Early Stages Of Diabetes Mellitus Research Articles

Study of thyroid function in type 2 diabetic and non-diabetic population

Background: Diabetes mellitus (DM) is a common endocrine metabolic disorder and is one of the leading causes of death worldwide. Thyroid disorders are also very common in the general population and are second only to diabetes as the most common condition to affect the endocrine system. As a result, it is common for an individual to be affected by both thyroid diseases and diabetes. Objective: To compare the prevalence of thyroid dysfunction in type 2 diabetic patients and healthy controls. Methods and Methods: This study comprises 200 subjects including 100 type 2 diabetic patients and 100 controls, in whom serum-fasting glucose, serum triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were measured. Result: Among the 100 type 2 diabetic patients studied, 32% of the patients had abnormal thyroid hormone levels and 68% had normal thyroid hormone levels. Among the 32% of diabetic patients with abnormal thyroid hormone levels, 22% of them had hypothyroidism (8% clinical hypothyroidism and 14% subclinical hypothyroidism) and 10% had hyperthyroidism (4% clinical hyperthyroidism and 6% subclinical hyperthyroidism). All the controls were found to have normal thyroid hormone levels. Conclusion: There is high prevalence of thyroid dysfunction in type 2 diabetic patients as compared to healthy controls. Hypothyroidism was found more common than hyperthyroidism. Therefore, detection of abnormal thyroid hormone levels in the early stage of DM may help patients improve the quality of life and reduce the morbidity rate.

Optimal cut-off values for the homeostasis model assessment of insulin resistance (HOMA-IR) and pre-diabetes screening: Developments in research and prospects for the future.

Diabetes mellitus (DM) appears to be increasing rapidly, threatening to reduce life expectancy for humans around the globe. The International Diabetes Federation (IDF) has estimated that there will be 642 million people living with the disease by 2040 and half as many again who will be not diagnosed. This means that pre-DM screening is a critical issue. Insulin resistance (IR) has emerged as a major pathophysiological factor in the development and progression of DM since it is evident in susceptible individuals at the early stages of DM, and particularly type 2 DM (T2DM). Therefore, assessment of IR via the homeostasis model assessment of IR (HOMA-IR) is a key index for the primary prevention of DM and is thus found in guidelines for screening of high-risk groups. However, the cut-off values of HOMA-IR differ for different races, ages, genders, diseases, complications, etc. due to the complexity of IR. This hampers the determination of specific cut-off values of HOMA-IR in different places and in different situations. China has not published an official index to gauge IR for primary prevention of T2DM in the diabetic and non-diabetic population except for children and adolescents ages 6-12 years. Hence, this article summarizes developments in research on IR, HOMA-IR, and pre-DM screening in order to provide a reference for optimal cut-off values of HOMA-IR for the diagnosis of DM in the Chinese population.

Application of joint hospital and community intervention in the population with impaired glucose regulation

Objective To investigate the application effect of joint hospital and community intervention in the population with impaired glucose regulation （ IGR） .Methods Four selected communities were divided into the control group and the experimental group.All samples were screened for diabetes mellitus and then given different interventions.Totals of 121 samples were included.There were 57 cases in the experimental group, and 64 cases in the control group.The control group was given a three-month follow-up by the community health workers, while the experimental group was given a joint community and hospital worker’ intervention, including a three-month follow-up of the community, the first three months of hospital health lectures, on-site consultation, individualized diet and exercise prescription.The intervention time was 12 months.Before and after the intervention, samples were asked to complete an IGR health belief questionnaire and other clinical indicators of changes in blood glucose and body mass index were collected.Results One case in the experimental group was lost during follow-up, and 120 cases finished the research.The fasting blood glucose, postprandial 2 h blood glucose, glycated hemoglobin, body mass index were not statistically different between two groups before the intervention （P〉0.05）.After the intervention, fasting blood glucose, postprandial 2 hour plasma glucose, glycated hemoglobin, body weight index of the experimental group were （ 5.70 ± 0.66）mmol/L, （7.29 ±1.85） mmol/L, （6.26 ±0.45）% and （26.00 ±3.11）kg/m2, respectively.Those values of the control group were （6.21 ±0.99） mmol/L, （8.18 ±2.26） mmol/L, （6.55 ±0.74）% and （27.20 ±3.13）kg/m2.There were significant differences between the two groups （t=3.148, 2.271, 2.379, 2.070, respectively;P〈0.05）.The score of health belief was not statistically different between the two groups before the intervention （P〉0.05）.After the intervention, the score of health belief of the experimental group was （127.63 ±11.64）, which was significantly higher than （121.76 ±12.53） of the control group （t=2.944, P〈0.05 ） .One year after the intervention, 53.57% cases in the experimental group returned to normal glycometabolism, and 31.25%cases in the control group returned to normal, and the difference was significant （ Z=2.560, P 〈0.05 ） .Conclusions Joint hospital and community intervention can improve the state of abnormal glucose metabolism, and reduce the incidence of diabetes in population with IGR. Key words: Early stage of diabetes mellitus; Hospital,community; Health education; Joint hospital and community intervention

