Insulin-dependent Diabetes Mellitus Patients Research Articles

Long-term mortality after primary PCI for STEMI in patients with insulin-dependent diabetes mellitus

Introduction: Primary PCI (pPCI) is the gold standard in the treatment of patients with acute myocardial infarction (AMI) with ST elevation (STEMI). Aim: The purpose of this study is to evaluate the influence of diabetic status upon arrival at five year survival in patients with STEMI that were treated with pPCI. Material and methods: Consecutive data for 2087 patients admitted in the period from 1st of January 2009. to 31st of December 2010. with diagnosis of acute STEMI were collected from catheterisation laboratory cardiology clinic CCS electronic database. Patients were divided into 3 groups: those without diabetes mellitus (DM), IDDM (insulin dependent diabetes mellitus), NIDDM (non-insulin dependent diabetes mellitus). Results: 1664 patients (79.7%) did not have DM, 98 (4.7%) had IDDM and 325 (15.6%) had NIDDM. There was a statistically significant difference in mortality rate among three groups after 30 days, one year and five years after intervention, and the highest rates were recorded at the IDDM patients, then at the NIDDM and the lowest in patients without DM (15.3% vs 8.3% vs 5.9 %, p < 0.001 after 30 days; 21.4% vs 15.4% vs 10.9%, p < 0.001 after one year and 32.7% vs 24.3% vs 18%, p < 0.001 after 5 years). Also, there was a highly statistically significant difference in five-year mortality rate between patients with and without DM (26.2 % vs 17.6%, p < 0.001). IDDM was a independent factor when it comes to predicting five-year mortality (HR = 1.58, 95% CI 1.07-2.32, p = 0.02) whereas NIDDM was not (HR = 1.24, 95% CI 0.95-1.63, p = 0.12). Conclusion: Diabetic patients had an increased risk of mortality in the short and long-term follow-up after pPCI. Insulin-dependent was a single predicting factor after five year follow-up.

Evaluation of salivary albumin in diabetic children

Aim: To evaluate salivary albumin in insulin-dependent diabetes mellitus (IDDM) patients and to compare with the healthy nondiabetic control group. Study Design: The study consisted of 30 IDDM patients and 30 age- and sex-matched healthy controls. All the subjects were subjected to salivary albumin estimations. The salivary albumin estimations were done by bromocresol green (BCG) dye method, end point. All the estimations were performed using an AutoAnalyzer. Results: The results showed elevated levels of salivary albumin in the IDDM group compared to the healthy controls. Conclusion: The salivary albumin can be used to assess the metabolic status of the diabetic subjects since it showed increased levels compared to the healthy controls. Salivary parameters can act as adjuncts in assessing the overall metabolic status of the patient.

Differential impact of non-insulin-dependent diabetes mellitus and insulin-dependent diabetes mellitus on breast reconstruction outcomes.

While the comparative safety of breast reconstruction in diabetic patients has been previously studied, we examine the differential effects of insulin and non-insulin-dependence on surgical/medical outcomes. Patients undergoing implant/expander or autologous breast reconstruction were extracted from the National Surgical Quality Improvement Program 2005-2012 database. Preoperative and postoperative variables were analyzed using chi-square and Student's t test as appropriate. Multivariate regression modeling was used to evaluate whether non-insulin-dependent diabetes mellitus (NIDDM) or insulin-dependent diabetes mellitus (IDDM) is independently associated with adverse 30-day events following breast reconstruction. Of 29,736 patients meeting inclusion criteria, 23,042 (77.5 %) underwent implant/expander reconstructions, of which 815 had NIDDM and 283 had IDDM. Of the 6,694 (22.5 %) patients who underwent autologous reconstructions, 286 had NIDDM and 94 had IDDM. Rates of overall and surgical complications significantly differed among non-diabetic, NIDDM and IDDM patients in both the implant/expander and autologous cohorts on univariate analysis. After multivariate analysis, NIDDM was significantly associated with surgical complications (OR 1.511); IDDM was significantly associated with medical (OR 1.815) and overall complications (OR 1.852); and any type of diabetes was significantly associated with surgical (OR 1.58) and overall (OR 1.361) complications after autologous reconstruction. Diabetes of any type was not associated with any type of complication after implant/expander reconstruction. In this large, multi-institutional study, diabetes mellitus was significantly associated with adverse outcomes after autologous, but not implant-based breast reconstruction. The multivariate analysis in this study adds granularity to the differential effects of NIDDM and IDDM on complication risk.

