 May 19


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