NIDDM Subjects Research Articles

Assessment of Serum Insulin and VASPIN Levels Among Type 2 Diabetes Mellitus Patients with or Without Obesity: A Cross-sectional Analytical Study.

A collection of diverse conditions together referred to as diabetes mellitus frequently manifest as periods of hyperglycemia and glucose intolerance, which can be caused by insufficient insulin, improper insulin action, or both. A medical condition known as obesity is the accumulation of excess body fat to the point that it may be harmful to one's health. It has been determined that the adipokine vaspin (visceral adipose tissue-derived serpin A12) belongs to the family of serine protease inhibitors. Insulin, a polypeptide hormone, is released by the pancreatic beta cells. This hormone is both anti-catabolic and anabolic. Insulin decreases blood glucose levels by preventing its synthesis and encouraging its storage and use. In total, 125 male and female participants of various ages participated in the current study. They included 25 healthy controls, 50 non-obese and 50 obese non-insulin-dependent diabetes mellitus patients, who visited the MDM Hospital's outpatient clinic in Jodhpur, Rajasthan. Commercially available reagents and kits were utilized for the analysis of serum insulin and vaspin samples. Standard statistical tools were utilized to evaluate the parameters. When results were compared with healthy participants and non-obese NIDDM subjects, obese NIDDM subjects showed statistically significant higher fasting serum insulin and serum vaspin levels (P < 0.0001). Our study's conclusions demonstrated a strong correlation between blood insulin and vaspin levels and diabetes and obesity. Vaspin has a positive impact on insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. It also enhances glucose tolerance and insulin sensitivity, reducing diabetes complications. This novel biomarker has the potential to enhance diabetes mellitus outcomes by facilitating prompt diagnosis, improved management, and reduction of complications.

Influence of Angiotensin Receptor Blocker (Candesartan) and Angiotensin-Converting-Enzyme Inhibitor (Enalapril) Combined with Glimepiride on Glycated Hemoglobin in Non-Insulin Dependent Diabetic Rats (NIDDM)

Background: Antihypertensive agents like Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin-Converting Enzyme Blockers (ARBs) are commonly indicated for patients with both hypertension and diabetes. However, the effect of these agents on blood sugar level or glycated hemoglobin (HbA1c) is still controversial. This study aims at investigating the short, and long term effects of ACEIs and ARBs on blood sugar level and HbA1c of a group of streptozocin (STZ)-induced NIDDM rats when given in combination with Glimepiride (antidiabetic drug from Sulfonylureas group).&#x0D; Methods: Diabetes mellitus (DM) was induced in 100 Wistar albino adult male and female laboratory rats above 8 weeks old, and weigh between 250-300 gm by the administration of Streptozocin 75% α-anomer. Two weeks later, the 100 rats were then randomized into four groups (25 rats each). Group one was the untreated control group (received placebo only), while other groups (II, III, and IV) were treated by Glimepiride only, Glimepiride plus ARB (Candesartan), and Glimepiride plus ACEI (Enalapril) respectively. HbA1C levels were measured at baseline (pre-test/directly after randomization) to ensure that there was no significant difference between study groups at the baseline, post-test (after two weeks), and delayed-post-test (12 weeks after randomization/ 10 weeks after post-test) to measure short and long-term changes in the study groups.&#x0D; Results: There was no significant difference (p-values &gt;0.05) between the four groups (groups I, II, III, and IV) in the HbA1C mean level at the beginning of this study (two-weeks after randomization and injection of STZ) (mean = 7.62 ±SD = 0.41, 7.72 ±SD = 0.48, 7.66 ±SD = 0.47, and 7.52 ±SD = 0.51respectively). However, two weeks later, treated groups (groups II, III, and IV) showed moderate reduction of HbA1C mean level compared to the untreated (placebo) group I, that was significant in groups III, and IV, and insignificant in group II (mean =7.43±SD 0.54, 6.97±SD 0.33, 6.72±SD 0.26, and 7.71 ±SD 0.44 respectively). Furthermore, treated groups (groups II, III, and IV) showed significant dramatic reduction of HbA1C mean level when compared to the untreated group (group I) (mean = 6.22 ±SD 0.51, 5.24 ±SD 0.62, 5.22 ±SD 0.13, and 7.62 ±SD 0.42 respectively).Overall, treated groups showed significantly lower HbA1C level than placebo groups. Moreover, Glimepiride + Enalapril combination showed a stronger hypoglycemic effect than the Glimepiride + Candesartan combination at post, and post-delayed tests, however, these differences were not significant.&#x0D; Conclusion: The addition of either ACEIs like Enalapril, or ARBs like Candesartan to Sulfonylureas like Glimepiride to in NIDDM patients will synergize its anti-diabetic effect in NIDDM subjects, and might increase the possibility of hypoglycemia. Caution and/or dose adjustment should be considered upon using these agents together in patients with hypertension along with diabetes.

