Post-transplantation diabetes is better controlled after conversion from prednisone to deflazacort: a prospective trial in renal transplants

It is well known that long-term use of steroids plays a decisive role in the development of glucose intolerance and diabetes mellitus (DM). Deflazacort, an oxazoline derivative of prednisolone, has been introduced as a potential substitute for conventional steroids in order to ameliorate glucose intolerance. We initiated a randomized study of conversion from prednisone to deflazacort in kidney transplantation (Tx) recipients presenting with pre-Tx or post-Tx DM to ascertain whether or not the switch to deflazacort would ameliorate the diabetic state. Forty-two recipients in the conversion group were compared with 40 patients on prednisone (the control group) in a prospective manner. The dose reduction of insulin or oral blood glucose-lowering agents, the adequacy of glucose control, and the development of side effects were the criteria for evaluating outcome. In the conversion group, patients were switched to deflazacort at a dose ratio of 6 mg deflazacort to 5 mg prednisone. During the mean follow-up period of 13.2 months, neither graft dysfunction nor acute rejection developed in the conversion group. Improvement in blood glucose control in the conversion group was noted. When the conversion group was stratified into pre- or post-Tx DM, promising effects were clearly evident in the post-Tx DM patients. More than 50 % dose reduction of blood glucose-lowering agents was possible in 42.3 % of post-Tx DM patients. In conclusion, it was readily possible to control blood glucose better in post-Tx DM recipients without seriously affecting the immunosuppressive activity after conversion to deflazacort. Received: 20 August 1996 Received after revision: 25 November 1996 Accepted: 6 December 1996     

Treatment of diabetic autonomic neuropathy with an aldose reductase inhibitor

To evaluate the effects of the aldose reductase inhibitor Ponalrestat (Statil) on diabetic autonomic neuropathy, a double-blind placebo controlled trial was carried out on a group of 34 diabetic patients with documented cardiac autonomic neuropathy. After a 4-week, placebo run-in period, patients were randomised for treatment with 600 mg Statil or placebo for another 24 weeks. Moreover, the reliability of the autonomic nerve function tests was investigated by comparing the results at onset and at week 4. Fifteen patients treated with Statil and 12 with placebo completed the study. Neither symptom scores nor cardiovascular reflexes, pupil reflexes and skin vasomotor reflexes improved after Statil therapy, which led us to conclude that Statil is not effective in the treatment of diabetic autonomic neuropathy. Reliability coefficients for cardiovascular reflexes and pupil reflex showed high values, ranging from 60% to 80%. Therefore these methods are recommended in future therapy trials.     

Therapeutic traditions in type 2 diabetes — are they changing?

The utilisation of antidiabetic drugs reflects both the prevalence of diabetes and the different therapeutic traditions of physicians. A questionnaire survey to study attitudes to the use of oral antidiabetic drugs amongst physicians and possible changes in treatment habits was carried out in a representative sample of Finnish physicians (n=454) in 1992 and the results were compared with those of a similar survey carried out in 1985, and with drug utilisation statistics.The mean fasting blood glucose level at which a physician would start pharmacological treatment was 8.7 mmol·l^–1, which was significantly lower than in the 1985 survey. The responses to various case histories suggested a more active approach to pharmacological treatment compared to the 1985 survey. Insulin treatment especially seems to have gained in popularity. This change in attitude was paralled by an increase in the consumption of antidiabetic drugs in Finland during the observation period. The increase in use of oral drugs was steeper in Finland than in Norway and Sweden.Whether this active approach will improve the metabolic control and prognosis of patients with Type 2 diabetes, remains to be demonstrated.     

糖尿病患者微血管病变与血小板功能

测定21例有微血管病变和27倒无并发症的糖尿病人血小板功能，并与40例正常人作比较。结果发现糖尿病人，尤其是微血管病变者血浆血栓烷素（TXB2）、第八因子相关抗原（VWF）浓度及血小板膜糖蛋白（G、P）Ib显著高于对照组。提示血小板功能异常可能对糖尿病患者做血管并发症的发生起重要作用。     

Does the Prepubertal Duration of Diabetes Influence the Onset of Microvascular Complications?

This study investigated the relationship between the development of diabetic retinopathy and pubertal status at onset of diabetes in 521 Type 1 diabetic patients diagnosed between 1950 and 1985. Pubertal status was based on age at onset (girls ≧ 11 years and boys ≧ 12 years). Retinopathy (all forms) developed in 112 patients (21.5%; 65 background and 47 proliferative retinopathy). For subjects diagnosed in either the prepubertal or postpuberal period, a similar proportion survived without developing retinopathy for any given duration of diabetes (X² = 0.3822, p = 0.54). However, if only the postpubertal duration of diabetes is considered, then the proportion of patients surviving without retinopathy was significantly less for those diagnosed in the prepubertal period (X² = 14.2, p = 0.002). This study suggests that the prepubertal duration of diabetes is an important phase and that the years prior to puberty do contribute to the risk of developing microvascular injury.     

