Reduced intraplatelet magnesium concentrations in elderly patients with non-insulin dependent diabetes mellitus (NIDDM)

Intraplatelet magnesium concentrations were evaluated in 50 non-insulin dependent diabetes mellitus (NIDDM) patients divided into two groups of 25 each (<60 or >65 years) and in a control group of 30 healthy subjects, divided into two age-matched subgroups of 15 each. In all patients magnesium concentrations were assayed in plasma, erythrocytes and platelets by means of direct current plasma spectrometry. Plasma, erythrocyte and platelet magnesium levels in healthy elderly subjects were found to be comparable to those in the group of younger healthy subjects, whereas plasma, erythrocyte and platelet magnesium levels in diabetics were lower than in controls. The reduction in intraplatelet magnesium concentrations found in elderly diabetics was greater than in the younger diabetics. In diabetics, moreover, an inverse correlation was found between platelet magnesium and age, but not between plasma or erythrocyte magnesium and age. Our findings show that aging can influence the alterations in the metabolism and compartmentalization of magnesium determined by type 2 diabetes mellitus. This condition may underlie platelet function alterations which, in turn, can exacerbate vascular complications from diabetes.     

Diet therapy in non-insulin dependent diabetes mellitus (NIDDM)

The main approach in NIDDM therapy is diet. Most patients present insulin resistance characterized by overweight, VLDL increase, minimal increase of LDL, decrease of HDL cholesterol, and hypertension. The overall goals of nutrition therapy are the maintenance of near normal glucose levels, and the achievement of optimal serum lipid levels with adequate calories for maintaining or attaining a reasonable body weight. In presence of obesity and hypertension even a slightly weight loss could achieve an improvement in metabolic control and in hypertension with a better life expectance. General-ly carbohydrate intake would represent the 50-60% of total caloric amount (with preference to those with low glycemic index), and lipids no more than 35% (less than 10% of these 10-15% from monounsaturated fats with less than 300 mg/day of cholesterol). If elevated very low density lipoproteins level is the primary problem, a beneficial approach is 10% of total caloric intake from saturated fats, 10% from polyunsaturated, and 15-20% from monounsaturated fats with less than 200 mg/day of cholesterol and 40% of carbohydrates. A large amount of fructose (20% of calories) may increase LDL levels but sweeteners as saccarine or aspartame are approved and determine a better diet compliance. Daily consumpion of 20-35 g of dietary fibres from food sources is recommended for metabolic control. Protein intake would be of about 10% of total caloric amount especially in presence of diabetic nepropathy. Alcohol would not exceed 30 g/day for men and 20 g/day for women keeping in mild that alcohol may worsen metabolic control, diet compliance, and may be dangerous itself. For people with hypertension a decrease of dietary sodium intake is recommended. Nutritional recommendations are developed to meet treatment goals and desired outcomes. Monitoring metabolic parameters, blood pressure, and body weight is very important to ensure successful outcomes.     

Effect of insulin therapy on lipoproteins in non-insulin dependent diabetes mellitus (NIDDM)

