Limited joint mobility (LJM) in elderly subjects with type II diabetes mellitus

LJM is frequently observed in young subjects with insulin-dependent diabetes mellitus (IDDM). Aim of this study was to evaluate whether non-insulin-dependent diabetes mellitus (NIDDM) increases the risk of LJM in elderly subjects. Thirty patients (15 males, 15 females, mean age 73.93 ± 12.72 years) with NIDDM in good glycemic control were compared with thirty non-diabetic elderly, well matched for sex and age (15 males, 15 females, mean age 74.3 ± 4.24 years), and with ten young normal subjects (5 males, 5 females, mean age 26.3 ± 1.56 years). In these subjects, the range of motion (ROM) of ankle, knee, hip, elbow and shoulder were measured with a double-armed goniometer. Moreover, abnormalities of supraspinatus, patellar and Achilles tendons were evaluated with a standardized ultrasound (US) procedure. A significant reduction in the mobility of all joints was found in elderly subjects, compared to younger ones, with exception for the knee and elbow flexion. Elderly patients with diabetes, compared with their age-matched counterpart, showed LJM for ankle dorso- and plantar flexion, hip flexion and adduction, shoulder abduction and flexion. Moreover, tendons sonographic abnormalities were more frequently observed in diabetics. Our data confirm that diabetes worsens the LJM in the elderly, increasing the cross-linking of collagen by the non-enzymatic advanced glycation end products formation.     

老年糖尿病肺部感染患者临床病原学特点及治疗

目的通过对住院老年糖尿病合并肺部感染患者和非糖尿病合并肺部感染患者的观察,探讨老年糖尿病和非糖尿病合并肺部感染的病原菌学分布特点和药物敏感性。方法对2年住院诊断为老年糖尿病合并肺部感染患者54例和非糖尿病合并肺部感染患者46例,采用痰标本进行细菌学培养与鉴定。结果老年糖尿病合并肺部感染的患者病原菌以G-杆菌多见,主要为肺炎克雷伯杆菌、铜绿假单孢杆菌、产气杆菌,其次以金黄色葡萄球菌多见,真菌位于第三位。且老年糖尿病合并肺部感染的患者更易出现抗生素耐药。选择有效、敏感的抗生素是治疗老年糖尿病合并肺部感染患者的关键。     

Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001–2010: Report of the Committee on Causes of Death in Diabetes Mellitus

The principal causes of death among 45,708 patients with diabetes (29,801 men and 15,907 women) who died in 241 hospitals throughout Japan during 2001–2010 were determined based on a survey of the hospital records. Autopsy had been conducted in 978 of the 45,708 cases. The most frequent cause of death was malignant neoplasia (38.3%), followed by, in order of descending frequency: infections (17.0%); and then vascular diseases (14.9%), including renal failure (3.5%), ischemic heart diseases (4.8%) and cerebrovascular diseases (6.6%). Diabetic coma associated with hyperglycemia with or without ketoacidosis accounted for only 0.6% of the deaths. In regard to the relationship between the age and cause of death in patients with diabetes, the incidence of death due to vascular diseases was higher in patients over the age of 30 or 40 years, and the 97.0% of the total death due to vascular diseases was observed in patients over the age of 50 years. The incidence of death due to infectious diseases, especially pneumonia, increased in an age‐dependent fashion, and the 80.7% of the total death due to pneumonia was observed in patients over the age of 70 years. ’Poorer’ glycemic control was associated with the reduced lifespan of patients with diabetes, especially of those with nephropathy. The average age at death in the survey population was 72.6 years. The lifespan was 1.6 years shorter in patients with ‘poorer’ glycemic control than in those with ‘better’ glycemic control. In patients with diabetes of less than 10 years’ duration, the incidence of death due to macroangiopathy was higher than that due to nephropathy. Of the 45,708 patients with diabetes, 33.9% were on oral medication, 41.9% received insulin therapy and 18.8% were treated by diet alone. Among the patients in whom the cause of death was diabetic nephropathy, a high percentage, 53.7%, was on insulin therapy. The average age at death of the 45,708 patients with diabetes was 71.4 years in men and 75.1 years in women. However, the report of the Ministry of Health and Welfare of Japan in 2010 set the average lifespan of the Japanese at 79.6 years for men and 86.3 years for women. Thus, the average lifespan of patients with diabetes still appears to be shorter than that of the general population in Japan. However, the differences in lifespan between patients with diabetes and the general population were shorter than those in the former surveys.     

