Circulating lipids and cardiovascular risk in newly diagnosed non-insulin-dependent diabetic subjects in India

Circulating concentrations of total cholesterol, triglycerides, non-esterified fatty acids (NEFA), glycerol, and 3-hydroxybutyrate (3-HB) were measured in 133 subjects with normal glucose tolerance (NGT), 78 with impaired-glucose-tolerance (IGT) and 189 non-insulin dependent (Type 2) diabetic (NIDDM) patients. Plasma cholesterol concentration was similar in the three groups; NGT (4.2 (2.3–7.5) mmol l⁻¹ , median (range)), IGT (4.7 (2.7–6.3)) and NIDDM (4.3 (2.3–6.9)). Plasma triglycerides (NGT 0.88 (0.37–2.80), IGT 1.26 (0.43–3.82) and NIDDM 1.38 (0.62–3.91) mmol l⁻¹ ) and NEFA (NGT 0.81 (0.29–1.58), IGT 1.02 (0.33–1.87) and NIDDM 1.02 (0.48–2.77) mmol l⁻¹ ) were higher in the two hyperglycaemic groups, but blood 3-HB concentration was similar in the three groups. Plasma cholesterol concentration in these subjects is lower than that reported in white Caucasians in the UK and USA and migrant Indian NIDDM patients in the UK. In NIDDM patients plasma cholesterol concentration was related to age, body mass index (BMI), and plasma glucose concentration while plasma triglyceride concentration was related to plasma NEFA and insulin (IRI) concentration. Evidence of ischaemia on electrocardiography in patients with diabetes was associated with higher age, blood pressure, plasma triglyceride, glucose, and IRI concentrations. © 1997 by John Wiley & Sons, Ltd.     

Peripheral vascular disease and diabetic foot

Peripheral vascular disease is one component of the diabetic foot. Diabetic patients should be assessed for lower limb arterial disease resulting from the high prevalence of this complication. Medical management includes the treatment of vascular risk factors, anti-thrombotic agents, and walking rehabilitation. Vascular testing is required in the presence of a foot wound. Ischemia alone is implicated in only 10% of foot wounds, whereas inadequate tissue perfusion is often a nonhealing factor. Managing a diabetic patient with a foot wound will be more effective in a dedicated center providing vascular assessment, a multidisciplinary pre concerted plan, and vascular management. Lowering the number of major amputations in the diabetic population requires better arterial evaluation and treatment (vascular functional testing and revascularization when possible).     

Kidney function in newly diagnosed Type 2 (non-insulin-dependent) diabetic patients, before and during treatment

Summary Glomerular filtration rate, kidney volume, and urinary albumin excretion rate were studied in otherwise healthy newly diagnosed Type 2 (non-insulin-dependent) diabetic patients, untreated at diagnosis, after short-term treatment and after 3 months treatment. In 10 patients (Group A) glomerular filtration rate (measured by the plasma clearance of 51-Cr-EDTA) decreased from the time of diagnosis 106.2±14.6 ml·min^–1·1.73m^2–1 (mean±SD) to 95.9±13.7 ml·min^–1·1.73m^2–1 after 3 months treatment (p=0.049). At the same time, mean plasma glucose was reduced from 13.3±3.2 mmol/l to 6.5±1.1 mmol/l. The fall in mean plasma glucose was correlated to the reduction in glomerular filtration rate, r=0.76, p=0.011. Kidney volume as measured by ultrasonic scanning was reduced from 264.0±33.7 ml/l.73m² to 210.8±23.8 ml/l.73 m² (p<0.005). The relative decline in urinary albumin excretion rate was correlated to the fall in glomerular filtration rate, r=0.69, p=0.026. In 15 patients (Group B) 24-h urine collections were made during 9.5±3.2 days, urinary albumin excretion rate fell from the first to the last day in hospital from 14.0×/÷3.0 g/min (geometric mean ×/÷ tolerance factor) to 7.0×/÷2.7 g/min p=0.015. The relative decline was correlated to the change in mean plasma glucose, r=0.65, p=0.032.Thus, kidney function in Type 2 diabetic patients is influenced by metabolic control, although to a lesser extent than is seen in Type 1 (insulin-dependent) diabetic patients with comparable glycaemic control. Urinary albumin excretion is reduced by improvement in glycaemic control, to which it is significantly correlated. Long-term consequences of reduction in urinary albumin excretion on the development of diabetic nephropathy and on survival remains to be elucidated.     

