Vertebral hyperostosis and diabetes mellitus: a case-control study.

OBJECTIVE--To compare glucose metabolism in patients with vertebral hyperostosis (VH), with that in control patients. METHODS--We studied 50 patients aged 60 years or more who had VH according to Resnick's criteria, and 50 control patients without VH, matched for sex, age, weight and height. Plasma glucose was evaluated before and 120 minutes after ingestion of 75 g glucose. World Health Organisation criteria for diabetes mellitus (DM) were used. Radiographs of the pelvis and thoracic and lumbar spine were performed and read blind by two physicians. RESULTS--Statistical analysis showed no difference between cases and control patients for prevalence of DM, and plasma glucose at 0 and 120 minutes. CONCLUSION--These data suggest that glucoregulation in patients with VH does not differ from that in matched controls.     

Risk factors for amputation in patients with diabetes mellitus. A case-control study.

OBJECTIVE: To identify and quantify risk factors for lower extremity amputation in persons with diabetes mellitus. DESIGN: Case-control study. SETTING: A Veterans Affairs medical center. PATIENTS: Eighty patients having amputation associated with diabetes and 236 diabetic controls without limb lesions were enrolled before surgery from the 21,167 inpatient care and outpatient surgical patients seen at the Seattle Veterans Affairs Medical Center during a 30-month period. MEASUREMENTS: Selected vascular, neuropathic, environmental, health care, self care, nutritional, metabolic, lifestyle, and psychosocial risk factors were measured in all patients before surgery. RESULTS: Statistically significant risk factors identified from analysis included insufficient mean below-knee and foot cutaneous circulation (odds ratio, 161; 95% CI, 55.1 to 469); ankle-arm blood pressure index less than 0.45 (odds ratio, 55.8; CI, 14.9 to 209); absence of lower leg vibratory perception (odds ratio, 15.5; CI, 8.3 to 28.7); low levels of high-density lipoprotein (HDL) subfraction 3 less than or equal to 0.7 mumol/L (odds ratio, 4.9; CI, 2.9 to 8.3); and no previous outpatient diabetes education (odds ratio, 3.2; CI, 1.6 to 6.6). A logistic regression analysis done to control for the potentially confounding effects of age; race; socioeconomic status; diabetes duration, type, and severity confirmed these findings and added a statistically significant interaction between foot transcutaneous oxygen tension and peripheral vascular disease history. Clinical interventions to alter these risk factors were identified, including aggressive treatment of infection, diabetes education, protective footwear, and preventive footcare. CONCLUSIONS: Multiple risk factors exist along the continuum of conditions and events leading to lower extremity amputation in diabetes. Modification of certain risk factors by patients and health professionals may reduce the risk for amputation and thus decrease the human and dollar costs that accompany limb loss in this prevalent chronic disease.     

Gestational diabetes mellitus in teenage pregnancy: a case-control study

In a retrospective study, teenage Asian pregnancies with gestational diabetes managed over a 4-year period were compared with a group of age and parity matched controls (2 for each study case) to determine the incidence of gestational diabetes and its impact on the pregnancy outcome. The incidence of gestational diabetes in teenage pregnancy was 5.4 % (33/611), and accounted for 1.4 % of all the cases of gestational diabetes. There was no difference in the maternal anthropometric parameters or antenatal complications, but the study group had a higher incidence of postpartum haemorrhage (p = 0.010), greater amount of estimated blood loss at delivery (p = 0.016), a trend towards a higher incidence of large-for-gestational age infants, a higher incidence of admission to the neonatal unit (p = 0.024), mostly due to meconium-stained liquor for observation (p = 0.014), and a lower first minute Apgar score (p = 0.012). Our findings support the recommendation that in ethnic groups with a high prevalence of diabetes, universal as opposed to age-limited screening for gestational diabetes should be undertaken. Copyright © 1998 John Wiley & Sons, Ltd.     

Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients

OBJECTIVE: Subclinical hypercortisolism (SH) may play a role in several metabolic disorders, including diabetes. No data are available on the relative prevalence of SH in type 2 diabetes (T2D). In order to compare the prevalence of SH in T2D and matched non-diabetic control individuals, we performed a case-controlled, multicenter, 12-month study, enrolling 294 consecutive T2D inpatients (1.7% dropped out the study) with no evidence of clinical hypercortisolism and 189 consecutive age- and body mass index-matched non-diabetic inpatients (none of whom dropped out). DESIGN AND METHODS: Ascertained SH (ASH) was diagnosed in individuals (i) with plasma cortisol after 1 mg overnight dexamethasone suppression >1.8 microg/dl (50 nmol/l), (ii) with more than one of the following: (a) urinary free cortisol >60.0 microg/24 h (165.6 nmol/24 h), (b) plasma ACTH <10.0 pg/ml (2.2 pmol/l) or (c) plasma cortisol >7.5 microg/dl (207 nmol/l) at 24:00 h or >1.4 microg/dl (38.6 nmol/l) after dexamethasone-CRH (serum cortisol after corticotrophin-releasing hormone stimulus during dexamethasone administration) test, and (iii) in whom the source of glucocorticoid excess was suggested by imaging and by additional biochemical tests (for ACTH-dependent ASH). RESULTS: Prevalence of ASH was higher in diabetic individuals than in controls (9.4 versus 2.1%; adjusted odds ratio, 4.8; 95% confidence interval, 1.6-14.1; P = 0.004). In our population the proportion of T2D which is statistically attributable to ASH was approx. 7%. Among diabetic patients, the presence of severe diabetes (as defined by the coexistence of hypertension, dyslipidaemia and insulin treatment) was significantly associated with SH (adjusted odds ratio, 3.8; 95% confidence interval, 1.4-10.2; P = 0.017). CONCLUSIONS: In hospitalized patients, SH is associated with T2D.     

New-onset diabetes mellitus after liver transplantation in the patients with acute liver failure

International Journal of Diabetes in Developing Countries - To detect the frequency and possible risk factors of new-onset diabetes after liver transplantation in the patients with acute liver...     

Cardiac transplantation in patients with insulin-treated diabetes mellitus.

BACKGROUND AND METHODS: As documented earlier the incidence of cardiac mortality in diabetic patients due to coronary artery disease is high. Cardiac transplantation for congestive heart failure due to coronary artery disease, cardiomyopathy, and valvular diseases is obviously a therapeutic option in patients suffering from insulin-treated diabetes mellitus. To shed more light on this problem we performed a retrospective analysis of 40 patients with insulin-treated diabetes mellitus (three type-1; 37 type-2: insulin-treated for at least three months before cardiac transplantation) referred to our transplant unit for cardiac transplantation between March 1989 and December 1996. RESULTS: Orthotopic cardiac transplantation was performed in 40 patients (4 women, 36 men) aged 32-73 years (mean 56 years) with an insulin-treated diabetes mellitus preexisting for 3-348 months (mean 65.1 months). Donor age ranged from 15 to 72 years (mean 35.5 years) matched for body weight and blood group. Overall mortality in this group was 40.0% with an early mortality of 12.5%. CONCLUSIONS: Our results show that type-1/2 insulin-treated diabetes mellitus preoperative to heart transplantation is not a contraindication in patients suffering from end-stage heart failure. Adequate therapy of diabetes mellitus as well as individual immunosuppressive therapy are important in order to minimize additional organ damage caused by the drugs themselves or resulting infectious complications.     

Preemptive kidney transplantation in patients with diabetes mellitus.

Kidney transplantation is the most preferred treatment for end-stage renal disease because it improves not only the patient's survival compared with dialysis, but also the quality of life. Preemptive transplantation is transplantation performed prior to the initiation of renal dialysis. Recent observational studies have shown increased patient and graft survival with preemptive transplantation, compared to patients receiving transplantation after the initiation of dialysis. Preemptive simultaneous pancreas and kidney transplantation in type 1 diabetic recipients has also been shown to improve patient survival. These results indicate the importance of early referral of patients who have chronic kidney disease to nephrologists and transplant centers.     

