Indicators Of Metabolic Control Research Articles

Glycated haemoglobin or mean blood glucose as indicators of metabolic control in Type 2 diabetes?

The aim of the study was to assess whether HbA 1c levels reflected mean blood glucose (MBG) levels in Type 2 diabetes. Despite the good correlation between HbA 1c and MBG, one-third of the patients had consistently higher HbA 1c or lower HbA 1c levels than that expected under the hypothesis that HbA 1c is solely determined by MBG, suggesting the existence of different haemoglobin glycation phenotypes. The use of HbA 1c alone for glycemic control monitoring in these patients could be insufficient to clearly trace their risk of complications.

CA 72-4 levels in patients with type 2 diabetes mellitus

CA 72-4 is one of the blood group carbohydrate antigens which can be used as a tumour marker in ovarian, pancreatic and gastrointestinal carcinomas. It can also be elevated in various benign conditions including pancreatitis. Diabetes mellitus is a chronic disorder related with the pancreas. In this study, we investigated CA 72-4 levels in patients with type 2 diabetes and its relation to the metabolic status. Sixty-nine patients with type 2 diabetes mellitus (female/male = 40/29) and 60 healthy subjects (female/male = 35/25) participated in this study. The levels of serum CA 72-4 were measured and faecal occult blood tests (following 3 days of white diet were obtained for three consecutive days) were performed in all patients. Patients had a pathological finding for any of these two parameters were further investigated with upper gastrointestinal endoscopy, colonoscopy and computerised tomography. The mean levels of CA 72-4 was 1.89 +/- 2.61 U/ml in the study group and 1.4 +/- 0.98 U/ml in the control group (p > 0.05). There was no association between CA 72-4 levels and age and sex of the patients, duration of diabetes, body mass index, biochemical indicators of metabolic control (the levels of HbA(1c), fasting and postprandial glucose, serum lipids), the presence of microvascular complications (retinopathy, nephropathy, neuropathy) or treatment modalities. Elevated levels of CA 72-4 in diabetic patients are not related to diabetes and it should be interpreted as evaluated in a non-diabetic patient.

Integration of a Promotora-Led Self-Management Program Into a System of Care

The purpose of this article is to describe the integration of a promotora-led self-management component into a system of care and assess the influence of this program on indicators of metabolic control over time. Gateway Community Health Center is a federally qualified health center in Laredo, Texas, that serves a predominantly Hispanic population. Gateway integrated self-management support into care for people with diabetes by incorporating promotora-led self-management services into the clinic structure, operations, and patient visits. The self-management program included education, goal setting, depression screening with symptom follow-up, and support groups after course end. Indicators of metabolic control, HbA1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were compared at baseline and at 12 months. The integration of promotora-led self-management services into the system of care allowed for continual improvements of self-management services in response to patient needs. Patients enrolled in the self-management course showed improved indicators of metabolic control that were sustained over time, and they reported a high level of goal achievement. The integration of the promotora-led self-management program into diabetes care at Gateway generated a system of referral, follow-up, feedback, and documentation that produced consistently high-quality clinical care.

Differentiating the impact of episodic and chronic stressors on hypothalamic-pituitary-adrenocortical axis regulation in young women.

The goal of this study was to examine the impact of episodic stress and chronic interpersonal stress on indices of HPA regulation. To explore the potential downstream consequences of altered HPA dynamics, the authors also assessed indicators of metabolic control and systemic inflammation. One hundred four medically healthy women between the ages of 15 and 19 participated. Following an in-depth interview of life stress, a sample of blood was drawn through antecubital venipuncture. Over the course of the next 2 days, participants gathered salivary cortisol samples. Cortisol morning response, cortisol daily output, glucocorticoid receptor (GR) mRNA, C-reactive protein (CRP), insulin, and glucose. The simple presence of episodic stress or chronic interpersonal stress was not reliably associated with cortisol output, GR mRNA, insulin, or glucose. When women were exposed to an episodic stressor in the midst of chronic stress they showed increased cortisol output and reduced expression of GR mRNA. By contrast, when women had low levels of chronic stress, episodic events were associated with decreased cortisol output and increased GR mRNA. Episodic and chronic stress also interacted to predict CRP, but not insulin or glucose. The impact of episodic stress is accentuated in the midst of chronic interpersonal stress and diminished in its absence. Simultaneous exposure to episodic and chronic stress may create wear and tear on the body, whereas exposure to episodic stress in the context of a supportive environment may toughen the body, protecting it against subsequent stressors.