Fatal rhinocerebral mucormycosis in newly diagnosed diabetic

A 48-year-old male developed fever and sore throat while in Spain and was admitted to hospital, dehydrated, ketotic, pyrexial, and with a blood glucose of 35 mmol/l. Despite treatment with intravenous fluids, insulin, cephalosporin, potassium and bicarbonate he returned to Britain 7 days later, underhydrated and acidotic, though euglycaemic. His face was discoloured, there was painless nasal and maxillary swelling, oral candidiasis, and he went on to develop ophthalmoplegia and sudden blindness. Staphylococcus albus and mycelial fungus were isolated, the latter was identified as Mucor hiemalis, but despite treatment with amphotericin B co-ordinated with radical maxillary-facial surgery he died 31 days after the initial symptoms. Rhinocerebral mucormycosis is a recognized complication of ketoacidosis which is rarely reported in the UK. The organism invades arteries aggressively, therefore radical therapy must be started early to prevent the high mortality.     

Prevalence of coronary heart disease,left ventricular failure and hypertension in middle-aged,newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects

Summary The prevalence of coronary heart disease, left ventricular failure and hypertension was examined in a representative group of 133 newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects (70 men, 63 women), aged 45 to 64 years, and in a group of 144 randomly selected non-diabetic control subjects (62 men, 82 women) of the same age group. The prevalence of previous myocardial infarction (major Q-QS abnormalities in resting ECG and/or myocardial infarction verified at hospital) was increased 1.7-fold in male (NS) and 4.4-fold in female (p = 0.007) diabetic patients compared with that found in non-diabetic subjects. Chest pain symptoms and ischaemic ECG abnormalities were about twice as common among diabetic than among non-diabetic subjects. The frequency of coronary heart disease defined by chest pain symptoms and ECG abnormalities was 3.5 times higher in male (p = 0.001) and 3.1 times higher in female (p = 0.001) diabetic patients than in the respective non-diabetic subjects. The frequency of current digitalis therapy was increased 3.3-fold in male (p = 0.006) and 3.9-fold in female (p = 0.001) diabetic patients suggesting an increased frequency of left ventricular failure among diabetic subjects. The prevalence of hypertension, based on the elevated blood pressure levels and/or current use of antihypertensive drugs, was increased 1.6–1.7-fold among the diabetic patients.     

Microalbuminuria predicts the development of serum lipoprotein abnormalities favouring atherogenesis in newly diagnosed type 2 (non-insulin-dependent) diabetic patients

Summary We studied the relationship of slight albuminuria (microalbuminuria) to serum lipid and lipoproteins in a representative group of middle-aged Type 2 (non-insulin-dependent) diabetic patients. A random sample of non-diabetic control subjects was also examined. Diabetic patients had both at diagnosis and after five years higher total, LDL- and VLDL-triglyceride levels and higher VLDL-cholesterol, but lower HDL-cholesterol levels than non-diabetic subjects. No consistent difference was found in LDL-cholesterol levels between diabetic and non-diabetic subjects. The prevalence of microalbuminuria (>35 mg/24 h) remained about the same in diabetic patients at both examinations (19–20%). The diabetic patients with persistent microalbuminuria were slightly hyperglycaemic and they tended to have lower creatinine clearance at the 5-year examination than those without persistent microalbuminuria. There were no differences in the blood pressure levels or the occurrence of hypertension between the diabetic groups with and without microalbuminuria. At the baseline examination, no differences were seen in serum lipids and lipoproteins between diabetic patients with and without microalbuminuria. In patients with persistent microalbuminuria. a statistically significant increase in VLDL-cholesterol (p<0.05) and VLDL- and LDL-triglyceride levels (p<0.05) and a decrease in HDL-cholesterol level (p<0.05) was seen at the 5-year follow-up. These changes could not be explained by age, sex, body mass index or HbA₁. In conclusion, persistent microalbuminuria predicts and aggravates abnormalities in lipoprotein composition and a decrease in HDL-cholesterol in patients with Type 2 diabetes mellitus. The excess cardiovascular morbidity and mortality in diabetic patients with increased albuminuria may, in part, be explained by these lipoprotein abnormalities.     

