Function In Diabetic Subjects Research Articles

198-OR: The Stimulatory Effect of Glucagon on Insulin Secretion Is Glucose Dependent in Healthy Human Subjects

Glucagon is generally considered to be a counter-regulatory hormone with a primary role to raise blood glucose concentrations by increasing endogenous glucose production (EGP). However, recent preclinical findings support a paracrine action of glucagon to act directly on pancreatic beta cells to promote nutrient-stimulated insulin secretion. In mice, the divergent actions of glucagon are dependent on glycemic status: during fasting glucagon acts predominantly at the liver to raise blood glucose, whereas in the fed state when glycemia is elevated, the insulinotropic effects predominate to lower glucose. These mechanistic findings have not been extended to human physiology. Therefore, we designed a study to test the hypothesis that in healthy humans glucagon actions are also dependent on ambient glycemia. Subjects received glucagon (100 ng/kg) during fasting euglyemia or experimental hyperglycemia (~150 mg/dl) on separate days. On both days, glycemia was maintained for 60 min prior to a glucagon infusion for an additional 60 min. Blood glucose was monitored at bedside and plasma samples were analyzed for C-peptide and di-deuterated glucose enrichment to calculate HGP. During fasting euglycemia, blood glucose was 85 mg/dl and glucagon elicited an increase to a 60 minute average of 132 mg/dl with a peak at ~156 mg/dl at the end of the infusion. Concordant with increased glycemia was an immediate increase in HGP (1.8x) and a delayed increase in C-peptide AUC (1.5x). For the hyperglycemia studies, blood glucose was maintained at 150 mg/dl before and during glucagon administration. Here, glucagon caused a rapid and robust increase in C-peptide AUC (4x) and a more gradual increase in HGP (2x). This glycemic-dependent behavior of glucagon suggests a physiologic role to promote prandial insulin secretion in healthy subjects. This raises the possibility that this incretin function of glucagon plays a role in β-cell function in diabetic subjects. Disclosure S. M. Gray: None. G. Zhang: None. W. Bennett: None. J. Tong: None. J. Campbell: None. D. A. D’alessio: Advisory Panel; Self; Eli Lilly and Company, Sun Pharmaceutical Industries Ltd., Research Support; Self; Eli Lilly and Company, Merck & Co., Inc. Funding National Institutes of Health (F32DK121420, R01DK101991)

Metoprolol rescues endothelial progenitor cell dysfunction in diabetes.

Added risk portended by diabetes in addition to hypertension has been related to an amplification of endothelial dysfunction. β-blockers are widely used for cardiovascular diseases and improve the endothelial function compared with a placebo. However, the effect of β-blockers on the endothelial progenitor cells (EPCs) function in diabetes is still unknown. Five β-blockers (metoprolol, atenolol, propranolol, bisoprolol, and nebivolol) were tested in EPC functional screening. Metoprolol improved EPC function significantly among the five β-blockers and was chosen for the in vivo tests in STZ induced diabetic mice. Reactive hyperemia peripheral arterial tonometry (RH-PAT) measurements were performed using the Endo-PAT2000 device in diabetic patients. Metoprolol, but not other β-blockers, improved EPC function in both tube formation and migration assay. EPC function was significantly decreased in diabetic mice, and metoprolol treatment restored damaged EPC migration capabilities and circulation EPC number. Metoprolol treatment promoted wound healing and stimulated angiogenesis in diabetic mice. Furthermore, metoprolol significantly enhanced eNOS phosphorylation and decreased O2− levels in EPCs of diabetic mice. In clinical trials, the RH-PAT index was significantly higher in metoprolol-treated versus bisoprolol-treated diabetics. Metoprolol could accelerate wound healing in diabetic mice and improve endothelial function in diabetic subjects, which may be mediated in part by improving impaired EPC function.

Contrast sensitivity to spatial gratings in moderate and dim light conditions in patients with diabetes in the absence of diabetic retinopathy

ObjectiveTo evaluate the ability of contrast sensitivity (CS) to discriminate loss of visual function in diabetic subjects with no clinical signs of retinopathy relative to that of normal subjects.Research design...

Relationship between serum irisin, glycemic indices, and renal function in type 2 diabetic patients.