Effect of Indigenous Drug Administration (KARELA) on Different Parameters Studied Among Healthy and NIDDM Subjects: A Hospital Based Study

Effect of Indigenous Drug Administration (KARELA) on Different Parameters Studied Among Healthy and NIDDM Subjects: A Hospital Based Study

Lipid profile in Diabetes Mellitus

Diabetes mellitus is the most common metabolic disorder affecting the people all over the world. Diabetes mellitus has been known to be associated with lipid disorders and cardiovascular complications. This study is planned to assess the lipaemic changes in diabetes mellitus patients attending the out-patient department of medicine department in HSK Hospital and Research Centre. Total Cholesterol(TC), Triglycerides(TG), LDL Cholesterol(LDL-C), HDL Cholesterol (HDL-C) levels were studied in serum of diabetes patients. This is a case control study which included 76 patients of diabetes as cases and 50controls of the same age group and sex. All the samples were taken from subjects who fasted for at least 12 hours before the blood collection. The parameters were determined by manual method using spectrophotometer by liquid chemistry. The Triglycerides, Total cholesterol, LDL Cholesterol were higher in cases as compared to controls in both IDDM and NIDDM. The HDL-C was lower in NIDDM subjects who were on sulfonylurea or biguanides and was not significantly altered in IDDM patients on insulin. There was significant correlation between FBS and TC, TG, LDL-C and HDL-C in NIDDM patients. TC, TG, LDL-C showed significant correlation in IDDM subjects.

Effect of tender mango leaves (Masala mix) on type 2 diabetics

Present study was conducted on 20 NIDDM subjects above 40 years from tirupati area. The data relating to study was collected using questionnaire. In this study effectiveness of Mangifera Indica (tender mango leaves) along with other beneficial spices ways analyzed on 20 NIDDM subjects, the product was supplemented for 60 days as a part of their daily diet. It proved to be highly beneficial owing to the phytochemicals present in the masala mix. The product resulted as a very useful functional food for daily use in controlling NIDDM.

Serum electrolytes and lipid profiles in non-insulin dependent diabetes mellitus patients

Background: Diabetes mellitus and hyperlipidemia are the most common metabolic disorder affecting the people all over the world. Hyperglycemia is considered a primary cause of diabetic vascular complications and is associated with impaired electrolytes in some of the metabolic dysfunctions is not clear. Aim: The purpose of this study was conducted to investigate the relationship among diabetes mellitus, lipid profiles and electrolytes (Na+, K+ and Cl-). Methods: In the sera of 85 non insulin-dependent diabetes mellitus NIDDM, 45 with hyperlipidemia, 40 without hyperlipidemia, 50 samples of hyperlipidemia without NIDDM, and 50 non diabetic healthy control subjects. The mean age of the diabetic patients was similar to that of control. The mean duration of the disease was (10.2±5.9) years (2-23) years. From the results, it was discovered that there was a significant decrease in Na+ and Cl- in patients with NIDDM without high level of lipid profile (group I), but our results show that the concentration of K+ not changed significantly. The plasma levels of Na+ and Cl- ions were show significant change in patient with hyperlipidemia without NIDDM (group II), while plasma K+ not changed significantly in this group as compared with control. The mean value of Na+ and Cl- show high significant change in NIDDM patients with high level of lipids profile (group III),were plasma K+ not changed significantly as compared with control group. Conclusion: These finding may explain the role of impaired electrolytes status in NIDDM and hyperlipidemia subjects. DOI: http://dx.doi.org/10.3126/ajms.v6i3.11088Asian Journal of Medical Sciences Vol.6(3) 2015 38-41

