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Limited weight loss following jejunoileal bypass in 24 diabetic persons who were still distinctly overweight five to ten months after a mean weight decrease of 78 lbs. was accompanied by a return of normal fasting glucose and insulin levels, normal insulin responses, and a decrease in glucose intolerance. The glucose disappearance rate had improved in the majority of the subjects, but only three had attained values in the normal range. Concomitants of the undue hyperglycemia and/or obesity included labile and, rarely, sustained hypertension and/or cardiomegaly. The blood pressure returned to normal but heart size did not change. Electrocardiographic abnormalities noted in about one-half of the patients persisted after the operation. Triglyceride and cholesterol levels decreased. No patients had diabetic retinopathy visible on funduscopy. Proteinuria did not change in three patients. Neuropathy consisting of absent ankle reflexes and/or decreased vibration perception noted in one-half of the subjects persisted despite the improvement in carbohydrate metabolism.
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PMID:Remissions of diabetes mellitus after weight reduction by jejunoileal bypass. 72 40

A total of 6695 diabetic men and women, aged 35 to 54 years, from 14 centres and representing 13 national groups, participated in a vascular disease prevalence survey. A random sample was drawn after stratification of each centre's diabetic base population by sex, duration of diabetes and age. A common agreed protocol, standardized examination procedures, and centralized laboratory methods were used in the investigation. Within the age range examined there was considerable variation between centres in a number of variables, including degree of obesity (measured as Body Mass Index (BMI)), proportion treated with insulin and proportion of cigarette smokers. The latter also showed considerable sex differences within centres. Subjects with age at onset below 25 years were notably few in Hong Kong, Tokyo and Oklahoma. There was also considerable variation in the apparent prevalence of both large- and small-vessel (macrovascular and microvascular) disease between centres. In pooled data, measures of large-vessel disease were significantly and independently associated with age, blood pressure and BMI in both sexes, and with diabetes duration and plasma cholesterol in men only. Within-centre analyses showed blood pressure to be the most consistently associated variable in both sexes. In pooled data, small-vessel disease of the eye was significantly and independently associated with diabetes duration, blood pressure, BMI and type of treatment in both sexes. In within-centre analyses, diabetes duration was the most consistently associated variable, followed by blood pressure. Proteinuria as an index of small-vessel disease of the kidney was, in pooled data, significantly and independently correlated with diabetes duration, blood pressure and plasma cholesterol in both sexes. In within-centre analyses, blood pressure was the most consistently associated variable, with diabetes duration and plasma cholesterol equal second - significant in 12 of the 28 centre/sex groups. Heterogeneity of large-vessel disease prevalence in diabetic subjects is confirmed by this study, and the possibility of heterogeneity in small-vessel disease prevalence and severity is suggested.
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PMID:Prevalence of small vessel and large vessel disease in diabetic patients from 14 centres. The World Health Organisation Multinational Study of Vascular Disease in Diabetics. Diabetes Drafting Group. 406 55

Arteriosclerosis obliterans (ASO) of the lower extremities was found in 32 cases (1.9%) among 1673 Japanese diabetic patients. Comparison with age-and sex-matched control patients revealed that male sex, older age, hypertension and neglect of treatment of diabetes were positively correlated with ASO, but obesity, smoking and hyperlipidemia were not correlated with ASO. Proteinuria, cerebral vascular disease and myocardial infarction were significantly associated with ASO. The arterial pulses of the foot were examined in 451 diabetic patients. The pulse of A. dorsalis pedis was absent in 29 (6.4%) and was significantly related to the clinical signs and symptoms of ASO. The loss of the pulse of A. dorsalis pedis increased with age and was more frequent in men than in women. The results indicate a lower frequency of ASO in Japanese than in Western diabetic patients.
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PMID:Arteriosclerosis obliterans in Japanese diabetic patients. 668 May 33

