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

Non-insulin dependent (Type 2) diabetes mellitus (NIDDM) and long-term complications such as nephropathy have a strong genetic predisposition. Insulin resistance is thought to be a pathogenetic factor, predisposing genetically prone individuals to develop the microvascular complications of diabetes. To test these hypotheses, two groups of young individuals were studied: 28 offspring of parents having NIDDM and diabetic nephropathy (group 1) aged 29.5 +/- 6.1 years, BMI 25.2 +/- 4.7 kg m(-2) and 31 offspring of diabetic parents with no history of nephropathy, aged 31.6 +/- 4.1 years and BMI 26.3 +/- 4.9 kg m(-2) (group 2). All underwent a standard oral glucose tolerance test with measurement of serum insulin levels and serum lipid profile. Urine albumin:creatinine ratio (A/C ratio) and blood pressure were also recorded. Diabetes was detected in 2/28 (7.1%) and 3/31 (9.7%) and IGT was detected in 5/28 (25%) and 8/31 (25%) of groups 1 and 2, respectively. These differences were not statistically significant, but were higher than in a group of non-diabetic controls with healthy parents. Comparison of the normoglycaemic subjects (19 and 20 in group 1 and 2, respectively) showed no significant differences between blood pressure readings, fasting and 2 h plasma glucose, and lipid profiles. Plasma insulin values, fasting and 2 h, and the area under the graph were also similar in both groups, indicating an absence of higher insulin response in group 1 in comparison with group 2. These values were also not different from those in the non-diabetic controls. A delay in insulin response to glucose was noted in many of the offspring as indicated by a low deltaI/deltaG at 30'. We conclude that offspring of diabetic parents with nephropathy do not show higher risk of glucose intolerance or insulin resistance compared to those with diabetic parents without nephropathy. The relatively high plasma glucose values in the presence of normal insulin secretion in both groups of offspring of diabetic parents suggest the presence of insulin resistance.
 ...
PMID:Does the presence of diabetic nephropathy in parents influence the metabolic response in the offspring? 937 78

The clinical features and quantitative renal morphometry, including the index of mesangial expansion (IME), the index of arteriolar hyalinous change (IAHC), the percentage of globally sclerosed glomeruli (%GS), and interstitial volume fraction for total renal cortex (Vv int/T) of 67 Japanese non-insulin dependent diabetes mellitus (NIDDM) patients were examined. For the total subject population, Vv int/T correlated with urine protein, creatinine clearance, blood pressure, IME, IAHC and %GS, but not with duration of NIDDM. No significant difference in interstitial expansion between normo- and microalbuminuric patients was observed, and Vv int/T did not correlate with urine albumin excretion rate in those patients. However, in the area without hyalinized glomeruli and atrophic tubules, we found significant interstitial expansion and thickening of the tubular basement membrane (TBM) in patients without overt proteinuria as compared with those in the age-matched minimal change control group. This study confirmed that interstitial expansion in NIDDM progresses in parallel with glomerular and arteriolar lesions and that the expansion occurs concurrently with TBM thickening before the appearance of proteinuria.
 ...
PMID:Tubulointerstitial lesions in non-insulin dependent diabetes mellitus. 940 56

Our objective was to assess mean transit time (MTT) and initial uptake, both parameters derived from the renal retention function (RRF), in the study of renal function in patients with diabetic nephropathy. We studied 25 patients, 7 with type I diabetes mellitus and 18 with type II diabetes mellitus, all of whom fulfilled the criteria for diabetic nephropathy with proteinuria and/or retinopathy. We found a statistically significant correlation between initial uptake and the other biochemical and renographic parameters studied except proteinuria: serum creatinine (r = 0.66, P < 0.002), creatinine clearance (r = 0.61, P < 0.003), glomerular filtration rate (r = 0.74, P < 0.003) and effective renal plasma flow (r = 0.66, P < 0.003). The other renographic parameters studied (maximal activity of the conventional renogram and MTT of the deconvoluted renogram) did not show any correlation. Initial uptake is a semi-quantitative renographic parameter that can provide complementary information to biochemical data and it may be useful in the management of diabetic nephropathy, especially in patients with high serum creatinine or creatinine clearance.
 ...
PMID:Renogram deconvolution in the management of diabetic nephropathy: utility of the measurement of initial tracer uptake. 942 2