Outcome of acute cholecystitis in patients with diabetes mellitus

Prophylactic cholecystectomy has been recommended in patients who have diabetes and silent gallstones because of the reports of increased mortality resulting from acute cholecystitis in such patients. To assess recent mortality rates, we reviewed the course of acute cholecystitis in patients hospitalized between 1960 and 1981 at one hospital. Death occurred in 3 of 46 patients with diabetes and in 7 of 263 patients without the disease (p = 0.55). The age-adjusted estimate of the relative risk for death was 2.2 (95% confidence interval, 0.5 to 9.4) for diabetic compared with nondiabetic patients. All 3 diabetic patients who died had been diagnosed as having diabetes within 5 years of death, and only one had been taking insulin. Patients who had elevated blood urea nitrogen levels (greater than 20 mg/dL) were found to have an increased mortality rate when compared with patients with normal levels (27% compared with 2%; p less than 0.001). Results were similar for the outcome of serious complications. These results suggest the need for reconsideration of the recommendation for prophylactic cholecystectomy in diabetic patients with silent gallstones.     

Outcome of liver transplantation in patients with alcoholic liver disease

BACKGROUND: Liver transplantation is accepted as effective therapeutic option for end-stage liver disease, including alcoholic liver disease AIM: To evaluate the outcome of liver transplantation for alcoholic liver disease in the Liver Transplantation Program at "Hospital de Clínicas" of the Federal University of Paraná, Curitiba, PR, Brazil. PATIENTS AND METHODS: It was performed a retrospective study of the patients who underwent liver transplantation for alcoholic end-stage liver disease between September 1991 and January 2001. The minimum abstinence period required was 6 months before liver transplantation. Identification of alcohol consumption after liver transplantation was determinated by information provided by patient or family and biochemical or histological anormalities. RESULTS: Twenty patients underwent liver transplantation for alcoholic liver disease in the study period, 95% (19/20) were men and the median age was 50 years (29-61 years). Seventy-five percent of the patients (15/20) had severe liver disfunction (Child C class) in the pre-transplant period. In six of them (30%) there was association with viral hepatitis and in one, with hepatocarcinoma. Median abstinence period before liver transplantation was 24 months, varying from 9 to 120 months. One-year and 3-year survival rate were 75% and 50%, respectively. The main complications were: acute cellular rejection (40%), chronic rejection (5%), hepatic artery thrombosis (15%), biliary complications (15%), bacterial or fungal infections (45%), cytomegalovirus infection (20%). Three patients returned to alcohol use after liver transplantation CONCLUSION: The survival of patients who received liver transplant for alcoholic cirrhosis are satisfactory. In the present study there was a small index of alcohol use after liver transplantation.     

肝移植术后糖尿病发病机制研究进展

肝移植术后糖尿病(PTDM)是一种发生于肝移植术后的继发性糖尿病,其发生机制与糖皮质激素和钙调磷酸酶抑制剂等免疫抑制剂的应用、肝功能损害、丙型肝炎病毒(HCV)感染、器官失神经等有关.PTDM的发病率高,严重影响移植物的存活和受者的长期生存.现结合近年相关研究和报道就其发病机制作一综述.     