Islet-cell antibodies and beta-cell function in insulin-dependent diabetics

Summary Residual insulin secretion and islet-cell antibodies were studied in 399 insulin-dependent diabetics with age at onset of between 10–19.9 years (248 patients) or 30–39.9 years (151 patients). We found the prevalence of islet-cell antibodies to be independent of residual beta-cell function as measured by serum C-peptide and age at onset. The cause and role of the persistence of islet-cell antibodies in insulin-dependent diabetics remain obscure.     

糖尿病患者超声乳化白内障吸除手术的临床观察

目的:探讨糖尿病患者进行超声乳化白内障吸除联合人工晶状体植入手术的临床效果。方法:50例(61只眼)糖尿病患者(设为A组)和同期163例(174只眼)血糖正常患者(设为B组)接受超声乳化白内障吸除联合人工晶状体植入手术。糖尿病患者手术前通过饮食疗法、口服药物或肌注胰岛素治疗,使空腹血糖降到 10mmol/L以下。术后随访 1～28个月(平均 8.6个月),复查视力、裂隙灯及眼底检查。结果:术后矫正视力≥0.5者,A组为77.1%;B组为80.5%。两组经统计学处理差异无显著性(P>0.05)。两组术中出现后囊破裂及术后发生角膜水肿和前房渗出等并发症的差异无显著性(P>0.05 )。结论:糖尿病患者进行超声乳化白内障吸除手术前只要有效控制血糖,其手术效果与对照组患者相同。但术后血糖的控制仍然十分重要。眼科学报2003;19:98-100。     

Controlled extension of oral antidiabetic therapy on former insulin dependent diabetics by means of the combined i.v. glibenclamide-glucose-response-test

Summary A new sulphonylurea response test is described for predicting the results of long-term treatment with a recently developed sulphonylurea compound, glibenclamide, particularly in insulin-dependent tolbutamide-non-responsive elderly diabetics. The test is based on the observation that the insulin-stimulating capacity of glucose and the determination of the insulin increases are strikingly potentiated following glibenclamide plus glucose i.v. (25 plus 0.33 g/kg body weight) in serum samples where insulin binding antibodies have been removed. 11 out of 40 diabetics demonstrating between 60 and 90 min following injection, a mean increase of insulin of more than 500 per cent above the initial values, correlated satisfactorily with successful long-term oral treatment with glibenclamide. A positive glibenclamide-glucose-response test contrasted with primary failure of glibenclamide therapy in only one patient suffering from haemochromatosis. Oral treatment with glibenclamide may have certain advantages over insulin therapy, especially in elderly diabetics suffering from visual impairment, who are unable to inject themselves with insulin.Support of this Study by Deutsche Forschungsge-meinschaft (Pf 38/28) is gratefully acknowledged.     

Body Mass Index as a Proxy Indicator for Poor Oral Hygiene Habits in Adult Diabetic Patients