Lp(a), one of the most atherogenic lipoproteins, is believed to contribute significantly to vascular diseases in non-insulin-dependent diabetic (NIDDM) patients. Contradictive data have been published on these patients concerning plasma concentrations of Lp(a) and their relation to renal function. Since apo(a) fragments appear in urine, we measured urinary apo(a) in 134 NIDDM patients and 100 matched controls and related urinary apo(a) concentrations to plasma Lp(a) levels and kidney function. Plasma Lp(a) values were found to be significantly higher in NIDDM patients. NIDDM patients also secreted significantly more apo(a) into their urine as compared to control subjects. There was no correlation between creatinine clearance or albumin excretion and urinary apo(a) concentrations. Patients with macroalbuminuria exhibited a twofold higher apparent fractional excretion of apo(a) in comparison to patients with normal renal function. Urinary apo(a) values in both patients and control subjects were highly correlated to plasma Lp(a), yet no correlation was found with HbA1c or serum lipoproteins. It is concluded that urinary apo(a) excretion is correlated to plasma Lp(a) levels but not to creatinine clearance in patients suffering from NIDDM.
 ...
PMID:Urinary excretion of apo(a) fragments in NIDDM patients. 944 54

This study was undertaken to investigate the prevalence of diabetes complications and level of glycaemic and blood pressure control in Black African patients at the primary care level in the public sector Cape Town, South Africa. A stratified random sample of 300 patients attending the three largest ambulatory diabetes clinics in community health centres in Black African residential areas of Cape Town (100 patients from each) during the last 6 months of 1992 was selected. Each patient had a clinical examination, interview, and 1 year retrospective record review. Eighty-one per cent of the sampled patients were reviewed, 90% were non-insulin-dependent (NIDDM) and 10% were treated with insulin. The mean duration of diabetes was 8 (range 0-28) years. Acceptable glycaemic control was present in 49.4% (95% Confidence Intervals 45.6-53.5) of patients while 38.5% (CI 24.8-52.2) of hypertensive patients had acceptable blood pressure control. The prevalence of any grade of retinopathy was 55.4% (CI 48.90-62.9), proliferative and preproliferative retinopathy 15.6% (CI 8.5-22.8), cataracts 7.9% (CI 4.4-11.4), peripheral neuropathy 27.6% (CI 15.2-39.4), absent foot pulses 8.2% (CI 5.2-12.6), amputations 1.4% (CI 0.4-2.4), persistent proteinuria 5.3% (CI 2.5-8.1) and an elevated albumin-creatinine ratio 36.7% (CI 29.0-44.4). The complications were not documented in the clinic records of the preceding year with the exception of 1 patient with absent foot pulses and the 12 patients with proteinuria. The high prevalence of suboptimal glycaemic and blood pressure control as well as complications of diabetes, largely unrecorded in the preceding years' clinic notes, demonstrates the deficiency of and need for preventative diabetes care at the primary care level. The design, institution, and evaluation of effective intervention programmes are a priority to improve the quality of care provided and the health of diabetic patients.
 ...
PMID:Audit of public sector primary diabetes care in Cape Town, South Africa: high prevalence of complications, uncontrolled hyperglycaemia, and hypertension. 945 36

The study aim was to measure body composition and fat distribution in premenopausal and postmenopausal women with insulin-dependent ([IDDM] n = 53) and non-insulin-dependent ([NIDDM] n = 32) diabetes mellitus by dual-energy x-ray absorptiometry. IDDM and NIDDM patients had similar, normal lean tissue mass (LTM) and 24-hour urinary excretion of creatinine. Total body and abdominal fat percentages were higher in the NIDDM group (approximately 40%) than in the IDDM group (-27%, P < .001) and were constant with age and menopausal status in both groups. In postmenopausal patients with IDDM, total body and abdominal fat values were less than in postmenopausal healthy women (approximately 27% v approximately 37%, P < .001). In premenopausal patients with NIDDM, total body and abdominal fat were higher than in premenopausal healthy women (approximately 42% v approximately 25%, P < .001). In conclusion, women with IDDM or NIDDM have a normal LTM and probably a normal muscle mass. Total body and abdominal fat were higher for women with NIDDM than for those with IDDM.
 ...
PMID:Body composition and fat distribution measured by dual-energy x-ray absorptiometry in premenopausal and postmenopausal insulin-dependent and non-insulin-dependent diabetes mellitus patients. 947 73

