The British Diabetic Association Cohort Study, II: cause-specific mortality in patients with insulin-treated diabetes mellitus.

AIMS: To measure cause-specific mortality, by age, in patients with insulin-treated diabetes incident at a young age. METHODS: A cohort of 23 752 patients with insulin-treated diabetes diagnosed under the age of 30 years, from throughout the United Kingdom, was identified during 1972-93 and followed to February 1997. Death certificates have been obtained for deaths during the follow-up period and cause-specific mortality rates and standardized mortality ratios by age and sex are reported. RESULTS: During the follow-up period 949 deaths occurred and at all ages mortality rates were considerably higher than in the general population. Acute metabolic complications of diabetes were the greatest single cause of excess death under the age of 30 years. Cardiovascular disease was responsible for the greatest proportion of the deaths from the age of 30 years onwards. CONCLUSIONS: Deaths in patients with diabetes diagnosed under the age of 30 have been reported and comparisons drawn with mortality in the general population. To reduce these deaths attention must be paid both to the prevention of acute metabolic deaths and the early detection and treatment of cardiovascular disease and associated risk factors.     

Challenges in secondary stroke prevention: prevalence of multiple metabolic risk factors,including abnormal glycaemia,in ischaemic stroke and transient ischaemic attack

Background: Secondary prevention of ischaemic stroke (IS) and transient ischaemic attack (TIA) mandates identification and treatment of multiple metabolic risk factors. The aim was to determine the prevalence of abnormal glycaemia, hypertension and dyslipidaemia in patients presenting to an Acute Stroke Unit of a tertiary referral teaching hospital with IS or TIA. Methods: We reviewed the clinical characteristics of consecutive patients presenting with symptoms of acute stroke or TIA between 1 February 2006 and 30 June 2007 to determine the prevalence of diabetes, impaired fasting glucose (IFG), post‐stroke dysglycaemia (PSD), hypertension and dyslipidaemia. Results: Mean age ± SD of the 224 patients (84 female) was 71 ± 15 years. Seventy per cent (n= 157) of patients presented with IS and 30% (n= 67) with TIA. Of the cohort, 15% (n= 33) had previously diagnosed diabetes, 10% (n= 22) were diagnosed with diabetes during admission and 19% (n= 42) had IFG diagnosed during admission. A further 4% (n= 9) were classified as having PSD. Sixty‐two per cent (n= 139) of patients had previously diagnosed hypertension; another 7% (n= 15) were diagnosed during admission. Eighty‐eight per cent (n= 197) of patients had dyslipidaemia. Thirty per cent had all three risk factors concurrently. Conclusion: Abnormal glycaemia was present in almost half the patients presenting with IS/TIA, with the majority of cases undiagnosed. One‐third of patients had abnormal glycaemia, hypertension and dyslipidaemia concurrently. Patients presenting with stroke should be routinely screened for abnormal glycaemia in concert with other vascular risk factors.     

Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway

Aims/hypothesis We examined long-term total and cause-specific mortality in a nationwide, population-based Norwegian cohort of patients with childhood-onset type 1 diabetes. Materials and methods All Norwegian type 1 diabetic patients who were diagnosed between 1973 and 1982 and were under 15 years of age at diagnosis were included (n=1,906). Mortality was recorded from diabetes onset until 31 December 2002 and represented 46,147 person-years. The greatest age attained among deceased subjects was 40 years and the maximum diabetes duration was 30 years. Cause of death was ascertained by reviews of death certificates, autopsy protocols and medical records. The standardised mortality ratio (SMR) was based on national background statistics. Results During follow-up 103 individuals died. The mortality rate was 2.2/1000 person-years. The overall SMR was 4.0 (95% CI 3.2–4.8) and was similar for males and females. For ischaemic heart disease the SMR was 20.2 (7.3–39.8) for men and 20.6 (1.8–54.1) for women. Acute metabolic complications of diabetes were the most common cause of death under 30 years of age (32%). Cardiovascular disease was responsible for the largest proportion of deaths from the age of 30 years onwards (30%). Violent death accounted for 28% of the deaths in the total cohort (35% among men and 11% among women). Conclusions/interpretation Childhood-onset type 1 diabetes still carries an increased mortality risk when compared with the general population, particularly for cardiovascular disease. To reduce these deaths, attention should be directed to the prevention of acute metabolic complications, the identification of psychiatric vulnerability and the early detection and treatment of cardiovascular disease and associated risk factors. Electronic Supplementary Materials Supplementary material is available in the online version of this article at . T. Skrivarhaug et al.: Mortality of type 1 diabetes in Norway     