Prevalence of Microalbuminuria in NIDDM Hypertensives and Non-Diabetic Hypertensives A Comparative Study

Urinary albumin excretion is indicative of glomerular permeability with increasing levels of albumin in the urine indicates renal damage. An excretion rate of 300mg/day is macroalbuminuria. Microalbuminuria of 20-200µg/min (30-300 mg/day) is an early indicator of renal injury and predicts the development of proteinuria and progressive renal failure. Microalbuminuria is also an important predictor of cardiovascular events in patients with both insulin dependent diabetes mellitus (IDDM) and non insulin dependent diabetes mellitus (NIDDM). Urinary albumin excretion depends on permselectivity of the glomerular basement membrane (GBM). Majority of patients with nephropathy have NIDDM due to higher prevalence of NIDDM ( 90% ) in general population. Hypertension accelerates rate of decline of renal function and more closely related to higher blood pressure and longer duration. Increased glomerular hydrostatic pressure and increased permeability of GBM are two proposed mechanisms for increased Urinary Albumin Excretion ( UAE ). The aim of study is to compare the prevalence of microalbuminuria in non insulin dependent diabetic (NIDDM) hypertensives with non-diabetic hypertensives and to correlate with sex, age, family history, body mass index(BMI), mean arterial pressure(MAP) risk factors. Only type2 diabetic hypertensives and non diabetic hypertensives were included. IDDM patients and hypertensives on angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARBS) were excluded from the study. 150 persons were enrolled into the study. 50 non insulin dependent diabetic hypertensives, 50 non-diabetic hypertensives and 50 healthy individuals were included as controls. Urinary Albumin Excretion(UAE) was estimated by particle enhanced Immunoturbidimetric test in 24 hr urinary sample. The study showed higher prevalence of microalbuminuria in NIDDM with HTN group (74%) than non-diabetic hypertensive group (38%). Males showed higher prevalence of microalbuminuria 56.75% in NIDDM with HTN and 68.42% in hypertensives than females in both groups. The study showed patients in higher age group 50-60yrs had higher prevalence of microalbuminuria 78.37% in NIDDM with HTN and 63.15% in non diabetic hypertensives. It has been observed that increasing of age associated with increased prevalence of microalbuminuria. 74% of patients in NIDDM with HTN and 54% of patients in non diabetic hypertensives showed positive family history. Higher BMI 25-35 showed higher prevalence of microalbuminuria 67.56% in NIDDM with HTN and 42% in HTN group. Higher prevalence of microalbuminuria 74% in diabetic hypertensives and 38% in non diabetic hypertensives with MAP ranging between 111-150 mmHg. The results were analysed by applying Chi-square test. p-value calculated and compared among three groups. P- value < 0.005 which is highly significant..

Optimal H&lt;SUB align="right"&gt;&amp;infin; insulin injection control for blood glucose regulation in IDDM patient using physiological model

This paper addresses the design of output feedback H∞ controller to deliver insulin via an implantable micro insulin dispenser for insulin-dependent diabetes mellitus (IDDM) patients. The theory of H-infinity optimal control has the feature of minimising the worst-case gain of an unknown disturbance input. When appropriately modified, the theory can be used to design a ‘switching’ controller that can be applied to insulin injection for blood glucose (BG) regulation in IDDM patient. The ‘switching’ controller is defined by a collection of basic insulin rates and a rule that switches the insulin rates from one value to another. The rule employed an estimation of BG from noisy measurements and the subsequent optimisation of a performance index that involves the solution of a ‘jump’ Riccati differential equation. With an appropriate IDDM patient model, simulation studies have shown that the controller could correct BG deviation using clinically acceptable insulin delivery rates to maintain normoglycaemia.