Myocardial Perfusion Scintigraphy in Detection of Myocardial Ischemia and Therapy Planning in Early Stages of Diabetes Mellitus

Summary Patients with diabetes mellitus (DM) develop complications including coronary artery disease (CAD), which is the leading cause of mortality in this group of patients. One of the diagnostic modalities for early detection of myocardial ischemia in symptomatic and asymptomatic patients with DM is myocardial perfusion tomography (MPI). The aim of this study was to determine the usefulness of MPI in detection of myocardial ischemia in symptomatic and asymptomatic patients in early stages of DM. Thirty-four patients with DM, aged from 24 to 65 years, nine women and fifteen men were examined. Thirteen patients were CAD symptomatic, and 21 were asymptomatic. MPI was performed through a standard two-day protocol, and findings were categorized as normal perfusion, reversible perfusion defect (ischemia), and fixed perfusion defect (scar). Patients with ischemia were elected for coronary angiography (CAG). MPI and CAG findings were statistically analyzed. Fifteen (44,12%) patients had normal left ventricle perfusion, while 19 (55,88%) patients had perfusion defects. Scar was found in one patient, and ischemia in 18 patients. CAG showed stenosis of coronary artery in 7 (36,84%) of 19 patients with perfusion defects on MPI. Statistical analysis showed no correlation between MPI ischemia and stenosis on CAG. Discrepancy between ischemia on MPI and CAG presentations of epicardial coronary arteries is related to endothelial dysfunction rather than atherosclerosis. These patients benefit more from pharmacological therapy than from revascularization. MPI and CAG should be reserved for individuals with high risk of CAD.

Two‐point discrimination in diabetic patients (糖尿病患者的两点辨别力)

Diabetes mellitus (DM) is a common cause of polyneuropathy. The aim of the present study was to evaluate two-point discrimination (TPD) compared with nerve conduction studies in the early stages of DM. Forty-eight patients with early diagnosed (<5 years) type 2 DM and 17 healthy controls were evaluated. Of the patients with DM, 26 had neuropathic pain and 22 were asymptomatic. TPD and electrophysiological evaluations was obtained for all subjects. Nerve conduction studies in patients showed findings related to both demyelination and axonal damage. Patients with neuropathic pain had higher TPD values on the plantar surface of the foot and both groups of DM patients had higher TPD values on the outer lateral malleolus compared with the control group (P < 0.05). There was a correlation between TPD and axonal damage in patients with neuropathic pain (P < 0.05). In patients without neuropathic pain, there was a correlation between TPD values and distal latencies of motor or sensory nerves (P < 0.05). In the control group, only third digit TPD values were related to the distal motor latency of the median nerve (P < 0.05). In conclusion, the TPD method is a less painful, practical, cost-effective, and more easily applicable method that was completed in less time than nerve conduction studies. Higher TPD values in the lower extremities indicate nerve damage in patients. These findings suggest that increased TPD values can easily determine neuropathy starting in the early stages of diabetes in patients with DM.