Thirty patients with NIDDM and severe hyperglycemia (fasting plasma glucose greater than 200 mg/dl) were initiated on insulin therapy. Lipoprotein concentrations were measured by the Vertical Autoprofile procedure before insulin therapy and 1, 3, 6 and 26 weeks after insulin initiation. Patients were divided into 4 phenotypes based on their pretreatment lipoprotein profile: HyperVLDL (elevated VLDL), HyperLDL (elevated LDL), HyperVLDL-LDL (elevated VLDL and LDL), and non-hyperlipidemic. There were no differences in the initial fasting plasma glucose, Hgb Alc, or fasting free insulin concentrations between the groups. Both the HyperVLDL and HyperLDL groups had significantly lower HDL-C concentrations that the non-hyperlipidemic group and the HyperVLDL-LDL group had significantly higher IDL-C than any of the other groups. Insulin therapy resulted in similar decreases in fasting plasma glucose and increases in fasting free insulin concentrations in all 4 groups. HDL-C increased in all 4 groups. The most marked improvements in HDL-C were seen in the non-hyperlipidemic (+37%) and HyperLDL (+42%) groups while the HyperVLDL group had only an 18% increase. VLDL-C fell in all groups but in the HyperVLDL group it fell dramatically to almost normal levels within the first week, whereas it took 6 weeks for the HyperVLDL-LDL group to reach its VLDL-C nadir and this was still significantly higher than normal. LDL-C improved modestly in only the HyperLDL patients after 6 weeks of insulin therapy. There were no statistically significant changes in either the IDL-C or Lp(a)-C in any of the groups during insulin therapy. The changes in HDL-C and IDL-C were negatively correlated with the fasting plasma glucose and Hgb Alc but not with the free insulin concentration. We conclude that: 1) Insulin therapy can cause dramatic improvements in HDL-C and VLDL-C while it has only a mild suppressive effect on LDL-C and no statistically significant effect on IDL-C or Lp(a)-C. The degree of improvement in the lipid profiles varied considerably between the different lipid phenotypes. 2) The hyperlipidemic phenotypes seen in these patients appear to be determined primarily by factors other than the degree of hyperglycemia and hypoinsulinemia.     

Barriers to non-insulin dependent diabetes mellitus (NIDDM) self-care practices among older women

OBJECTIVES. Noninsulin dependent diabetes mellitus (NIDDM) constitutes a significant threat to the health and well-being of older women. Appropriate self-care, the cornerstone of glycemic control, is reported to be modest. We aimed to investigate barriers to recommended self-care for NIDDM. METHODS. A total of 51 African American and White women age 65 and older, completed the Diabetes Self-Care Barriers Assessment Scale for Older Adults, ethnomedical protocol, and other instruments during in-depth interviews. RESULTS. African American women were more likely than their White counterparts to indicate financial, pain, and visual barriers to self-care. Both African American and White women expressed a reluctance to check blood sugar and to exercise; however, most indicated that they regularly followed medication recommendations and visited their physician. DISCUSSION. This study extends our knowledge of the existence of self-care barriers by providing a qualitative, in-depth perspective detailing how these barriers often prevent optimal self-care behaviors and, conceivably, successful glycemic control.     

非胰岛素依赖型糖尿病微量白蛋白尿患者红细胞膜ATPases活力的变化

测定非胰岛素依赖型糖尿病(NIDDM)微量白蛋白尿患者20例及NIDDM无微量白蛋白尿患者20例和正常人20例红细胞膜ATPases活力。结果NIDDM微量白蛋白尿患者Na~+-K+ATPase,Ca~(2+)+ATPase活力明显低于正常人(P分别<0.05及0.001),Mg~(2+)ATPase活力无明显改变(P>0.05).NIDDM无微量白蛋白尿患者Ca~(2+)ATPase活力也低于正常人(P<0.01),但不及微量白蛋白尿组明显;无白蛋白尿组Na~+-K~+ATPase活力虽有下降,但P>0.05,Mg~(2+)ATPese活力无明显变化(P>0.05).     

老年NIDDM患者ApoE基因与冠心病的关系

载脂蛋白 E(Apo E)调控含 Apo B的脂蛋白代谢 ,在动脉粥样硬化的发生与发展中起重要作用。其结构基因位点上存在 3个常见的共显性等位基因ε2 、ε3、ε4,分别编码 Apo E蛋白异型E2 、E3、E4,可产生 6种 Apo E基因型ε2 /2 、ε4/2 、ε3/2 、ε3/3 、ε4/3、ε4/4 。2型糖尿病 (NIDDM)患者常并发冠心病 (CHD) ,然而其机制尚未完全阐明。本文报道老年 NIDDM患者 Apo E基因与 CHD的关系。1　对象与方法1.1　 对象　随机选择老年 NIDDM患者 15 3例 ,年龄 6 0～ 93岁 (平均 6 8± 11岁 ) ,男 90例 ,女 6 3例。选择年龄、性别匹配…     

