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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Therapy for diabetes mellitus, especially type I diabetes mellitus, is changing rapidly. Several developments and discoveries have contributed to this change. Most important, the data relating to the relationship between vascular disease and neuropathy and control of blood sugar and the developments in monitoring of glucose control have had a major impact on concepts of therapy. The development of new and purer insulins and new delivery systems have also improved diabetic control. The major concept that has evolved in recent years has been that the vascular disease and neuropathy of diabetes are related to control of the blood glucose and, therefore, it is important to deliver insulin in a physiologic way that duplicates the pattern of control found in nature. Techniques to better accomplish this goal are now evolving.
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PMID:Self-monitoring of blood glucose: an important adjunct to diabetes therapy. 351 58

The possible role of Mg in the pathogenesis of vascular disease has recently received increasing attention. Accumulating evidence indicates that Mg strongly influences vascular tone and responsiveness to pressor agents and that Mg deficiency may be associated with an increased risk of hypertension. Moreover, experimental Mg deficiency produces vascular lesions with calcifications while increasing the dietary intake of Mg has been shown to prevent atheroma and thrombotic complications. The modifications of lipid metabolism during experimental Mg deficiency have been recently characterized. Severe Mg deficiency in weanling rats produces a marked hypertriglyceridemia and a decrease in the percentage of cholesterol transported by high-density lipoprotein. The decreased clearance of circulating triglycerides appears to be the major mechanism contributing to hyperlipemia. The same animals were found to have a reduced insulin response after intravenous glucose challenge and a slight reduction in heparin release lipoprotein lipase. A marked reduction in plasma activity of LCAT and a significant decrease in esterified/total plasma cholesterol ratio have also been reported. Severe Mg deficiency in weanling rats produces marked changes in the fatty acid pattern of total plasma lipids, as shown by decreased levels of stearic acid, increased of oleic acid and linoleic acid, and decreased levels of arachidonic acid. Platelets from Mg-deficient rats become more sensitive to thrombin. Such an increased sensitivity of platelets may in turn play an important role in initiating the vascular lesion as well as in thrombotic complications. In view of these experimental data in animal models, more work seems necessary in man to assess the effect of Mg on lipid metabolism and vascular disease.
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PMID:Magnesium, lipids and vascular diseases. Experimental evidence in animal models. 352 56

To study prostaglandin (PG) metabolism in peripheral vascular beds, PGs and TxB2 released from perfused mesenteric tissues were measured in both normal and streptozotocin (STZ)-induced diabetic rats. The release of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), thromboxane B2 (TxB2) and prostaglandin E2 (PGE2) was significantly increased in mesenteric vascular beds from diabetics in comparison with control rats. The 6-keto-PGF1 alpha/TxB2 ratio was decreased in diabetics. In order to clarify the mechanism of this imbalanced synthesis of eicosanoids, we infused buffer with 500 mg/dl glucose which was similar to the concentration of blood glucose in the diabetic rats. In response to this high glucose concentration, TxB2 released into the effluent from the mesenteric beds of normal animals was increased to the diabetic level. The release of the other PGs was not changed significantly. The 6-keto-PGF1 alpha/TxB2 ratio was decreased in control rats perfused with buffer containing 500 mg/dl glucose. We also investigated the effect of insulin (50 and 100 microU/ml) in the diabetic mesenteric vascular beds, but there were no changes in prostaglandin or TxB2 release. These data suggest that a high glucose level may have an important role in regulating TxA2 synthesis and in modulating the balance between PGI2 and TxA2 in diabetes. It is postulated that an increase in the micro-circulation of PGI2 may partially be protective against the progression of angiopathy.
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PMID:Increased release of prostaglandins from the mesenteric vascular bed of diabetic animals: the effects of glucose and insulin. 354 Sep 97

This review covers the effects and complications of the major contraceptives on the diabetic state, and their suitability for diabetics. Originally, high estrogen oral contraceptives compromised glucose tolerance by impairing insulin secretion, causing carbohydrate intolerance and reducing insulin receptors. The current low-dose orals neither precipitate diabetes in predisposed women nor worsen insulin requirements in most diabetics. There is a concern, however, that the progestogen may decrease HDL or increase triglycerides or LDL, and increase the incidence of major vascular disease. Insufficient data are available on lipoproteins in diabetics. Another side effect of pills that bothers some diabetics is the frequency of monilial vaginitis. Many diabetic women take the progestogen-only pill, and have little difficulty following a rigid schedule because they already do so with insulin injections. The greatest concern for the IUD is an increased risk of pelvic inflammatory disease (PID), however, there is no evidence that this risk is greater in diabetic women. Another fear is that of septic abortion in case of failure, as occurred with the Dalkon shield. The UK Family Planning Association recommends that diabetic women, especially nulliparas, not use the IUD as their first choice of contraceptive method. Barrier methods have become less popular than the IUD and low dose pills, but they are totally without risk, and quite effective for motivated diabetic women. Sterilization is recommended once the family is completed.
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PMID:Contraception and diabetes mellitus. 354 77

In 51 individuals with Type 1 (insulin-dependent) diabetes mellitus initially of more than 15 years' duration, the acute hypoglycaemic effect of intravenous insulin (0.11 IU/kg) was related to outcome over 18 years. This acute insulin sensitivity, or glucose assimilation index, was reproducible over the period of study. At 18-year follow-up, initial low glucose assimilation index (less than 0.082 mmol X l-1 X min-1 was significantly (p less than 0.01) associated with death from vascular disease. Low glucose assimilation index was similarly significantly (p less than 0.01) associated with progression of atherosclerotic disease, but not with microangiopathy alone. Hypertension (systolic blood pressure greater than 150 mmHg and/or diastolic blood pressure greater than 95 mmHg) was the only other parameter significantly (p less than 0.01) related to outcome, but this relationship was no longer significant once glucose assimilation index had been taken into account. A linear logistic analysis confirmed that acute insulin sensitivity was independently associated with outcome. Neither initial clinical control of diabetes nor glycosylated haemoglobin level in the 26 survivors was related to vascular prognosis.
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PMID:The relationship of acute insulin sensitivity to the progression of vascular disease in long-term type 1 (insulin-dependent) diabetes mellitus. 355 89

