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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-four type 1 and type 2 diabetic patients with obesity and overt nephropathy were studied for 12 months after hypocaloric diet change from 1870 to 1410 kcal/day (without changes of protein:carbohydrate ratio). Several parameters were evaluated: arterial blood pressure, blood glucose, fructosamine, HbA1c, proteinuria, albuminuria, glomerular filtration rate (GFR), creatinine clearance, triglycerides, HDL and total cholesterol. A significant reduction of body weight (body mass index from 33 +/- 1.6 to 26 +/- 1.8 kg/m2, P less than 0.001), concomitantly with a decrease of blood pressure levels (P less than 0.002) was demonstrated at the end of the study. Triglyceride (P less than 0.002), HDL (P less than 0.002), HDL (P less than 0.05) and total cholesterol (P less than 0.01) levels were reduced after diet-therapy, while a mild improvement of glycometabolic profile was observed in the same period. A marked decrease of proteinuria (from 1280 +/- 511 to 623 +/- 307 mg/24 h, P less than 0.01) and albuminuria (from 723 +/- 388 to 492 +/- 170 micrograms/min, P less than 0.01), and an improvement of GFR (from 66 +/- 13 to 81 +/- 11 ml/min/1.73 m2, P less than 0.01) and creatinine clearance (from 79 +/- 14 to 91 +/- 13 ml/min, P less than 0.01) was demonstrated after 12 months of diet-treatment. Our data suggest that body weight reduction by hypocaloric diet may delay the progression of clinical nephropathy in obese diabetic patients.
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PMID:Effects of diet-therapy on urinary protein excretion albuminuria and renal haemodynamic function in obese diabetic patients with overt nephropathy. 274 32

A follow-up study of 1939 diabetic patients with a mean observation period of 9.4 years was carried out in Osaka, Japan. The mortality rates per 1000 person-years were 31.35 for males and 21.99 for females, and the ratios of observed to expected number of deaths were 1.69 for males and 1.74 for females, indicating an excess mortality for diabetic patients of both sexes and higher mortality in males than in females in Japan. Factors related to the prognosis of the patients were age, elevated fasting glucose level, lower obesity index, hypertension, diabetic retinopathy, and albuminuria at entry to the study. Insulin treatment was also associated with poor prognosis. Cerebro-cardiovascular and renal disease were the major causes of death in diabetic patients; heart disease killed 19.5%, cerebrovascular disease 16.7% and renal disease 13.1%. The relatively high frequency of renal disease as a cause of death in type 2 diabetes, especially in patients with a lower age of onset, was noteworthy, suggesting some difference in the clinical manifestations of diabetes between Japan and Western countries. Malignant neoplasms accounted for 25% of deaths, and cirrhosis of the liver for 6.4%.
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PMID:Mortality and causes of death in type 2 diabetic patients. A long-term follow-up study in Osaka District, Japan. 275 88

The relation between hypertension and diabetic nephropathy is complex. Nephropathy is probably involved in the elevated blood pressure found in diabetic patients. In maturity onset diabetes, patients may also have hypertension which is associated with obesity or essential hypertension. It has been suggested that in both types of diabetes, hypertension enhances the development of diabetic nephropathy. Moreover, an aggressive antihypertensive treatment seems able to reduce rate of decline in kidney function in insulin-dependent diabetic patients with patent nephropathy. In this work, creatinine clearance and microalbuminuria in 20 diabetic patients (mostly with maturity-onset-diabetes) with known moderate and effectively treated hypertension were therefore measured and the results were compared with those for 18 normotensive diabetic patients and 22 controls. Duration of diabetes was from one to 26 years (mean: 11 years) and duration of hypertension was from one to 35 years (mean: 10 years). Patients and controls had normal serum creatinine and proteinuria below 0.1 g/l. Microalbuminuria was measured by immunonephelometric assay using specific antiserum (sensitivity = 1.5 mg/l; intra and interassay coefficients: 6.5% and 8% respectively). The highest value was observed in hypertensive diabetic patients with retinopathy (group 1). But hypertensive patients without retinopathy (group 2) and normotensive patients also had significantly increased microalbuminuria. In group 1, microalbuminuria was significantly higher than in group 2. The creatinine clearance was reduced in groups 1 and 2 versus normotensive diabetics, but hypertensive patients were older.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Microalbuminuria in diabetics with moderate hypertension]. 309 93

