Autonomic nerve function in children and adolescents with insulin-dependent diabetes mellitus

Autonomic nerve function was assessed in 67 insulin-dependent diabetic children and adolescents and in 30 control subjects of the same age. The heart rate and blood pressure reactions to a deep breathing test (E/I ratio) and a tilt table test (acceleration and brake indices) were used. The E/I ratio, 1·54 +0·21, and the acceleration index, 25 ± 7·7, in the diabetic children were not significantly different from those of the control children, 1·51 ± 0·16 and 24 ± 7·5, respectively. Neither was any difference observed between the mean brake index values; 24·3 ± 14·6 vs 23·5 ± 7·5. However, the variance of the brake index in diabetic children was significantly higher than in control children (P< 0·005). The brake index was negatively correlated to age in the healthy control children (r= -0·48, P <0·1). The acceleration index, but not the E/I ratio, also tended to be age related (r= -0·32, P<0·01 NS). No correlation was observed between sex, glycaemic control or duration of diabetes and the autonomic nerve function. Neither were severe hypoglycaemic episodes in diabetic children related to the autonomic nerve function. It is concluded that autonomic neuropathy is uncommon in diabetic children and adolescents and that age-related index values should be used when autonomic nerve function is evaluated in children of different ages.     

肾移植后并发糖尿病的危险因素及治疗

背景：肾移植后并发糖尿病是肾移植治疗后常见的并发症之一。目的：探讨肾移植后并发糖尿病的危险因素以及临床治疗。方法：应用数据库文献检索的方法获取肾移植后并发糖尿病研究的文献,对符合研究标准的文献进行深入的数据分析,文章选取肾移植后并发糖尿病的危险因素进行深入分析,并总结国内外关于肾移植后并发糖尿病的治疗方法。结果与结论：肾移植后并发糖尿病是由多种因素作用而引起的糖代谢异常,肾移植后并发糖尿病与患者年龄、体质量指数、血脂水平、免疫抑制剂方案、急性排斥发生频率、糖皮质激素累积等因素相关。在肾移植后定期检测血糖变化,可以较早的发现糖尿病的发生,通过中西医药物降低血糖和调整免疫抑制剂等方法可以有效治疗。     

The influence of psychological factors on the self-management of insulin-dependent diabetes mellitus

This study investigated the influence of a number of psychological factors upon the practice and outcome of diabetic self-management among young adults with insulin-dependent diabetes mellitus. Health beliefs, perception of control and knowledge were assessed by scales and questionnaires and glycosylated haemoglobin results and clinic attendance records obtained for 263 patients. The results demonstrated that the sample members perceived that they were responsible for the control of their diabetes, that the benefits of following treatment were greater than any barriers and that they were knowledgeable about their diabetes. However, these factors were not predictive of the outcome variables of metabolic control or clinic attendance according to multiple regression analysis. Implications of these results for nursing practice and for future research are discussed.     

肾移植术后糖尿病的护理

目的探讨肾移植术后并发糖尿病（PTDM）的护理措施，以提高护理质量。方法对8例肾移植术后糖尿病患者进行回顾性分析，了解治疗方案，并对其护理措施进行总结。结果8例患者经饮食控制、口服降糖药及胰岛素降糖治疗，并逐渐减量激素，调整免疫抑制剂及精心护理。取得满意的效果。结论合理饮食，适度运动，坚持科学药物治疗，可有效地减少糖尿病对肾移植术后患者生活质量和存活年限的不利影响。     

Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus

AIM OF THE STUDY: Factors associated with adherence to self-care and glycaemic control were studied in 213 people with insulin-dependent diabetes mellitus using a self-report questionnaire and a biochemical indicator (glycosylated haemoglobin). METHODS: The data were collected in the Oulu Health Center and the Central Hospital of Lapland in Northern Finland. The response rate was 76%. In order to verify the reliability and validity of the instruments, we used correlation coefficients, factor analysis and item-total analysis. Internal consistency was checked by Cronbach's alpha. The connections between self-care and the background variables were examined by cross-tabulation. FINDINGS: The majority of subjects accomplished their insulin treatment as scheduled, but had more difficulties with the other aspects of self-care. According to the findings, a fifth (19%) of the respondents were neglecting their self-care. The others undertook flexible (46%), regimen-adherent (16%) or self-planned self-care (19%). The subjects who were adherent to self-care had better metabolic control than those who neglected self-care. According to logistic regression analysis, poor metabolic control (P=0.003), smoking (P=0.009) and living alone (P=0.014) were associated with neglect of self-care. Gender, concurrent diseases and complications as a result of diabetes increased the risk, but had no significant association with adherence to or neglect of self-care. CONCLUSION: The findings demonstrated that adherence to self-care does not always lead to good metabolic control, but neglect of self-care is likely to lead to poor metabolic control.     