Influence of an antidiabetic treatment with sulfonylurea drugs on long-term survival after acute myocardial infarction in patients with type 2 diabetes. The LAngendreer Myocardial infarction and Blood glucose in Diabetic patients Assessment (LAMBDA).

INTRODUCTION: Patients with type 2 diabetes show a significantly higher mortality after acute myocardial infarction than non-diabetic patients. The influence of sulfonylureas on the survival after acute myocardial infarction is still under debate. PATIENTS AND METHODS: Survival of 562 patients, consecutively admitted to an intensive care unit with the diagnosis acute myocardial infarction, was prospectively assessed for > 3 years. At the time of hospital admission, patients were grouped as (a) non-diabetic patients; (b) patients with newly diagnosed type 2 diabetes; (c) patients with known type 2 diabetes not treated with sulfonylureas and (d) patients with known type 2 diabetes treated with sulfonylureas. Survival-analysis was performed according to Kaplan-Meier. RESULTS: 324 patients were non-diabetics, in 86 cases type 2 diabetes was newly diagnosed at the time of hospital admission, 77 patients with known diabetes had taken sulfonylureas (glibenclamide in all cases) prior to the acute myocardial infarction, 75 patients were on any other antidiabetic treatment. Long-term-survival was significantly shorter in patients with type 2 diabetes compared to the non-diabetic patients (p < 0.0001). However, no significant differences were observed between the patients with type 2 diabetes treated with sulfonylurea-drugs and those receiving any other antidiabetic treatment (p = 0.53) CONCLUSIONS: An antidiabetic treatment with sulfonylurea-drugs prior to acute myocardial infarction does not have negative effects on the long-term survival. Larger prospective studies will be necessary to finally clarify this question.     

UK Prospective Diabetes Study. IV. Characteristics of Newly presenting Type 2 Diabetic Patients: Male Preponderance and Obesity at Different Ages

The characteristics of newly presenting Type 2 diabetes mellitus have been examined in 1857 newly diagnosed diabetic patients aged 25–65 years inclusive. The males were less obese than the females (121% vs 141% IBW, respectively), but a male-dominated sex ratio of 1.54 was found. Taking into account the prevalence of obesity in the general population, males had a 2.5-fold relative risk of presenting with diabetes, although with increasing obesity the male preponderance was lost. Presentation increased with age up to the age of 55 years. Patients presenting at all ages had similar glycaemia and were similarly obese. Those presenting at a younger age were usually particularly obese in relation to the general population. Obese patients were less physically active than normal weight patients. Type 2 diabetes had a seasonal variation of presentation with a peak in January to April.     

Presenting features at diagnosis and complications of hemophilia in Dakar: apropos of 25 cases

In order to describe the presenting features at diagnosis and complications of hemophilia in Dakar, we conducted a study of hospital records between October 1991 and January 1993. Twenty-five cases of hemophilia were identified. We found that only 4% of our patients were diagnosed in the first 6 months of life whereas 64% of patients were diagnosed between 6 months and 5 years of age, 32% were detected between 5 years and 14 years of age. The presenting feature at diagnosis was external bleeding in 60% of cases and internal bleeding in 40%. 92% of cases were hemophilia type A and only 8% hemophilia type B. 56% of patients had mild hemophilia, 40% moderate and only 4% severe disease. Hemophiliac arthropathy was present on radiography in 76%. Complications were dominated by repeated joint bleeding, which was present in 92% of patients, and repeated hematomas (80% of patients). A functional handicap was present in 60% of cases. 12% of transfused hemophiliacs developed an inhibitor and 4% of patients were HIV positive. Greater awareness of hemophilia amongst the medical community as well as continued efforts to improve care for hemophiliacs in Senegal are necessary.     