Peripheral vascular disease in Type 2 diabetic Chinese patients: associations with metabolic indices, concomitant vascular disease and genetic factors.

AIMS: Conventional and genetic risk factors have been reported to play a role in the pathogenesis of vascular disease, but do not explain the lower burden of cardiac and peripheral vascular disease (PVD) in Chinese compared with Caucasians. The role of renin-angiotensin system (RAS) gene polymorphisms and conventional vascular risk factors has not been determined. METHODS: A total of 3097 Chinese diabetic subjects were screened for PVD, which was identified in 194 of the 2967 patients with Type 2 diabetes. Biochemical parameters and the genotype and allele frequencies of three RAS gene polymorphisms, the angiotensin-converting enzyme (ACE) insertion/deletion, angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT1R) A1166C polymorphisms were then compared between the PVD patients and 1046 age, gender and diabetes duration-matched patients without PVD. RESULTS: PVD identified in 6.5% was associated with significantly worse glycaemic control, lipid profile and renal function. Smoking was more common, as were the other macro- and microvascular diseases. The prevalence of hypertension was similar between the groups, yet diastolic blood pressure was slightly lower in the PVD group. The ACE D allele was significantly more frequent in patients with PVD compared with the matched diabetic controls (38.1 vs. 29.8%, P = 0.039). No differences in the AT1R or AGT polymorphisms were observed. CONCLUSIONS: PVD was associated with a worse metabolic profile and greater concomitant vascular disease than controls. The ACE I/D polymorphism was associated with PVD in these Type 2 diabetic patients.     

胰岛自身抗体阳性的成人糖尿病患者的临床特征

在669例临床初诊为2型糖尿病患者中，胰岛细胞抗体(ICA)阳性11％，谷氨酸脱羧酶抗体(GADA)阳性11％，双抗体阳性4％。自身抗体阳性的115例和随机选取的94例自身抗体阴性的成人糖尿病患者的比较发现，自身抗体阳性的患者体质指数升高。     

Peripheral vascular disease in Behcet's syndrome

We describe a patient with Behcet's syndrome who had peripheral vascular disease involving the left subclavian artery for which angioplasty with stent placement was performed and reangioplasty done for in-stent restenosis. She presented with recurrence one year after stent placement; angiography revealed diffuse disease of the axillary and radial arteries with mild to moderate restenosis at the site of stent placement.     

Fulminant severe retinopathy in a newly diagnosed diabetic without risk factors

The authors describe a 26-year-old female developing severe proliferative retinopathy within 2 weeks of diagnosis of insulin-dependent diabetes mellitus. The patient presented with profound diabetic ketoacidosis, but had no other risk factors for retinopathy. She had marked bilateral myopia which did not protect her from retinopathy. Nine months after diagnosis of diabetes, she has profound visual impairment despite correction for myopia, and has also developed marked autonomic neuropathy and diabetic nephropathy.     

2型糖尿病的初诊冠心病患者的临床特点

目的 探讨2型糖尿病(T2DM)的经冠状动脉造影初诊冠心病患者的临床特征.方法 回顾性分析2006年1月至2007年5月期间1358例连续入院并行冠脉造影的T2DM患者的临床资料,按是否合并冠心病分成两组,比较两组患者间的一般情况、各项生化和炎症指标间的差异.结果 单因素分析表明两组间年龄、性别、BMI、糖尿病病程、吸烟、HDL-C、FPG、糖化血红蛋白(HbA1c)存在统计学差异.多因素logistic回归分析确定年龄(OR 1.032; P=0.011)、性别(OR 1.928; P=0.010)、糖尿病病程(OR 1.066; P=0.012)、HbA1c(OR 1.210; P=0.012)为糖尿病患者发生冠心病的独立危险因素.结论 T2DM患者冠心病的形成与进展可能为多因素共同参与的结果.年龄、性别、糖尿病病程和HbA1c水平在此过程中可能发挥重要作用.     