Coexistent diabetes and hypertension affect an estimated 2.5 million persons in the United States. Hypertension occurs approximately twice as frequently in persons with diabetes as without and contributes to most of the chronic complications of diabetes, including coronary artery disease, stroke, lower extremity amputations, renal failure and, perhaps, to diabetic retinopathy and blindness. The proportions of complications in the diabetic population attributable to hypertension range from 35 to 75 percent. Hypertension in the diabetic population increases with age and is particularly associated with obesity and nephropathy. Limited data suggest the control of hypertension in the diabetic population may be better than in the general population, perhaps due to greater contact that persons with diabetes have with the health care system. Yet, in approximately half, hypertension is not controlled. Control strategies for hypertension in the diabetic population must take into account the higher frequency of hypertension, increased risks for adverse sequelae from the coexistent conditions, more complicated clinical management, and the greater contact with the health care system experienced by persons with diabetes. Community programs to improve hypertension control in the diabetic population may target a subset of the diabetic population and should tailor strategies to meet the needs of the target population. Hypertension control in the diabetic population must be addressed at multiple levels in the health care system, including improved detection, evaluation, and treatment of hypertension; improved adherence to antihypertensive therapy and long-term followup; provision of quality professional education and patient education and support; and systematic health care monitoring and program evaluation. Hypertension control should be emphasized in all comprehensive diabetes control programs.The treatment and control of hypertension may significantly reduce morbidity and mortality in the diabetic population.
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PMID:The control of hypertension in persons with diabetes: a public health approach. 311 83

Alfentanil is a short acting opioid that has an established place in anaesthesia. Its predictable pharmacokinetics and pharmacodynamics, particularly its rapid termination of effect and haemodynamic stability, have led to its use by continuous intravenous infusion both during anaesthesia and more recently in critically ill patients. Fine control of a potent analgesic that has respiratory depressant and antitussive properties would be particularly advantageous in this group, offering patients an improvement in comfort without increasing the risk of oversedation. Pharmacokinetic studies of alfentanil have demonstrated wide interindividual variations. This may be due to a wide variety of factors including age, obesity, hepatic dysfunction, changes in regional haemodynamics, sex, and alterations in plasma protein binding ability and concentration. The importance of pharmacogenetic differences and tolerance to alfentanil remains to be elucidated. Renal disease does not appear to significantly alter the pharmacokinetics of this agent, which may make it particularly useful in this situation. Since alfentanil does not depress conscious level or produce anxiolysis, additional agents such as a benzodiazepine will be necessary to provide adequate sedation. The difficulties in accurately predicting the response of an individual critically ill patient necessitate careful and continuous dose titration of alfentanil according to the clinical response.
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PMID:Alfentanil infusions in patients requiring intensive care. 314 17

More and more people are turning to exercise as a means of achieving long-term health. The World Health Organization has endorsed this concept. The best available evidence suggests that an employee fitness programme will result in decreased health-care costs, decreased absenteeism and increased productivity for the employer. Regular physical activity is also associated with lower mortality rates. Appropriate physical activity may be a valuable tool in therapeutic regimens for the control and amelioration (rehabilitation) of cardiovascular disease, coronary artery disease, hypertension, congenital heart disease, peripheral vascular disease, obesity, chronic obstructive pulmonary disease, diabetes mellitus, musculoskeletal disorders, end-stage renal disease, stress, anxiety and depression, etc. Regular physical activity, independent of other factors, reduces the probability of coronary artery disease and early death. Patients with risk factors for coronary artery disease need more intensive preexercise evaluation than those not a risk, and those with known or suspected cardiovascular disease need the most intensive evaluation and follow-up. Participation in vigorous sports activities, such as jogging, swimming, tennis, etc., helps to protect against the development of hypertension, even when other predisposing factors are present. Several studies have been conducted on the use of exercise in the treatment of hypertension. Physical exercise also contributes to the control of body weight. Consideration of the metabolic abnormalities in patients with type II (adult onset) diabetes indicates that they would make excellent candidates for an exercise programme. Osteoporosis is an important health problem for the elderly. The best treatment available at present is prevention, and a high level of physical activity throughout life can result in a larger skeletal mass during old age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of physical activity in the prevention and treatment of noncommunicable diseases. 323 11

