Non-insulin-dependent Diabetes Mellitus Group Research Articles

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes: A retrospective cohort study.

The impact of type 2 diabetes mellitus (T2DM) on acute respiratory distress syndrome (ARDS) is debatable. T2DM was suspected to reduce the risk and complications of ARDS. However, during coronavirus disease 2019 (COVID-19), T2DM predisposed patients to ARDS, especially those who were on insulin at home. To evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes. We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database. Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus (DM) (IDDM) and non-insulin-dependent DM (NIDDM) groups. After applying exclusion criteria and matching over 20 variables, we compared cohorts for mortality, duration of mechanical ventilation, incidence of acute kidney injury (AKI), length of stay (LOS), hospitalization costs, and other clinical outcomes. Following 1:1 propensity score matching, the analysis included 274 patients in each group. Notably, no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates (32.8% vs 31.0%, P = 0.520), median hospital LOS (10 d, P = 0.537), requirement for mechanical ventilation, incidence rates of sepsis, pneumonia or AKI, median total hospitalization costs, or patient disposition upon discharge. Compared to alternative anti-diabetic medications, outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Expression of advanced glycation end products and receptors in gingival tissues of patients with noninsulin-dependent diabetes mellitus-associated periodontitis

Background/purposeAdvanced glycation end products (AGEs) are known to accumulate in the periodontal tissues of patients with diabetes mellitus (DM). Through this study, we aimed to investigate the distribution of AGEs and the receptor of AGEs (RAGE) in the gingival tissues of patients with chronic periodontitis with and without non-insulin-dependent diabetes mellitus (NIDDM). Materials and methodsGingival biopsy samples from 13 patients with both NIDDM and periodontitis and 6 patients with both non-DM (NDM) and periodontitis were collected. The tissue sections were processed using immunohistochemical (IHC) staining to detect the distributions of AGEs and RAGE. Spearman correlation coefficients of all samples were calculated (P < 0.05) for the AGE and RAGE rankings of the following clinical parameters: plaque score (PI), probing depth (PD), bleeding on probing (BOP), and tooth loss (TL). ResultsIHC analysis revealed that AGEs among patients with NIDDM had a significantly higher ranking than those of the NDM group (P < 0.05). Positive staining for RAGE was observed in both groups but was not significantly different (P > 0.05). A positive correlation between AGE ranking and TL was observed in the NIDDM group, but not between AGE ranking and PI, PD, or BOP. The distribution of RAGE was not correlated with PI, PD, BOP, or TL. ConclusionAGEs were particularly distributed in the highly inflamed gingiva of patients with NIDDM-associated periodontitis and was statistically correlated with the long-term parameter TL.

Diabetes status and postoperative complications for patients receiving open rotator cuff repair.

Diabetic patients are known to have poor wound healing and worse outcomes following surgeries. The purpose of this study is to evaluate diabetes status and complications for patients receiving open rotator cuff repair. Patients undergoing open rotator cuff repair from 2006 to 2018 were identified in a national database. Patients were stratified into 3 cohorts: no diabetes mellitus, non-insulin dependent diabetes mellitus (NIDDM), and insulin dependent diabetes mellitus (IDDM). Differences in demographics, comorbidities, and complications were assessed with the use of bivariate and multivariate analyses. Of 7678 total patients undergoing open rotator cuff repair, 6256 patients (81.5%) had no diabetes, 975 (12.7%) had NIDDM, and 447 (5.8%) had IDDM. Bivariate analyses revealed that IDDM patients had increased risk of mortality, extended length of stay, and readmission compared to non-diabetic patients (p < 0.05 for all). IDDM patients had higher risks of major complications and readmission relative to NIDDM patients (p < 0.05 for both). On multivariate analysis, there were no differences in any postoperative complications between the non-diabetic, NIDDM, and IDDM groups. Diabetes does not affect postoperative complications following open rotator cuff repairs. Physicians should be aware of this finding and counsel their patients appropriately.Level of Evidence: III.