他克莫司转换为环孢素A改善肾移植后新发糖尿病

背景：肾移植后糖尿病的发生原因目前尚不明确,一般认为与患者种族、年龄、体质量、家族史、丙肝病毒感染及免疫抑制剂方案有关.目的：探讨将他克莫司转换为环孢素A改善移植后新发糖尿病的有效性和安全性。方法：将42例符合入组标准的肾移植受者随机分为转换组（n=20）和对照组（n=22）;转换组将他克莫司转换为环孢素A,对照组不转换。从对照组确诊为新发糖尿病、转换组他克莫司转换为环孢素A的时间开始随访1年,动态监测患者的血糖状况,同时监测患者体质量指数、血清肌酐、尿素氮、尿酸、肝功能、血脂、免疫抑制剂用量及浓度范围、尿微量白蛋白、急性排斥反应发生率、感染发生率、丙肝感染率、人/肾存活率等直至随访终点。 结果与结论：随着时间的增长,转换组的空腹血糖及糖化血红蛋白逐渐改善,需要接受降糖治疗的患者例数逐渐减少,转换1年后,有11例（55%）新发糖尿病完全缓解,不需接受降糖药物治疗;而对照组,需要接受降糖药物治疗的患者例数逐渐增多,1年后所有患者均需接受治疗,而且空腹血糖及糖化血红蛋白控制情况均不如转换组。同时,转换组与对照组相比,血清肌酐、谷丙转氨酶、三酰甘油、胆固醇、尿酸等均无明显差异,而尿微量白蛋白在转换后6个月开始则明显少于对照组;两组的急性排斥反应发生率、感染发生率及人/肾存活率均无明显差异。将他克莫司转换为环孢素A,短期内（1年内）改善肾移植后新发糖尿病是安全而有效的。     

An overview on the development of a bio-artificial pancreas as a treatment of insulin-dependent diabetes mellitus

This paper presents the concept and most of the research undertaken all over the world for the development of a bio-artificial pancreas (BAP) device over the last 30 years. The devices studied, meant to mimic the insulin secretion of the natural organ, were diverse and have been reviewed. Allogeneic or xenogeneic cells or cell clusters have been separated from the host's immune system by synthetic biocompatible semipermeable membranes to prevent the need, of the host, for immune-suppressing regimens. The biocompatible polymer used as a barrier and its intrinsic characteristics, the cell immobilization or suspension media, the existence or not of co-immobilized molecules or cells, the number of devices used and the implantation site, were addressed.     

Abnormal plasma noradrenaline response and exercise induced albuminuria in type 1 (insulin-dependent) diabetes mellitus

Submaximal exercise provokes an abnormal elevation in albuminuria in type 1 (insulin-dependent) diabetes mellitus. Plasma catecholamines might be involved in this phenomenon by a renal vasoconstrictive effect. Twelve healthy subjects (Controls: albuminuria < 10 μg min^-1), 13 normoalbuminuric type 1 diabetic patients (DNormo: albuminuria < 10μg min^-1) and 13 microalbuminuric type 1 diabetic patients (DMicro: albuminuria 10–200 μg min^-1) performed a fixed bicycle workload (600 kpm for 20 min + urine collection 40 min post exercise). None of the patients suffered from autonomic neuropathy or hypertension. Fractional albumin clearance (FalbCl) rose in DNormo (p=0.02) and DMicro (p=0.01) but not in the Controls (p=0.40). Basal plasma adrenaline and noradrenaline were not different in the three groups. The increments in noradrenaline were more pronounced in DNormo and DMicro than in Control (Controls < DNormo, p < 0.05; Controls < DMicro, p < 0.01). The changes in FalbCl were significantly correlated with the changes in noradrenaline (all subjects r=0.65, p < 0.001). The increments in adrenaline were not different in the diabetic groups compared to the controls, and were not related to the changes in FalbCl. Multiple regression analysis showed that changes in plasma noradrenaline (p < 0.002) and in mean arterial pressure (p < 0.005) independently contributed to the changes in FalbCl (multiple r=0.73).