Alternative indicators of metabolic control

This brief review will focus on indicators of metabolic control alternative to glucose, ketone body and lactate measurements, specifically reviewed in other articles of this issue. The effects of insulin on protein metabolism are summarized and, the potential clinical relevance of monitoring energy expenditure in diabetic subjects is discussed. Many studies have shown that maintaining a regular physical activity regimen improves quality of life, reduces the risk of mortality from all causes, prevents type 2 diabetes mellitus in subjects with impaired glucose tolerance, and enhances glucose control in subjects affected by type 2 diabetes mellitus. Monitoring energy expenditure is a novel approach to implement the non-pharmacological treatment of subjects with diabetes mellitus.

Blood ketone bodies in patients with recent-onset type 1 diabetes (a multicenter study)

Insulin deficiency with glucagon excess leads to the release of ketone bodies (KBs) by the liver and excretion in the urine. So far, only KB monitoring in urine has been used during assessment of children with diabetes. Currently used nitroprusside strips for urine KB detection react only with acetoacetate (AcAc) and not with the most prevalent KB moiety - 3beta-hydroxybutyrate (3HB) - that is in equilibrium with AcAc (up to 10:1 ratio). To verify the significance of 3HB in the blood compared to that of AcAc in the urine in recently diagnosed type 1 diabetic subjects independent of the presence of diabetic ketoacidosis (DKA). A total of 118 consecutive newly diagnosed subjects with type 1 diabetes from different centers in Italy underwent intensive insulin therapy and hydration when necessary (38/118 = 32% with DKA). Hourly urine and capillary blood samples were used to monitor KBs until metabolic control was achieved. Although DKA was present in 32% of patients, blood 3HB was significantly increased (3.56 +/- 1.7 mmol/L) in 83% of the patients and correlated with blood glucose (r = 0.39; p < 0.01) according to a bimodal model. The strongest association was found between 3HB and venous pH (r =-0.56; p < 0.0001). Time required for blood 3HB normalization depended strongly on the starting blood KB values (r = 0.44; p < 0.0001) and was significantly lower than that required for disappearance of KB from urine (17.4 +/- 13.6 h, range 1-69 h vs. 19.7 +/- 17.8 h, range 1-120 h; p = 0.004). However, urine KBs disappeared before blood 3HB normalization in 23% of the patients. Blood 3HB evaluation is a better indicator of metabolic control compared to urine KB detection and is useful to predict the time required for blood KB clearing. Further studies are needed to assess its use in the early detection and management of DKA.

The potential role of increased adrenal volume in the pathophysiology of obesity-related Type 2 diabetes

The hypothalamic-pituitary-adrenal (HPA) axis seems to play an important role in obesity and Type 2 diabetes (DM). The aim of the present study was to determine the adrenal volume in obese patients with DM in comparison to obese non-diabetic patients. Eleven diabetic obese and 19 non-diabetic obese women were sequentially invited to take part in the study. Computed tomography (CT) scan of the abdomen was performed to determine adrenal volume, visceral (VF) and sc fat (SCF). Daily urinary free cortisol (UFC) was used as a measure of integrated cortisol production. In the diabetic patients, hemoglobin A1c was measured as an index of metabolic control. Compared to nondiabetic controls, patients with diabetes had a significantly higher total adrenal volume (4.29+/-1.50 vs 2.95+/-1.64; p=0.03). A highly significant correlation was detected between VF and VF/SCF ratio and total adrenal volume in the whole group (r=0.36, p=0.04 and r=0.48, p=0.008, respectively). This study, therefore, suggests an association between abdominal obesity, enlarged adrenals and Type 2 diabetes. These findings support the hypothesis that an increased activity of the HPA axis in obese subjects may be involved in the pathogenesis of Type 2 diabetes.