脉冲式多普勒超声心动图对糖尿病左室舒张功能的评价

用脉冲式多普勒超声心电图对51例糖尿病患者的左室舒张功能参数进行了测定.与正常对照组结果相比,糖尿病患者的左室舒张早晚期最大流速之比、快速充盈分数、快速充盈减速度及左室舒张早期最大流速显著降低,而左室舒张晚期最大流速显著增高.在糖尿病患者中,有视网膜病变组与无视网膜病变组相比,左室舒张早晚期最大流速之比、快速充盈分数及快速充盈加速度显著降低,而左室舒张晚期最大流速显著增高.提示糖尿病患者左室舒张功能受损.     

丹参注射液治疗糖尿病周围神经病变

筛选出非胰岛素依赖型糖尿病伴周围神经病变患者５３例，随机分两组。两组患者均接受糖尿病常规治疗，同时其中一组加用丹参注液治疗，一组做为对照，结果显示：与对照组相经治疗组症状改善显著，并且改善症状所需时间也缩短，表明丹参注射液有助于糖尿病周围神经病变的恢复。     

糖尿病大鼠肺病理改变及同期肾脏病理变化对比

目的:观察糖尿病(DM)大鼠肺组织改变及与同期肾脏变化的关系.方法:链脲菌素腹腔注射制作糖尿病大鼠模型,4周后胶原、网状纤维染色及透射电镜方法观察糖尿病大鼠肺组织基底膜病理改变,同期观察肾脏改变.结果:DM大鼠4周后肺组织病理改变为毛细血管基底膜及Ⅱ型肺泡上皮细胞基底膜不同程度的增厚及肺间质胶原成分等细胞外基质的增多,与同期糖尿病肾脏病变相平行.结论:DM大鼠4周后肺组织与糖尿病肾病相似,主要表现为微血管病变.     

解毒保肾汤治疗早期糖尿病性肾病

[目的 ]观察解毒保肾汤治疗早期糖尿病性肾病的疗效 .[方法 ]将诊断为早期糖尿病性肾病的病人随机分为 2组 ,其中治疗组 4 4例给予解毒保肾汤 ,对照组 2 0例给予阳性对照药络汀新 ,观察治疗前后 2组病人的临床症状、空腹血糖、糖化血红蛋白量及尿蛋白排泄率等的变化 .[结果 ]治疗组总有效率为 80 % ,对照组总有效率为 6 5 % ,治疗组疗效优于对照组 ;治疗组在改善临床症状 ,降低空腹血糖、糖化血红蛋白量及尿蛋白排泄率等方面均优于对照组 .[结论 ]解毒保肾汤能够降低早期糖尿病性肾病患者的血糖、减少尿蛋白的排泄 ,具有一定的保护肾脏功能 ,对早期糖尿病性肾病有治疗作用 .     

Structured treatment and teaching of patients with Type 2 diabetes mellitus and impaired cognitive function--the DICOF trial.

BACKGROUND: Patient education is integral part of any diabetes therapy in Germany, but elderly patients are not able to follow the variety of topics comprising standard treatment and teaching programmes (TTP), primarily due to impaired neuropsychological function. This leads to deficits in diabetes knowledge and hindered ability for diabetes self-management. AIM: To evaluate structured TTP for geriatric patients with impaired cognitive function. PATIENTS AND METHODS: A neuropsychological examination was performed on all patients over 54 years [n=102, age 68.6 +/- 8.7 years, diabetes duration 10.3 (0.03-35.4) years, HbA1c 10.3 +/- 1.7% (HPLC, Diamat, NR 4.5-6.3%), cognitive function 87.7 +/- 12.3 IQ points] who took part in TTP for insulin therapy. Patients with impaired cognitive function participated either in the standard TTP of Berger [n = 35, age 67.6 +/- 8.9 years, diabetes duration 9.9 (0.04-35.4) years, HbA1c 10.3 +/- 2.0%] or in the specialized structured geriatric DICOF-TTP [n=33, age 70.4 +/- 8.2 years, diabetes duration 10.4 (0.03-24.9) years, HbA1c 10.7 +/- 1.8%]. RESULTS: After TTP there were no differences in knowledge and ability for diabetes self-management (standard/DICOF: knowledge 11.0 +/- 2.6 vs. 12.2 +/- 2.7 points, P = 0.11; handling 14.9 +/- 3.3 vs. 15.9 +/- 2.5 points, P = 0.18). However, patients who took part in the DICOF programme showed better scores in satisfaction with the education programme [standard/DICOF 44.7 (31-57) vs. 52.5 (45-59) points, P < 0.001]. Six months later the DICOF participants showed better results regarding diabetes self-management (standard/DICOF: handling 12.5 +/- 4.1 vs. 15.9 +/- 3.1 points, P = 0.001). Both groups showed HbA1c decrease (8.3 +/- 1.4 vs. 8.5 +/- 1.3%, P=0.62) and similar incidence of acute complications. CONCLUSIONS: Elderly patients with impaired cognitive function should take part in specialized structured TTP. This leads to both better satisfaction with the education programme and an improved ability for diabetes self-management.