PREVALENCE OF MICROALBUMINURIA IN NON-INSULIN-DEPENDENT DIABETES MELLITUS

The prevalence of microalbuminuria was assessed in 50 patients of non-insulin dependent diabetes mellitus. The mean age of patients was 52.1 ± 11.6 years and the duration of diabetes was 8.3 ± 6.8 years. Twenty (40%) patients had microalbuminuria. Microalbuminuria was more common in patients with a longer duration of diabetes (more than 5 years), a poor glycaemic control, and higher systolic blood pressure.KEY WORDS: Microalbuminuria, Diabetes mellitus, Diabetic nephropathy, Chronic renal failure     

THYROID HORMONES IN NON-INSULIN-DEPENDENT DIABETES BEFORE AND AFTER THERAPY

Twenty patients of non-insulin-dependent diabetes mellitus (NIDDM) (15 males and 5 females) who developed secondary failure to oral hypoglycaemic drugs, were evaluated for thyroid hormone abnormalities before and after control of diabetic state with insulin. Blood glucose (mean ± SEM mg/dL) fasting and post prandial levels were 260±16 and 370±20 respectively before therapy. After 15 days of intensive insulin therapy these levels fell to 110±14 and 130±12 respectively (p < 0.005). Glycosylated haemoglobin percent (GHb%) (mean ± SEM) was 10±0.4 before therapy and after therapy it fell to 9.2±0.3 (p < 0.05). Serum tri-iodothyronine levels (mean ± SEM ng/mL) were 0.55±0.03 which was significantly lower (p < 0.05) as compared controls. After therapy it significantly (p < 0.05) rose to 1.22±0.08). Serum thyroxine (T4) (mean ± SEM mcg/dL) was 8.5±0.6 before therapy and it did not change significantly after therapy. Serum reverse tri-iodothyronine (rT3) values of (mean ± SEM ng/dl) 0.24±0.05 were higher before therapy and decreased to 0.20±0.82 after therapy. However thyrotropin (TSH) values before and after therapy remained same. There was no significant change in TSH response to thyrotropin releasing hormone (TRH) before and after control of diabetic state.It was concluded that peripheral changes in T3, T4 and rT3 (low T3, high rT3 and low or normal T4) occurred in uncontrolled diabetic state. However, pituitary thyrotroph function in NIDDM with ideal body weight was not significantly affected.KEY WORDS: Thyroid hormones, Non-insulin-dependent diabetes mellitus     

Effect of erythropoietin on lipid profile in haemodialysis patients

Summary: Effect of recombinant human erythropoietin (rHuEPO) was determined on lipid levels (i.e. total cholesterol, triglycerides, high density lipoproteins [HDL], low density lipoproteins [LDL]) of 17 anaemic patients on maintenance haemodialysis. Estimations were done before initiating rHuEPO therapy and repeated 6 months later. There was an increase in haemoglobin (7.6 ± 1.09 to 10.9 ± 1.62 gm/dL, P < 0.001), and a significant decrease in total cholesterol (217 ± 22 to 196 ± 18 mg/dL, P < 0.001) and triglyceride levels (200 ± 20 to 186 ± 15 mg/dL, P < 0.001). There was no significant effect on HDL and LDL levels.     

Experience of iron saccharate supplementation in haemodialysis patients treated with erythropoietin

We assessed the efficacy of intravenous (i.v.) iron saccharate (VENOFER) vs oral iron supplementation in haemodialysis patients treated with low-dose erythropoietin (EPO). Twenty haemodialysis patients with serum ferritin >200 ng/mL and transferrin saturation >30% were assigned to one of the two groups. In Group 1, 10 were given i.v. iron saccharate (100 mg i.v. twice weekly) post dialysis. In Group 2, oral ferrous sulphate 200 mg was given thrice daily. In both groups, subcutaneous EPO 25 units/kg body weight (BW) was started simultaneously, twice weekly. After 3 months (study completion) the mean haemoglobin and haematocrit was significantly increased in Group 1 than in Group 2 (Hb 11.60±0.64 G/dL vs 10.5 G/dL±1.14 P <0.01). The final mean EPO dose was 25% lower in Group 1 than in Group 2 (3400±1356 U/week vs 4600±1356 U/week P =0.10) and the mean serum ferritin was higher in the i.v. iron group than the oral group (671 ng/mL±388 vs 367 ng/mL±238 P =NS). The same was also observed with transferrin saturation (44.6%±19.8 in Group 1 vs. 29%±11.0 in Group 2 P =NS). No adverse effects were seen during the study. In conclusion, we observed that regular use of i.v. iron had a significantly enhanced haemoglobin response, better maintained serum ferritin and lower EPO dosage requirement than the oral iron group.     

Experience of iron saccharate supplementation in haemodialysis patients treated with erythropoietin

SUMMARY: We assessed the efficacy of intravenous (i.v.) iron saccharate (VENOFER) vs oral iron supplementation in haemodialysis patients treated with low-dose erythropoietin (EPO). Twenty haemodialysis patients with serum ferritin >200 ng/mL and transferrin saturation >30% were assigned to one of the two groups. In Group 1, 10 were given i.v. iron saccharate (100 mg i.v. twice weekly) post dialysis. In Group 2, oral ferrous sulphate 200 mg was given thrice daily. In both groups, subcutaneous EPO 25 units/kg body weight (BW) was started simultaneously, twice weekly. After 3 months (study completion) the mean haemoglobin and haematocrit was significantly increased in Group 1 than in Group 2 (Hb 11.60 ± 0.64 G/ dL vs 10.5 G/dL ± 1.14 P <0.01). the final mean EPO dose was 25% lower in Group 1 than in Group 2 (3400 ± 1356 U/week vs 4600 ± 1356 U/week P =0.10) and the mean serum ferritin was higher in the i.v. iron group than the oral group (671 ng/mL ± 388 vs 367 ng/mL ± 238 P =NS). the same was also observed with transferrin saturation (44.6%± 19.8 in Group 1 vs. 29%± 11.0 in Group 2 P =NS). No adverse effects were seen during the study. In conclusion, we observed that regular use of i.v. iron had a significantly enhanced haemoglobin response, better maintained serum ferritin and lower EPO dosage requirement than the oral iron group.     

Stimulation of myocardial lactate extraction by oxfenicine (L-hydroxyphenylglycine)

In animal experiments oxfenicine (L-hydroxyphenylglycine) (LHPG)has been shown to increase myocardial carbohydrate utilizationand decrease fat consumption. Seven patients, six of whom provedto have coronary artery disease, were studied during diagnosticcardiac catheterization. Myocardial substrate extraction, coronarysinus flow, cardiac output and left ventricular pressure weremeasured at basal heart rale and three pacing rates before andafter 800 mg oxfenicine (LHPG). A small decrease in systolicpressure at low heart rates and reduction of end-diastolic pressureat the highest pacing rate were the only haemodynamic changesobserved after the drug. Coronary sinus flow and myocardialoxygen uptake did not change, although there was a small fallin arterio-venous oxygen difference at basal heart rate. Afterthe drug lactale extraction ratio increased in all patientsat each heart rate. Pyruvate extraction ratio increased afteroxfenicine (LHPG) significantly at basal heart rate and thelowest pacing rate. Arterial free fatty acid concentration roseand extraction ratio fell. It is concluded that oxfenicine (LHPG)has a potent effect upon lactate metabolism and is without majorhaemodynamic effects.