Outcome of orthotopic liver transplantation in patients with haemophilia

Background—Many patients with haemophilia havedeveloped cirrhosis or hepatocellular carcinoma due to transfusionacquired chronic viral hepatitis.
Aims—To assess the long term outcome of allhaemophilic patients reported to have undergone orthotopic liver transplantation.
Methods—Transplant centres of patients identifiedby medical database search were contacted and survival data assessed by Kaplan-Meier analysis.
Results—Twenty six haemophilic men (median age 46 years, range 5-63 years) underwent orthotopic liver transplantation in16centres between 1982 and 1996. Indications for transplantation werehepatitis C cirrhosis (69%), hepatitis B with or without C cirrhosis(15%), viral hepatitis related hepatocellular carcinoma (12%), andbiliary atresia (4%). Six patients (23%) were infected with humanimmunodeficiency virus (HIV). Postoperatively, the median time tonormal clotting factor levels was 24 hours (range 0-48 hours) andexogenous clotting factors were stopped at a median of 24 hours (range0-480 hours). Four patients (15%) had bleeding complications. The oneand three year survival of HIV positive recipients (67% and 23%) wassignificantly poorer (p=0.0003) than that of HIV negative recipients(90% and 83%). Coagulopathy was cured in all patients surviving morethan 12 days post-transplant. Six of the 20 patients (30%) withhepatitis C cirrhosis pretransplant had evidence of disease recurrenceat a mean of nine months post-transplant.
Conclusions—Hepatitis C cirrhosis is the mostcommon indication for orthotopic liver transplantation in patients withhaemophilia. Transplantation results in long term cure of haemophiliabut may be complicated by the effects of HIV infection or recurrentviral hepatitis.

Keywords:liver transplantation; haemophilia; hepatitis C; cirrhosis; HIV

     

供肝脂肪变性与肝移植术后糖尿病发病风险的关系

目的探讨肝移植术后糖尿病（PTDM）发病的危险因素以及供肝脂肪变性对PTDM发病风险的影响。方法回顾性分析2001年4月至2008年12月438例接受肝移植患者的术前、术后的临床资料。采用2006年中华医学会肝脏病学分会制定的非酒精性脂肪性肝病（NAFLD）诊疗指南的组织病理评分标准判定供肝脂肪变性程度,肝功能状态判定采用Child—Pugh评分系统。根据术后空腹血糖将患者分为非PTDM组（n=298,男250例,女48例,平均年龄48岁）与PTDM组（n=140,男120例,女20例,平均年龄50岁）。对PTDM可能的危险因素,包括年龄、性别、空腹血糖、体质指数、术前肝功能、供肝脂肪变性、术后抗排异药种类、白细胞介素-2受体拮抗剂（IL-2RA）应用等进行单因素分析。在单因素分析基础上进行logistic多元回归分析。结果非PTDM组供肝脂肪变性者占34．6％（103／298）,PTDM组供肝脂肪变性者占44．3％（62／140）,2组无显著差别（X^2=3．83,P=0．05）。单因素分析提示术前空腹血糖（F=23．38,P〈0．05）、术前肝功能、IL-2RA、免疫抑制剂类型与PTDM显著相关（X^2值分别为7．69、8．30、0．02,均P〈0．05）,而供肝脂肪变性与PTDM相关性处于临界水平（X^2=3．83,P=0．05）。logistic多元回归分析提示术前空腹血糖异常（OR=1．853,P〈0．01）、供肝脂肪变性（OR=1．80,P〈0．05）可提高PTDM患病风险,而使用IL．2RA（OR=0．43,P〈0．01）可降低PTDM患病风险。结论供肝脂肪变性、术前空腹血糖异常为PTDM的危险因素,而IL-2RA应用则可降低PTDM发生风险,术前肝功能异常可能增加PTDM的发生风险,免疫抑制剂与PTDM的关系有待进一步研究。     

Pancreas and islet transplantation in patients with diabetes mellitus

Pancreas and kidney transplants have specific indications, benefits and risks. The procedure has become more common and more often as long-term success has improved and risks have decreased. Compared with a patient being on dialysis, simultaneous pancreas-kidney transplant offers a distinct advantage when it comes to mortality, quality of life and diabetic complications. Since there can be a living-donor kidney transplant,, a possibly similar patient and graft survival by 10 years follow-up, this procedure should be considered. Pancreas after kidney transplants, when successful, can improve microvascular complications compared with kidney transplant alone, but immediate mortality may be higher. Solitary pancreas transplantation can improve the quality of life in selected patients, but it may also increase the immediate risk of mortality due to the complexity of the surgery and the risks of immunosupression. The results of Islet transplantation differ from the higher metabolic performance achieved by whole pancreas allotransplantation and its applicability is limited to selected adult diabetic patients.     