Mexican Americans are the second largest minority group in the United States (8.73 million people according to the 1980 US census) and are known to have an excess prevalence of obesity and non-insulin-dependent diabetes mellitus, but similar or lower rates of hypertension when compared with non-Hispanic whites. To our knowledge, no data are available on incidence of end-stage renal disease in this population. Using a data base from the Texas Kidney Health Program, a division of the Texas Department of Health, and the 1980 US census for the state of Texas, the authors calculated age-adjusted incidence of treatment of end-stage renal disease in Mexican Americans, non-Hispanic whites, and blacks for the years 1978-1984. Mexican Americans and blacks have an excess of treatment of end-stage renal disease (all etiologies combined) compared with non-Hispanic whites (incidence ratios of 3 and 4, respectively). For diabetes-related end-stage renal disease, Mexican Americans have an incidence ratio of 6, while blacks have an incidence ratio of 4 compared with non-Hispanic whites. For Mexican Americans, this excess is higher than would be expected on the basis of their underlying prevalence of diabetes. The incidence of hypertensive end-stage renal disease in Mexican Americans was 2.5 times higher than in non-Hispanic whites, which is higher than expected given the lack of excess in their underlying prevalence of hypertension. The high prevalence of diabetes in Mexican Americans explains some, but not all, of the excess of treatment of end-stage renal disease in this population.
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PMID:Excess incidence of treatment of end-stage renal disease in Mexican Americans. 327 55

Individuals with an upper-body form of obesity show greater associations with higher glucose excursions, exacerbated insulin resistance, increased abnormality of lipoprotein profile, and higher cardiovascular risk. Individuals with obesity and diabetes are at great risk for cardiovascular disease. Weight reduction and improvement in blood glucose control through dietary interventions for the obese person with non-insulin-dependent diabetes mellitus (NIDDM) hold the greatest potential for reducing morbidity and mortality. The relative merits of different weight-reduction programs are unclear, but regimens should be nutritionally complete, easy to follow, and include a program for maintaining the reduced weight level. Improvement in insulin action and the possibility of slowing development of clinical nephropathy or end-stage renal disease in NIDDM through weight loss have been found. Very low calorie diets, when used with medical supervision, may lead to significant weight loss, improved metabolic status, and even reduction or elimination of the need for oral hypoglycemic agents or insulin; however, further studies are needed to examine possible negative outcomes in people with NIDDM before very low calorie diets can be recommended. The causes of obesity and its connection with diabetes are unclear, but even modest calorie restriction may be beneficial to obese diabetic patients because of the positive effects on blood glucose levels and requirements for insulin and oral antidiabetic agents.
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PMID:Dietary considerations for obese diabetic subjects. 328 66

To determine the nature, extent, and severity of renal involvement in Laurence-Moon-Biedl syndrome (obesity, mental retardation, polydactyly, hypogonadism, and pigmented retinal dystrophy), we evaluated 20 of 30 patients with the disorder identified from ophthalmologic records in Newfoundland. The mean age was 31 years, and seven were male. All 20 patients had structural or functional abnormalities of the kidneys or both. Three had end-stage renal disease, with two requiring maintenance hemodialysis. The remaining 17 patients had normal serum creatinine values and estimated creatinine clearances. Half the subjects had hypertension. Fourteen of 17 patients could not concentrate urine above 750 mOsm per kilogram of body weight even after vasopressin, whereas all 10 normal controls could. Urinary pH decreased below 5.3 after ammonium chloride administration in all 15 normal controls, but in only 13 of 18 patients. Calyceal clubbing or blunting was evident in 18 of 19 patients studied by intravenous pyelography; 13 patients had calyceal cysts or diverticula. Seventeen of 19 patients had lobulated renal outlines of the fetal type. Four patients had diffuse renal cortical loss, but only two of these had renal insufficiency. We conclude that Laurence-Moon-Biedl syndrome includes the presence of renal abnormalities.
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PMID:The spectrum of renal disease in Laurence-Moon-Biedl syndrome. 341 78

Diabetes mellitus has been associated with high mortality rates in patients with acute myocardial infarction (AMI). To better define prognosis in this population, the clinical course of 183 diabetics with AMI was studied. In-hospital mortality for all patients was 28% (52 of 183 patients). Mortality was significantly higher in patients with prior AMI than in patients without prior AMI (41 vs 18%, p less than 0.01) and was significantly higher in women than in men (37 vs 19%, p less than 0.01). The 2-fold increase in mortality among diabetic women was observed both in patients with and without prior AMI. The excess mortality among diabetic women was attributable to their increased risk for severe congestive heart failure (CHF) and cardiogenic shock. Death due to CHF occurred in 22% of all diabetic women with AMI compared with 6% of the diabetic men (p less than 0.01). Death resulting from complications other than CHF was similar for both sexes. There were no male-female differences in the history of prior AMI, systemic hypertension, obesity, nephropathy, frequency of Q-wave AMI, anterior AMI or peak creatine kinase levels to account for the high risk for CHF in diabetic women. It is therefore concluded that diabetic women with AMI are at increased risk for death due to CHF, and that this risk is not readily attributable to known conditions associated with CHF.
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PMID:Acute myocardial infarction in diabetes mellitus and significance of congestive heart failure as a prognostic factor. 342 Nov 62


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