Dose- and time-dependent effect of high glucose concentration on viability of notochordal cells and expression of matrix degrading and fibrotic enzymes

Diabetes mellitus is an important aetiological factor in intervertebral disc degeneration. The disappearance of notochordal cells in the nucleus pulposus is thought to be the starting point for intervertebral disc degeneration. A cellular effect of diabetes mellitus on apoptosis of notochordal cells and intervertebral disc degeneration has been recently reported. However, how the duration and severity of diabetes mellitus affects viability of notochordal cells and intervertebral disc degeneration is still unknown . Rat notochordal cells were isolated, cultured, and placed in either 10 % foetal bovine serum (FBS) (normal control) or 10 % FBS plus three different high glucose concentrations (0.1 M, 0.2 M, and 0.4 M) (experimental conditions) for one, three, five and seven days, respectively. We identified and quantified the degree of proliferation and apoptosis, caspase activities, and cleavages of Bid and cytochrome-c. In addition, we examined the cells for expression of matrix metalloproteinases (MMPs) and their tissue inhibitors of metalloproteinases (TIMPs). Each three high glucose concentrations significantly decreased proliferation and increased apoptosis of notochordal cells from culture days one to seven in a dose-dependent manner. Compared with those of 10 % FBS, caspase-9 and -3 activities and cleavage of Bid and cytochrome-c were significantly increased in each three high glucose concentrations, accompanied by increased expression of MMP-1, -2, -3, -7, -9, and -13 and TIMP-1 and -2. High glucose concentration significantly decreased proliferation and increased apoptosis of notochordal cells via the intrinsic pathway with dose- and time-dependent effects. We also found that expression of MMPs and TIMPs was increased with dose- and time-dependent effects. Therefore, these results suggest that aggressive glucose control from an early stage of diabetes mellitus should be recommended to prevent or limit intervertebral disc degeneration.

Effect of intranasal insulin and serotonin on functional activity of the adenylyl cyclase system in myocardium, ovary, and uterus of rats with prolonged neonatal model of diabetes mellitus

Disturbances in hormonal signaling systems, in the adenylyl cyclase system (ACS) in particular, occur at early stages of diabetes mellitus (DM) and are one of the key causes of its complications. Since there is a correlation between the severity of DM and of disturbances in the ACS, the study of the ACS activity can be used to monitor DM and its complications and to evaluate effectiveness of their treatment. Comparatively recently, for treatment of the type 2 DM, there began to be used the intranasal insulin (I-I) and drugs increasing brain serotonin level, which effectively restore CNS functions. However, mechanisms of their action on peripheral tissues and organs with DM remain to be not understood. The goal of this work was to study effects. of I-I and intranasal serotonin (I-S) on the ACS functional activity in myocardium, ovary, and uterus of rats with a neonatal model of the type 2 DM. In tissues of diabetic rats there were revealed changes in regulation of adenylyl cyclase (AC) by guanine nucleotides and hormones that both stimulated and inhibited this enzyme, such changes being characterized by the receptor and tissue specificity. In diabetic rats, I-I restored the AC stimulating effects of isoproterenol in the myocardium, guanine nucleotides and gonadotropin in ovaries and relaxin in uterus, as well as the AC inhibitory effects of somatostatin in all tissues, and of noradrenaline in myocardium. Treatment with IS led to a partial restoration of the AC-inhibitory effect of noradrenalin in the diabetic myocardium, but did not affect regulation of AC by other hormones. These data indicate that I-I normalizes the ACS functional activity in myocardium and in tissues of the reproductive system of female rats with neonatal DM, whereas the effect of I-S on in the studied tissues is less pronounced. These results are necessary to be taken into account at development and optimization of strategy of use of I-I and I-S for treatment of DM and of its complications.

Angiotensin-converting enzyme inhibition curbs tyrosine nitration of mitochondrial proteins in the renal cortex during the early stage of diabetes mellitus in rats