Effect of fiber supplement on blood glucose level of niddm subjects

An investigation was undertaken to assess effect of fiber rich supplement on blood glucose level of type 2 diabetic patients. Fiber rich supplement was tested on eleven type 2 diabetic subjects for blood glucose lowering effect by undertaking an intervention of two months feeding trials. Results with respect to two months supplementation indicated that the fiber rich supplement was helpful in significantly reducing the fasting and postprandial blood glucose level of subjects. The reduction in the fasting blood glucose level after two months supplement intake was 30-70 mg/dl. While, the postprandial blood glucose values of the subjects were reduced by 92-140 mg/dl. There was reduction in the physiological symptoms at the end of the supplementation. It can be concluded from the study that the fiber rich supplement had therapeutic value as it was beneficial for lowering the blood glucose content of type 2 diabetics.

Studies on lipid profile in patients with non insulin dependent diabetes mellitus

Diabetes mellitus is a global health problem and is associated with abnormalities of lipids and lipoprotein metabolism in variable frequency. The aim of the present work was to study the lipid abnormalities in NIDDM patients. Dyslipidaemia is of special interest because to compare it between male and female NIDDM patients and as well as to see the impact between women of reproductive age group and post menopausal women. For this purpose total serum cholesterol, triglyceride, LDL-C, HDL-C and LDL/HDL ratio were determined of a total number of 160 subjects. Out of these 80 subjects were diabetic and 80 were non-diabetic control subjects of both sexes. In this study, the total serum cholesterol levels were higher in NIDDM than control subjects and showed significant statistical difference (P&lt;0.05) between control and NIDDM subjects. The serum triglyceride levels were found higher amongst diabetics as compared to the normal healthy controls and showed statistically significant difference (P&lt;0.05). Higher LDL-C levels were showed in NIDDM and revealed significant difference (P&lt;0.05) in comparison to control non-diabetic subjects and NIDDM patients. HDL-C levels were found decreased in patients with NIDDM compared to controls. The findings in the patients with NIDDM between male and female revealed no significant difference (P&gt;0.05) in mean TC, TG, HDL-C and LDL-C between male and female diabetic patient in unpaired t-test. With improvement of diabetic control some improvement of the lipid abnormalities can be achieved. Most studies have shown that improvement of lipid abnormalities occur with proper glycaemic control in patients with NIDDM. The atherosclerotic process in the diabetic patient is indistinguishable from that seen in the non-diabetic population but it begins earlier and is more severe. Risk factors associated with atherosclerosis in the non-diabetic subject appear to have a similar relation to coronary heart disease among diabetics. Further studies are necessary to confirm the present suggestions, studies involving more number of subjects, estimation of Hb AIC.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13516 KYAMC Journal Vol.2(1) 2011 pp.123-127

Effect of dehydrated Salacia prinoides on experimental mice and on NIDDM subjects