Detection of microalbuminuria in non-insulin dependent diabetes mellitus (NIDDM) patients without overt proteinuria by a semiquantitative albumin-creatinine urine strips

Microalbuminuria is the hallmark of the reversible stage of incipient diabetic nephropathy. A cost- effective and convenient bedside screening test is essential to detect this phase. We used Clinitek 50® which is a semiquantitative strip test to check spot urine sample from 81 patients with albustix one plus or less. The incidence of Clinitek 50® microalbuminuria was 17%, 18.2% and 75% in 47, 22 and 12 patients with albustix negative, trace or one plus respectively. Nineteen and 13 of the 21 Clinitek 50® positive patients were checked for spot urine DCA 2000® and two 12-hour urine collection for immunoassay respectively. Around 60% of these samples fell into the microalbuminuria range and 40% into the overt albuminuria range by either technique. There was no false positive of Clinitek 50®. The lowest range of microalbuminuria detected by Clinitek 50® was 27 μg/minute (38 mg/day). We concluded that Clinitek 50® is a useful screening test as it is nonexpensive, easily operated and has a sensitivity close to the lower range of microalbuminuria.     

非胰岛素依赖型糖尿病病人心脏功能的改变

经静注潘生丁锝－９９ｍ标记的甲氧基异丁基异腈心肌断层显像术筛选后，用核素心室造影术评价非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人组１８例及对照组１６例在静息及极量运动状况下的心脏收缩功能变化；以多普勒超声心动图评价静息时心脏舒张功能改变。结果：静息状态下ＮＩＤ－ＤＭ组心率虽快于对照组，射血分数（ＥＦ）、峰射血率（ＰＥＲ）与对照组无差异；极量运动时则ＰＥＲ有统计学意义地明显低于对照组，且有４例ＥＦ较运动前降低＞５％，对照组无此现象，此差异接近显著意义（Ｐ＝０．０６５）．静息时ＮＩＤＤＭ组的Ｅ／Ａ比值降低，等容舒张时间延长，揭示ＮＩＤＤＭ病人心室收缩贮备功能降低，舒张功能在静息时已异常。     

Insulin therapy in elderly patients with diabetes mellitus

Insulin therapy is an effective measure of improving glucose control even in elderly patients with type 2 diabetes. However, it is controversial whether insulin therapy does disturb the quality of life (QOL) as well as cognitive function in the elderly. In our previous study of 455 diabetic patients, the well-being as assessed by the morale scale was similar in three treatment groups. In contrast, the symptom-burden, social burden, and worry about diabetes as assessed by the Elderly Diabetes Burden Scales was more increased in insulin-treated group as compared to the diet-treated group after adjustment for age, gender, HbAlc, frequency of hypoglycemia, microangiopathy, macroangiopathy, and social support. In another study of 213 patients, MMSE scores were similar among treatment groups, while attention and learning were most impaired in insulin-treated groups after adjustment for age, gender, HbAlc, and duration of diabetes. Although the mechanism for the association between insulin treatment and cognitive impairment is unknown, hyperglycemia, hypoglycemia, and cerebral complications in insulin-treated patients may be possible explanations. Whatever mechanism may be involved, hypoglycemia should be considered especially if unexpectedly low HbAlc (< 6.5%) is observed or atypical neuropsychological symptoms appear. It is unknown how insulin withdrawal is successful in elderly diabetic patients. Using rapid or ultrarapid insulin injections three times daily, good glucose control achieved the goal of plasma glucose level of < 140 mg/dl before meals and at bedtime. Then, insulin therapy was converted to oral treatment of glimepiride (2 to 6 mg/day) and/or voglibose (0.6 mg/day) in 30 patients with poorly controlled Type 2 diabetes. About 83% of the patients were successful in the insulin withdrawal according to the criteria of HbAlc levels after two months < 8.0%. After removal of glucose toxicity, insulin withdrawal should be attempted to improve QOL in elderly patients with diabetes mellitus.     