Acute urinary retention in the elderly: an unusual presentation of appendicitis with a high perforation risk

BACKGROUND: Urological manifestations are rare in acute appendicitis. Although acute urinary retention (AUR) is more commonly found in elderly patients, any previous cases reported have been under the age of 30. OBJECTIVE: The aim of this study was to investigate the incidence, clinical presentation, and results of adult appendicitis patients presenting with AUR. AUR is defined as the sudden inability to urinate with obstructive symptoms. METHODS: A retrospective case note review of 480 adult patients (>/=18 years) with appendicitis, diagnosed at the Veterans General Hospital-Taipei over a 3-year period, was carried out. RESULTS: Six patients (1.3% of the adults or 3.9% of the elderly patients), 5 men and 1 woman averaging 71.5 years of age, presented with AUR. Associated existing diseases were benign prostatic hyperplasia in 2 of the males and surgical repair for uterine prolapse in the only female. The mean duration from initial gastrointestinal symptoms to AUR was 1.7 days. The quantity of residual urine ranged from 180 to 450 ml. All patients had persistent right lower quadrant tenderness and hematuria. Five (83.3%) were found to have a perforated appendix at operation, and their average hospital stay was 14.7 (8-29) days. CONCLUSIONS: AUR may occur as an initial presentation in acute complicated appendicitis in the elderly. It has been reported that the prolonged hospital stay might be related to the delayed diagnosis and resulting complications arising in these patients. Primary care physicians need to be reminded that this common genitourinary complaint may arise in patients with acute appendicitis. When confronted with a geriatric patient presenting with AUR, one should entertain an alternative diagnosis and a reexamination of the patient is mandatory.     

Evaluation of a hospitalization unit opened during the winter influenza epidemic of 1999-2000

PURPOSE: Last winter, a great many patients with influenza-like infection were admitted to our hospital, leading us to open a specific unit for 6 weeks. We report the evaluation of medical care given to these patients. METHODS: Useful data for evaluating care to patients presenting respiratory infections were determined beforehand by the retrospective analysis of patients' charts. RESULTS: Fifty-seven out of 185 admitted patients (31%) had infectious respiratory symptoms. The mean age was 81 years. Six cases of influenza virus infection, 43 cases of viral bronchitis, six cases of bacterial pneumonia, one superinfected asthma and one septic shock were diagnosed. All patients presented with cardiac and/or chronic pulmonary diseases. Influenza vaccination had been performed in 28 patients (49%). Before hospitalisation, 30 patients (52%) had received antibiotics, and 17 (30%) a steroid therapy. In contrast, only 12 patients (21%) have received anti-infective agents during the hospitalisation. Twenty-five patients were able to go back home and a nursing home was required for 27 patients (47%); five patients died. Tools for improving this specific department in a public hospital are discussed. CONCLUSION: Vaccinations in the elderly appear to be poorly utilized; meanwhile, antibiotic treatments, as well as steroid therapy, are overused. Managing epidemic infections requires attention from the public hospital system.     

Relationship between the exocrine and endocrine pancreas after acute pancreatitis