Thyroid Hormones, Cytokines, Physical Training and Metabolic Control

During the acute training response, peripheral cellular mechanisms are mainly metabolostatic to achieve energy supply. During prolonged training, glycogen deficiency occurs; this is associated with increased expression of local cytokines, and decreased insulin secretion and beta-adrenergic stimulation and lipolysis in adipose tissue which looses energy. This is indicated by decrease of adipocyte hormone leptin, which has inhibitory effects on excitatory hypothalamic neurons. Leptin, insulin, and cytokines such as interleukin 6 (IL-6) contribute to the metabolic error signal to the hypothalamus which result in decrease of hypothalamic release hormones and sympathoadrenergic stimulation. Thyroid stimulating hormone (TSH) is correlated to the metabolic hormones leptin and insulin, and may be used as indicator of metabolic control. Because the hypothalamus integrates various error signals (metabolic, hormonal, sensory afferents, and central stimuli), the pituitary's releasing hormones represent the functional status of an athlete. Long-term overtraining will lead to downregulation of hypothalamic hormonal and sympathoadrenergic responses, catabolism, and fatigue. These changes contribute to myopathy with predominant expression of slow muscle fiber type and inadequacy in performance. Thyroid hormones are closely involved in the training response and metabolic control.

Asymptomatic bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: The Fremantle Diabetes Study

We examined the prognosis of well-characterised community-based diabetic patients with asymptomatic bacteriuria (ASB). We studied 496 adults with type 1 or 2 diabetes participating in a prospective observational study. In addition to detailed clinical and laboratory data, a single mid-stream urine sample was taken for aerobic culture and antibiotic-sensitivity testing. ASB was defined as >/=10(5) colony-forming units/ml of one or two organisms without symptoms of urinary infection. Patients were followed for 2.9+/-0.6 years for hospital admission for/with urosepsis or death. Thirty-six patients (7.3%) had ASB, comprising 33 females (14.4% of all females) and three males (1.1% of all males). Only female sex predicted ASB amongst a range of variables including indices of metabolic control. Twenty-nine patients (5.8%) were subsequently hospitalised with urosepsis. Of these, urosepsis was the principal diagnosis in 12 (41%). In a Cox proportional hazards model, ASB was associated with an increased risk of hospitalisation for urosepsis as principal diagnosis (hazard ratio [95% CI] 4.4 [1.2-16.5]; p=0.004). ASB did not predict the combined endpoint of hospitalisation with urosepsis as principal or secondary diagnosis (2.3 [0.8-6.7]; p=0.12), or of non-urinary sepsis as principal (n=12) or principal/secondary (n=28) diagnosis (p>0.3). ASB identifies diabetic patients who are at significantly increased risk of subsequent urosepsis requiring hospitalisation. Further large-scale studies are needed to establish the cost-effectiveness of screening for, and pre-emptive treatment of ASB, especially in females.

Mood and Cognitive Function in Elderly Diabetic Patients Living in Care Facilities

Community studies found deficits of cognitive function in elderly persons with diabetes. The aim of the present study was to compare diabetes and other age-related diseases among residents of senior citizens’ care facilities. Participants were 130 residents with and 130 without a diagnosis of diabetes aged between 65 and 98 years. Measures were neuropsychological tests designed for this age group, questionnaires of mood, quality of life and daily activities and level of glycosylated hemoglobin (HbA_1c) as an index of metabolic control. Only verbal memory was significantly more impaired in residents with than without diabetes. Otherwise, both groups showed overall impairment of cognitive function and mood. Unexpectedly, a slightly elevated HbA_1c level (6–8%) was associated with an increased level of cognitive and everyday functioning. In old age, diabetic patients might benefit from a slightly higher level of blood glucose than has hitherto been assumed.

The Relation Between Family Factors and Metabolic Control: The Role of Diabetes Adherence

To examine family factors as predictors of metabolic control in children with type 1 diabetes and determine whether adherence behaviors mediate this relationship. Participants were 109 children (ages 8-18) and a parent. Measures of diabetes-specific family functioning and an adherence interview were completed. Glycosylated hemoglobin (HbA1c) was the index of metabolic control. Family functioning and adherence were strongly associated with metabolic control. Combined with demographic information, these constructs accounted for 49% of the variance in metabolic control. Age moderated the relation between aspects of family functioning and HbA1c. Path analyses suggest that adherence mediates the relationship between family functioning and metabolic control. Family functioning and adherence behaviors are strongly related to a child's health status. Assessment of diabetes-specific family functioning, in addition to adherence, is an important factor in understanding metabolic control.