Introduction: Irisin is a novel peptide that plays notable role in human and animal biology and physiology. It has been reported that irisin may improve insulin resistance and related disturbances. Objectives: The aim of this investigation was to assess the relationship between serum irisin, glycemic indices, and renal function in diabetic subjects. Patients and Methods: In this cross-sectional study, a total of 102 type 2 diabetes mellitus (T2DM) patients were recruited. Blood biochemical parameters, including fasting plasma sugar (FBS), glycosylated hemoglobin (HbA1C), serum uric acid (sUA), creatinine concentration and glomerular filtration rate (GFR) were measured. All statistical analysis was performed with SPSS 16.0. Results: There was a positive correlation between irisin and age (P=0.05, r=0.19) and a negative correlation between irisin and body mass index (BMI) (P=0.01, r=-0.25) was detected. There was a significant difference of serum irisin level between patients with normal and abnormal FBS too. Conclusion: In this study we found, irisin concentration was increased with age, decreased with BMI, and it was higher in subject with abnormal FBS. Thus further research is needed to provide inclusive understanding of irisin associated physiological effects and possible implications in clinical conditions.

DIABETIC PNEUMOPATHY

Introduction: Diabetes mellitus is a condition whose main characteristic is excessive blood glucose and, if not controlled, can cause chronic systemic complications such as, nephropathy, pulmonary dysfunction, retinopathy and vascular disorders, among others. Lung complications in diabetics, due to chronic hyperglycemia, have been studied more recently. Objective: This study aims to conduct a literature review on changes in lung function in diabetes mellitus, through an integrative bibliographical review. Method: Bibliographic survey, through an integrative literature review, to establish a correlation between glycemic control and lung function in diabetic subjects. The integrative review was made by searching the Medline international databases for review of manuscripts. Selection of these databases was based on the wide range of journals covered by each of them and our goal was to provide an overview of the scientific production devoted to the topic over the timeframe of analysis. The following inclusion criteria were considered during the review: use of the keywords “lung” OR “pneumopathy” OR “lung disease” MeSH “diabetes mellitus” entered into the search form, and availability of an abstract in English. Results: A total 12 scientific productions were selected by contain information about the pulmonary function alterations in diabetes. Conclusion: The main pulmonary function abnormalities found in diabetics are: lung volume reduction; lung elasticity reduced; capillary blood volume reduction; thickening of the capillary basement membrane; decrease in muscle strength; and paresis or bilateral diaphragmatic paralysis due to phrenic neuropathy.

Heart rate variability is associated with interstitial glucose fluctuations in type 2 diabetic women treated with insulin.

Heart rate variability (HRV) analysis is a commonly used tool for assessment of autonomic function in diabetic subjects. Nevertheless, the effects of glucose fluctuations on HRV remain to be clarified. In this study we investigated the associations of frequency-domain HRV parameters with current and antecedent interstitial glucose fluctuations in insulin-treated type 2 diabetic women at high cardiovascular risk. Sixty-seven women with type 2 diabetes, from 48 to 78 years of age, including 46 ones with cardiovascular autonomic neuropathy (CAN), underwent simultaneous continuous glucose monitoring (CGM) and Holter recording. Eight glucose variability (GV) indices, including standard deviation, 2-h continuous overlapping net glycemic action (CONGA2), lability index, J-index, mean amplitude of glucose excursions, mean absolute glucose (MAG), low blood glucose index (LBGI) and high blood glucose index (HBGI), were calculated from CGM data. The low frequency (LF) and high frequency (HF) power values were estimated on 5-min intervals at fasting and postprandial daytime periods, at night and during CGM-defined hypoglycemia. The values of LF and HF power declined after meals in diabetic women with normal autonomic function tests. Patients with CAN demonstrated blunted postprandial LF and HF reduction and diminished LF/HF ratio during daytime hypoglycemic events. Daytime LF and HF at fasting state correlated negatively with MAG derived from antecedent nocturnal CGM recordings. Positive correlation was found between fasting LF and nocturnal LBGI. The LF power during daytime hypoglycemia demonstrated negative correlations with nocturnal CONGA2, J-index, HBGI and MAG. The nocturnal HBGI and CONGA2, along with HbA1c and daily insulin dose, were predictors of LF during daytime hypoglycemia in multiple regression analysis. Both postprandial and antecedent nocturnal glucose fluctuations affect daytime frequency-domain HRV parameters in insulin-treated type 2 diabetic women. In patients with increased GV the results of short-term assessment of HRV should be interpreted with caution. Fasting state rather than postprandial one seems to be preferable for HRV estimation.