It is concluded that the exercise-induced plasma noradrenaline response is increased in normo-and microalbuminuric type-1 diabetic patients. Noradrenaline appears to contribute in the exercise-induced changes in renal protein handling, possibly by its effect on renal haemodynamics.     

Ocular and systemic reactivity to isoprenaline in patients with insulin-dependent diabetes mellitus

There is experimental evidence of decreased β-adrenergic myocardial sensitivity in patients with insulin-dependent diabetes mellitus (IDDM). In the present study we hypothesized that the ocular response to isoprenaline, as a consequence of increased arterial vessel rigidity, might also be blunted in patients with IDDM. We therefore compared the correlation between systemic pulse pressure amplitude (PPA) and fundus pulsation amplitude (FPA) during intravenous isoprenaline administration in 11 otherwise healthy IDDM patients and 11 healthy control subjects. Ocular fundus pulsations were measured by a recently developed laser interferometric method. Isoprenaline increased PPA in both study groups in a dose-dependent way, but the response was significantly less in IDDM patients (at 0.8 μg min⁻¹: + 38% in control subjects, + 27% in IDDM patients, P  < 0.05 between groups). Moreover, a dose-dependent increase in FPA was observed, which again was more pronounced in healthy subjects (at 0.8 μg min⁻¹: + 45% in controls, + 17% in IDDM patients, P  < 0.005 between groups). The regression line between PPA and FPA was very close to the 45° line in healthy subjects, whereas it was significantly flattened in IDDM patients. In conclusion, linear regression between PPA and FPA during isoprenaline suggests arterial stiffening in patients with IDDM. Hence, comparison of systemic PPA and FPA during isoprenaline provocation may be a useful method of estimating changes in arterial capacitance in patients with diabetes mellitus.     

A comparison of direct measures of glycaemia and glycated blood proteins in insulin-dependent diabetes mellitus

We have studied associations between various direct measures of glycaemia and glycated blood proteins in 113 subjects with insulin-dependent diabetes mellitus (IDDM), and examined whether or not the 'fructosamine' assay results were affected by differing patient serum concentrations of lipids, albumin or C peptide. Serum fructosamine correlated less closely with HbA1 (r = 0.44) than did HbA1 with glycated serum albumin (GSA) (r = 0.68). Serum fructosamine and GSA also were poorly correlated (r = 0.48). Although fructosamine, HbA1 and GSA correlated to a similar degree with fasting blood glucose (r range 0.34 to 0.37), GSA was most closely related to mean blood glucose (r = 0.39 vs. 0.30-0.35) and the M value (a marker of diurnal glycaemic instability) (r = 0.42 vs. 0.33-0.35). The serum concentration of fructosamine was not significantly affected by a variation in serum cholesterol, but tended to be lower in subjects with moderate hypertriglyceridaemia (p = 0.05). The fructosamine assay may be altered by moderately lipaemic serum but is not affected by serum albumin concentration in normoalbuminaemic patients with IDDM. Our study indicates, however, that GSA is a more reliable marker of short-term glycaemic control in IDDM than fructosamine.     