2型糖尿病并发脂肪肝的临床研究

目的探讨2型糖尿病合并脂肪肝的主要危险因素。方法采用病例对照研究的方法观察338例2型糖尿病并发脂肪肝和无脂肪肝患者的年龄、身高、体重、腰围、臀围、体重指数（BMI）、腰臀比、空腹血糖（FBG）、C肽、糖化血红蛋白（HbAlc）、谷草转氨酶（AST）、谷丙转氨酶（ALT）、总胆红素（TBIL）、直接胆红素（DBIL）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（γ-GT）、肌酐、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、2 h血糖、2 h C肽等指标：多因素相关分析采用Logistic逐步回归。结果2型糖尿病并发脂肪肝组与无脂肪肝组年龄、身高、FBG、2 h血糖、HbAlc、TBIL、DBIL、ALP、肌酐、TC、LDL无显著性差异（P〉0.05）,体重、BMI、腰围、臀围、腰臀比、空腹C肽、2hC肽、AST、ALT、γ-GT、TG、HDL有显著性差异（P〈0.01）;BMI（OR=1.22）、空腹C肽（OR=2.24）与2型糖尿病并发脂肪肝呈正相关,HDL（OR=0.26）与2型糖尿病并发脂肪肝呈负相关。结论肥胖、胰岛素抵抗及脂质代谢紊乱是2型糖尿病并发脂肪肝的主要危险因素。     

Amputations and diabetes: a case-control study.

AIMS: Data concerning the relative risk of amputations in diabetic patients compared with the general population are scarce. Therefore, we carried out a case control study to quantify the relationship between diabetes and amputations. METHODS: In 20 hospitals in seven German cities and counties we obtained complete lists of non-traumatic lower limb amputations performed in 1990 and 1991. Controls were selected from patients of the same surgical departments operated on in the same years. We drew a random sample of patients with procedures not likely to be associated with diabetes. Diabetic status was determined from patients' records in both cases and controls. We calculated age- and sex-specific and, using logistic regression, adjusted odds ratios (OR) and attributable risks. RESULTS: N = 2400, mean age 61.7 (SD 16.3) years. Cases: n = 729; 486 (66.7%) of them had diabetes. Controls: n = 1671; 127 (7.6%) of them had diabetes. Adjusted OR: 18.2 (confidence interval (CI) 14.2-23.6). Adjusted attributable risk among exposed (ARE): 0.95 (CI 0.93-0.96). Adjusted population attributable risk (PAR): 0.62 (CI 0.57-0.66). CONCLUSIONS: This study has demonstrated a strong association between the risk of amputation and diabetes. The odds ratios and attributable risks for diabetic individuals are higher in the younger than in the older age groups. Population attributable risks are great. We conclude that the reduction of amputations in the general population will be achieved by improving foot care in people with diabetes.     

Family history and risk of insulin-dependent diabetes mellitus: a population-based case-control study

Insulin-dependent diabetes mellitus (type 1) is a common chronic disease of childhood occurring throughout the world. In the literature, its most important determinants include genetic, environmental and familial factors. We evaluated family history as a determinant of the risk of type 1 diabetes mellitus with a population-based case-control study. Information about type 1 patients was taken from the dedicated register of the Abruzzo Region; the register has been collecting incident cases in the age group 0–14 years, diagnosed between 1 January 1990 and 31 December 1996. The control group was taken from the lists of patients attending family pediatricians. The family history data for type 1 and type 2 patients was obtained by a questionnaire, administered to their parents. The risk of type 1 diabetes mellitus associated with its occurrence in first- and second-degree relatives was estimated using logistic regression methods. Our results show that the risk is indeed increased with a positive family history (OR=3.96; 95% CI 1.54–10.14). This shows that the risk of type 1 diabetes mellitus for children whose fathers are affected by the disease is 11 times higher with respect to controls. Moreover, the risk for children whose brothers are affected by the disease is 20 times higher with respect to controls. In contrast, a family history for type 2 diabetes mellitus does not influence the risk. Received: 11 September 1997 / Accepted in revised form: 23 December 1997