Abstract 11580: Platelet Activity and Cardiovascular Events in Patients with Diabetes and Peripheral Artery Disease: Findings from the American Heart Association Cardiometabolic Health Strategically Focused Research Network

Introduction: Peripheral artery disease (PAD) and diabetes mellitus (DM) are significant risk factors for atherothrombosis. Platelets mediate atherothrombosis and are therapeutic targets in PAD and DM. We investigated the relationships between PAD, DM, platelet activity, and cardiovascular risk. Methods: The Platelet Activity and Cardiovascular Events (PACE) study enrolled 289 PAD patients undergoing lower extremity revascularization (LER). Prior to LER, platelet activity was measured via light transmission aggregometry in response to submaximal ADP, collagen (coll), serotonin (ser), epinephrine (epi), and arachidonic acid (AA). Patients were followed for a median of 18 months for the composite of major adverse cardiac or limb events (MACLE; MI, stroke, death, major amputation, and limb revascularization). Results: There were 93 (32%) patients with insulin-dependent DM (IDDM), 60 (21%) with non-insulin dependent DM (NIDDM), and 136 (47%) without-DM. Patients with IDDM were more likely than those without DM to be female, non-white, and Hispanic, and to have history of coronary artery disease, heart failure, and critical limb ischemia (P&lt;0.05 for all). Use of antiplatelet therapy was similar across groups. Maximum platelet aggregation was highest in the IDDM group in response to multiple agonists ( Figure) . MACLE occurred in 51%, 57%, and 69% of the without-DM, NIDDM, and IDDM groups, respectively (P=0.02). Compared to subjects without DM, only those with IDDM were at increased risk of MACLE after multivariable adjustment (aHR 1.6 [95% CI 1.02-2.4]; P=0.04) ( Figure ). After further adjustment for platelet aggregation, the association between IDDM and MACLE was no longer statistically significant (1.4 [0.9-2.3]; P=0.17); platelet aggregation mediated 24% of the excess MACLE risk in individuals with IDDM. Conclusions: In patients with PAD, IDDM is associated with increased platelet activity that mediates, in part, the risk for incident cardiac and limb events.

Evaluation of Epicardial Adipose Tissue by Echocardiography and Its Correlation with Aortic Velocity Propagation and Carotid Intima-Media Thickness in Patients of Type 2 Diabetes Mellitus.

Epicardial fat thickness (EFT) is associated with aortic stiffness in diabetic patients. In this study, we aimed to determine if there is an association among the parameters of EFT, aortic velocity propagation (AVP), and carotid intima-media thickness (CIMT) in patients with non-insulin dependent diabetes mellitus. This study included 55 non-insulin dependent diabetes mellitus patients and 40 non-diabetic control patients. For all participants, EFT and AVP were determined by echocardiographic method and CIMT was calculated using an ultrasonographic exam. The EFT and CIMT values were found to be significantly increased in the non-insulin dependent diabetes mellitus group. On the other hand, aortic velocity propagation was decreased in the non-insulin dependent diabetes mellitus group compared to non-diabetic patients (EFT; 8.43 ± 1.68 versus 6.36 ± 2.21 mm, p < 0.001; CIMT; 0.92 ± 0.24 versus 0.58 ± 0.18 mm, p < 0.001; and AVP; 28.20 ± 16.02 versus 58.10 ± 17.50, p < 0.01, respectively). Significantly higher EFT and CIMT values were found in addition to lower AVP values in non-insulin dependent diabetes mellitus patients. Moreover, we demonstrated that there was a strong correlation between EFT, CIMT, and AVP.