肾移植后糖尿病：可改变与不可改变的危险因素

背景：肾移植后糖尿病是肾移植的主要并发症,了解其发生的危险因素并进行预防,可提高肾移植患者的存活率。目的：探讨肾移植后糖尿病发生的高危因素。方法：应用文献检索的方法获取肾移植后糖尿病发生危险因素的相关研究文献,对符合研究标准的文献进行深入的数据分析。对进行肾移植的患者进行空腹血糖、餐后2 h血糖、糖化血红蛋白以及肝功能、免疫抑制剂浓度谷值等各项指标的检测观察,分析肾移植后糖尿病的发生是否与患者性别、年龄、体质量指数、糖尿病家族史、肾移植后糖尿病起病时间、肝功能以及免疫抑制剂和激素的应用等因素有关。结果与结论：研究结果显示,肾移植后糖尿病患者的症状不典型,起病早,胰岛功能受损,肝功能异常。肾移植患者的年龄、体质量指数、糖尿病家族史、糖耐量异常、肝功能异常以及免疫抑制剂的应用均是肾移植后糖尿病发生的高危因素,而患者性别则与肾移植后糖尿病的发生无明显相关性。了解肾移植后糖尿病发生的高危因素有助于预防移植后糖尿病的发生,提高肾移植患者的存活率。     

Normal lipoprotein(a) concentrations and apolipoprotein(a) isoforms in patients with insulin-dependent diabetes mellitus

Lipoprotein(a) [Lp(a)] is an LDL particle in which apoliporotein B-100 is attached to a large plasminogen-like protein called apolipoprotein(a) [apo(a)]. Apo(a) has several genetically determined phenotypes differing in molecular weight, to which Lp(a) concentrations in plasma are inversely correlated, and plasma Lp(a) concentrations above 20-30 mg dl-1 are an independant risk factor for ischaemic heart disease (IHD). To investigate whether Lp(a) could be important for the high cardiovascular mortality rate in patients with insulin dependent diabetes mellitus (IDDM), we determined Lp(a) concentrations and phenotypes in a group of 108 men (median age 32 years) with IDDM without nephropathy. A group of 40-year-old men (n = 466) served as controls. The median Lp(a) concentration was 7.4 mg dl-1 [95% CI 4.9 to 11.7] in the diabetic patients and 6.3 mg dl-1 [95% CI 5.2 to 7.0] in controls. The Lp(a) concentration exceeded 30 mg dl-1 in 22% of IDDM patients and in 20% of controls (P = 0.13). Moreover, the distribution of apo(a) phenotypes did not differ between patients and control. Lp(a) levels and apo(a) phenotypes are thus apparently the same in IDDM patients without nephropathy and controls. These findings do not exclude the possibility that Lp(a) may be increased in patients with nephropathy in whom coronary artery disease frequently co-exist or that Lp(a) in a given concentration is more atherogenic in IDDM patients than in persons without IDDM.     

Persons with insulin-dependent diabetes mellitus: acceptance and coping ability

AIMS: The purposes of this study were to describe how persons with insulin-dependent diabetes mellitus (IDDM) accept their disease and what sense of coherence they have, in order to determine whether a person's acceptance of the disease is related to his or her sense of coherence. Whether acceptance of the disease and sense of coherence are related to the disease duration, complications of the disease, metabolic control and demographic data would also be determined. DESIGN: One hundred and seven, randomly selected, insulin-dependent, diabetic subjects (47 men and 60 women) participated in the study. The Acceptance of Disability Scale Modified (ADM scale), the Sense of Coherence Scale (SOC scale), a study-specific questionnaire and the patients records were used to collect the data. BACKGROUND: IDDM implies a major change in way of life. Ingrained procedures and patterns of behaviour must be adapted to the disease and its treatment. RESULTS: The results of the present study show that educational level seems to be an important factor for how well a person accepts the disease and the sense of coherence. Persons with higher scores on the ADM and the SOC scales had higher levels of education. Moreover, they also had a better metabolic control. Individuals with a poor metabolic control had more disease-related complications. A significant correlation between the ADM and the SOC scores was found, indicating that persons with a high degree of acceptance of the IDDM also had a high coping capability. CONCLUSIONS: It is important to individualize the care of subjects with IDDM and to identify the persons with low acceptance of their disease and a low sense of coherence.     