Ovarian function in women with non-insulin dependent diabetes mellitus

OBJECTIVE Although insulin has been shown to stimulate ovarian steroidogenesis and hyperinsulinaemia has been implicated in the raised androgen levels found in diseases associated with significant insulin resistance, ovarian function has not been studied so far in women with NIDDM. We have assessed ovarian function in women with NIDDM at the early (hyperinsulinaemic) and late (relative insulinopaenic) stages of evolution of the disease after strong stimulation with buserelin, a long-acting GnRH analogue. Significant differences in ovarian function would be expected, depending on the stage of evolution of NIDDM. DESIGN Following an overnight fast, a standard OGTT (75 g, orally) was performed (0830 h) in all diabetic and control women. Blood samples were obtained for blood glucose, insulin and C-peptide measurements before and at 30-minute intervals for 2 hours. On the termination of the OGTT, a buserelin test (100 μg, s.c.) was performed (1030 h) and blood samples were obtained for FSH, LH, Δ₄-androstenedione, total testosterone, free testosterone and oestradiol measurements before and then at 4-hour intervals for 20 hours. SUBJECTS Thirty-one women with NIDDM (13 hyperinsulinaemic and 18 with relative insulinopaenia), 12 obese and 11 normally menstruating non-obese, non-diabetic women, aged 29–39 years, were studied. RESULTS The integrated response (AUC) of oestradiol to buserelin was found to be normal in hyperinsulinaemic NIDDM and obese non-diabetic women in the face of an increased free testosterone response, while in relatively insulinopaenic NIDDM women the oestradiol response was significantly reduced in the face of a normal free testosterone response. CONCLUSIONS The results suggest that in women with NIDDM the ovaries have a reduced ability to convert androgen to oestrogen, probably due to a reduction of ovarian aromatase activity. As oestrogens protect against atherogenesis, it is speculated that the relative inability of the ovaries to produce oestradiol in NIDDM women with relative insulinopaenia might be involved in the development of the macroangiopathy, which often complicates this disease.     

Increase in left ventricular chamber stiffness in patients with non-insulin dependent diabetes mellitus

Indices of left ventricular ejection and diastolic filling were measured by cineventriculography in 11 patients with non-insulin dependent diabetes mellitus without significant coronary stenosis and 11 control subjects without diabetes mellitus. Indices of left ventricular ejection, such as ejection fraction and peak ejection rate, were the same in the two groups. The left ventricular end-diastolic volume index and the rapid filling volume index were significantly smaller, the peak filling rate was lower, the left ventricular end-diastolic pressure was higher and the modulus of left ventricular chamber stiffness was larger in the diabetic patients than in the control subjects. These results indicate that left ventricular chamber stiffness is increased in patients with non-insulin dependent diabetes mellitus.     

Aortic pressure-diameter relation in patients with non-insulin dependent diabetes mellitus: new insights

Aims/hypothesis. Type II (non-insulin-dependent) diabetes mellitus is associated with macrovascular disease. Therefore, we investigated the aortic elastic properties by a new method in patients with diabetes and control patients matched with them. Methods. Patients with Type II diabetes (n = 20) and control patients without diabetes (n = 21) were enrolled in the study. All patients had coronary artery disease. Instantaneous aortic diameter was measured by an intravascular catheter developed in our institution. Instantaneous aortic pressure was measured simultaneously at the same aortic level with a catheter-tip micromanometer. Thus, aortic pressure-diameter loops were obtained and slope and intercept were calculated. Aortic distensibility, stiffness constant and energy loss were also calculated. Results. The mean age and the heart rate were similar in the two groups. The pulsatile changes in aortic diameter were greater in the control group (0.94 ± 0.4 vs 1.28 ± 0.4 mm, p < 0.01). The stiffness of the aortic wall was greater in diabetic patients as indicated from the following variables: the distensibility was less in patients with diabetes (1.16 ± 0.6 vs 1.95 ± 0.9 cm²· dyne^–1· 10^–6, p < 0.01); the slope was greater (113.4 ± 120.1 vs 51.61 ± 3.3 mmHg/mm, p < 0.01) and the intercept was less in diabetic patients (–2301.9 ± 2692.9 vs –1114.45 ± 295.6 mmHg, p < 0.01); the stiffness constant was greater in patients with diabetes (1.66 ± 1.8 vs 0.77 ± 0.8 mm^–1, p < 0.03). Aortic energy loss was, however, similar between the groups. Conclusion/interpretation. In patients with non-insulin dependent diabetes aortic elastic properties, evaluated by pressure-diameter relation, are impaired. This could play an important part in the development of vascular complications related to diabetes. [Diabetologia (2000) 43: 1070–1075] Received: 17 April 2000     

