Prevalence of Hyperglycaemia and Undiagnosed Diabetes Mellitus in Patients with Acute Myocardial Infarction

ABSTRACT The prevalence of hyperglycaemia and undiagnosed diabetes mellitus was assessed in 214 consecutive patients admitted to the coronary care units with acute myocardial infarction (AMI). On admission, 16 patients (7.5%) had known diabetes, and 19 patients, not previously known to be diabetic, had blood glucose concentrations of ≥9 mmol/1. Fifteen patients survived for 2 months at which time a 75 g oral glucose tolerance test showed diabetes in 9 (60%) and impaired glucose tolerance in 4 (27%). Ten of these 13 patients (77%) with abnormal glucose tolerance had elevated glycosylated haemoglobin (HbA_1c) on admission, indicating pre-existing glucose intolerance or diabetes. The prevalence of undiagnosed diabetes was 4.5% (9/198). However, we may have overlooked undiagnosed diabetes in a small number of patients on admission, since only a random blood glucose <8 mmol/1 rules out diabetes, WHO criteria. Elevated blood glucose in patients with AMI is more likely to reflect a stationary pre-existing abnormal glucose tolerance than a temporary stress-induced phenomenon.     

ACID GLYCOSAMINOGLYCANS IN MYXOEDEMA

Acid glycosaminoglycans were measured in the tissues of a virtually untreated 83-year-old woman with myxoedema. Intercellular oedema was demonstrated histologically in the tongue, myocardium, striated muscles, and in the skin. Tissue oedema was absent in two female control patients. All tissues from the patient with myxoedema, apart from the stomach, showed high concentrations of hyaluronic acid, but there was no consistent elevation of chondroitin-4,6-sulphate, heparan sulphate or dermatan sulphate. The accumulation of hyaluronic acid might contribute to the oedema formation in myxoedema.     

Postpartum autoimmune thyroid disorder associated with HLA-DR4?

Thirteen Danish women with postpartum thyroiditis were HLA-A,B,C and -DR typed. Nine of ten unrelated probands were DR4-positive which is significantly (corrected p = .01) different from the frequency (34.7%) of this antigen in unrelated controls.     

Prevention and treatment of diabetic nephropathy with blood pressure lowering drugs

Summary: Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (>300 mg/24 h), a relentless decline in glomerular filtration rate (GFR), and raised arterial blood pressure. the prevalence of abnormal elevated albumin excretion rate (>30 mg/24 h) is approximately 40% in insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) patients. Diabetes has become the leading cause of end-stage renal failure in the United States of America and Japan and it remains the second leading cause in Europe. Patients suffering from diabetic nephropathy have an enormous increase in morbidity and mortality from cardiovascular disease in addition to renal death. Elevated blood pressure is an early and frequent phenomenon and furthermore accelerates the course of diabetic nephropathy. Studies in humans suggest that angiotensin-converting enzyme (ACE) inhibitors postpone and may even prevent progression to clinical overt diabetic nephropathy in normotensive IDDM and NIDDM patients with persistent microalbuminuria. Conventional antihypertensive therapy and ACE inhibition usually combined with a diuretic reduces albuminuria and postpones renal insufficiency in hypertensive IDDM patients with overt nephropathy. A more beneficial effect on the rate of decline in glomerular filtration rate has been demonstrated by ACE inhibitors compared to conventional antihypertensive treatment in IDDM patients with diabetic nephropathy and reduced kidney function (serum creatinine >133 mmol/L). These findings suggest that ACE inhibition causes renal protection (i.e. a beneficial effect on kidney function [structure] above and beyond what would be expected from blood pressure lowering effect alone). Finally, it should be stressed that ACE inhibition and conventional antihypertensive treatment postpone end-stage renal failure and improve survival in diabetic nephropathy.     