Inhibition of EGF Signaling Protects the Diabetic Retina from Insulin-Induced Vascular Leakage

Diabetes mellitus is a disease with considerable morbidity and mortality worldwide. Breakdown of the blood-retinal barrier and leakage from the retinal vasculature leads to diabetic macular edema, an important cause of vision loss in patients with diabetes. Although epidemiologic studies and randomized clinical trials suggest that glycemic control plays a major role in the development of vascular complications of diabetes, insulin therapies for control of glucose metabolism cannot prevent long-term retinal complications. The phenomenon of temporary paradoxical worsening of diabetic macular edema after insulin treatment has been observed in a number of studies. In prospective studies on non-insulin-dependent (type 2) diabetes mellitus patients, a change in treatment from oral drugs to insulin was often associated with a significant increased risk of retinopathy progression and visual impairment. Although insulin therapies are critical for regulation of the metabolic disease, their role in the retina is controversial. In this study with diabetic mice, insulin treatment resulted in increased vascular leakage apparently mediated by betacellulin and signaling via the epidermal growth factor (EGF) receptor. In addition, treatment with EGF receptor inhibitors reduced retinal vascular leakage in diabetic mice on insulin. These findings provide unique insight into the role of insulin signaling in mediating retinal effects in diabetes and open new avenues for therapeutics to treat the retinal complications of diabetes mellitus.

The Association of Myasthenia Gravis with HLA class II Antigens in Iraqi Patients

The nature and intensity of the association of myasthenia gravis (MG) with distinct human leukocyte antigen (HLA) haplotypes differ between ethnic populations, so this study determined the association of HLA class II antigens with myasthenia gravis (MG) in Iraq.The study included Iraqi patients diagnosed with MG and two control groups the first of 54 insulin dependent diabetes mellitus patients and the second of 237 subjects as a normal control group. The test used was microlymphocytotoxicity test.The work was done in the Teaching Laboratories/Medical City/Baghdad.Results: positive associations were observed (etiological risk factors) as follows: 1. HLA-DR locus showed one positively associated allele when compared to healthy control and this was HLA-DR3 (RR: 21.05, EF0.73, &amp; P value ? 0.05), While when compared to IDDM control no significant association appeared (since the same allele is positively associated with IDDM). 2. HLA-DQ locus showed only one positively associated allele when compared to healthy control; this was HLA-DQ2 (RR 4.67, EF 0.50, and P value ? 0.05). While no significant association appeared when compared to IDDM control. Other important clinical association were observed; association with age, gender, strong stressful events, thymoma, and other autoimmune disorders. Conclusion: The positively associated antigens which were found as follows HLA-DR3 and HLA-DQ2, while no negative association was detected.

The Association of Myasthenia Gravis with HLA class II Antigens in Iraqi Patients

The nature and intensity of the association of myasthenia gravis (MG) with distinct human leukocyte antigen (HLA) haplotypes differ between ethnic populations, so this study determined the association of HLA class II antigens with myasthenia gravis (MG) in Iraq.The study included Iraqi patients diagnosed with MG and two control groups the first of 54 insulin dependent diabetes mellitus patients and the second of 237 subjects as a normal control group. The test used was microlymphocytotoxicity test.The work was done in the Teaching Laboratories/Medical City/Baghdad.Results: positive associations were observed (etiological risk factors) as follows: 1. HLA-DR locus showed one positively associated allele when compared to healthy control and this was HLA-DR3 (RR: 21.05, EF0.73, &amp; P value ? 0.05), While when compared to IDDM control no significant association appeared (since the same allele is positively associated with IDDM). 2. HLA-DQ locus showed only one positively associated allele when compared to healthy control; this was HLA-DQ2 (RR 4.67, EF 0.50, and P value ? 0.05). While no significant association appeared when compared to IDDM control. Other important clinical association were observed; association with age, gender, strong stressful events, thymoma, and other autoimmune disorders. Conclusion: The positively associated antigens which were found as follows HLA-DR3 and HLA-DQ2, while no negative association was detected.