Experiments were performed to evaluate the hypothesis that ACE (angiotensin-converting enzyme) inhibition (enalapril) suppresses 3-NT (3-nitrotyrosine) production in the renal cortex during the early stage of Type 1 DM (diabetes mellitus) in the rat. Enalapril was administered chronically for 2 weeks to subsets of STZ (streptozotocin)-induced DM and vehicle-treated sham rats. O2− (superoxide anion) and NOx (nitrate+nitrite) levels were measured in the media bathing renal cortical slices after 90 min incubation in vitro. SOD (superoxide dismutase) activity and 3-NT content were measured in the renal cortex homogenate. Renal cortical nitrated protein was identified by proteomic analysis. Renal cortical production of O2− and 3-NT was increased in DM rats; however, enalapril suppressed these changes. DM rats also exhibited elevated renal cortical NOx production and SOD activity, and these changes were magnified by enalapril treatment. 2-DE (two-dimensional gel electrophoresis)-based Western blotting revealed more than 20 spots with positive 3-NT immunoreactivity in the renal cortex of DM rats. Enalapril treatment blunted the DM-induced increase in tyrosine nitration of three proteins ACO2, GDH1 and MMSDH (aconitase 2, glutamate dehydrogenase 1 and methylmalonate-semialdehyde dehydrogenase), each of which resides in mitochondria. These data are consistent with enalapril preventing DM-induced tyrosine nitration of mitochondrial proteins by a mechanism involving suppression of oxidant production and enhancement of antioxidant capacity, including SOD activation.

The relationship between sleep condition and autonomic nervous function in women in their 70s with type 2 diabetes mellitus

The aim of this study was to determine the relationship between sleep condition and autonomic nervous function of women in their 70s with type 2 diabetes mellitus by analyzing the activity counts (AC) on actigraphs and heart rate variability (HRV). Ten healthy women in their 30s to 40s as control and four women patients with type 2 diabetes in their 70s wore the electrocardiograph and an actigraph for 24 hours while keeping a diary of activities, including their sleep and food intake. The Pittsburgh Sleep Quality Index was used to assess subjective sleep conditions. The subjective sleeping results were significantly correlated with those measured by the AC and HRV. However, AC and HRV correlation pattern showed different activity in the patients with type 2 diabetes mellitus. The quality of sleep of those with chronic diabetes was not good even if their HbA1c was well controlled. Furthermore, their automatic nervous function was different from the control group. The sleeping hours of patients with type 2 diabetes were shorter or longer than those of healthy women. Ultimately, this study maintains that it is important to examine automatic nervous functions using objective examination index during the early stage of diabetes mellitus.

Early Ventricular Dysfunction in Type II Diabetes: Role of Metabolic Unbalance

Introduction: Diabetic cardiomyopathy is characterized by early myocardial systolic and diastolic impairment. Many studies have highlighted reduced contractile reserve in patients affected by Metabolic Syndrome (MS) and in the early stages of diabetes mellitus, however, it has not been confirmed by all the authors. A conclusive hypothesis on the basis of this early myocardial dysfunction needs to be ascertained. Methods: Forty patients: 20 (age 59 ± 7 years) with type II diabetes, diagnosed at least 5 years earlier and treated with insulin sensitizers, 20 with MS (WHO definition; age 57 ± 10 years), and 20 age- and sex-matched healthy controls were studied. MS patients with elevated insulin resistance (HOMA-IR >2.8), but no arterial hypertension with evidence of cardiac hypertrophy, were selected. In order to exclude ischemic heart disease and to evaluate left ventricle contractile reserve (LVCR), dobutamine echocardiography was performed on all patients. Results: No significant differences were shown by basal echocardiography between the 3 groups of subjects except for left ventricular mass, which was higher in diabetics than in MS and control subjects (78.8 ± 17.9 g/m2 vs. 64.3 ± 11.1 g/m2 and 58.2 ± 9.4 g/m2, respectively; p=ns and p<0.05). A significant decrease in delta longitudinal Strain Rate was noticed in the MS group compared to diabetics and controls (0.59 ± 0.29 s-1 vs. 1.07 ± 0.44 s-1 and 1.11 ± 0.43 s-1, respectively; p<0.001) Conclusion: The present findings show that insulin resistance is responsible for an initial myocardial impairment in patients with MS. This negative effect is not evident in the diabetic patients, probably due to the optimal treatment with insulin sensitizers. In our opinion, insulin resistance is able to modulate heart function, as testified by a depressed myocardial contractility reserve. Our data strengthen the need for the utmost attention to be paid to insulin resistance condition and to the opportunity of early therapeutic intervention.