A pilot study to examine the correlation between cognition and blood biomarkers in a Singapore Chinese male cohort with type 2 diabetes mellitus.

BackgroundDiabetes is reported to be linked to poorer cognitive function. The purpose of this study is to examine (a) clinical correlation between cognitive function and the biochemical perturbations in T2DM, and (b) the impact of statin treatment on cognitive function in diabetic subjects.MethodsForty Singaporean Chinese males with diabetes and twenty Singaporean Chinese males without diabetes were recruited for this study. Twenty-two of the diabetic subjects were on statin therapy and all subjects were non-demented. This was a 2-period non-interventional case-control study in which subjects were assessed for cognitive function in period 1 and blood samples taken over 2 periods, approximately 1 week apart. Blood was collected to determine the level of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, glucose and insulin. Cognitive performance was measured by a neuropsychological battery covering domains of attention, language, verbal and visual memory, visuomotor speed and executive function. Z-scores were derived for each cognitive domain using the mean and standard deviations (SDs), and they were used to compare between (a) diabetic and non-diabetic groups, and (b) diabetic subjects with and without statin treatment. ANCOVAs with age, education, BMI, and the duration of diabetes as covariates were employed to examine differences in mean score of cognitive domains and subtests between the two groups.ResultsOverall cognitive function was similar among diabetics and age matched non-diabetic controls. Among diabetic statin users, HDL, LDL and total cholesterol were negatively correlated with executive function, whereas peripheral insulin levels and insulin resistance were negatively associated with attention.ConclusionDiabetic statin users were likely to have poorer performance in attention and executive function. Increasing levels of the peripheral biomarkers are likely to contribute to poorer cognitive performance.

Intrarenal arterial resistance is associated with microvascular complications in Chinese type 2 diabetic patients

Increased renal arterial resistance is associated with various types of chronic renal parenchymal diseases. A resistance index (RI) > 0.8 predicts deterioration in renal function in diabetic subjects. However, the association between renal RI and other diabetic complications has not been investigated. In this study, we examined the association between intrarenal arterial RI and diabetic complications in Chinese type 2 diabetic subjects. Three hundred and eighty-seven Chinese type 2 diabetic patients were recruited from a structured assessment programme to evaluate their risk factors and complications as a part of the quality improvement programme at the Prince of Wales Hospital. All subjects underwent ultrasound examinations for the assessment of intrarenal arterial RI of both kidneys. Clinical and biochemical parameters, including diabetes-related microvascular complications (nephropathy, retinopathy and sensory neuropathy) and macrovascular diseases, were examined. The mean RI of patients with any microvascular complications (0.70 ± 0.09 versus 0.65 ± 0.06) such as nephropathy (0.71 ± 0.09 versus 0.66 ± 0.06), retinopathy (0.71 ± 0.08 versus 0.67 ± 0.08) and sensory neuropathy (0.75 ± 0.07 versus 0.68 ± 0.08) and with any macrovascular complications (0.71 ± 0.09 versus 0.68 ± 0.08) was higher than those without (P < 0.05). On multivariate analysis, after controlling for confounding variables, an RI ≥0.75 was associated with microvascular complications, nephropathy, retinopathy and sensory neuropathy, with odds ratio of 4.02 [95% confidence interval (CI) 1.72-9.4], 4.99 (2.61-9.56), 2.78 (1.52-5.09) and 5.74 (1.8-18.3), respectively. The association of RI with macrovascular complications was not significant in multivariate analysis. Increased intrarenal arterial resistance was independently associated with an increased risk of microvascular complications including diabetic nephropathy, diabetic retinopathy and diabetic sensory neuropathy in Chinese type 2 diabetic patients.

The role of foot morphology on foot function in diabetic subjects with or without neuropathy

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03).While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.

When to initiate ACEI/ARB therapy in patients with type 1 and 2 diabetes

Angiotensin converting enzyme inhibitors (ACEI) and angiotensin 2 receptor blockers (ARB) have become a mainstay of adjunctive therapy for the prevention and amelioration of diabetic nephropathy. Although ACEI were shown over 20 years ago to slow the rate of loss of renal function in diabetic subjects with decreased renal function, the question of how early in the course of diabetes to introduce them remains unresolved. Recent studies suggest that very early initiation of ACEI/ARB therapy may not have demonstrable beneficial effects even over a period of years.