Application of community periodontal index of treatment need (CPITN) in a group of insulin dependent diabetes mellitus (IDDM) patients

The aim of this study was to assess periodontal status and treatment need of insulin dependent diabetic mellitus patients by using the CPITN system and to shed additional light on the possible effects of the duration of diabetes on the periodontal status in these patients. A comparison was made between 150 diabetic patients and 150 control subjects. The surveys comprised of a self-administered questionnaire, along with medical and dental examinations. The results indicated that prevalence of code 0 was lower and code 1, 2 and 3 were higher in diabetic than control group. Oral hygiene instruction was required for 64.7 % of diabetic group and 47.3 % of control group. Professional scaling was required for 34.7 % of diabetic group and 20 % of control group. Complex treatment required for 2 % of diabetic group and 0.7 % of control group. To conclude, strong association was found between diabetes and periodontal health in the present study. Hence, it is recommended that an oral examination should be one of the components of the initial visit for children and adolescents having diabetes.

Increased level of platelet P-selectin in nonarteritic anterior ischemic optic neuropathy

P-selectin receptor is expressed in platelets and endothelial cells in a cell-activation-dependent manner. Platelet P-selectin (CD62) levels may become elevated in a number of vasoocclusive diseases, including arteriosclerosis, atherothrombosis, and diabetes mellitus (DM). Nonarteritic anterior ischemic optic neuropathy (NAION) is associated with a sudden loss of vision due to the vascular insufficiency of ciliary arteries supplying the optic nerve. In this study, our aim was to investigate the presence of increased platelet reactivity in the development of NAION. Twenty-one NAION patients, 39 healthy control subjects, and 44 patients suffering from diabetes mellitus (DM) were examined in our case-control, pilot study. Platelet activation was investigated by flow cytometric analysis of the mean fluorescence intensity (MFI) of CD62 on platelets. These results were compared among the different study groups. NAION patients showed considerably although not significantly (p = 0.2017) higher P-selectin MFI values (71.98 ± 40.30) versus healthy subjects (55.48 ± 20.95), insulin-dependent DM patients (50.02 ± 13.08), and non-insulin-dependent DM subjects (54.72 ± 24.74). However, logistic regression analysis resulted in a statistically significant adjusted effect on the odds of NAION when CD62 MFI values were logarithmically transformed (OR: 3.86, 95 % CI: 1.10 to 13.53, p = 0.0346). Elevated platelet CD62 positivity may be related to NAION, suggesting a possible role of enlarged platelet activity in the generation of this type of ischemic optic neuropathy.

Pancreas Transplant at Taipei Veterans General Hospital

Background: Insulin-dependent diabetes mellitus (IDDM) or Type 1 diabetes eventually leads to nephropathy, neuropathy, retinopathy and angiopathy after 10 - 30 years. Currently, pancreas transplant is the treatment of choice in tight control of blood sugar for IDDM patients, and further to stabilize, prevent or even to reverse the diabetic complications. According to the International Pancreas Transplant Registry (IPTR) and United Network for Organ Sharing (UNOS), over 25,000 cases of pancreas transplant have been performed worldwide, with an increase of more than 1,600 - 1,800 cases per year, mainly in the USA. The 1-year pancreas graft survival rate is 86.0% and 5-year is 69.8%, very close to those of kidney transplant. Among the whole pancreas transplants, 80% are simultaneous pancreas-kidney transplant (SPK), 15% pancreas after kidney transplant (PAK), and 5% pancreas transplant alone (PTA). Materials: From 2003 to 2011, there were 73 pancreas transplants performed for 69 patients at Taipei Veterans General Hospital, with 27 SPK, 7 PAK, 35 PTA and 4 PBK. Results: The blood sugar usually returned to normal level within 5 hours (median) after revascularization of the pancreas grafts. The fasting blood sugar maintained within normal range thereafter throughout the whole clinical course in most cases. The technical success rate was 95.5%. There were 8 graft loss, due to acute rejection in 1, chronic rejection in 2, technique failure in 3 and 2 died with functioning graft, and 4 of them received another successful re-transplant. All SPK patients are free from dialysis, but 1 primary nonfunction of kidney graft. Post-transplant infection disease included 5 CMV gastroenterocolitis, 1 CMV pneumonia, 4 UTI (urinary Tract Infection), 2 BK virus infection,3 herpes zoster infection, 1 pseudomembraneous colitis, 2 varicella zoster infection, 1 skin infection with MRSA and cryptococcus, 2 bacteria pneumonia, 1 sepsis. Conclusion: Pancreas transplant provided an ideal insulin-free solution for DM, especially IDDM. Pancreas transplant could be performed with similar successful rate of kidney transplant if they were done simultaneously.