AIM:To determine the prevalence and time course of pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis.METHODS:Relevant literature cited in three major biomedical journal databases(EMBASE,MEDLINE,and Scopus)was reviewed independently by two authors.There were no language constraints but the search was limited to human studies.Studies included were cohort studies of adult patients who were discharged after an attack of acute pancreatitis.Patients were excluded if they were under 18 years of age or had a previous diagnosis of prediabetes or diabetes mellitus,pancreatic exocrine insufficiency,or chronic pancreatitis.The main outcome measure was the prevalence of concomitant pancreatic exocrine insufficiency in patients who were diagnosed with prediabetes and diabetes mellitus after an attack of acute pancreatitis.Subgroup analysis was conducted for patients who were diagnosed with prediabetes only and those who were diagnosed withdiabetes mellitus only.Subgroup analysis looking at the time course of concomitant pancreatic exocrine and endocrine insufficiency was also conducted.Pooled prevalence and corresponding 95%confidence intervals were calculated for all outcome measures and P-values<0.05 were deemed statistically significant.RESULTS:Eight clinical studies comprising of 234patients met all eligibility criteria.The pooled prevalence of newly diagnosed prediabetes or diabetes in individuals after acute pancreatitis was 43%(95%CI:30%-56%).The pooled prevalence of pancreatic exocrine insufficiency in individuals after acute pancreatitis was 29%(95%CI:19%-39%).The prevalence of concomitant pancreatic exocrine insufficiency in individuals with newly diagnosed prediabetes or diabetes was 40%(95%CI:25%-55%).The prevalence of concomitant pancreatic exocrine insufficiency among individuals with prediabetes alone and diabetes mellitus alone was 41%(95%CI:12%-75%)and 39%(95%CI:28%-51%),respectively.Further analysis showed that the prevalence of concomitant pancreatic exocrine insufficiency in individuals with prediabetes or diabetes decreases over time after an attack of acute pancreatitis.CONCLUSION:Pancreatic exocrine insufficiency occurs in 40%of individuals with newly diagnosed prediabetes or diabetes mellitus after acute pancreatitis.Further studies are needed to investigate the pathogenesis of diabetes in this setting.     

Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes

Aims/hypothesis The aim of this study was to investigate the prevalence of fulminant type 1 diabetes and the clinical characteristics of the disease among newly diagnosed Korean patients. Methods Using data retrieved from the Seoul National University Hospital database, we identified all patients newly diagnosed with type 1 diabetes from 1 January 1999 to 31 July 2006. Information on clinical manifestations and laboratory data, including the presence of islet autoantibodies detected at diagnosis, were obtained by reviewing medical records. Results We identified 99 patients newly diagnosed with type 1 diabetes. Seven patients (7.1%) fulfilled the criteria for fulminant type 1 diabetes. Among the patients aged ≥18 years at onset, 30.4% had fulminant type 1 diabetes. Patients with this diabetes subtype tested negative for islet autoantibodies, had a higher age of onset (median 28 vs 10 years, p < 0.001) and a markedly shorter duration from onset of hyperglycaemic symptoms to first hospital visit (median 3 vs 30 days, p < 0.001) than patients with non-fulminant type 1 diabetes, and showed trends of increased serum aspartate aminotransferase and amylase levels and a decreased glucagon-stimulated serum C-peptide response. Conclusions/interpretation In Korea, the prevalence of fulminant type 1 diabetes was 7.1% among all patients newly diagnosed with type 1 diabetes and 30.4% among patients with adult-onset diabetes. The clinical and metabolic characteristics of the patients with fulminant type 1 diabetes were similar to those reported in Japanese studies. Y. M. Cho and J. T. Kim contributed equally to this work.     

Young Chinese adults with new onset of diabetic ketoacidosis--clinical course, autoimmune status and progression of pancreatic beta-cell function.

AIMS: To examine the clinical course, autoimmune status and pancreatic beta cell function, over a 2-year period, in young Chinese subjects newly presenting with diabetic ketoacidosis (DKA). METHODS: A prospective study involving 562 out of 27,893 patients who were admitted to the medical ward with a principal diagnosis of diabetes mellitus during the recruitment period of 1 year. RESULTS: Of these 562 patients, 27 were aged less than 35 years and admitted with a diagnosis of DKA and 11 (six males and five females) of these were newly diagnosed. Antibodies to glutamic acid decarboxylase (GAD) were present in five patients. Anti-ICA 512 was not detected in any of the patients. Basal and post-glucagon stimulated plasma C-peptide remained in the insulin-deficient range although showing improvement at 2 years. CONCLUSIONS: These findings confirm the relative rarity of autoimmune Type 1 diabetes in young Chinese. Even when the clinical presentation takes the extreme form of acute DKA, less than 50% have positive autoimmune markers.     