The Strong Heart Study, a study of cardiovascular disease among American Indians, was conducted to determine cardiovascular disease rates and the prevalence of risk factors among members of 13 tribal groups in South Dakota/North Dakota (SD/ND), southeastern Oklahoma, and Arizona. From 1989 to 1992, 4,549 tribal members aged 45-74 years (62% of eligible participants) were surveyed and examined for cardiovascular disease and its risk factors. Mean total cholesterol concentrations were over 20 mg/dl lower among the men and 27 mg/dl lower among the women than national mean levels for the same age groups. Cholesterol levels varied by tribal group; Arizona Indians had mean levels more than 20 mg/dl lower than those of SD/ND Indians. The prevalence of hypercholesterolemia was almost twice as high among SD/ND Indians as among Arizona Indians, but the rates for all three groups were much lower than total US rates (all races). Mean levels of high density lipoprotein cholesterol were lower among Indian men and women than in the US population as a whole. The prevalence of hypertension among Arizona and Oklahoma Indians was higher than that for the entire United States. SD/ND Indians had significantly lower mean blood pressures and prevalence rates of hypertension than Oklahoma and Arizona Indians and the United States as a whole. The prevalence of cigarette smoking was higher for all Indian groups except Arizona women in comparison with US rates. Smoking rates were highest in SD/ND and lowest in Arizona. Indian smokers smoked fewer cigarettes per day than the average US smoker. Arizona Indians had the highest prevalence of diabetes mellitus; over 60% of those participants were diabetic. In Oklahoma and SD/ND, one third of the men and over 40% of the women were diabetic. In addition, 13-20% of the participants had impaired glucose tolerance. Proteinuria was also a common problem; almost half of the Arizona Indians had micro- or macroalbuminuria, and 20% of Oklahoma and SD/ND Indians had significant proteinuria. The prevalence of obesity was high in all three groups, with Arizona Indians having the highest rates and the highest mean body mass indices. The prevalence of current alcohol use was lower among Indians than in the nation as a whole, but binge drinking was common among those who used alcohol. These results indicate that cardiovascular disease risk factors vary significantly among tribal groups. Prevention programs tailored toward decreasing the prevalence of risk factors are recommended for long-term reduction of cardiovascular disease rates in American Indian communities.
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PMID:Cardiovascular disease risk factors among American Indians. The Strong Heart Study. 763 31

Ten hospitals participated in a cross-sectional study to determine the prevalence of vascular complications in non-insulin dependent diabetes mellitus (NIDDM). The patients were 1433 females and 627 males, aged 24-88 years (mean +/- S.D. = 58.0 +/- 9.9). Duration of diabetes varied from newly diagnosed to 42 years (mean +/- S.D. = 8.2 +/- 6.5). Obesity was noted in 16.9% of males and 27.4% of females. The prevalence of hypertension, myocardial infarction (MI), hemiplegia, absent dorsalis pedis pulse, gangrene and amputation were 38.4, 2.8, 3.7, 5.8, 0.3 and 1.3%, respectively. Diabetic retinopathy (DR) was found in 32.1% of the patients. Proteinuria of > or = 2+ was observed in 18.7% of the patients. Stepwise multiple logistic regression analysis revealed that hypertension was significantly and independently correlated with MI, hemiplegia and DR but not with proteinuria or absent dorsalis pedis pulse. DR and proteinuria had a strong correlation with each other. Age of the patients weakly correlated with macrovascular diseases. Diabetic control and duration showed a weak correlation with microvascular complications. This study showed that DR was frequently found in Thai NIDDM. Hypertension was not only the commonest disorder but it also showed an independent association with other vascular complications. Early detection and intervention for both need to be emphasized and re-enforced in clinical practice.
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PMID:Vascular complications in non-insulin dependent diabetics in Thailand. Thai Multicenter Research Group on Diabetes Mellitus. 783 13

To evaluate the effect of insulin and/or triglycerides on the pathogenesis of glomerulosclerosis, acarbose (BAYg5421), an inhibitor of intestinal alpha-glucosidases, was administered as a dietary admix (40 mg/100 g chow) to Zucker obese rats (ZOA), from 1.5 months until sacrifice at 1.5, 5, 8, 10 and 15 months. Obese (ZO) and lean (ZL) rats served as controls. Despite a similar food intake, ZOA weighed less than ZO at all ages. Acarbose reduced serum triglycerides at all ages, and insulin until 10 months. Glycemia remained normal in all groups. Proteinuria developed with age and to a greater degree in ZO than in ZOA rats. In ZL, a faint proteinuria appeared only in the oldest animals. Glomerulosclerosis, tubular and interstitial lesions rapidly affected ZO kidneys. These lesions were reduced in ZOA until 10 months. Acarbose did not modify the hypertrophy of the glomeruli that developed after three months, but slowed down the expansion of the mesangial domain seen in ZO. Thus, by reducing the amount of ingested glucose, acarbose yielded a normal glycemia with a lesser production of insulin and reduced renal impairment. Therefore, insulin could be a key factor involved in the pathogenesis of glomerulosclerosis, either directly or through a control of triglyceride concentrations.
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PMID:Reduction of insulin and triglycerides delays glomerulosclerosis in obese Zucker rats. 940 98

An obese male patient with steroid-dependent nephrotic syndrome since age 6 years had a thirty-third relapse at the age of 29 years. Renal biopsy showed focal segmental glomerulosclerosis. Proteinuria disappeared after treatment with prednisolone. He went into complete remission and renal function remained normal at the age of 31 years. Focal segmental glomerulosclerosis associated with obesity was suspected. Long-term follow-up with renal biopsy is necessary in obese children with steroid-dependent nephrotic syndrome.
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PMID:A male patient with steroid-dependent nephrotic syndrome for 25 years and obesity-associated focal segmental glomerulosclerosis. 1548 Sep 5