Determination of Insulin in Humans with Insulin-Dependent Diabetes Mellitus Patients by HPLC with Diode Array Detection

A simple and reliable high-performance liquid chromatographic method with diode array detection has been developed and validated for the determination of insulin in human plasma. A good chromatographic separation was achieved on a C18 column with a mobile phase consisting of acetonitrile and 0.2M sodium sulfate (pH 2.4), 25:75 (v/v). Its flow rate was 1.2 mL/min. Calibration curve was linear within the concentration range of 0.15-25 µg/mL. Intra-day and inter-day relative standard deviations for insulin in human plasma were less than 6.3 and 8.5%, respectively. The limits of detection and quantification of insulin were 0.10 and 0.15 µg/mL, respectively. Also, this assay was applied to determine the pharmacokinetic parameters of insulin in eight insulin-dependent diabetes mellitus patients after subcutaneous injection of 25 IU of Actrapid HM.

Adaptation of Gastrointestinal Motility to Diabetes Mellitus

Gastrointestinal (GI) motility is defined by the movement of the digestive system and the transit of the contents within it. Delayed gastric emptying indicates the symptoms included nausea and vomiting, especially in diabetes mellitus (DM). Clinically, diabetic patients may experience upper GI symptoms such as epigastric fullness, nausea and heartburn, and lower GI symptoms such as constipation, diarrhea and fecal incontinence. Insulin-dependent diabetes mellitus patients showed more delayed gastric emptying than non-insulin-dependent diabetes mellitus patients. During insulin stimulation, the GI motility is changed and accelerated. In diabetic gastroparesis, motilin, incretins (glucagon-like peptide-1and glucose-dependent insulinotropic polypeptide) are also a group of GI hormones that cause an increase in the amount of insulin released from the beta cells and are discussed in the article. Ghrelin, secreted in hunger, is found chiefly from the oxyntic glands in the stomach and are often referred to as growth hormone secretagogues. It plays a much newer role in the development of metabolic syndrome as it modifies glucose as well as insulin metabolism, blood pressure levels, and adipogenesis in diabetes. The rapid gastric emptying may be due to the rising levels of ghrelin and growth hormone secretagogue receptor (GHSR) in the hypothalamus during early hyperglycemia. The duration of hyperglycemia is affected by the rising ratio of ghrelin/obestatin. Diabetic diarrea, celiac disease, as well as mechanic obstruction, were also general GI problems in hyperglycemia. Delayed gastric emptying of solids in diabetic patients with autonomic neuropathy was proven in our study, implying the gastric electrical stimulation improved the gastric motility in streptozotocin-induced diabetic rats. Clinically, prokinetic agents, including D2 receptor antagonist, motilin receptor agonists and 5-hydroxytryptamine receptor 4 receptor agonists, are generally used to improve the gastroparesis. We conclude that the mechanism between GI motility and DM may be related to the treatment of gastroparesis, the neuropathic disorders, and the roles of endocrine cell in diabetic gastroenteropathy. Further studies on the role of GHSR or some drugs for complications in clinical diabetes should be conducted.

