Pancreatic autoantibodies in Italian patients with newly diagnosed type 1 diabetes mellitus over the age of 20 years

Abstract The aim was to estimate the prevalence of the serological markers of pancreatic autoimmunity in a cohort of Italian patients with type 1 diabetes mellitus occurring after 20 years of age in order to determine the prevalence of autoimmune diabetes and the most sensitive autoantibody combination to be employed for the diagnosis. We investigated 57 patients (31 males and 26 females) at clinical diagnosis of type 1 diabetes. 35 patients were 21–40 years and 22 were 41–72 years of age. Autoantibodies to islet-cells (ICA) were detected by indirect immunofluorescence, while those against glutamic acid decarboxylase (GADA), tyrosine-phosphatase (IA2A) and insulin (IAA) were detected by radiobinding assays. A positive test for at least one of the pancreatic autoantibodies was found in 45 of the 57 patients (78.9%). Coupling two antibody tests, GADA and/or IAA were found in 73.7%, ICA and/or GADA in 71.9%, while GADA and/or IA2A were found in 70.2% of the patients. The most frequently positive test was for GADA (66.7%). In general, the frequency of diabetes-related antibodies was higher in the 21–40-year-old group compared to the 41–72-year-old group and in females than males. Based on the detection of pancreatic autoantibodies determination, the great majority of the adult patients with recent onset type 1 diabetes were found to be autoimmune in nature. The best cost/benefit combination is provided by coupling the detection of GADA and ICA.     

The electrophysiological findings of subclinical neuropathy in patients with recently diagnosed type 1 diabetes mellitus

To assess the prevalence of subclinical neuropathy within the first year of type 1 diabetes mellitus, 30 patients and 14 healthy subjects have been studied prospectively. The patients whose diabetes duration was longer than 1 year have been excluded from the study. Control group consisted of healthy volunteers. Subjective neuropathy symptoms, neurological examination, and electrophysiological findings were evaluated. All patients were clinically asymptomatic. At least two abnormal independent neurophysiological nerve parameters, which were required as the criterion of the peripheral nervous system subclinical involvement, were found as in 96.6% of diabetic patients in the first years. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 86.7% in sural nerve, 83.3% in peroneal motor nerve, 73.3% in posterior tibial motor nerve, 66.7% in median motor nerve, 63.3% in ulnar motor nerve, 60% in median sensory nerve, and 46.7% in ulnar sensory nerve. While distal motor latency, F conduction time, and minimum F latency were the most frequent abnormal parameters in the upper extremity electrophysiological study; conduction velocity, minimum and mean F latencies, F conduction time were the most frequent abnormal parameters in the lower extremity. In all sensory nerve conduction studies, the most frequent abnormal parameter was the onset latency. In the autonomic sympathetic nerve electrophysiological study, plantar SSR latency was found significantly longer than the control group. In the lower extremity generally somatic motor fibres, sensory large fibres and sympathetic autonomic nerve fibres were found to be more affected. There is a correlation between HbA1c levels and nerve conduction velocity in posterior tibial and peroneal nerves. However, upper extremity nerve conduction dysfunction was not correlated with HbA1c value. Neither the duration of disease nor the age of the subject correlated with the nerve dysfunction.     

Cardiovascular events in patients with over 10 years history of type 2 diabetes mellitus

BackgroundDiabetes is one of the concerns of today's public health and patients with type 2 diabetes are at increased risk of death due to cardiovascular diseases. The aim of this study was to evaluate the prevalence of cardiovascular diseases in patients with over 10 years history of type 2 diabetes mellitus referred to the Sanandaj Diabetes Clinic.MethodsIn this study, 400 patients with type 2 diabetes who had over 10 years history of diabetes were selected and the required information was prepared based on taking their history and files. Finally data were analyzed using T-test, Chi-square and Fisher test methods.ResultsIn this the mean duration of diabetes was 14.59 ± 4.07 years. 95.25% of patients had dyslipidemia. The frequency of history of cardiovascular events was 78.25%. 12.25% of patients had a history of ischemic heart disease and 82.75% had a history of high blood pressure. There was a significant relationship between the incidence of cardiovascular events with hypertension, HDL level and family history of early cardiovascular disease (p < 0.05).ConclusionThe high risk of cardiovascular events in diabetic patients it strongly emphasizes the need for quick and serious approaches to prevent cardiovascular events in diabetic patients.     

2型糖尿病、动脉粥样硬化与炎症

糖尿病与动脉粥样硬化关系密切,表现为糖尿病患者出现动脉粥样硬化的时间早、程度重和预后差,而出现动脉粥样硬化性心脏病的患者有相当部分出现不同程度的糖调节受损。控制血糖可以明显减少慢性微血管并发症,但不能显著降低动脉粥样硬化所致的大血管并发症。近年的研究提示,2型糖尿病和动脉粥样硬化可能是同一个病理基础上平行发展的两个疾病(图1),糖调节受损的出现意味着导致动脉粥样硬化的危险因素的作用加强。他们的共同基础是慢性、亚临床性的炎症,以图及1炎症导致的胰岛素抵抗[1]。炎症是2型糖尿病和动脉粥样硬化的共同土壤一、炎症导…     

Social factors in understanding illness behaviour of women with Type 2 diabetes mellitus in Jammu,North India

AimsFemales in the South Asian region form a deprived community in diabetes management, and if we narrow it down to the Indian context, the situation is even grimmer. This necessitates an exploration of the socio-cultural factors, in the form of personal perception of the respondents, responsible for diabetes management among women.MethodsData for the present study were collected at Government Medical College (GMC) Hospital, Jammu (India). In total 41 female respondents suffering from diabetes, for more than two years, were interviewed by using an unstructured interview schedule. Field research consisted of purposive sampling method and observation which took place in the out-patient department and in-patient department of the Department of Medicine, GMC.ResultsResults show that the biggest challenge posed by diabetes management for women is to take care of household expenses amid treatment demanded by this disease. Results were looked at from social constructivist point of view which revealed that socially constructed notions about disease have a major role to play in its management.ConclusionThese women opt for different mechanisms for diabetes management which may or may not be recommended by their diabetologist; however, their personal beliefs have maximum role to play in disease management.     