The effect of glycemic control on heart failure severity in diabetics

Introduction: Glycosylated hemoglobin (Hb A1c) is an index of metabolic control in diabetes (D). Recent studies suggest that poor glycemic control in diabetic patients (pts) indicated by elevated Hb A1c levels (>7.0%) may be associated with increased risk of heart failure (HF). Our goal was to investigate the association between Hb A1c level and severity of HF in advanced HF pts with D. Methods: Among 180 pts referred for cardiac transplantation, 35 consecutive patients with advanced HF and D underwent evaluation with serum glucose, serum creatinine, Hb A1c, B-type natriuretic peptide (BNP), cardiopulmonary exercise testing and right heart catheterizaton. Pts were divided into two groups based on Hb A1c7% (Group A, mean Hb A1c=5.9±0.8) and Hb A1c >7% (Group B, mean Hb A1c=10.1±2.4). Results:∗Parameter (mean value)Hb A1c ≤7% (Group A: n=19)Hb A1c >7% (Group B: n=16)p valueAge (years)53.9±13.149.6±13.30.34Gender (male %)79690.70NYHA Class2.9±0.83.9±0.90.43Peak Oxygen Consumption (V02) ml/kg/minute16.2±2.214.5±3.40.25BNP (pg/ml)399.6±281.1754.8±696.40.05∗Pulmonary capillary wedge (PCW) pressure (mm Hg)22.2±8.026.2±8.50.24Glucose (mg/dl)141±75217±1190.03∗Creatinine (mg/dl)1.4±0.51.4±0.40.88BMI26.5±7.927.9±6.30.57% on Insulin9130.09∗p ≤ 0.05 Conclusion: BNP level was significantly elevated in diabetic pts with Hb A1c >7% (Group B). Glucose level was significantly higher in Group B. In Group B pts compared to Group A there was also a trend towards increased severity of symptoms demonstrated by worse NYHA class, lower peak VO2 and higher PCW pressure. Poor glycemic control in HF pts appears to have negative impact on functional capacity and severity of symptoms. Persistent glucose intolerance as shown by elevated Hb A1c>7% may be contributing to increased fluid retention reflected by higher PCW pressure and significantly higher BNP level in Group B compared to Group A pts. The effect of improved glycemic control on clinical outcomes such as frequency of hospitalization and survival in advanced HF pts with D deserves further study.

Abstract #7: Evaluation of Serum Lipid Levels and Their Correlation with HbA1c as a Metabolic Control Index in Children and Adolescents with Type 1 Diabetes

Abstract #7: Evaluation of Serum Lipid Levels and Their Correlation with HbA1c as a Metabolic Control Index in Children and Adolescents with Type 1 Diabetes

Metabolic control and body mass index in patients with type 1 diabetes on different insulin regimens

Without sufficient insulin treatment, acceptable level of glycoregulation, avoidance of dislipoproteinaemia and maintenance of body mass is difficult to achieve in patients with type 1 diabetes mellitus (DM). On the other hand sometimes it is difficult to prevent weight gain, endogenous hyperlipidemia and iatrogenic insulin resistance. To compare metabolic control indicators in patients with type 1 DM in patients treated conventionally to those on intensified insulin regimen. A sample of 52 persons with type 1 DM, without late complications and long duration of the disease, was selected. Among them 19 (36.5%) persons were treated with insulin in 4 or 5 doses, and 33 (63.5%) conventionally, in 2 doses. All the participants had biochemical indicators of metabolic control determined (glycosylated Hb , fasting and postprandial glycaemia, total cholesterol, triglycerides as well as lipoprotein fractions, HDLC and LDLC), body height (BH) and weight (BW) measured, body mass index calculated (BMI) and blood pressure measured (BP). In the group treated conventionally we found significantly higher mean values of BMI as compared to those on intensified insulin treatment (23.2 +/- 2.0 kg/m2, and 21.2 +/- 1.2 kg/m2 respectively, p%<0.01) and proportion of those with overweight was as well significantly higher (27.3% versus 0%, p =0.012). We noted higher mean values of systolic (134.2 +/- 17.6 mmHg, versus 123.4 +/- 12.7. p<0.05) and diastolic (83.2 +/- 10.1, versus 74.0 +/- 9.7, p<0.01) BP. Biohemical indicators of glycoregulation were significantly worse with, at the same time, higher total dose of applied insulin ( 55.9 +/- 8.5 IU, versus 46.3 +/- 10.0 IU, p<0.01), and insulin units per kg of body weight (0.84 +/- 0.11 IU/kg versus 0.77 +/- 0.15 IU/kg, p<0.05). Results indicate that intensified insulin treatment is more favourable variant of treatment, by which the certain level of insulin resistance, which might be present in patients treated with two higher insulin doses, is probably reduced. Therefore it improves metabolic outputs, blood pressure values and body mass index but also may have beneficial impact to economic aspect of insulin treatment as well.