Alpha-Lipoic Acid for the Prevention of Diabetic Macular Edema

Introduction: To evaluate the effect of α-lipoic acid (ALA) on the occurrence of diabetic macular edema. Methods: Randomized, double-blind, placebo-controlled, multicenter, multinational study. Patients were randomized to the treatment group with 600 mg ALA per day or the placebo group. Every 6 months stereo fundus photographs, HbA1c levels, and an ophthalmological examination were documented. The primary endpoint was the occurrence of clinically significant macular edema (CSME) within a follow-up period of 2 years. Results: We randomized 235 patients with type II diabetes mellitus into the treatment group (mean age 58.0 years) and 232 into the placebo group (mean age 57.9 years). Mean HbA1c level was 8.1, with no significant differences between the treatment (mean 8.2, SD ± 1.35) and placebo groups (mean 8.1, SD ± 1.29). HbA1c values remained constant over time. In the treatment and placebo groups, 84 and 86 patients (35.7 and 37.1%) had insulin-dependent diabetes mellitus (IDDM) with a median duration of diabetes of 9.3 versus 9.0 years in the placebo group. Visual acuity remained unchanged during the entire trial. Concerning the primary endpoint, the study provided a negative result, i.e. 26/235 patients in the treatment group and 30/232 patients in the placebo group developed CSME. Confirmatory intention-to-treat analysis of the primary endpoint revealed no statistically significant difference between groups (log-rank test, p = 0.7108, HR = 0.9057 with CI = 0.5355–1.5317). Median follow-up was identical (2.00 years). Conclusions: A daily dosage of 600 mg ALA does not prevent the occurrence of CSME in IDDM patients.

Diabetic Patients With Traumatic Brain Injury: Insulin Deficiency Is Associated With Increased Mortality

Hyperglycemia after traumatic brain injury (TBI) is an independent predictor of mortality. Insulin deficiency, as opposed to elevated blood glucose, might be the reason for increased mortality. TBI patients with diabetes mellitus (DM) were analyzed to determine how insulin deficiency affects mortality after TBI. NTDB version 7 was queried for patients with isolated moderate to severe TBI (head abbreviated injury score [AIS]≥3 with AIS≤3 for other body regions). Demographics and outcomes were compared between TBI patients with insulin-dependent DM (IDDM), noninsulin-dependent DM (NIDDM), and those without DM. Logistic regression analysis was used to investigate the relationship between mortality and DM. Overall, 51,585 patients with isolated moderate to severe TBI were analyzed. Mortality was 14.4% and 8.2% in patients with and without DM, respectively (p<0.0001). Although head AIS scores were similar, patients with DM had a statistically higher Glasgow coma scale (GCS) at presentation compared with patients without DM (GCS score 12.4 vs. GCS score 10.9; p<0.0001). After multivariable logistic regression analysis, DM was an independent predictor for mortality (odds ratio 1.5, confidence interval 1.29-1.74, p<0.0001). When comparing TBI patients with IDDM to NIDDM, mortality was 17.1% for IDDM and 13.0% for NIDDM (p=0.025). DM is a significant predictor for mortality after moderate to severe TBI. Insulin deficiency is a likely contributor to increased mortality after TBI as IDDM patients have higher mortality than NIDDM patients who have higher mortality than no-DM patients.

肥満を伴わないインスリン非依存型糖尿病における主要組織適合抗原(HLA)の検討

肥満を伴わないインスリン非依存型糖尿病における主要組織適合抗原(HLA)の検討

A novel Enzyme Inhibition Assay for Screening of Type 1 Diabetes Mellitus

Glutamate decarboxylase (GAD) antibody has been found in patients with recent-onset insulin dependent diabetes mellitus (IDDM). Several analytical methods are described for detection and quantitation of anti-GAD antibodies whereas the inhibition of the enzyme activity by anti-enzyme antibody is given little attention. In this study a quenching fluorimetric method based on changes of fluorescence intensities upon addition antiserum into the enzyme/substrate medium is described. The activity of the purified rat brain GAD was measured by both manometeric and fluorimeteric methods in the presence of serum samples from IDDM patients (n=21) or non diabetic subjects (n=21). Significant differences between the patients and control groups were observed using both methods. However, high degree of fluorescence sensitivity of fluorimetric technique allows for less error, less time and satisfactory useful and economical for screening of IDDM in the large populations.