Childhood diabetes mellitus in Ethiopians

Of 1088 consecutive Ethiopian diabetic patients registered over 9 years 80 (7.4%) were diagnosed at or before age 15 years. There were 48 girls and 32 boys, with mean age of onset of 10.1 years. Diabetes had been present 10 years or less in 62, 11 to 20 years in 15, and more than 20 years in only 2. Twenty-two were rural, 27 had poverty certificates. Twenty-three have known diabetic relatives. The original mode of presentation could not be verified in 16, 7 presented in ketoacidosis, 5 were diagnosed by a diabetic relative, and the rest presented with the rapid onset of classical symptoms. To date, 43 have been ketoacidotic at least once. No pancreatic calcification was seen in 34 abdominal radiographs. Three of 6 newly diagnosed patients tested had islet cell surface antibodies. Three cases, initially suggestive of 'tropical malnutrition diabetes', evolved into typical type 1 diabetes. Serious complicating illnesses were tuberculosis (6), bacterial endocarditis (1) and rhinocerebral mucormycosis (1). Six patients have had metabolic cataracts. Ten patients (12%) have died, 4 of ketoacidosis and 4 of diabetic nephropathy. Childhood diabetes mellitus in Ethiopians is clinically very similar to type 1 diabetes elsewhere.     

老年人围手术期急性脑卒中危险因素分析

目的 分析围手术期发生急性脑卒中的相关危险因素,提出降低脑卒中发生率的预防措施.方法 回顾性分析我院近5年发生围手术期急性脑卒中老年患者的临床资料,分析各种危险因素与脑卒中发生的相关性.结果 围手术期发生急性脑卒中78例,年龄60～98岁,平均70岁,56例(71.8%)急性脑卒中发生在术后1周内.与72例无急性脑卒中患者比较,回归分析显示,高血压、脑血管病史、围手术期血压波动和肥胖是发生脑卒中的危险因素;围手术期新发心房颤动和颈动脉粥样硬化是发生脑卒中的高危因素.结论 脑卒中是围手术期常见并发症,对具有脑卒中发生危险因素患者,术前进行必要检查和积极治疗并存疾病,围手术期严密血流动力学监测、减少血压波动及加强对新发心房颤动患者的抗凝治疗,对减少围手术期急性脑卒中的发生具有积极意义.     

Type II diabetes in young subjects. A study of 90 unrelated cases

Type II, non insulin dependent diabetes mellitus is commonly diagnosed after the age of 45 years. For this reason it was previously called maturity onset diabetes. Type II diabetes occurring in young subjects has generally been described in selected pedigrees. The purpose of this work was to review data from all the unrelated type II diabetics (with fasting hyperglycemia) diagnosed before the age of 45 and observed in our department over the last four years. A total of 90 such patients including 44 men and 46 women were included in this study. Of 43 cases diagnosed before the age of 30, there were 30 women compared to only 16 women out of 47 cases diagnosed between 30 and 45 years (p less than 0.001). At the time of diagnosis 42 patients had a relative body weight lower than 120%. In 66,7% of the cases, one parent was a known diabetic. The rate of diabetes in the sibships was 50%. Differences in family history of diabetes were not observed in relation to age or weight at diagnosis. Comparison with a series of 150 conventional type II diabetics in whom diagnosis was made between 45 and 60 years of age showed a significantly greater frequency of obesity (86%) and fewer diabetic parent (36%). The mean apparent duration of diabetes was 14 years (range 5-42). Microangiopathy was not infrequent in these diabetic patients. Twenty-three patients had retinopathy, proliferative in 8 cases, and 3 were blind. Nine had renal insufficiency, severe in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Treatment and outcomes of nonagenarians with ST-elevation myocardial infarction