2型糖尿病与男性骨质疏松

2型糖尿病 （type 2 diabetes mellitus,T2DM）和骨质疏松（osteoporosis,OP）是常见老年病.女性糖尿病患者的骨质疏松问题已受到广泛关注,而男性T2DM患者随年龄增长,同样存在骨代谢异常或骨质疏松等合并症,若不及时治疗,后果与女性一样严重.本文就近年对于男性T2DM患者骨密度研究进展、胰岛素、雄激素、骨转换标志物变化以及降糖药物对骨代谢的影响作一综述.     

Type II diabetes mellitus and selected metabolic disorders in urban population aged over 35 years

Recent epidemiologic studies show increasing "epidemic" of diabetes mellitus throughout the world. Reliable data on diabetes prevalence in Poland are scarce. Therefore Polish Ministry of Health initiated a programme aiming at gathering substantial amount of epidemiologic data on the prevalence of diabetes and other metabolic disorders. The aim of the present study was to evaluate the prevalence of diabetes, obesity and lipid disorders in a well-defined urban population aged 35 and over. The study subjects were 6000 randomly chosen inhabitants of the Central District of Lodz. All were invitated to participate in the study by mail. Every participant underwent full medical examination, with body mass index (BMI) calculation, and blood pressure as well as waist-to-hip ratio measurements. Serum total, LDL and HDL cholesterol and triglycerides were assessed. In non-diabetes subjects oral glucose tolerance test (75 g) (OGTT) according to WHO protocol was performed unless their fasting capillary blood glucose exceeded 8 mmol/l. In selected subjects serum samples were stored for future insulin and C-peptide assays. 2018 persons took part in the study (response rate 33.6%), including 1217 (60.3%) women and 801 men (39.7%), mean age 58.2 years. 179 (8.9%) persons claimed to have been diagnosed with diabetes previously (8.9%). OGTT was performed in 1574 subjects. Impaired glucose tolerance (IGT) was found in 342 (17.0%), and diabetes in 138 (6.8%) subjects. Total diabetes prevalence reached therefore 15.7%. Excessive body weight (BMI > or = 25 kg/m2) was noted in 806 (39.9%), and obesity (BMI > or = 30 kg/m2) in 626 (31.0%) persons. Total cholesterol > 5.2 mmol/l was observed in 1170 (58.0%), LDL-cholesterol > 3.5 mmol/l in 734 (36.4%), cholesterol HDL < 0.9 mmol/l in 953 (47.2%), and triglycerides > 1.7 mmol/l in 1392 osób (69.0%) subjects. In conclusion, high prevalence of known and unknown diabetes together with other metabolic disorders is strikingly high in adult urban population, which in all may require effective implementation of specific nationwide prevention programmes.     

Abnormalities of CD4+ T lymphocyte proliferative responses from patients with recently diagnosed insulin-dependent diabetes mellitus

To investigate the abnormalities of cell-mediated immunity in patients with recently diagnosed insulin-dependent diabetes mellitus (IDDM), we studied the responses of the two major T lymphocyte subsets from peripheral blood lymphocytes (PBL) to mitogen stimulation. Samples for PBL were obtained from a group of IDDM patients and from a group of normal controls. CD4+ and CD8+ T cells were isolated and were subsequently stimulated with three specific lymphocyte mitogens, namely Phytohemagglutinin (PHA), Concanavalin A (Con A) and Pokeweek mitogen (PWM). The proliferative response was measured by incorporation of radioactive thymidine in lymphocyte cultures which were stimulated by the three mitogens. The responses of CD8+ T cells from IDDM patients and from controls were not significantly different. However, CD4+ T cells from IDDM patients showed significantly depressed responses to PHA and Con A and to a much lesser extent to PWM. These data provide new information regarding the CD4+ T lymphocyte abnormalities found in patients with IDDM.     

Microalbuminuria in patients with Type 2 diabetes mellitus from general practice: course and predictive value.

AIMS: To assess the course of microalbuminuria in patients with Type 2 diabetes mellitus in general practice and the predictive value of urinary albumin concentration on all-cause mortality, cardiovascular mortality and cardiovascular morbidity. METHODS: Cohort study in Type 2 diabetic patients tested for microalbuminuria in 1992, and re-tested in 1998. During follow-up all cardiovascular morbidity and mortality were recorded. RESULTS: Of the original sample of 317 patients, 163 patients were re-tested. The mean change in urinary albumin concentration was +16.2 mg/l (range -122.0 to +602 mg/l). Seventy-five per cent of the patients without microalbuminuria in 1992 still had no microalbuminuria in 1998 and 40% of those with microalbuminuria in 1992 reverted to normoalbuminuria in 1998. Cox survival analysis, stratified for age, showed that microalbuminuria at baseline resulted in a risk ratio of all-cause mortality of 1.4 (95% confidence interval 0.8-2.7), of cardiovascular mortality of 1.2 (0.5-2.8) and of new cardiovascular events (including cardiovascular mortality) of 1.4 (0.8-2.3). CONCLUSIONS: In the majority of patients the change of urinary albumin excretion was small, but the range was wide. A weak non-significant relationship between microalbuminuria and all-cause mortality and cardiovascular morbidity was observed.