Evaluación de un programa de seguimiento farmacoterapéutico a diabéticos tipo 2

To evaluate the results of pharmaceutical intervention in a programme to monitor the drug therapy of type-2 diabetics; and to assess the improvement of the indicators, glycosylated haemoglobin, basal glycaemia, lipid profile, albumin/creatinine, blood pressure, BMI, medication-related problems and adherence. Randomised clinical trial. 14 local pharmacies in the province of Pontevedra (Galicia), Spain. 126 type-2 diabetics, over 18 years old and who joined voluntarily a monitoring programme, distributed 50-50 into intervention and control groups. The main variable was HbA1c. Other variables were: clinical indicators of metabolic control (mean basal glycaemia, lipid profile), blood pressure, BMI, medication-related problems, understanding of the illness and its complications, adherence to medical treatment and to changes in life-style, and incidence of complications. Introduction and randomisation of patients. Recording of the initial status of the research variables, study and assessment stage, pharmaceutical interventions to detect and resolve any passing medication-related problems and educational activities. Referral to family doctor if his/her intervention required. Follow-up lasted 12 months with monthly scheduled visits and on-demand visits, after which the variables were assessed once more. The stages of study, evaluation, intervention and education did not occur in the control group. The study will enable the role of the chemist in achieving the objectives of controlling type-2 diabetes patients to be achieved through educational intervention and assistance in drug therapy monitoring.

The role of active family nutritional support in Navajos' type 2 diabetes metabolic control.

We examined if active family nutritional support is associated with improved metabolic outcomes for Diné (Navajo) individuals living with type 2 diabetes. The presence of family support, using variables identified in earlier ethnographic research, was assessed via surveys in a convenience sample of 163 diabetic individuals. Diabetes outcome measures (HbA(1c), serum glucose, triglycerides, total cholesterol, creatinine, and systolic and diastolic blood pressure measures) were extracted from participants' medical records. Bivariate analyses and multiple logistic regressions were conducted. All measures of family support showed a relation with one or more indicators of metabolic control in bivariate analyses. In multivariate analyses, respondents were more likely to be in the best tertile for triglyceride (P < 0.05), cholesterol (P < 0.05), and HbA(1c) (P < 0.05) if another person cooked most of the meals. Respondents in families who bought/cooked "light" foods were more likely to be in the best tertile for triglyceride (P < 0.005) and cholesterol levels (P < 0.005), and those in families whose members ate "light" foods with them were more likely to be in the best tertile for triglycerides (P < 0.005). When all three support variables were entered into a multivariate model, only the variable "other family members cook the majority of the meals" was significantly associated with being in the lowest triglyceride (P = 0.05), HbA(1c) (P < 0.05), or cholesterol tertiles (P < 0.05). These relationships were most evident for women with diabetes. Active family nutritional support, as measured by culturally relevant categories, is significantly associated with control of triglyceride, cholesterol, and HbA(1c) levels. The findings suggest that the family is a more useful unit of intervention for Diné individuals than for the individual alone when designing diabetes care strategies.

Influence of knowledge of the disease on metabolic control in phenylketonuria.

In patients with phenylketonuria (PKU) knowledge of the disease and its treatment is not a major independent predictor for dietary compliance. PKU is an inborn error of amino-acid metabolism caused by a deficiency of phenylalanine hydroxylase (PAH), resulting in high plasma phenylalanine (Phe) concentrations and consequently severe mental retardation. Treatment comprises a life-long diet and PKU patients maintaining good metabolic control develop normally [3]. Poor dietary compliance is a regularly encountered problem. Increasing knowledge of the disease and its treatment may be a possibility to improve dietary compliance. Until now few studies have investigated this issue in PKU and the results are not conclusive [2, 4, 5, 6]. We therefore conducted a study to assess knowledge of the disease and its treatment in a large population of PKU patients and their parents and to determine the association between knowledge and the plasma Phe concentration as an indicator of dietary compliance in PKU. Parents of 161 PKU patients (aged 1 to 22 years) and 62 PKU patients (aged 12 to 22 years) completed a questionnaire to assess knowledge. The mean plasma Phe concentration during a 3-year period (1994 to 1996) was taken as an indicator of metabolic control. Table 1 shows the questions and the number of parents and patients correctly answering each separate question. We had expected that the greater part of the patients and their parents would correctly answer the questions. However, only 52% of the parents and 29% of the patients answered more than 11 of the 14 questions adequately. Linear regression showed that higher knowledge was associated with lower Phe concentrations, but this association was statistically significant only in the parent group (parents: b=)28, 95% CI)39/)17; patients: b=)20, 95% CI)42/2). After adjustment for confounders (pre-treatment Phe concentrations and dietary Phe tolerance, both as indicators for the severity of the enzyme deficiency, patient’s age, parental educational level and ethnicity) this association disappeared (parents: b=)0.4, 95% CI)8/ 7; patients: b=)1.5, 95% CI)10/7) and pre-treatment Phe concentrations, Phe tolerance and ethnicity were the strongest predictors for Phe concentration.