EFFECTS OF ATORVASTATIN ON ENDOTHELIAL DYSFUNCTION IN TYPE 2 DIABETIC PATIENTS WITH DIFFERENT DURATION F THE DISEASE

Aim. To evaluate dynamics of endothelial vasoregulatory function in type 2 diabetic patients after 6 months of combined treatment with atorvastastin 20 mg/day depending on the disease duration and target lipid levels achievement. Material and methods. The total of 161 type 2 diabetic patients with dyslipidemia were enrolled into non-randomized open-label study, of which 149 patients were assigned to a group of follow-up (group 1) and 12 to a group of comparison (group 2). All the patients received combined antihypertensive and glucose-lowering therapy. Patients of group 1 were additionally receiving atorvastatin 20 mg/day. Parameters of glucose and lipid metabolism and reactive hyperemia test were assessed in all patients initially and 6 months later. Results. Patients with newly diagnosed diabetes were more likely to restore endothelial vasoregulatory function as compared to the patients with 1-5 and 6-10 years of diabetes duration (56% vs 42% and 35%, respectively). Patients who reached target lipid levels as compared with those who didn’t, more often revealed normalization of endothelial function (38% vs 33%, respectively). Atorvastatin benefited was more effective in newly diagnosed diabetic patients who had achieved target lipid levels. Conclusion. Addition of atorvastatin to glucose-lowering and antihypertensive treatment can restore endothelial vasoregulatory function in 6 months in more than half of new-onset type 2 diabetic patients. Maximal effect of combined therapy with atorvastatin is obtained at early stages of diabetes mellitus and at target lipid levels achievement.

Застосування "Рейтоілу" в профілактиці атеросклерозу у хворих на цукровий діабет

The paper was conducted sonographic study of extracranial atherosclerotic vascular changes in patients with diabetes mellitus, and lipid profile study of the dynamics under the influence of treatment with the inclusion of the drug "Reytoil". Structural changes of the vascular wall correlates with changes of lipid profile in patients with diabetes. Structural assessment of intima-media complex (IMC) can be used as a marker for early diagnosis of vascular remodeling in patients with diabetes, as well as the criterion of efficiency of a treatment. Detection of lipid exchange and evaluation of IMC in the early stages of diabetes mellitus will make it possible pathogenetic approach to provi ding comprehensive treatment of diabetes with dyslipidemia, including the drug "Reytoil".

Expression of ERK and c-fos and effect of brain derived neurotrophic factor in early retinal neuropathy of streptozotocin-induced diabetes in rat

Background Recent studies showed that diabetic retinal neuropathy is an earlier and more dangerous complication and neurotrophin has a protective effect on retina. Objective The present study was to observe the changes of brain derived neurotrophic factor (BDNF),its receptor TrkB,signal pathway protein phosphatized extracellular signal-regulated protein kinase1/2 (p-ERK1/2) and c-fos in the retina after injection of BDNF into the vitreous in STZ induced Wistar diabetic rats. Methods Wistar rats aged 9 weeks-old were randomly divided into BDNF injection group,diabetes mellitus (DM) control group and normal control group and 20 rats for each group.STZ was intraperitoneally injected in the rats of BDNF injection group and DM control group to create the experimental DM.BDNF was intravitreously injected in the rats of BDNF group 2 weeks after administration of STZ in three-day interval for 5 times,and BSS containing O.1％ bovine serum albumin (BSA) was used at the same way in the DM control group and normal control group.The retina was isolated for hybridization in situ for BDNF,and TrkB,p-ERK1/2 and c-fos.Levels in retina were detected using sandwich method ELISA. Results The number of BDNF positive cells and the gray scale were lower obviously in the rat retina of DM control group than those of BDNF injection group and normal control group,showing significant differences among the 3 groups ( F =102.36,92.55 ;P＜0.05 ).ELISA assay showed that TrkB,p-ERK1/2 and c-fos values in retina were statistically significantly different among the 3 groups ( F =92.54,95.46,94.84,P＜0.05 ).The TrkB level in retina was statistically reduced,but the p-ERK1/2 and c-fos levels in retina were increased statistically in DM control group compared with BDNF injection group and normal control group( P＜0.05 ).No statistical difference was found in TrkB,p-ERK1/2 and c-fos values between the BDNF injection group and normal control group(P＞0.05). Conclusions The injection of BDNF into the vitreous cavity can protect retina from downregulating BDNF and TrkB levels and up-regulating the p-ERK1/2 and c-fos protein levels in the early stage of DM. Key words: Diabetes mellitus/diabetic retinopathy; Brain derived neurotrophic factor; Signal cascade pathway