There is no age limit for reperfusion therapy in the current guidelines for the treatment of patients with ST-elevation myocardial infarction (STEMI). Reperfusion therapy, although associated with better outcomes, is not always offered to the oldest patients. A retrospective analysis at our institution of all patients ≥ 90 years of age with a diagnosis of acute coronary syndrome at discharge from 2004 to 2008 identified 24 patients with STEMI. The majority of patients were Caucasian, females, hypertensive, with a low incidence of dementia and diabetes. Only 29% of patients presented to the hospital in less than 6 hours. Thirteen patients were treated with percutaneous coronary intervention (PCI) and 11 patients were treated medically. The in-hospital mortality was 23% in the PCI group and 36% in the medical therapy group. Kaplan-Meier analysis demonstrated a survival benefit favoring PCI, which disappeared when only patients presenting after 6 hours to the hospital were analyzed. PCI-treated patients had no procedure-associated complications and had a good prognosis if they survived to hospital discharge. PCI should be offered to nonagenarians presenting with STEMI.     

Conventional risk factors among newly diagnosed coronary heart disease patients in Delhi

AIM:To analyze the conventional risk factors among newly diagnosed cases of coronary heart disease(CHD) admitted to a hospital in Delhi,India.METHODS:This hospital-based prospective study in-cluded 276 consecutive newly diagnosed cases of CHD in the Coronary Care Unit of a tertiary care hospital in Delhi.RESULTS:The mean age of the cases was 49.7± 9.5 years,with the youngest case aged 27 years.The two risk factors present most frequently among the cases were inadequate physical activity and abnormal lipid profile.Just about 3.6%of cases in our study had a physical activity level(PAL)that could be termed as"active",with a large proportion(96.4%)having a PAL suggestive of a sedentary lifestyle.A majority of patients were found to be current tobacco smokers(53.3%)and 188(68.1%)subjects were lifetime ever smokers.There was not a single case who did not have one or more of the risk factors.More than one-quarter(n=76)had six or more of the studied risk factors.CONCLUSION:Indians have among the CHD highest mortality rates amongst all ethnic groups studied so far.It is important to study the regional epidemiology of the cardiovascular events to allow for location-specific prevention and control programs.     

Characteristics of newly diagnosed type 1 diabetes in paediatric and adult population from Reims University Hospital,France from 1997 to 2019

French health insurance data showed that the incidence of type 1 diabetes mellitus (T1DM) in children increased over the years to 2015. The objective of our study was to assess the evolution of the number of incident cases of paediatric and adult type 1 diabetes in our institution, and to describe their clinical presentation and its evolution. All patients with T1DM managed at diagnosis at Reims University Hospital between 1997 and 2019 were included. The clinical and biological data were extracted from the Champagne-Ardenne Diabetes Network database. Included were 847 patients with a median age of 10.3 years. Diagnosis was established in 71% of cases before 15 years, 7.4% after 35 years. The number of newly diagnosed cases was 3.6-times higher in 2019 compared to 1997. Ketoacidosis, the frequency of which decreased with age (P < 0.0001), revealed diabetes in a total of 32% of cases and in 46% of children under 5 years. It was more severe in children than in adults (P = 0.03), and its frequency increased over the study period. Hypotrophy was found in 23% of children under 15 years of age, and was more pronounced before 5 years of age, with no improvement over time. We saw an increase in the frequency of obesity or overweight among adults. Our study showed an increase in incident cases of diabetes in our hospital that continued over time for both children and adults. Clinical features at diagnosis deteriorated during this period for those under 15 years of age with an increase in ketoacidosis frequency.     