Studies conducted with dehydrated Salacia prinoides and soya flour individually show their beneficial effects on the physiological well being of animals and humans. Thus nutrient analysis of dehydrated Salacia prinoides and a supplementation study was conducted. Supplementation study included both animal and human subjects. It was observed that dehydrated Salacia prinoides is rich in protein and fibre. It is low in fat content. Copper and magnesium were present in negligible amounts. There was significant decrease in body weight, mean blood glucose levels, mean total serum cholesterol levels and an increase in mean serum total protein levels and serum urea level of the experimental albino mice. Histopathological findings revealed that there was a mild impact on liver, kidney and intestine, the representative segments showed mild changes in cell structure. Thus no significant toxicity was found in liver, kidney and intestine when the experimental albino mice were sacrificed. In the human study, purposive sampling technique was used to select NIDDM subjects. Five grams of Salacia prinoides was provided as a supplement for a period of 45 days. A reduction in body weight was observed among the experimental group subjects. There was significant reduction in fasting and post prandial blood sugar levels among the subjects in experimental group. A significant reduction in serum triglycerides and LDL cholesterol was also observed. Thus it can be concluded that dehydrated Salacia prinoides can be recommended as a food supplement with additional benefits of its active principle for its anti-diabetic activity

Effect of dehydrated Salacia prinoides on experimental mice and on NIDDM subjects

Effect of dehydrated Salacia prinoides on experimental mice and on NIDDM subjects

Activation of human platelet protein kinase C-beta 2 in vivo in response to acute hyperglycemia.

Protein kinase C (PKC) is known to be activated in experimental model systems by elevated glucose and may play an important role in the pathogenesis of diabetic complications. Since there is no information about its role in humans in vivo we investigated the activation of PKC in human thrombocytes during infusion of glucose and insulin in normal controls and in 19 NIDDM patients by determining membrane and cytosol levels of PKC beta 2 using immune blots. In the 27 subjects investigated (8 controls, 19 NIDDM) membrane-associated levels of PKC beta 2 increased significantly after 60 and 150 min (p < 0.005). In controls an increase of membrane and of cytosolic PKC beta 2 occurred upon elevation of glucose by 5.5 mmol/L or more and the membrane association persisted for at least 60 min. In NIDDM glucose was elevated by 7.5-10 mmol/L during infusions. Increases of both membrane and cytosolic PKC beta 2 (< 20%-300%) occurred in 10 NIDDM patients suggesting that both, translocation and increased synthesis of PKC beta 2 were stimulated by glucose. Nine other patients showed no alteration (i.e. < 20%) of PKC beta 2. The 2 groups were similar regarding parameters of diabetes control, baseline glucose and glucose elevation during the test. However, the PKC beta 2 responsive group had lower levels of serum triglycerides (1.39 +/- 0.19 vs. 2.32 +/- 0.34 g/L; p = 0.038). To assess whether absolute levels of PKC were altered in human diabetes, platelet levels of PKC alpha, beta 1 and beta 2 were determined in 22 controls and 25 NIDDM subjects with poorly controlled diabetes (HbA1c = 9.8 +/- 0.36%). Cytosolic levels of PKC alpha were significantly decreased by 27% compared to controls in NIDDM but there was no change of PKC beta 1 or PKC beta 2. We conclude that 1. acute elevation of glucose by 5.5 mmol/L or more can activate PKC beta 2 translocation in controls and NIDDM patients in vivo irrespective of parameters of metabolic control. 2. NIDDM patients differ in their PKC beta 2-responses to glucose and 3. poor metabolic control leads to moderate downregulation of PKC alpha suggesting continued activation.