Retinal morphologic change and related factor analysis in rats with early stage of diabetes mellitus

Background The pathological foundation of diabetic retinopathy is the breakdown of the bloodretina barrier induced by multifactors.Objective This study was to investigate the retinal morphologic change and the levels of serum vascular endothelial growth factor(VEGF),endothelin(ET)and nitric oxide(NO)in diabetic rats.Methods Forty healthy female SD rats were randomly divided into experimental group and control group and 20 rats for each group.Acute diabetes models were established by the intraperitoneal injection of 60 mg/kg streptozotocin in experimental group and the equal volume of buffer solution was injected at the same way in the control group.The serum VEGF level,ET level and NO concentration of diabetic and control rats were detected using ELISA double antibody sandwich method,125I radioimmune method and nitrate reduction method respectively at 2,4,6 and 8 weeks after injection.The eyeballs of rats were enucleated at the eighth week for retinal pathologic examination.This experiment followed the Measures for the administration of experimental animals of Shanghai City.Results The retinal structure was normal throughout the experimental duration in the control group.However,retinal edema and cellular disorganization appeared at 4 months and retinal blooding could be seen with the extending of diabetes course.The levels of serum VEGF and ET in each experimental group were significantly higher than those in control groups(P＜0.05).The levels of serum NO elevated in 2-month experimental group compared with same-phase control group(Z =-2.193,P＜0.05),and those in 6-and 8-month experimental groups were significantly lower than in corresponding control groups(Z =-2.449,Z =-2.236,P＜0.05).With the progression of the disease,the levels of VEGF and ET increased gradually,but the levels of NO decreased gradually,showing statistically significant differences(P＜0.05).The level of serum VEGF showed a positive correlation with serum ET level and a negative correlation with the serum NO concentration(r=-0.814,r=-0.803,P＜0.01)in the experimental group.A negative leaner relation was also found between serum ET level and serum NO concentration(r=0.821,P＜0.01).Conclusions The serum VEGF,ET and NO levels are closely associated with the degree of retinal lesion in early diabetic models.These results suggest that serum VEGF,ET and NO levels may be the important indexes predicting the course of retinal disease in diabetic rats. Key words: Diabetes mellitus; Retina; Vascular endothelial growth factor; Endothelin; Nitric oxide