Islet cell transplantation for the treatment of diabetes mellitus

Diabetes mellitus is estimated to affect at least 16 million individuals in the United States and 135 million persons worldwide. It is a significant cause of morbidity and early mortality. The related expenses are astronomical with at least 15% of healthcare expenditures in the United States being used for the treatment of diabetes and its complications, a figure that approaches US$100 billion annually. The Diabetes Control and Complications Trial (DCCT) convincingly showed that intensive glucose management delays the onset and slows the progression of diabetic complications. Numerous studies have shown that pancreas transplantation not only delays the onset and progression of diabetic complications, but in some cases reverses some of the effects of diabetes. Human islet cell transplantation provides an alternative, less invasive alternative to whole organ transplantation. Human islet allotransplantation would only exacerbate the organ shortage, as recipients usually require islets from more than one pancreas. Xenotransplantation of porcine islets is a more attractive option; however, the recipient’s immune response to xenografted tissue would be a formidable obstacle. Microencapsulation of the islets is a method of immunoisolation that would prevent the need for immunosuppressive drugs and the risks associated with their long-term use and have the potential to make xenoislet transplantation a clinical reality.     

Peripheral macro-and microcirculation in short-term insulin-dependent diabetes mellitus: the role of prostaglandins in early haemodynamic changes

Abstract. To determine whether vasodilator prostaglandins are involved in the peripheral hyperperfusion observed in patients with short-term insulin-dependent diabetes mellitus (IDDM), forearm and skin blood flow were studied before and after cyclooxygenase inhibition. Skin nutritive (CBV: capillary bloodcell velocity) and thermoregulatory (LDF: laserDoppler fluxmetry), and forearm (muscle) blood flow (FBF) were measured before and after 500 mg acetylsalicylic acid (ASA) infused intravenously in 14 short-term IDDM patients and 22 healthy control subjects. In the IDDM patients, baseline LDF (median: 27 (19–35); interquartile range) vs. 17 (15–23) pu) and FBF (3.4 (2.5–4.1) vs. 2.6 (2.2–2.9) ml 100 ml^-1 min-¹) were increased, while CBV (0.70 (0.40–1.33) vs. 069 (0.41–0.96) mm s^-1) was unchanged compared to healthy controls. ASA infusion had similar effects on baseline CBV, LDF, and FBF in patients and controls. In eight of the control subjects the role of prostaglandins in the regulation of basal peripheral blood flow was studied before and after ASA and placebo infusion. The changes in baseline CBV, LDF, and FBF were similar after ASA and placebo infusion in healthy controls. In conclusion, in short-term IDDM patients, increased skin thermoregulatory and forearm (muscle) blood flow are probably not related to vasodilator prostaglandins. Furthermore, prostaglandins are not likely to be involved in regulating basal peripheral blood flow in healthy man.     

Thyroid-stimulating immunoglobulins in insulin-dependent diabetes mellitus

Abstract. Increased frequencies of thyroid diseases and thyroid microsomal antibodies have been observed in insulin-dependent diabetes mellitus. However, the exact prevalence of thyroid-stimulating immunoglobulins has not been established. In the present study these antibodies were measured by both a radioreceptor and an adenylate-cyclase stimulation assay.
In forty-six patients with insulin-dependent diabetes mellitus without endogeneous insulin production (C-peptide concentration ≤ 0·06 nmol l^-1) the receptor assay was positive in ten and the stimulation assay in fifteen patients. The immunoglobulins of four patients inhibited the adenylate cyclase, and one of these was positive in the receptor assay. In nine patients with post-prandial C-peptide 0·07–0·19 nmol l^-1, five had adenylate-cyclase-stimulating antibodies, while none were positive in the receptor assay. Thyroid hormones and thyrotropin concentrations were not different in the forty-six patients without endogenous insulin production with thyroid-stimulating immunoglobulins compared with patients without these antibodies. Patients with thyroid-stimulating immunoglobulins required a daily median amount of 0·71 IE of insulin kg^-1 compared to median of 0·57 IE kg^-1 in patients without these antibodies ( P < 0·03), despite a similar degree of diabetic regulation.
The level of tri-iodothyronine was correlated to the antibody level in patients with adenylate-cyclase-stimulating antibodies. While the prognostic and possibly pathogenetic importance of these antibodies in Graves' disease have been established, their significance in insulin-dependent diabetes mellitus remains to be demonstrated.     