Diabetes‐related changes in hearing

Determine the effects on hearing of diabetes mellitus (DM) severity. We conducted a cross-sectional study among Veterans to investigate the relationship of diabetes severity and hearing in randomly selected subjects with (165) and without (137) DM and who had no more than a moderate hearing loss. Subjects were classified by three age tertiles (<50, 50-56, and 57+ years). Diabetes severity was classified as insulin-dependent (IDDM), noninsulin-dependent (NIDDM), or no DM. Other DM measures included concurrent serum glucose, serum HbA(1c), duration of disease, and several measures of DM-related complications. Pure-tone thresholds were measured in both ears of each subject at frequencies from 250 Hz through 14,000 Hz. Outcome measures were adjusted for age and frequency and analyzed for differences between subject groups using analysis of variance. Contrasts of the mean NIDDM and IDDM thresholds at each frequency to the DM group, and controlled for the effects of frequency, age, and interactions were modeled. There was greater hearing loss in younger tertile DM subjects compared to those without DM. Significant hearing differences were at all frequencies for NIDDM subjects, but for IDDM subjects, differences were at 1,000 Hz and below, and 10,000 Hz and above. Over age 50 years, there were significant associations between hearing at low frequencies and IDDM only. Self-report of prior noise exposure did not explain observed differences. Diabetes is associated with an increased risk of hearing loss, and this difference is manifest particularly in adults <50 years old.

Longer‐term Effects of a Low Glycemic Index Diet on Glycemic Control in Type 2 Diabetes

BackgroundNut consumption, including peanuts, has been associated with a reduced risk of coronary heart disease (CHD). More recently, interest has grown in the potential value of including nuts in diets of individuals with diabetes.ObjectiveTo determine if tree nuts and peanuts improve glycemic control in non‐insulin dependent diabetes, as assessed by HbA1c and to assess whether these outcomes relate to improvements in CHD risk (serum lipids, blood pressure and oxidative stress and inflammatory biomarkers).MethodsApproximately 120 NIDDM subjects (BMI ≤32kg/m2) treated with oral hypoglycemic agents (HbA1c 6.5‐8.0%) were recruited to a 3 month parallel design study. Subjects were randomized to one of three treatments: 1) Test (Full Dose Nut Diet): Raw nuts were added as supplements to the subject's usual diet based on required energy intake (≥2,400kcal/d received 100g/d nuts, ≈600kcal; 1,600‐2,400kcal/d received 75g/d nuts, ≈450kcal; ≤1,600kcal/d received 50g/d, ≈300kcal); 2) Test (Half Dose Nut Diet): Subjects received half dose of nuts and half dose of control muffin according to calorie needs; and 3) Control: whole wheat muffins were matched with energy content of nut supplements. One‐week weighed diet histories were obtained and fasting blood samples collected at baseline and weeks 2, 4, 8, 10 and 12 for markers of glycemic control and CHD risk factors.ResultsFinal data to be presented.

Glutathione synthesis by red blood cells in type 2 diabetes mellitus

Oxidative stress is implicated in the pathogenesis and complications of type 2 diabetes mellitus (NIDDM). Glycoxidation may damage the enzymes that synthesise glutathione (GSH), an endogenous intracellular antioxidant. Erythrocytes (RBCs) taken from NIDDM subjects, and non-diabetic controls, were GSH-depleted using 1-chloro-2,4-dinitrobenzene, incubated in a solution containing GSH-rebuilding substrates, and sampled for GSH using a 5,5′-γ-dithiobis-(2-nitrobenzoic acid)/enzymatic recycling procedure. NIDDM subjects, on average, had the same GSH concentration and synthesising ability as non-diabetic controls, indicating normal function of the synthesis enzymes. A positive correlation between synthesis and concentration of GSH seen in non-diabetic controls did not exist in NIDDM, due to their putatively larger oxidative load. The results, to the best of our knowledge, provide the first evidence that, despite a higher oxidative load, intact RBCs from NIDDM subjects are able to synthesise GSH normally. It is hypothesised that increased rates of GSH synthesis would maintain a normal steady-state GSH concentration.