Rates of end-stage renal disease in the Aboriginal community have been increasing over the past two decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities. Proteinuria predicts the rate of loss of renal function and is common in young adults and virtually universal in those over 50 years old. Cumulative independent risk factors include low birthweight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake and a family history of renal disease. A plausible theory is that intrauterine malnutrition permanently reduces total nephron numbers, which are then overworked in adulthood by the metabolic stresses of obesity (from excess alcohol and poor diet), blood pressure and infections, while starved of blood supply through smoking. Although renal disease is often only detected when already established, there are great rewards for active medical intervention. Control of blood pressure (preferentially using angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (AIIRB) in combination) can often stop or even reverse kidney damage, despite ongoing poor diabetic control. Adequately funded kidney health programmes with active Aboriginal Health Worker involvement are enormously cost-effective: tight blood pressure control at least halves the rate of disease progression, and every year of dialysis deferred for one patient could fund the appointment of two more health workers. Addressing the underlying social causes for this epidemic is critical.
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PMID:Antecedents of renal disease in Aborigines. 1560

Rates of end-stage renal disease among Australian Aboriginal people have been increasing over the past 2 decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities. Proteinuria predicts the rate of loss of kidney function; it is common in young adults and virtually universal in those over 50 years of age. Cumulative independent risk factors include low birth weight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake, and a family history of renal disease. A plausible theory is that intrauterine malnutrition permanently reduces total nephron numbers, which are then overworked in adulthood by the metabolic stresses of obesity (from excess alcohol and poor diet), by higher blood pressures, and by infections, while starved of blood supply because of smoking. Although kidney disease is often only detected when already well established, active medical intervention offers great rewards. Control of blood pressure (preferentially using angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (AIIRBs) in combination) can often stop or even reverse kidney damage, even if ongoing diabetes control is poor. Adequately funded kidney health programs with active Aboriginal health worker involvement are enormously cost-effective: tight blood pressure control at least halves the rate of disease progression, and every year of dialysis deferred for 1 patient could fund the appointment of 2 health workers. Addressing the underlying social causes for this epidemic is critical.
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PMID:Deprivation and dialysis: pathways to kidney failure in Australian Aborigines. 1571 38

Diabetes mellitus (DM) has been the leading cause of incident dialysis in Japan since 1998, according to the Japanese Society for Dialysis Therapy (JSDT). In particular, the number of male DM dialysis patients is increasing. DM is becoming a worldwide epidemic in both developed and developing countries. Strategies to detect individuals at high-risk of developing CKD and end-stage renal disease (ESRD) are needed that can be implemented on a population-basis. Among the commonly measured variables, dipstick urinalysis (proteinuria, haematuria), blood pressure, serum creatinine, body mass index (BMI), and serum uric acid are significant predictors of ESRD. Recently, we evaluated the effect of DM as a risk factor of developing ESRD. DM was diagnosed when the fasting plasma glucose (FPG) was 126 mg/dL or more in participants (n = 78529) of the 1993 screening program in Okinawa. The prevalence of DM was 5.2%. The odds ratio (95% CI) of DM for developing ESRD was 3.098 (1.738-5.525, P = 0.0001) after adjusting for possible confounding variables. Early detection and treatment of DM might prevent DM-related ESRD. We examined 7125 non-DM screenees who underwent a 1-day health check between April 1997 and March 1998. They were followed-up until March 2000 to determine whether they developed DM. Over the 2 years, the cumulative incidence of DM was 2.3%, 2.9% in men and 1.3% in women. Proteinuria was the most robust predictor of the development of DM; the adjusted relative risk (95% CI) was 1.90 (1.14-3.17). Obesity, per se, is also recognized as a risk factor for developing proteinuria. The higher the BMI, the higher the risk of developing ESRD; the adjusted odds ratio (95% CI) was 1.273 (1.121-1.446, P = 0.0002) for men. Other than being overweight (BMI = 25.0 kg/m2), a smoking habit was a significant predictor of developing proteinuria. The prevalence of obesity and DM is increasing in Japan. It is possible that the impact of obesity and complications of DM are different among races and ethnicities. Public relations regarding the risk of DM and its complications are especially important in Asian countries. Asians have more fat than non-Asians, even at the same BMI levels. Knowledge of the predictors of DM-ESRD is crucial as a first step toward prevention. Consistent with this notion, initiatives on the management of CKD and ESRD were recently organized in Japan and internationally.
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PMID:Predictors of diabetic end-stage renal disease in Japan. 1617 82


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