Time-Varying Procedures for Insulin-Dependent Diabetes Mellitus Control

This work considers the problem of automatically controlling the glucose level in insulin dependent diabetes mellitus (IDDM) patients. The objective is to include several important and practical issues in the design: model uncertainty, time variations, nonlinearities, measurement noise, actuator delay and saturation, and real time implementation. These are fundamental issues to be solved in a device implementing this control. Two time-varying control procedures have been proposed which take into consideration all of them: linear parameter varying (LPV) and unfalsified control (UC). The controllers are implemented with low-order dynamics that adapt continuously according to the glucose levels measured in real time in one case (LPV) and by controller switching based on the actual performance in the other case (UC). Both controllers have performed adequately under all these practical restrictions, and a discussion on pros and cons of each method is presented at the end.

Increased intima-media thickness of the carotid artery in childhood: a systematic review of observational studies

Increased carotid intima-media thickness (cIMT) in adults may be caused by a childhood exposure to cardiovascular risk factors. We systematically reviewed observational studies to determine whether obesity, insulin-dependent diabetes mellitus (IDDM), dyslipidemia (DL), hypertension (HT), and chronic renal failure (CRF) are associated with increased cIMT in children and adolescent patients compared with control subjects. We performed a PubMed literature search from January 1986 to February 2010. Two reviewers separately verified the inclusion criteria of relevant studies for the objective of the review. The data extracted in the patient and control groups were sample size, age, gender, cIMT measurement methods, cIMT values, and statistical analysis results. From 348 citations, 65 cross-sectional studies (2 cited twice) with case-control design met the inclusion criteria: 26 in obesity, 14 in IDDM, 11 in DL, 8 in HT, and 8 in CRF. cIMT measurement protocols varied according to the studies, with measurements being performed on the common carotid artery in 65/67 cases and on the far wall in 57/67 cases. From the 67 studies cited, 22/26 reported a significantly increased cIMT in obese children and adolescents compared with the control group, 8/14 in IDDM patients, 10/11 in DL patients, 7/8 in HT patients, and 8/8 in CRF patients. Despite the heterogeneity of ultrasound measurement methods, cIMT was significantly increased in 55 out of the 67 cited studies, confirming early vascular damages in pediatric populations with an increased future risk for vascular diseases.

Anti-müllerian hormone, inhibin B and antral follicle count as markers of premature ovarian failure in women with type I diabetes mellitus

Objective: To evaluate the different markers of ovarian reserve (AMH-Inhibin B , FSH and antral follicle count (AFC) in insulin dependent diabetes mellitus ( IDDM). Methods: We studied 30 patients with IDDM as study groups (10cases>32 years group IV and 20 cases 32 years group II) and 20 healthy women as control groups (8 cases >32 years group III and 12 cases 32 years group I . Serum levels of FSH, LH, inhibin B and AMH were measured at (days 1-7) of menstrual cycle and AFC was done by trans vaginal ultrasound. Results: AMH levels were lower in IDDM patients than in controls > 32 years (2.35 2.2 versus 7.79 difference in the levels of FSH .. AFC is valuable for the diagnoses of premature ovarian failure in IDDM. 1.73 p0.000). Also IDDM groups showed lower levels of inhibin B. While there is no Conclusion: Compared with FSH (AMH and inhibin B) are more valuable for the diagnosis of premature ovarian aging in IDDM patients which developed earlier decline in the ovarian follicle pool compared with the healthy women and also AMH is more valuable than AFC for detection of premature ovarian failure in IDDM.