Interrelationship of antioxidative status, lipid peroxidation, and lipid profile in insulin-dependent and non-insulin-dependent diabetic patients

This study aimed to investigate the interrelationship of plasma lipid profile, lipid peroxidation, and erythrocyte antioxidative defense in patients with insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus. Plasma levels of total cholesterol, triglycerides, and lipid peroxides and the activities of copper, zinc superoxide dismutase (CuZnSOD), catalase, glutathione peroxidase (GSH-Px), as well as the amount of glutathione in erythrocytes, were determined in IDDM, NIDDM, and nondiabetic control subjects. Additionally, morphology of erythrocytes in all subjects was examined. Plasma levels of total cholesterol and triglycerides were significantly increased in NIDDM compared with controls. Also, the lipid peroxide level was higher in NIDDM than in either control or IDDM subjects. CuZnSOD activity in erythrocytes was elevated in NIDDM patients compared with the control. In NIDDM patients, more extensive erythrocyte spherocytosis and echinocytosis compared with both control and IDDM subjects were observed. In contrast with the IDDM group, the observed abnormality in lipid metabolism in NIDDM patients is closely associated with increased lipid peroxidation, changes in antioxidative defense, and erythrocyte morphology.

Impaired activity of serum alpha-1-antitrypsin in diabetes mellitus

Alpha-1-antitrypsin (AAT) is the prototypic member of the serine protease inhibitor (serpin) superfamily of proteins, which has a major role in inactivating neutrophil elastase and other proteases to maintain protease–antiprotease balance. In this study, the serum AAT was measured using enzymatic assay in diabetic patients. The serum trypsin inhibitory capacity (s-TIC) was determined in 144 outpatients with uncontrolled insulin-dependent diabetes mellitus ( n = 47) and non-insulin dependent diabetes mellitus ( n = 97). The s-TIC values were 1.960 ± 0.399, 2.002 ± 0.4304 and 2.867 ± 0.395 μmol/min/ml in IDDM, NIDDM and healthy subjects, respectively. The diabetics individual had a significantly lower s-TIC than controls ( P < 0.0001). It was found that there was a negative correlation between the s-TIC and the duration of diabetes ( r = −0.5420; P < 0.0001). There was no correlation between s-TIC and age of patients ( P = 0.865). Thus, diabetes is associated with reduced trypsin inhibitory capacity of plasma.

Lower Muscle Strength Gains in Older Men with Newly Diagnosed NIDDM After a Resistance Training

Disability is two to three times higher among older people with diabetes than among those without diabetes. This is related with the fact that in older men with NIDDM declines in the functional capacity of the neuromuscular and neuroendocrine systems are increased with regard to the observed in healthy older men. On the other hand, exercise interventions that improve neuromuscular performance in older people are becoming recognized as an effective strategy against disability, increasing functional independence. PURPOSE: To determine if a twice- weekly whole body supervised- progressive resistance training (PRT) program is effective in neuromuscular (maximal strength and power output) and endocrine adaptations in newly diagnosed older men with NIDDM as it has been shown in healthy ones. METHODS: Eleven healthy and ten newly diagnosed NIDDM subjects completed 2 times per week a 16-week period of supervised PRT at intensities of 50–80% of one repetition concentric maximum (1-RM). Lower and upper body maximal strength and muscle power output were assessed using 1-RM action and a 30% of their respective 1- RM in a half-squat and in a bench-press position, respectively. Resting serum total testosterone (T), free testosterone (fT) and cortisol (C) were determined by radio immuno ass ays. RESULTS: Baseline maximal voluntary arm and leg strength was not significantly different between healthy and NIDDM groups (47.8 ± 12.4 vs. 45.9 ± 6.5 Kg; and 103.1 ± 25.9 vs. 106.3 ± 8.3 Kg, respectively). After training, the increase in arm and leg strength in NIDDM subjects (24.2 ± 4.1% and 17.0 ± 3.8%, respectively) was significantly smaller (P < 0.05–0.01) than that recorded in the control healthy group (36.7 ± 12.9% and 35.6 ± 12.2%, respectively). During the 16-wk training period the increases in power of the arm and leg extensors muscles were similar in both groups tested (22.5 ± 21.3 vs. 23.8 ± 18.3%, n.s.; and 34.2 ± 32.0 vs. 33.0 ± 21.2%, n.s., respectively). Significant linear correlations were observed in a combined group of healthy plus older men with NIDDM between both the mean level of individual serum total T and C concentrations (averaged for the entire training period) and the individual changes in 1-RM of the leg (r= 0.85 and 0.51; P < 0.05, respectively) and arm muscles (r= 0.63 and 0.70; P < 0.05, respectively). CONCLUSIONS: In NIDDM, PRT leads to a similar muscle power increase but to a smaller strength gains than in healthy older men. Collectivelly, these observations suggest that the partial androgen deficiency should play a key role in strength gains in these patients.