The relationship of cardiovascular risk factors to the prevalence of coronary heart disease in newly diagnosed Type 2 (non-insulin-dependent) diabetes

Summary The relationship of cardiovascular risk factors to the prevalence of coronary heart disease was examined in 133 newly diagnosed Type 2 (non-insulin-dependent) diabetic patients (70 men, 63 women) aged from 45 to 64 years and in 144 randomly selected non-diabetic control subjects (62 men, 82 women) of the same age. The prevalence of coronary heart disease in diabetic patients, defined by symptoms and ischaemic ECG abnormalities in resting or exercise ECG, was more than threefold that in non-diabetic subjects. In multiple logistic analyses (including age, history of smoking, hypertension (+/-), serum cholesterol, HDL-cholesterol, triglycerides, 2-h post-glucose serum insulin, body mass index and diabetes (+/-)) carried out separately for men and women, diabetes showed an independent, significant association to coronary heart disease in both sexes. In addition, age and hypertension had a borderline association to coronary heart disease in men, whereas smoking and high 2-h postglucose serum insulin level showed a significant association in women.     

Management of newly diagnosed non-insulin-dependent (type 2) diabetes mellitus: a retrospective audit

A retrospective survey of the case records of 130 patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) was performed to assess the effect of 1 year of clinical attendance on blood glucose control, body weight, lipid profile and blood pressure. The mean age of these patients was 63 +/- (SE) 0.1 years and 45% were 65 years or older. Body mass index (BMI) was 28.3 +/- 0.49 kg m-2 and 72% were overweight or obese. Sixty-seven percent of the patients were hypertensive (WHO criteria). Serum cholesterol was 6.0 +/- 0.2 mmol/l, HDL cholesterol 1.0 +/- 0.0 mmol/l and triglycerides 3.14 +/- 0.29 mmol/l (non-fasting). Seventy-two percent of the patients were managed on diet alone and 23% by diet plus sulphonylurea. The remaining 5% were treated by metformin or a combination of metformin plus sulphonylurea. After one year, glycated haemoglobin (HbA1) decreased from 10.7 +/- 0.3% to 8.2 +/- 0.2% (P less than 0.01; normal less than 7.5%). The sulphonylurea groups showed similar decreases in HbA1. Overall there was a small but significant fall in BMI (-0.5 +/- 0.2 kg m-2; P less than 0.05). However, the diet treated patients showed a significant decrease in BMI (-0.8 +/- 0.3 kg m-2; P less than 0.01) whilst BMI increased in the sulphonylurea treated group (+0.7 +/- 0.2 kg m-2; P less than 0.01). Serum lipid concentrations remained unchanged in both groups. The proportion of patients with hypertension remained the same. Hence after one year of clinical attendance, HbA1 improved but there was minimal change in the associated cardiovascular risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Coronary risk factors in newly diagnosed and previously diagnosed type 2 diabetic men with myocardial infarction

Risk factors for coronary artery disease in 131 known non-insulin-dependent (type 2) diabetic patients is compared to that in 115 newly diagnosed type 2 diabetic subjects and in 316 non-diabetic patients. The subjects, all Indian men aged 21-60 years, represent consecutive survivors of myocardial infarction and were investigated 3-4 months after their acute episode. A group of 524 healthy Indian men aged 21-60 years were included as controls. Significant differences in parameters measured were noted when all diabetic and non-diabetic patients were compared to the control group. Diabetic patients were older than the non-diabetic patients and with significantly higher frequency of hypertension and hypertriglyceridaemia, whilst smoking and family history of coronary artery disease were elicited more frequently in the non-diabetic patients. Mean concentrations of serum total cholesterol and lipoproteins in the diabetic and non-diabetic men were similar, whereas serum triglyceride concentrations were significantly higher in the diabetic patients. Newly diagnosed and known diabetic patients did not differ with respect to the risk factors examined. Clusters of various combinations of hypertension, obesity, hypertriglyceridaemia and low HDL-cholesterol values were encountered more frequently in diabetic patients when compared to non-diabetic patients, whilst no significant differences were observed when the two groups of diabetic subjects were compared. In conclusion, this study has demonstrated that in men with myocardial infarction there are significant differences between diabetic and non-diabetic patients with respect to certain risk factors. However, newly diagnosed diabetic men have similar risk profiles to their known diabetic counterparts.     