动态血压监测在非胰岛素依赖型糖尿病中的应用

对50例血压正常的非胰岛素依赖型糖尿病（NIDDM）患者进行24h动态血压监测（ABPM）。结果NIDDM组的24h平均舒张压（9．8±1．2kPa）、白天平均舒张压（10．0±1．2kPa）、夜间平均舒张压（9．5±1．2kPa）均比对照组（分别为8．8±1．0、9．1±1．0、8．1±1．1kPa）明显升高，夜间收缩压及舒张压下降百分率均明显降低，昼夜节律消失。有糖尿病肾病组患者眼底视网膜病变发生率高。提示随着血压昼夜节律的消失及夜间血压持续升高，可能导致肾病变及视网膜血管病变的发生。     

Insulin responsiveness of superficial forearm tissues in Type 2 (non-insulin dependent) diabetes

Summary Forearm perfusion studies were carried out to determine the responsiveness to insulin of the superficial forearm tissues in non-obese Type 2 (non-insulin-dependent) diabetics, and the interrelationships among plasma concentrations of glucose, insulin and non-esterified fatty acids (NEFA), tissue uptake of glucose and insulin and tissue release of NEFA. It was found that: (1) in normal subjects, up-take of glucose was dependent on glucose concentration. It was also dependent on insulin concentration in the range of 0–30 mU/l, but not over a wider range of insulin concentration (< 66 mU/l), indicating that the insulin effect was maximal at approximately 30 mU/l. In contrast, glucose uptake in diabetics was independent of glucose concentration but dependent on insulin uptake over an insulin concentration range up to 140 mU/l; glucose uptake reached the same levels as in control subjects but only at higher concentration and higher uptake of insulin. (2) Insulin uptake was directly dependent on insulin concentration and the regression coefficients were very similar in the two groups. (3) NEFA concentration fell to comparable levels in the two groups of subjects in response to insulin. It is concluded that in Type 2 diabetes: (1) the superficial forearm tissues show decreased responsiveness to the stimulatory effect of both hyperglycaemia and hyperinsulinaemia on glucose utilization but the NEFA-lowering effect of insulin is undiminished, and (2) tissue uptake of insulin is normal, despite the decrease in receptor capacity that has been demonstrated by others.     

Oxidative stress in non-insulin-dependent diabetes mellitus (NIDDM) patients

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia. The oxidative stress in diabetes was greatly increased due to prolonged exposure to hyperglycemia and impairment of oxidant/antioxidant equilibrium. Proteins and lipids are among the prime targets for oxidative stress. In the present study, the oxidative stress was evaluated in 55 diabetic patients and 40 healthy subjects by measuring the levels of protein oxidation, lipid peroxidation and some enzymatic and nonenzymatic antioxidants. The oxidative products of protein (PCG) and lipid peroxidation (MDA) and nitric oxide levels in plasma of NIDDM patients were significantly increased. However, the levels of enzymatic (GPx, SOD, catalase in RBC) and nonenzymatic (β-carotene, retinol, vitamin C & E and uric acid) antioxidants of RBC showed a significant decrease in NIDDM patients compared to normal subjects. Serum protein analysis by polyacrylamide gel electrophoresis (PAGE) showed the significant difference in the ceruloplasmin, transferrin, albumin, retinal binding protein, etc. in diabetic patients compared to healthy controls. In conclusion, the results suggest that increased protein oxidation, lipid peroxidation and NO levels, decreases the levels of enzymatic and nonenzymatic antioxidants and playing a major role in diabetic complications.