A correlation between increased platelet adhesiveness and aggregation and the development of angiopathy in diabetes mellitus can be made. Thromboxane produced by platelets represents a potent platelet aggregation factor. We studied the platelet TXB2 production during blood coagulation in carefully selected patients with type II diabetes mellitus in good metabolic control and the results were correlated with the presence or absence of microangiopathy, fasting blood glucose levels, type of therapy, age, duration of diabetes and the most important hematochemical parameters. No statistically significant differences were found between serum TXB2 concentrations in diabetic patients and control subjects, in diabetics with or without microangiopathy and in diabetics on insulin therapy or on oral hypoglycemic agents. We did not observe any correlation between TXB2 production and age, duration of diabetes, sex, basal blood glucose levels, total and HDL-cholesterol, triglycerides, blood creatinine and blood electrolytes. The thromboxane production may be a not important factor for determining the increased platelet aggregation which is at the origin of the angiopathy in diabetes mellitus.
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PMID:Thromboxane production in diabetes mellitus. 357 51

Previous studies of the relationship of gonadal function to impotence in men with diabetes mellitus have yielded conflicting results. Pituitary-testicular function was studied in 28 impotent diabetic men and 15 normal men. Impotence was documented by clinical history and subdivided into categories of primary organic (n = 16), primary psychogenic (n = 7), and unclassified (n = 5) on the basis of nocturnal penile tumescence (NPT) testing, psychological testing, and penile vascular studies. All NPT parameters were diminished (P less than or equal to 0.001) in the impotent diabetic men compared to values in the normal men. Endocrine studies revealed increased urinary LH (P less than or equal to 0.05) and diminished serum free testosterone levels in the diabetic men with primary organic impotence. These changes were not found in normal men or diabetic men with primary psychogenic impotence. Six months of treatment in a home blood glucose-monitoring program resulted in significant improvement in metabolic control but no improvement in pituitary-testicular function, NPT, or sexual performance in the primary organic impotent group. Eight patients with primary organic impotence and no evidence of penile vascular disease had significant improvement (P less than or equal to 0.01) in NPT results as well as subjective improvement in sexual function after 6 months of parenteral testosterone administration. These studies suggest that primary gonadal dysfunction may be related to organic impotence in diabetes, and improvement in selected patients can occur with androgen therapy.
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PMID:Gonadal dysfunction in diabetic men with organic impotence. 358 93

Factors potentially associated with adult-onset diabetes mellitus in the elderly were reviewed, using the Framingham Heart Study data and other population data. Incidence data for diabetes mellitus in the elderly are sparse, but they indicate that the prevalence of diabetes increases greatly with age. Prevalence rates commonly exceeded 10 percent in those over the age of 60. Men and women in the Framingham Study who were overweight by more than 40 percent had twice the prevalence of diabetes mellitus compared with those of normal weight. Hypertension and coexistent vascular disease were particularly common in elderly diabetic patients, with rates markedly greater than those found among younger adult-onset diabetic patients. In those 50 years of age or older, the later development of diabetes mellitus was associated with increased levels of very-low-density lipoprotein cholesterol, decreased levels of high-density lipoprotein cholesterol, obesity, elevated casual glucose levels, use of diuretics, and preexisting vascular disease.
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PMID:Epidemiology of diabetes mellitus in the elderly. The Framingham Study. 370 88

The retinae of 137 patients were examined ophthalmologically and for visual acuity at diagnosis of non-insulin dependent diabetes and again in 1982 and 1983, approximately 7 and 8 years later, when colour photographs were also taken. In 1983, 46% were without detectable retinopathy, 32% had haemorrhages (including microaneurysms) only, 4% exudates alone and 18% both lesions. Those with haemorrhages were more hyperglycaemic than those without retinopathy and those with exudates only. Indeed, those with exudates alone had lower mean glucose levels than those without retinopathy (p less than 0.05). Patients with exudates (+/- haemorrhages) had a lower percentage of the fatty acids of plasma cholesterol esters as linoleate than those without (p less than 0.05) but this did not hold for those developing haemorrhages. Different risk factors appear to operate in different features of diabetic retinopathy. In some respects exudate formation may be more akin to macro than to micro angiopathy.
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PMID:Diabetic retinopathy: different risk factors for exudates and haemorrhages. 372 7

Fasting plasma zinc levels were determined in 45 IDDM and in 40 NIDDM patients. Mean values were similar in both groups, but diabetic men showed a significantly higher plasma zinc (p less than 0.05) than diabetic women. In patients with diabetic nephropathy a lower zinc level was associated with decreased plasma albumin as compared to patients without complications (p less than 0.001). Neuropathy and macro-angiopathy were also associated with lower zincemia (p less than 0.05) but in the presence of normal albumin levels. In IDDM without nephropathy a significant positive correlation was found between plasma zinc and plasma glucose, albumin, branched chain amino acids and glutamine, while in NIDDM without nephropathy a significant positive correlation exists between plasma zinc and the amino acids glutamine, valine, histidine and lysine.
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PMID:Plasma zinc levels in diabetes mellitus: relation to plasma albumin and amino acids. 375 14


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