Increased urinary endothelin-1 excretion in newly diagnosed type 2 diabetic patients

To investigate whether urinary and plasma endothelin (ET)-1 concentrations are responsive to the alteration of intravascular blood volume in uncontrolled diabetic patients, we determined urinary ET-1 excretion and plasma ET-1 concentration in 42 newly diagnosed type 2 diabetic patients and 38 normal subjects. Mean fasting plasma glucose value (12.8 +/- 0.72 mmol l-1) and plasma renin activity (PRA, 2.80 +/- 0.44 ng ml-1 hr-1) in diabetic patients were significantly higher as compared to normal controls (mean plasma glucose value: 5.2 +/- 0.83 mmol l-1; mean PRA value: 1.34 +/- 0.17 ng ml-1 hr-1), whereas plasma ET-1 value (1.33 +/- 0.07 pmol l-1) was not significantly different from that (1.29 +/- 0.06 pmol l-1) of normal controls. Mean urinary ET-1 excretion level (7.53 +/- 0.74 nmol mol-1 creatinine) was significantly higher than that (5.36 +/- 0.37 nmol mol-1 creatinine) of normal controls. Urinary ET-1 excretion was correlated with plasma glucose value (r = 0.360, p < 0.05) and PRA value (r = 0.381, p < 0.05). Urinary ET-1 excretion rate (5.17 +/- 0.37 nmol mol-1 creatinine) and PRA value (1.42 +/- 0.18 ng ml-1 hr-1) declined to normal levels when mean plasma glucose value decreased to the level of 7.1 +/- 0.39 mmol l-1 in diabetic patients after 4 months of glycemic control. Our results indicated that renal-derived ET-1 was responsive to the alteration of intravascular blood volume in untreated newly diagnosed type 2 diabetic patients.     

Insulin action and insulin secretion in newly diagnosed type 2 diabetic patients

To clarify the insulin action and insulin secretion in newly diagnosed type 2 diabetic subjects, we investigated insulin and C-peptide response to an oral glucose tolerance test (OGTT) in 15 newly diagnosed type 2 diabetic patients and 17 healthy subjects. For insulin action, we found fasting hyperinsulinemia (8.4 +/- 0.8 vs. 6.0 +/- 0.5 microIU/ml, p = 0.014), higher insulin resistance by homeostasis model assessment (HOMA) (4.33 +/- 0.2 vs. 1.34 +/- 0.1 microIU/ml.mmol/l, p < 0.001), and lower insulin sensitivity index (ISI) (51.0 +/- 0.7 vs. 104.0 +/- 0.8, p < 0.001) in newly diagnosed diabetic patients compared to normal subjects. For insulin secretion, the increments of AUCI (area under curve of insulin) and AUCC-P (area under curve of C-peptide) (increment of AUCI: 26.1 +/- 1.4 vs. 82.8 +/- 4.5 microIU/ml.hour, p < 0.001; increment of AUCC-P: 3.9 +/- 0.2 vs. 11.4 +/- 0.6 ng/ml.hour, p < 0.001), insulin secretion by HOMA model (20.7 +/- 1.2 vs. 79.1 +/- 3.8 IU/mol, p < 0.001), and ratio of 30 min increment of fasting insulin to glucose during OGTT (1.14 +/- 0.1 vs. 13.1 +/- 0.5 IU/mol, p < 0.001) were significantly lower in the newly diagnosed diabetic patients than normal subjects. In addition, body mass index (BMI) in our type 2 diabetes is relatively lower (24 +/- 0.65 kg/m2) than those in western countries. These findings revealed poor insulin action and decreased insulin secretion in relatively less obese Taiwanese with newly diagnosed type 2 diabetes.