Caractéristiques immuno-analytiques du peptide-C

The C-peptide is a polypeptide of connection that is generated during the proteolytic cleavage of proinsulin in pancreatic beta cells. It is secreted in equimolar amounts with insulin. Unlike insulin, C-peptide is not metabolized by the liver but filtered by the kidneys and excreted in the urine. Because of its longer half-life (compared with insulin), the C-peptide value is better suited to control the secretion of β cells. The C-peptide plays an important role in the structural conformation of A and B chains of insulin and the formation of two disulfide bonds present in the proinsulin molecule that are conserved in the active insulin. The main indications of its assay are: evaluating the residual function of β cells in diabetic patients and in case of exogenous insulin substitution, the evaluation of secretory capacity of β cells in the early stage of diabetes mellitus, control of patients with symptoms of hypoglycemia. Less frequently, the assay may be useful in patients suffering from polycystic ovarian syndrome, the diagnosis of insulinoma, the diagnosis of factitious hypoglycemia, the evaluation of β-cell transplantation and monitoring of patients after pancreatectomy. The urinary assay facilitates the monitoring of gestational diabetes and the follow-up of patients with unstable glycemic status. Besides structural and physiological C-peptide data, this paper points out the optimal conditions for immunoassay and interpretation of results. Le peptide-C est un polypeptide de connexion qui est formé lors du clivage protéolytique de la pro-insuline dans les cellules béta pancréatiques. Il est sécrété en quantité équimolaire avec l’insuline. Contrairement à l’insuline, le peptide-C n’est pas métabolisé par le foie mais filtré par les reins et éliminé dans les urines. À cause de sa demi-vie plus longue que celle de l’insuline, la détermination du peptide-C est mieux adaptée pour contrôler les sécrétions des cellules β. Le peptide-C joue un rôle important dans la conformation structurelle des chaînes A et B de l’insuline et la formation des deux ponts disulfure présents dans la molécule de pro-insuline qui sont conservés dans celle de l’insuline active. Les principales indications du dosage sont : l’évaluation de la fonction résiduelle des cellules β chez les patients diabétiques et en cas de substitution par l’insuline exogène, l’évaluation des capacités sécrétoires des cellules β dans le stade précoce de diabète sucré, le contrôle des patients avec symptômes d’hypoglycémie. Plus exceptionnellement, son dosage peut être utile chez les patientes affectées d’un syndrome des ovaires polykystiques, le diagnostic d’un insulinome, le diagnostic d’une hypoglycémie factice, l’évaluation d’une greffe des cellules β et pour la surveillance de patients après pancréatectomie. Le dosage urinaire facilite le suivi du diabète gestationnel et celui des patients en cas de situation glycémique instable. Après les caractéristiques structurales et physiologiques du peptide-C, cet article aborde les données pré-, per- et postanalytiques utiles pour l’interprétation des dosages.

Optimal Treatment Strategies for Patients With Hypertension and Diabetes

See related article, pp 776–783 Ruggenenti et al1 conducted a multicenter randomized, controlled 3-arm trial in 380 hypertensive patients with type 2 diabetes mellitus without albuminuria to examine whether treatment with an angiotensin-converting enzyme (ACE) inhibitor alone, an ACE inhibitor with a third generation calcium channel blocker, or placebo, would ameliorate target organ complications over a period of 3 years. At baseline, measured glomerular filtration rate (GFR) was well preserved at ≈100 mL/min per 1.73 m2 in each group. Urinary albumin excretion was minimal (≈5 to 6 μg/min), and >10% of the patients had no evidence of microalbuminuria. The primary plan of this study was to evaluate whether different forms of antihypertensive treatment would impact changes in measured GFR over time in patients with minimal or no evidence of diabetic kidney disease. Given the diminished likelihood that the different antihypertensive treatments could measurably affect kidney function at such an early stage of diabetes mellitus, the investigators also considered other biomeasures of diabetic complications, such as cardiovascular events, retinopathy, and neuropathy progression. Even so, it was a bold plan to evaluate the possibility of treatment effects at such an early stage of disease. The observations of this clinical trial are fascinating and raise some important questions about treatment. The first interesting observation was the amazingly fast loss of GFR in this population of nonproteinuric diabetic patients with mild-to-moderate hypertension, ≈4 mL/min per 1.73 m2 per year. This rate of loss of renal function is on par with the trials of renin-angiotensin-aldosterone …

Diabetes mellitus and chronic kidney disease: achievements, unresolved problems, and prospects for therapy

The dramatic increase in the number of patients with diabetes mellitus (DM) and chronic renal disease (CRD) in the recent years emphasizes the closeassociation between the two conditions and the leading role of DM in the development of renal pathology. Diabetology and nephrology are highly costlybranches of public health, and the burden of substitution renal therapy in DM patients continues to grow. The necessity of a renoprotection programat the early stages of DM for the prevention or delay of terminal renal insufficiency becomes increasingly clear. Such program should be based on theconceptual model of the evolvement of diabetic nephropathy as a consequence of combined action of metabolic and hemodynamic factors modulatedby genetic ones.