Kidney function and size in normal subjects before and during growth hormone administration for one week

Abstract. Kidney function and size were studied in seven normal male subjects before and after administration of highly purified human growth hormone for 1 week. Glomerular filtration rate, renal plasma flow (steady-state infusion technique with urinary collections using ¹²⁵I-iothalamate and ¹³¹I-hippuran) kidney size (ultrasonic scanning) and urinary excretion rates of albumin and β₂-microglobulin (radioimmunoas-says) were measured. Highly purified growth hormone was injected subcutaneously, 2 IU in the morning and 4 IU in the evening. Glomerular filtration rate increased from (mean ± SEM) 114 ± 5 to 125±4ml/min x 1.73 m² ( P <0.01) and renal plasma flow increased from 554 ±30 to 601 ±36 ml/min ×1.73 m²( P < 0.01). Kidney size and urinary excretion rates of albumin and β₂-microglobulin did not change significantly.
Our results show that raising plasma growth hormone into a range similar to that found in insulin-dependent diabetics enhances glomerular filtration rate and renal plasma flow, while kidney size remains unchanged. Increased renal plasma flow is the major determinant of growth hormone induced elevation in glomerular filtration rate. Growth hormone may thus contribute to the enhancement of glomerular filtration rate and renal plasma flow typically found in insulin-dependent diabetics.     

Distribution and degradation of albumin in extensive skin disease

The distribution and degradation of albumin were determined in twelve patients with extensive skin disease and in ten control subjects by measuring the metabolic turnover and transcapillary escape of ¹³¹I-labelled albumin. The ratio of intravascular to total mass of albumin was normal. Thus the observed hypoalbuminaemia and the low intravascular mass reflect a reduced mass of total body albumin. The rate of synthesis was normal, but the transcapillary escape rate reflecting the micro-vascular leakiness to macromolecules, and the fractional disappearance rate were significantly higher n i the patients than in the controls (P<0·001). It is concluded that the hypoalbuminaemia in these patients is the result of an increased endogenous catabolism of albumin without signiflcant loss via urine, stools or skin. A positive correlation between the transcapillary escape rate and fractional catabolic rate of albumin supports the concept of a causal relationship between these parameters.     

SIMULTANEOUS DETERMINATION OF PLASMA VOLUME AND TRANSCAPILLARY ESCAPE RATE WITH 131 I-LABELLED ALBUMIN AND T-1824 IN THE NEWBORN

A new micro method for plasma volume determination with T-1824 was investigated in 10 newborn infants. Dye concentration was measured with a two wavelength spectrophotometric method. The method was found to be easy, rapid to perform and requires only 150 μl plasma. Thus several plasma samples could be obtained and the dye loss during mixing time calculated and corrected for. This is of special importance in the newborn due to the high transcapillary albumin loss mentioned below. Plasma volume was determined with ¹³¹I human serum albumin (RIHSA) serving as reference. Identical results were obtained, mean 43 ml/kg. Consequently it is concluded that the dye method, being a non-radioactive method, should be preferred for plasma volume determination in the newborn. Transcapillary escape rate of albumin (fraction of intra-vascular mass of albumin escaping to the extravascular space per unit time) was determined from the disappearance of intravenously injected RIHSA and T-1824 during the first hour after the injection. The mean transcapillary escape rate with RIHSA was: 18.4%/hour, with T-1824: 20.7%/hour (p<0.1). These values are 3 to 4 times higher than those obtained in adults thus indicating a high capillary permeability to albumin in newborns.     

Plasma volume, intravascular albumin and its transcapillary escape rate in patients with extensive skin disease

Plasma volume and plasma concentration and transcapillary escape rate of albumin (TER alb), i.e. the fraction of intravascular mass of albumin that passes to the extravascular space per unit time, were determined using 125I-labelled human albumin in eight patients with extensive skin disease. Plasma volume and plasma albumin concentration were reduced (P less than 0-05). Thus the intravascular albumin mass was moderately decreased to an average of 0-55 +/- 0-06 (s.d.) g/cm height compared with a normal mean value of 0-77 +/- 0-07 (s.d.) g/cm. This 29% decrease is statistically significant (P less than 0-001). The transcapillary escape rate of albumin (TER alb) was significantly elevated, mean 8-6 +/- 1-1 (s.d.) % X h-1, as compared to normal subjects, mean 5-6 +/- 1-1 (s.d.) % X h-1, (+54%, P less than 0-001). The same patients were studied again after a 1-week treatment with prednisone, 25-60 mg per day. Plasma albumin concentration, plasma volume and intravascular mass of albumin were unchanged, while TER alb decreased significantly during treatment, mean 5-9 +/- 0-8 (s.d.) % X h-1, (P less than 0-01). It is suggested that displacement of albumin into the skin and loss of albumin from the skin are the dominating mechanisms of the reduction in the intravascular albumin mass in patients with extensive skin disease.