Effect of Glucose or Fat Challenge on Aspirin Resistance in Diabetes

Aspirin has lower antiplatelet activity in diabetic patients. Our aim is to study the roles of acute hyperglycemia and hyperlipidemia on aspirin function in diabetic subjects with and without cardiovascular disease. Using urine thromboxane (pg/mg creatinine) and VerifyNow (Aspirin Resistance Measures-ARU), we investigated diabetic subjects during a 2-hour glucose challenge (n = 49) or a 4-hour fat challenge (n = 11). All subjects were currently taking aspirin (81 or 325 mg). After fat ingestion, urine thromboxane increased in all subjects (Mean ± SE before: after) (1209 ± 336: 1552 ± 371, P = .01), while we noted a trend increase in VerifyNow measures (408 ± 8: 431 ± 18, P = .1). The response to glucose ingestion was variable. Diabetic subjects with cardiac disease and dyslipidemia increased thromboxane (1693 ± 364: 2799 ± 513, P < .05) and VerifyNow (457.6 ± 22.3: 527.1 ± 25.8, P < .05) measures after glucose. We conclude that saturated fat ingestion increases in vivo thromboxane production despite aspirin therapy.

Effect of insulin-unstimulated diabetic therapy with miglitol on serum cystatin C level and its clinical significance

The serum cystatin C level is thought to provide a more accurate estimate of renal function in diabetic subjects than creatinine-based methods. This study was designed to compare miglitol and miglitinide, on cystatin C levels. Forty patients with type 2 diabetes were randomly assigned to receive 150 mg/day miglitol or 30 mg/day mitiglinide. The serum cystatin C level was measured in 36 patients (19 in the miglitol group and 17 in the mitiglinide group) undergoing meal tolerance testing. High sensitivity C reactive protein (hsCRP) was also assessed. After 3 months of therapy, the cystatin C level did not change but the log-transformed hsCRP value decreased (3.03 ± 0.32 to 2.83 ± 0.34 log[μg/L], P < 0.05) in the miglitol group, whereas in the mitiglinide group the cystatin C level increased (0.75 ± 0.18 to 0.78 ± 0.20 mg/L, P < 0.05) but the hsCRP value did not change. After 3 months, the levels of cystatin C and hsCRP were each correlated with the postprandial insulin level in the meal tolerance test in all patients. These results suggest that postprandial insulin secretion might increase cystatin C and that insulin-unstimulated miglitol therapy might suppress an increase in cystatin C accompanied by an anti-inflammatory effect in diabetic patients.

Beneficial effects of soy protein consumption for renal function.

Alterations in dietary protein intake have an important role in prevention and management of several forms of kidney disease. Using soy protein instead of animal protein reduces development of kidney disease in animals. Reducing protein intake preserves kidney function in persons with early diabetic kidney disease. Our clinical observations led us to the soy-protein hypothesis that "substitution of soy protein for animal protein results in less hyperfiltration and glomerular hypertension with resulting protection from diabetic nephropathy." These components of soy protein may lead to the benefits: specific peptides, amino acids, and isoflavones. Substituting soy protein for animal protein usually decreases hyperfiltration in diabetic subjects and may reduce urine albumin excretion. Limited data are available on effects of soy peptides, isoflavones, and other soy components on renal function on renal function in diabetes. Further studies are required to discern the specific benefits of soy protein and its components on renal function in diabetic subjects.

The Influence of PON1 192 Polymorphism on Endothelial Function in Diabetic Subjects with or without Hypertension