The presence of persistent microalbuminuria in IDDM is strongly predictive of the future development of end stage renal failure and of cardiovascular disease to a lesser extent. Screening for microalbuminuria is an essential component of modern diabetes practice, as effective antihypertensive therapy, and particularly, the use of angiotensin converting enzyme inhibitors is of proven benefit in retarding progression of renal disease. Cost benefit analysis justifies the expense of microalbuminuria screening programmes and early intervention. It has been estimated that the use of angiotensin converting enzyme inhibitors in microalbuminuric IDDM will save 5200 Pounds-11,000 Pounds per year of life saved. Angiotensin converting enzyme inhibitors are not free of side-effects, and it is therefore essential, given the intrinsic variability of the albumin excretion rate, and the regression to normoalbuminuria of a significant proportion of patients, to confirm the diagnosis of microalbuminuria by repeated measurements prior to the commencement of treatment. The value of intensive glycaemic control is unproven, and further prospective studies are required. There are no proven therapies for the prevention of macrovascular disease in IDDM, although the value of cessation of smoking and aggressive blood pressure control are undoubted in the non-diabetic population. Controversy persists about the value of lipid lowering therapy, especially in young patients, although even in this group there is an increased risk of cardiovascular disease. Microalbuminuria is the strongest known predictor of cardiovascular disease in NIDDM; in contrast to the situation in the non-diabetic population, active lipid lowering therapy is not of proven cardiac benefit, but intervention seems justifiable when taken in the context of the very high prevalence of cardiovascular disease. Microalbuminuria is also predictive of end stage renal disease in NIDDM. Although intervention with angiotensin converting enzyme inhibitors has not been proven to prevent end stage renal disease, stabilisation of albumin excretion rate and creatinine clearance have been demonstrated in normotensive NIDDM, and it seems likely that longer term follow-up studies will confirm the benefit of angiotensin converting enzyme inhibitors in the prevention of end-stage renal disease. The observed predictive power of microalbuminuria as regards both cardiac and renal risk in NIDDM when considered in conjunction with the preliminary results of the benefits of angiotensin converting enzyme inhibition lend further support to the employment of microalbuminuria screening in NIDDM.
 ...
PMID:Microalbuminuria: a marker to increased renal and cardiovascular risk in diabetes mellitus. 950 84

Picotamide both inhibits thromboxane synthetase and acts as a thromboxane antagonist at the receptor level. We investigated the long-term effect of picotamide on urinary albumin excretion (UAE) at rest and induced by exercise in 30 type 2 diabetic patients who were normotensive and had microalbuminuria while at rest. The subjects of our study had a mean age of 52.5 +/- 1.6 years, BMI of 28.5 +/- 0.7 kg/m2, diabetes duration of 9.1 +/- 1.8 years, and HbA1c of 7.0 +/- 0.8%. The study was a randomized double-blind placebo-controlled trial. The patients were randomly allocated to receive for 1 year either picotamide, 300 mg, 3 tablets/day, or placebo, 3 tablets/day. The patients were asked to visit our outpatient clinic after 1, 3, 6, 9, and 12 months of treatment. At all times, blood pressure, microalbuminuria at rest, blood glucose, serum creatinine, serum picotamide, and creatinine clearance were measured; at baseline and after 6 and 12 months, all patients underwent submaximal physical exercise. After 6 months of picotamide, baseline and exercise-induced microalbuminuria were significantly decreased (up to one-third) as compared with the baseline and placebo level, with no further drops at month 12 of picotamide treatment. On placebo treatment, UAE at rest and after exercise was slightly increased compared with baseline values. The effects of picotamide occurred without significant side effects or changes in either blood pressure levels or glycometabolic control. Our study is the first long-term intervention trial in type 2 diabetes showing that an antithromboxane agent is able to decrease microalbuminuria, which in this disease is a dual marker of macro- and microangiopathy. Our findings suggest an important role for thromboxane in the pathophysiology of microalbuminuria in diabetes; moreover, we hypothesize that antithromboxane agents may have a place in the treatment/prevention of both macro- and microvascular complications in type 2 diabetic patients.
 ...
PMID:Long-term treatment with the dual antithromboxane agent picotamide decreases microalbuminuria in normotensive type 2 diabetic patients. 951 49