AimTo analyse if body mass index (BMI) could be used as a fast proxy indicator of poor oral hygiene habits (POHH) among the adult population with diabetes mellitus.MethodsAdults, aged 25-74, from the Slovenian 2016 nationwide cross-sectional survey based on the Countrywide Integrated Non-Communicable Disease Intervention (CINDI) Health Monitor methodology, who reported being diabetic, were included in the study (n=560). We assessed the relationship between POHH and BMI, adjusted to confounders, using multiple binary logistic regression.ResultsIn the total sample, the POHH prevalence was 50.9%. Taking into account BMI, POHH prevalence in participants with normal BMI values was only 37.8%, in the overweight group it was 1.22-times higher (46.0%), while in the obese group it was 1.63-times higher (61.6%) (p<0.001). Also, the odds for POHH were 2.64-times higher in the obese group in comparison to the normal BMI group (95% CI: 1.55-4.51; p<0.001). After adjustment for confounders, this OR decreased only moderately (OR=2.45; 95% CI: 1.35-4.44; p=0.003).ConclusionsBMI could be used as a readily assessable, fast, simple, and cheap tool indicating higher odds for having POHH among the diabetic population. By defining the high-risk group it could be easier for physicians and dentists to take further referrals and actions for promoting oral health in this group. The suggested tool can save time and could have an important positive impact on the quality of life of diabetics, as well as on health expenditures.     

Osteodystrophy of diabetics in chronic dialysis: A histomorphometric study

Summary A decreased incidence of hyperparathyroidism in diabetic uremic patients has been reported, but comprehensive bone histomorphometric studies on uremic diabetic osteodistrophy are scarce. We present here the results of static and dynamic bone morphometry in 13 diabetic patients on dialysis (DCD) and their comparison with a pairmatched group of nondiabetic uremics with similar age, sex, and time on dialysis (NCDC), and with a group of 17 normals (N). Diabetic bone showed: (1) Low trabecular volume (Vt 9.9% in DCD and 22.8% in N), (2) Moderately increased remodeling values of intermediate intensity between N and NDCD values (Sf=19.3% in DCD, 37.4% in NDCD, and 8.8±6% in N, Sr=4.3% in DCD, 7.3% in NDCD and 2.04±0.9% in N), and (3) Moderate fibrosis (Sfib 1.2% in DCD, 12.9% in NDCD). Besides these confirmatory results, two suggestions emerged from the study: (1) The relative number of cells: osteoclast density (OI) and osteoblasts (Ob/OID) appears to be lower not only than NDCD values but also lower than N values (OI=0.04 c/mm. in DCD, 0.31 in NDCD, and 0.14 in N; Ob/OID=5.58% in DCD, 14.6 in NDCD and 22.12±9% m N). (2) Dynamic behavior in tetracycline based studies disclosed the appearance of two populations of DCD: a subgroup of preserved calcification dynamics with values not quite different than the NDCD group and a subgroup with a significant derangement of mineralization with no measurable bone trabecular dynamics. This late subgroup also showed significantly lower number of Ob/OID values compared with the former with preserved calcification. Both findings may agree with other reported experimental evidences on diabetes.     

B-CELL RESPONSE TO EXERCISE IN DIABETIC AND NON-DIABETIC CHILDREN

Abstract. Heding, L. G. and Ludvigsson, J. (Novo Research Institute, DK-2880 Bagsvaerd, Denmark and the Department of Pediatrics, Linköping University, S-581 85 Linköping, Sweden). B-cell response to exercise in diabetic and non-diabetic children. Acta Pediatr Scand, Suppl. 283: 57, 1980.—20 non-diabetic and 11 insulin dependent diabetic (IDD) children underwent short time (20 min) bicycle ergometer exercise followed by a 10 min rest period. Glucose, IRI, C-peptide and proinsulin were determined prior to and at the end of the exercise, and again after 10 min rest. While no significant change in mean glucose was observed during exercise in the non-diabetics, significant decreases were observed in IRI, C-peptide and proinsulin. After 10 min rest glucose as well as the three B-cell secretory products increased significantly. The change in glucose was Significantly ( p <0.001) correlated to the change in IRI. In the resting period IRI rose more than C-peptide in some subjects. IRI even rose without simultaneous rise in C-peptide indicating a release of tissue bound IRI. The group of IDD children did not show any significant changes in glucose and total IRI, while the endogenous insulin, as measured by C-peptide, did show a fall during exercise. The same was found for proinsulin. The lack of increased endogenous secretion during the rest period was most likely due to suppression of B-cell due to hyperinsulinism and lack of increased glucose concentrations during the rest period.