Hypertension and type 2 diabetes mellitus (T2DM) cause endothelial dysfunction probably through increased oxidant stress. Paraoxonase (PON1) is an high-density lipoprotein (HDL)-linked anti-oxidant enzyme whose capacity is influenced by a genetic polymorphism at codon 192. In the present study we have investigated the role of PON1 polymorphism on endothelial function in subjects with T2DM with or without hypertension. Three groups of male subjects were enrolled: 65 healthy control subjects without T2DM or hypertension (CON), 51 with only T2DM (DM), and 67 with both hypertension and T2DM (HYP+DM). The PON1 Gln192Arg polymorphism was determined by polymerase chain reaction (PCR) amplification and restriction analysis. Endothelial function was evaluated as flow-mediated vasodilatation (FMD) of the brachial artery after forearm ischemia. Data were analyzed according to the presence or absence of the Arg allele. Subjects with T2DM had markedly impaired FMD, compared with those of the CON group. In the CON and HYP+DM groups no difference was observed in FMD between subjects homozygous for the Gln allele and those carrying the Arg allele. In the DM group FMD was lower among those carrying the Arg allele compared with Gln/Gln homozygotes (2.1+/-2.4% vs. 6.2+/-5.2%, p=0.002). In conclusion, the present findings demonstrated that FMD was less impaired in normotensive diabetic subjects homozygous for the Gln allele, consistent with the notion that this isoform has a more effective antioxidant action that serves to protect circulating low-density lipoprotein (LDL). Hypertension seems to abolish the protective effect of the Gln isoform. These findings, however, warrant further investigation to clarify their clinical import.

Reversal of diabetes‐evoked changes in mitochondrial protein expression of cardiac left ventricle by treatment with a copper(II)‐selective chelator

Cardiac disease is the commonest cause of death amongst diabetic patients. Diabetic cardiomyopathy, which has a poor prognosis, is characterized by left ventricular hypertrophy and impaired cardiac function and mitochondrial damage is said to contribute to its development. We recently showed that treatment with the Cu(II) -selective chelator, triethylenetetramine (TETA), improved cardiac structure, and function in diabetic subjects without modifying hyperglycemia. Thus, TETA has potential utility for the treatment of heart disease. To further understand the molecular mechanism by which it causes these effects, we have conducted the first study of the effect of oral TETA on protein abundance in the cardiac left ventricle of rats with severe streptozotocin-induced diabetes. Proteomic methods showed that of 211 proteins changed in diabetes, 33 recovered after treatment. Through MS, 16 proteins were identified which may constitute major targets of drug action. Remarkably, most of these were mitochondrial proteins with roles in energy metabolism. In addition to components of the mitochondrial respiratory chain and enzymes involved in fatty acid oxidation, TETA treatment normalized both myocardial expression and enzymatic activity of carnitine palmitoyltransferase 2. These findings indicate that mitochondria constitute major targets in the mechanism by which TETA restores cardiac structure and function in diabetes.

β-Cell Function in Severely Obese Type 2 Diabetic Patients

Bariatric surgery in severely obese diabetic patients can restore glucose tolerance (1). Malabsorptive bariatric surgery (e.g., bilio-pancreatic diversion [BPD]) in nondiabetic subjects induces an improvement in insulin sensitivity that is greater than predicted by weight loss (2,3); such an effect can be demonstrated early after surgery (4). Impaired β-cell function is the main determinant of glucose intolerance, and modeling of C-peptide responses to graded glucose infusions (5) or oral glucose administration (6) makes it possible to estimate key dynamic parameters of β-cell function such as β-cell glucose sensitivity. The impact of bariatric surgery on β-cell function in diabetic subjects has been investigated using the intravenous glucose tolerance test (7). This test, however, can misjudge β-cell function as compared with more physiological challenges (such as the oral glucose tolerance test or mixed meals) because it explores only one specific aspect of islet function, namely the acute insulin discharge in response to a sudden maximal increment in plasma glucose concentrations (8). Recently, we have applied C-peptide–based modeling to reconstruct insulin secretion and β-cell function during a 24-h multiple-meal test (9). Here, we adopted this approach to analyze the long-term effects of BPD on glucose metabolism in morbidly obese patients with type 2 diabetes. We studied 10 morbidly obese (mean ± SE BMI 49.5 ± 2.9 kg/m2), non–insulin-treated type 2 diabetic patients (3 men and 7 women) (age 50 ± 2 years) whose weight had been stable (±2 kg) for the preceding 6 months. Oral antidiabetic drugs were discontinued 1 week before the baseline studies. The study protocol was approved by the local ethics committee, and all subjects provided informed written consent to participate. Following the baseline studies, patients underwent BPD, consisting of a partial gastrectomy with a distal Roux-en-Y reconstruction (2), and were restudied 24 ± 2 months postsurgery. …