Relationship between GLP‐1 levels and dipeptidyl peptidase‐4 activity in different glucose tolerance conditions

The reduced levels of glucagon-like peptide 1 (GLP-1) after an oral glucose load in Type 2 diabetic patients could be dependent either on a reduced synthesis or an increased degradation; but GLP-1 and dipeptidyl peptidase IV (DPP-IV) levels during an oral glucose tolerance test (OGTT) have not been studied together. The aim of the present study was to investigate GLP-1 and DPP-IV levels during an OGTT in patients with different degrees of glucose tolerance. Fifty six subjects (34 female, 22 male) matched for sex, age, body mass index (BMI) and waist circumference underwent a 75 g oral glucose tolerance test. Twenty-eight had normal glucose tolerance, 15 had impaired glucose tolerance and 13 had Type 2 diabetes mellitus. GLP-1 assay was performed with an ELISA kit, and DPP-IV assay using a colorimetric method. At 30 min GLP-1 levels were significantly lower in subjects with impaired glucose tolerance and type 2 diabetes mellitus compared to those with normal glucose tolerance. The area under the GLP-1 curve was significantly different among the three groups; there was a significant decrease between subjects with normal and impaired glucose tolerance(P = 0.004) and between those with normal glucose tolerance and type 2 diabetes mellitus. (P < 0.001), while the area under the curve for DPP-IV showed no significant difference between the groups. These results suggest that an increase of GLP-1 degradation does not play a role in the early stages of diabetes mellitus.

A Simple Method of Determining Pre-Diabetes

A simple formula for determining pre-diabetes (the very early stage of diabetes mellitus) was derived from the model of Ackerman et al. (Bull Math Biophys 1965; 27: s21-37) for very smoothly varying time course patterns of blood glucose level. The natural period of blood glucose level in a healthy subject calculated using the formula was in good agreement with the value obtained by computer work. Diabetes mellitus (DM) is a disease associated with dis- ordered metabolism of carbohydrates, and pre-diabetes mel- litus (PD) is a very early stage of mild DM caused by disor- dered secretion of insulin, glucagons and epinephrine. The study of PD is of great importance in opening a way to the early discovery of mild DM. Although quite many ap- proaches to DM and PD on mathematical basis have been reported thus far (1-6), most of them require advanced mathematical and computer work ability. The purpose of this report was to provide a simple method of determining PD in order to help general practitioners with limited mathematical and computer ability. This study was based on a simple model presented by Ackerman et al. (1, 7), which was based on the simple assumption that the blood glucose level tends to be regulatory and is influenced and controlled by a wide variety of hormones and other metabolites. In this model all these hormones are combined into a net hormonal concentration and the cumulative effect of them is taken into account. And thus the model centers attention on the concentration of glucose in the blood, labelled G and that of the net hormonal complex, labelled H. The hormones such as insulin which decrease G are considered to increase H. On the other hand, the materials such as glucagons, epinephrine and cortisol which increase G are considered to decrease H. Coupled linear differential equations for G and H can be established and these two first order equations can be com- bined into two separate forms of second order linear equa- tion. The solution for G, with t = 0 at the time the glucose loading has been completed, is generally given in three damped oscillation patterns. Among them, in analogy with mechanical vibration systems, the underdamped case seems to be more appropriate for PD, by assuming that there is no serious deficiency in the controlling system. Thus we have

Dietary Hesperidin Exerts Hypoglycemic and Hypolipidemic Effects in Streptozotocin-Induced Marginal Type 1 Diabetic Rats

Citrus bioflavonoids may offer some protection against the early stage of diabetes mellitus and the development of complications. We investigated the effect of hesperidin on blood glucose levels, hepatic glucose-regulating enzyme activities, serum insulin and adiponectin levels, serum and hepatic lipid levels, and parameters of bone loss in streptozotocin (STZ)-induced marginal type 1 diabetic rats. Weanling male rats were randomly assigned to experimental 3 groups: a control (C) group, a STZ induced marginal type 1 diabetes (S) group, and a diabetes and hesperidin group, and fed their respective diets for 4 weeks. STZ injection increased blood glucose in rats, but the increase was marginal. Serum and hepatic lipids, serum adiponectin and insulin levels were significantly changed by STZ injection. Dietary hesperidin (10 g/kg diet) decreased blood glucose by altering the activity of glucose-regulating enzymes, and normalized the lipids and adiponectin levels, but did not change bone parameters in the marginal type 1 diabetic rats. Hesperidin showed both hypoglycemic and hypolipidemic effects but did not affect bone tissue and bone metabolic makers in STZ-injected marginal diabetic weanling rats without any body weight loss due to STZ injection.