The plasma clearance of iohexol has recently been proposed as a new method for estimating GFR. The iohexol plasma clearance was compared with that of 51Cr-EDTA in 32 diabetic patients (12 IDDM, 20 NIDDM; age 23-70; diabetes duration 1-35 years) with normal to impaired renal function (serum creatinine: 0.8-6.4 mg/dL). Bolus i.v. injection of 51Cr-EDTA (1 muCi/kg) was followed by 5 mL slow i.v. injection of Omnipaque (Nycomed, Oslo, Norway). Samples for radioactivity and iohexol analysis were drawn at 0, 5, 10, 15, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300 min (+360 and 420 min if serum creatinine > 2.0; +1440 min if > 5.0 mg/dL). Iohexol was assayed in duplicate by HPLC throughout a Nova-Pak C18 column (Waters-Millipore, USA). Only the second peak obtained during elution of iohexol (about 4.5 min) was used for calculation. Dilution tests show highly linear regressions for concentrations between 3.25-650 micrograms/mL (r = 0.99). Imprecision of iohexol assay (the whole procedure from deproteinization to chromatography) was: intra-assay 1.4 +/- 1.5%, mlsd (95% CI: 1.0-1.8%); inter-assay 3.0 +/- 2.7% (1.4-4.6%). Iohexol plasma clearance ranged between 12.9 and 150.9 mL/min, while 51Cr-EDTA plasma clearance between 11.9 and 149.8 mL/min with excellent correlation (iohexol = 0.95 51Cr-EDTA + 2.49; r = O.995). Mean CV between the two methods was 1.7% (range 0-4.9%) with a significant negative correlation (r = 0.5 I, p = 0.007) with the GFR levels. Correlation between repeated measurements, performed in eight patients, was excellent (r = O.994, P = 0.0001). In diabetes, GFR measured by plasma clearance of iohexol shows an excellent agreement with plasma clearance of 51Cr-EDTA throughout a wide range of renal function. Iohexol provides an accurate alternative method for measuring GFR.
 ...
PMID:Iohexol plasma clearance in determining glomerular filtration rate in diabetic patients. 957 53

Microalbuminuria is associated with excess cardiovascular mortality in both diabetic and nondiabetic subjects. Patients with NIDDM and microalbuminuria are more insulin resistant than those without microalbuminuria. However, the relationship between insulin resistance and microalbuminuria in patients with NIDDM could be due to hyperglycemia, which can cause both insulin resistance and an increase in albumin excretion rate. Little is known about microalbuminuria and insulin resistance in nondiabetic subjects. Therefore, we examined, cross-sectionally, the relationship of insulin sensitivity (S(I) x 10(-4) min x microU(-1) x ml(-1)), estimated by a frequently sampled intravenous glucose tolerance test and the minimal model and fasting plasma insulin concentration, to microalbuminuria (albumin-to-creatinine ratio > or = 2 mg/mmol) in 982 nondiabetic subjects aged 40-69 years. Altogether, 15% of the subjects had microalbuminuria, and 32% had hypertension. Subjects with microalbuminuria had a lower degree of insulin sensitivity (means +/- SE, 1.70 +/- 0.11 vs. 2.25 +/- 0.07, P = 0.003) and higher fasting insulin concentrations (17.4 +/- 1.1 vs. 15.7 +/- 0.5 mU/l, P = 0.059) compared with subjects without microalbuminuria. In logistic regression analysis, an increasing degree of insulin sensitivity was related to a decreasing prevalence of microalbuminuria (odds ratio = 0.86, 95% CI: 0.79-0.94, P < 0.001). Although this relationship attenuated after adjustment for age, sex, ethnicity, hypertension, fasting glucose, and BMI, it still remained significant. The association between insulin sensitivity and microalbuminuria was shown not to be different between normotensive and hypertensive subjects. Our results suggest a relationship between insulin resistance and microalbuminuria in nondiabetic subjects that is partially dependent on blood pressure, glucose levels, and obesity.
 ...
PMID:Microalbuminuria is associated with insulin resistance in nondiabetic subjects: the insulin resistance atherosclerosis study. 958 52


<< Previous 1 2 3 4 5 6 7 8 9 10