Retinopathy in a Chinese population with type 2 diabetes: factors affecting the presence of this complication at diagnosis of diabetes

This study examined the prevalence of retinopathy in 2131 patients with type 2 diabetes attending a Beijing hospital for the first time. The median age of patients was 58 years (IQR 50-65). The overall prevalence of retinopathy was 27.3% (95% CI: 25.4-29.2) and for proliferative retinopathy 7.8% (95% CI: 6.7-8.9). When all patients were considered together, duration of diabetes (OR=1.8; P=0.001) and albumin excretion rate (OR=1.5; P=0.019) were independent risk factors for retinopathy. Blue-collar occupation (OR=1.5; P=0.047) and blood pressure (OR=1.2; P=0.021) were additional risk factors for non-proliferative and proliferative retinopathy respectively. Amongst the 773 newly diagnosed patients, 21% (95% CI: 17.8-23.6) already had retinopathy. The median age of those patients with retinopathy at diagnosis of diabetes was 3 years higher that those without retinopathy, and blue-collar workers (OR=2.2; P=0.012) as well as female gender were particularly at risk (OR=2.0; P=0.033). There was a strong correlation between duration of diabetes with the presence of retinopathy (r=0.95; P=0.01). By extrapolation, it could be estimated that some degree of hyperglycaemia might have been present for more than 20 years before diabetes was diagnosed. These findings emphasise the importance of earlier diagnosis of diabetes and its complications, especially in socially disadvantaged groups.     

Prevalence of dyslipidaemia, hypertension and vascular complications in newly diagnosed diabetics (prospective study: part 2)

In a 10-year prospective study of a group of 314 newly manifested diabetics (1988-1991) aged 20-65 years the authors follow up the development of diabetic complications and therapeutic methods used in diabetes. 85 patients were classified on detection of diabetes as diabetes mellitus (DM) type 1, 228 as DM type 2. At the age under 30 years there were 10 subjects (group M), the remainder (304) formed group A. In this second part of the initial results the authors provide information on biochemical changes, prevalence of hypertension and vascular complications already during manifestation of DM. Hypercholesterolaemia was detected in 29% of the group,triacylglycerylaemia was recorded in 31%. The mean cholesterol levels were in the subgroup of patients above 50 years of age significantly higher in women (6.51 mmol/l) as compared with men of similar age (5.66 mmol/l), while mean triacylglycerol levels did not differ in men and women above 50 years of age. Pathologically elevated levels of microalbuminuria were recorded in 13.7%. Hypertension was found in 42.7% diabetics type 2 in group A. 8.4% of this group were examined for ischaemic heart disease. 4.8% of the patients had an acute myocardial infarction in the case-history and 1.3% a cerebrovascular attack. Ophthalmological examination revealed in 8 type 2 diabetics (3.5%) diabetic retinopathy. CONCLUSION: In the investigated group of newly manifested diabetics aged under 65 years the authors detected a high prevalence of hypertension, hyperlipoproteinaemia and macroangiopathic complications, in particular in obese type 2 diabetics.     

39例Klinefelter综合征患者的糖尿病发生率和临床特点

目的评价Klinefelter综合征人群中MS、IGT和DM的发生率以及临床特点。方法采用横断面研究,对长期随诊的39例Klinefelter综合征患者的代谢状态、血糖水平、性激素水平进行总结,分析此特殊人群发生DM的可能高危因素,及其与核型之间的关系。结果（1）初诊时,Klinefelter综合征人群的MS发生率为30．8％,在睾酮替代治疗后（中位时间4年）发生率增加到38．5％。（2）Klinefelter综合征人群DM发生率为20．5％（8／39）,有4例在睾酮替代治疗前已经诊断为DM,另外4例在睾酮替代治疗的随访中确诊为DM。发生DM的年龄为（27．1±4．5）岁（20～55岁）,有4例（50％）患者需要胰岛素治疗,8例中有1例伴急性胰腺炎,有2例伴高TG血症。（3）Klinefelter综合征人群IGT发生率为7．7％。（4）长期随访发现,有9例患者体重明显增加,其中有2例进展为DM。结论（1）Klinefelter综合征患者的MS和DM发生率明显升高。（2）该人群DM发病年龄轻,血糖升高明显,多数需用胰岛素控制血糖。（3）染色体异常、睾酮水平降低、体重进行性增加、急性胰腺炎、高TG血症,是该人群糖代谢异常的重要危险因素。