Cochleovestibular complications of diabetes mellitus in Ibadan, Nigeria

Diabetes mellitus comprises of a clinically heterogeneous group of hyperglycaemic disorders with various end-organ complications. Reports of cochleovestibular involvement have been sparse and at times inconclusive.The objective of the study is to determine the prevalence and pattern of cochleovestibular dysfunction in diabetic subjects in the University College Hospital, Ibadan, and to find correlation (if any) with the duration of diabetes mellitus, severity of diabetes mellitus and the presence of other chronic medical complications.The prevalence of cochleovestibular complications was found to be 79%. Benign positional paroxysmal vertigos accounted for 55 (23%), followed by tinnitus 50 (21%) and sensorineural hearing loss (SNHL) 41(17%). The mean bone conduction threshold in subjects was 57 dB compared with controls with 33 dB (P value=0.000000); air conduction was normal. Some of the subjects (22.5%) had severe-to-profound hearing loss, which adversely affected their quality of life. Hearing is worse in IDDM compared with NIDDM subjects. There was significant association between the presence of SNHL and nephropathy (P value=0.00062) and impotence (P value=0.0288). It was concluded that cochleovestibular complications are highly prevalent among diabetics. It is usually insidious and may be missed. The pathogenesis of SNHL may be microangiopathy.It is, thus, recommended that diabetics have otologic assessment regularly at least once a year for early detection and intervention.

Progressive renal and cardiovascular disease: Optimal treatment strategies

Progressive renal and cardiovascular disease: Optimal treatment strategies

Islet autoantibodies in Latvian subjects with non-insulin-dependent diabetes mellitus: slow-onset type 1 diabetes or polyendocrine autoimmunity?

In Latvia diabetes mellitus is diagnosed using the WHO's clinical criteria; assays for the detection of autoantibodies are not available, and hence slowly progressive autoimmune diabetes is likely to be missed. Autoantibodies against glutamic acid decarboxylase (GAD65) and protein tyrosine phosphatase (IA-2) among patients with clinically diagnosed NIDDM identify group of patients with slow-onset type 1 diabetes or LADA. The aim of this study was to estimate the risk of polyendocrine autoimmunity among clinically diagnosed NIDDM patients from Latvia. One hundred NIDDM patients and 100 healthy controls were tested for GAD65 and IA-2 autoantibodies as well as 21-hydroxylase (21-OH) and tissue transglutaminase (TTG) antibodies by RIA assay. Age at onset was >or= 30 years, and duration of disease less than 5 years. Of 100 patients, 85 were on oral hypoglycemic agents and 15 were on insulin. Body mass index (BMI) under 19 was recorded in 1% (1 of 100 cases), while overweight (BMI > 25.5 in females and 27 in males) was documented in 45% (45 of 100 cases). GAD65 antibodies were found in 30 of 100 (30%) and IA-2 antibodies in 40 of 100 (40%) patients. Either GAD65 or IA-2 antibodies were found in 55 of 100 (55%). None of the patients carried antibodies against 21-OH and only 1 of 100 (1%) carried antibodies against TTG. From the results obtained in our study we conclude that in Latvian adult NIDDM subjects, islet autoantibodies identify groups of slow-onset type 1 diabetes but not polyendocrine autoimmunity.