Effect of essentiale in diabetic subjects with Non - Alcoholic fatty liver

Nonalcoholic fatty liver (NAFL) has been reported to be common among subjects with diabetes. However, there are not much therapeutic options for NAFL. In this open labeled clinical trial we studied the effect of Essentiale in diabetic subjects with NAFL. Twenty-eight type 2 diabetic patients attending the out-patient division of M.V. Diabetes Specialities Centre, Chennai and satisfying the inclusion criteria were recruited for the study. High resolution B mode ultrasonography was carried out for diagnosis of NAFL. Liver function markers [Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Gamma Glutamyl transferase (GGT)] were measured. 22 out of the 28 patients (78.5%) were available for follow up. The mean age of the study subjects was 41±8 years and 50% were males. A significant reduction in all the liver enzymes were observed after Essentiale treatment (baseline vs. six months after treatment: ALT: 54.5± 29.6 IU/L vs. 37.1±18.7 IU/L, p< 0.05, AST: 38.0±18.0 IU/L vs. 27.6±12.4 IU/L, p< 0.05, GGT: 38.7±27.5 IU/L vs. 29.6±13.8 IU/L, p< 0.05). Ultrasound studies revealed that the hepatic echotexture improved after Essentiale treatment in 12/22 (54.5%) of the study subjects, while there was no change in 9/22 (40.9%), and it worsened in only one patient (4.5%). The study results suggest that Essentiale protects and improves liver function in diabetic subjects with NAFL. Prospective, blinded clinical trials are required to confirm these findings.

Use of runs test to assess cardiovascular autonomic function in diabetic subjects.

We suggest a simple, noninvasive method to assess the autonomic function in diabetic subjects. The method requires only a monitoring of heart rate (HR) with subjects in the sitting position. Sixty diabetic subjects, 44 men and 16 women, between 20-80 years of age, were recruited, chronologically, for this study. Subjects treated for high blood pressure were not included. Their autonomic function was assessed by the total score of five classical cardiovascular function tests. In the same subjects and in 44 healthy subjects, blood pressure and HR were determined from beat to beat by the Finapres system with subjects in the sitting position. We examined the randomness of the HR changes by calculating the zeta statistic of the runs test on 1,000 successive HR readings (the zeta value is low if the HR changes are random). When the HR changes are random, we consider that the autonomic control of HR is impaired. The zeta values of HR changes were significantly lower in diabetic subjects compared with normal subjects (2.98 +/- 0.97 vs. 3.54 +/- 0.97, P < 0.004). In diabetic subjects, the zeta value was closely correlated to the total score of disautonomy (r = -0.66, P < 0.0001, after correction for age effect) and to the office systolic blood pressure (r = -0.43, P < 0.001). The zeta value of HR changes might be a marker of the autonomic function in diabetic subjects.

Hypertension and diabetes mellitus

The association of arterial hypertension and diabetes mellitus is frequent: one third of patients attending a diabetic clinic. Excess hypertension frequency is marked in type II, non insulin-dependent diabetes, a condition often associated with other vascular risk factors such as obesity and lipid disorders. Insulin resistance is a common feature between type II diabetes, hypertension and other risk factors. In type 1. insulin-dependent diabetes. hypertension is often linked to diabetic nephropathy. There is a genetic basis for diabetic nephropathy, which may share a common background with familial hypertension. Apart from possible genetic predispositions to hypertension diabetes association, chronic hyperlycaemia can lead to alteration in functional and structural properties of blood and vessels, which both contribute to elevated vascular resistance and blood pressure. From a therapeutic viewpoint, blood pressure values above 140/90 mmHg are not tolerable in diabetic subjects under 40 years of age. Due to their renal haemodynamic effects, angiotensin I converting enzyme inhibitors may be of special interest to protect kidney function in diabetic subjects.

Hand Function in Patients With Diabetes Mellitus

Using validated clinical tests and standardized controls, we measured hand function in diabetic subjects. Fifteen diabetic patients (median age 48 years), all having used insulin for a minimum of 5 years, were randomly selected from inpatient and outpatient services of an academic medical center. Testing was done on an outpatient basis. The three hand function tests used were the Purdue Pegboard, O'Connor Tweezer Dexterity, and Smith Hand Function. A symptom questionnaire was also included in the study. Function was significantly decreased in the diabetic group, and the decrease was out of proportion to their own subjective pretest assessments. These findings may have implications for occupational performance as well as activities of daily living.