Celiac Disease in Children and Adolescents with Type I Diabetes: Importance of Hypoglycemia

ABSTRACTBackgroundSymptomatic hypoglycemia is an unavoidable problem in the treatment of type I diabetes. Celiac disease is associated with malabsorption and may therefore represent an important risk factor.MethodsThe frequency of symptomatic hypoglycemia in patients with type I diabetes and celiac disease (cases) was compared with those of patients who had diabetes without celiac disease (controls). For this purpose, each case was matched for age, sex, and duration of disease with one to two control patients. Indices of metabolic control (hemoglobin [Hb]A1c, frequency of hypoglycemia, and total insulin requirement) were retrieved for the 18 months before and after diagnosis of celiac disease.ResultsEighteen patients (6 males and 12 females) had diagnosed celiac disease and were matched with 26 control patients (10 males and 16 females). There was no difference in age (11.0 years; range, 1.8–21.9 vs. 13.1 years; range, 2.3–22;P = 0.3) and duration of disease (8.4 years; range, 1.2–19.3 vs. 8.3 years; range, 1.1–18.7;P = 0.3) between the two groups. During the 6 months before and after diagnosis of celiac disease the cases had significantly more hypoglycemic episodes than the controls (means ± SD; 4.5 ± 4 vs. 2.0 ± 2.2 episodes/months, P = 0.01). This was reflected by a progressive reduction in insulin requirement over the 12 months before diagnosis reaching a nadir at time 0 (0.6 ± 0.2 vs. 0.9 ± 0.3, P = 0.05).ConclusionThese data suggest that underlying celiac disease is associated with an increased risk of symptomatic hypoglycemia and that the introduction of a gluten‐free diet with normalization of the intestinal mucosa may reduce its frequency.

Diabetic Cardiomyopathy and Carnitine Deficiency

This study was designed to study the pathogenesis of cardiomyopathy in animals with longstanding (6 months) diabetes mellitus. Male Wistar rats were made diabetic by the injection of streptozotocin (35 mg/kg) intraperitoneal at 6 months of age. Myocardial contractility was evaluated at 1 year of age by an echocardiogram. Blood was collected at that time to measure blood glucose and hemoglobin A 1c as an indicator of metabolic control. Serum carnitine was also measured on the same sample to evaluate the availability of this substance so essential for fatty acid metabolism in the myocardium. Myocardial anatomy was evaluated by both light and electron microscopy after the animals had diabetes for 6 months. It was found that the left ventricular volume was greater at the end of systole and diastole. There was the suggestion of left ventricular fractional shortening and calculated reduced ejection fraction indicating decreased contractility consistent with cardiomyopathy. The hearts had no evidence of coronary vascular occlusion, and the serum cholesterol was normal. Myocardial ultrastructure revealed abnormal-appearing mitochondria consistent with carnitine deficiency. Serum and myocardial carnitine levels in the animals with diabetes and reduced myocardial function were low. Carnitine levels and metabolism could be important in the pathogenesis of diabetic cardiomyopathy.

Corneal and Lens Autofluorescence in Young Insulin-Dependent Diabetic Patients

To study the early ocular abnormalities in young diabetic patients, corneal and lens autofluorescence was measured by fluorophotometry in 30 eyes of 30 insulin-dependent diabetic patients without retinopathy. The lens [f(l)] and the corneal [f(c)] autofluorescence values in diabetic patients were significantly higher than in controls. In diabetic patients, f(l) was significantly correlated with the duration of diabetes, the f(c) was significantly correlated with the duration of diabetes and the indices of metabolic control, i.e. HbA_1c and fructosamine. Our study demonstrated that young diabetic patients clearly had corneal and lens abnormalities before the appearance of overt diabetic retinopathy. The f(c) value might be a good indicator of metabolic control in diabetic patients.