Influence of residual C-peptide secretion on the arginine vasopressin response to hypoglycaemia and metoclopramide in insulin-dependent diabetes

Abstract. Arginine vasopressin (AVP) hypersecretion in response to metoclopramide or to insulin-induced hypoglycaemia has been described in type I diabetes mellitus. In the present study, we examined whether residual endogenous insulin secretion may play a role in the control of this abnormal AVP secretory pattern. For this purpose, 21 insulin-dependent diabetic men and 10 age- and weight-matched normal men were tested with MCP (20 mg in an i.v. bolus). On a different occasion, subjects were tested with insulin (0.15IU kg^-1). The diabetic patients were subdivided into C-peptide negative patients (CpN, 11 patients without detectable endogenous pancreatic β cell activity) (group I) and C-peptide positive patients (CpP, 10 patients with residual endogenous insulin secretion) (group II). Experiments started after optimization of the metabolic status of the diabetic men by 3 days of treatment with continuous subcutaneous insulin infusion. The basal concentrations of AVP were similar in all groups. The administration of MCP induced a striking elevation in plasma AVP levels in the normal controls and in the diabetic subjects of groups I and II. However, the AVP rise was significantly higher in group I and group II than in normal controls. Furthermore, group I diabetics showed higher AVP increments than group II. Insulin induced a similar hypoglycaemic nadir in all subjects at 30 min, even though the diabetic subjects of groups I and II had a delayed recovery in blood glucose levels. The hypoglycaemic pattern was similar in group I and II. Hypoglycaemia induced a striking AVP increase in the normal controls. However, significantly higher AVP responses to hypoglycaemia were observed in the diabetic men of group I and group II than in the normal controls. Furthermore, group I diabetics showed higher AVP increments than group II. These data indicate that the hypothalamic-pituitary disorder affecting the AVP response to MCP and insulin-induced hypoglycaemia in well controlled type I diabetic men is inversely related to residual β-cell activity.     

Preserved vasodilator response to adenosine in insulin-dependent diabetes mellitus

Experimental data derived from animal models suggest that the endogenous nucleoside adenosine has important cardioprotective properties. The potent vasodilator effects of adenosine may contribute to this cardioprotection as ischaemia-induced release of endogenous adenosine has been suggested to adjust local blood flow to the metabolic demands of the tissue. Interestingly, the vascular effects of adenosine appeared to be impaired in animal models for diabetes mellitus. This observation may be of importance with respect to the increased cardiovascular mortality in diabetes. Therefore, the authors investigated the in vivo vasodilator effects of adenosine in insulin-dependent diabetic patients. In 12 uncomplicated insulin-dependent male diabetic patients and 12 healthy male age-matched subjects, the brachial artery was cannulated for infusion of adenosine (0.15, 0.5, 1.5, 5, 15 and 50 μg 100^?1 mL min^?1) and for measurement of mean arterial pressure (MAP). Forearm blood flow (FBF) was measured by venous occlusion mercury-in-silastic strain gauge plethysmography. Maximal vasodilatation was assessed by standardized post occlusive reactive hyperaemia (PORH). Baseline forearm blood flow was 2.7 ± 0.4 and 1.8 ± 0.2 0.2 mL 100^?1 mL min^?1 for the diabetic patients and control group respectively. In the diabetic patients, adenosine infusion raised forearm blood flow to 2.4 ± 0.4, 2.6 ± 0.4, 4.4 ± 0.7, 6.3 ± 1.0, 9.8 ± 1.5 and 14.2 ± 2.1 mL 100^?1 mL min^?1 for the respective dosages. In the control group these values were 1.7 ± 0.21, 1.9 ± 0.3, 3.2 ± 0.8, 6.0 ± 1.2, 10.9 ± 2.1 and 17.1 ± 3.4 mL 100^?1 mL min^?1 respectively (P > 0.1 for between group comparison). Forearm blood flow at the contralateral side was not significantly affected by the placebo and adenosine infusions. Similar results were obtained when results were expressed as changes in forearm vascular resistance or forearm blood flow ratio (FBF infused arm/FBF control arm). Maximal vasodilatation did not differ between the two groups. The authors conclude that the forearm vasodilator response to adenosine is preserved in uncomplicated insulin-dependent diabetic patients. This observation argues against a primary role of a reduced adenosine responsiveness in the cardiovascular sequelae of diabetes.