Blood pulmonary tuberculosis biomarkers on diabetic individuals

Event Abstract Back to Event Blood pulmonary tuberculosis biomarkers on diabetic individuals Carmen J. Serrano-Escobedo1, Rosa A. Gonzalez-Curiel1, Leonor Enciso-Moreno1, Noe Macias-Segura1 and Jose A. Enciso-Moreno1* 1 INSTITUTO MEXICANO DEL SEGURO SOCIAL, UNIDAD DE INVESTIGACION MEDICA ZACATECAS, Mexico SETTING. Tuberculosis (TB) associated to chronic health conditions such as non-insulin-dependent diabetes mellitus (NIDDM) could represent nowadays a worldwide Public Health threat. The relative odds of developing tuberculosis in diabetic patients ranges from 3 to 8 compared with non-diabetic patients. No molecular diagnostic or prognostic test to distinguish latent (LTB) from active TB (ATB) exists, neither biomarkers to follow TB pharmacology interventions. Given exacerbated inflammation by TB leads to pulmonary damage; key molecules on the inflammation process could be useful as diagnosis biomarkers for TB states, even in individuals with NIDDM. METHODS. Previous microarrays analysis at our laboratory identified a group of overexpressed genes on mice lungs infected with a Mycobacterium tuberculosis virulent strain that were not induced by a persistent strain that induces no inflammation. Based on the hypothesis that PBMCs from individuals with different TB infectious status could exhibit distinct transcription profiles, the present study evaluated the gene expression capability of 7 mice overexpressed genes on human whole blood, to discriminate subjects with pulmonary TB (PTB) (with or without NIDDM) from non infected or LTB subjects. RESULTS. In the no NIDDM group, CXCR5 presented lower expression on PTB compared to LTB, while PSTP1 expression was higher. On the other hand, NIDDM-PTB individuals showed higher expression for GBP2, ARHGAP30, NCF1, and FPR2 compared to the LTB individuals, while CXCR5 expression was lower. CONCLUSIONS. Gene expression profile of four overexpressed genes on TBA were found with potential utility to discriminate on NIDDM, LTB persons from those with activated pulmonary TB. Acknowledgements This study was supported by the Mexican Council for Science and Technology (grant CONACYT-SALUD-2011-1-161677) Keywords: Tuberculosis, diabetes, biomarkers, Inflammation, Blood Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Host-pathogen interactions Citation: Serrano-Escobedo CJ, Gonzalez-Curiel RA, Enciso-Moreno L, Macias-Segura N and Enciso-Moreno JA (2013). Blood pulmonary tuberculosis biomarkers on diabetic individuals. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00056 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 08 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Jose A Enciso-Moreno, INSTITUTO MEXICANO DEL SEGURO SOCIAL, UNIDAD DE INVESTIGACION MEDICA ZACATECAS, ZACATECAS, ZACATECAS, 98000, Mexico, enciso_2000@yahoo.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno Google Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno Google Scholar Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno PubMed Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Comparison of Spinal Deformity Surgery in Patients With Non–Insulin-Dependent Diabetes Mellitus (NIDDM) Versus Controls

A retrospective review. To quantify the exact impact of non-insulin-dependent diabetes mellitus (NIDDM) on operative complications and additional surgeries associated with spinal deformity surgery. There are many references supporting diabetes mellitus (DM) as one of the major risk factors for perioperative complications in spinal surgery. However, the results vary depending on the type of DM, suggesting that insulin-dependent DM causes more complications than NIDDM, which is far more prevalent in the adult population with spinal deformity. Among 5119 adult patients (older than 40 yr) with deformities, 23 patients with NIDDM and 23 control (group C) patients with a minimum 2-year follow-up were selected. Both groups were matched for age at surgery, sex, body mass index, number of comorbidities, smoking history, current and prior fusion levels, estimated blood loss, and the amount of transfusion. Pre- and final Scoliosis Research Society (SRS) scores and Oswestry Disability Index (ODI), number of perioperative complications, and additional surgeries were compared. Within the group with NIDDM, patients with (+) or without (-) complications were compared in terms of postoperative glucose control. There were no significant differences in the number of major or minor complications or additional surgeries between the 2 groups. There was no significant difference in postoperative glucose control with the NIDDM group (+) and (-). Group C reported significantly improved scores at final follow-up in all SRS domains and ODI. The group with NIDDM reported improvement in all domains except for the mental health and pain domains. However, there were no significant differences between the group with NIDDM and group C in terms of SRS and ODI scores preoperatively and postoperatively. Contrary to traditional thinking, properly selected NIDDM was not a significant risk factor for perioperative complications or additional surgeries in adult patients with spinal deformities.

Effects of melatonin on plasma and lenticular oxidative stress in rats with streptozotocin induced diabetic cataract

Objective: Chronic production of reactive oxygen species (ROS) and/or deficiency in the antioxidant defense system are observed in non-insulin-dependent diabetes mellitus (NIDDM) patients. As an adjunct to the usual indirect parameters for evaluating oxidative stress, we assessed the feasibility of oxyradicals detection in venous blood by electron spin resonance spectroscopy (ESR). Detection of the ascorbate pool was also performed using the validated ESR analysis of the ascorbyl free radical (AFR)-dimethyl sulfoxide (DMSO) complex.Methods and results: Plasma lipoperoxidation was characterized by higher levels of total MDA (1.50 ± 0.08 nmol/L), lower levels of GSH (0.54 ± 0.02 mmol/L) and of vitamin A (2.13 ± 0.52 μmol/L) in the NIDDM group than in the controls (0.75 ± 0.05 nmol/L, 0.90 ± 0.05 mmol/L, 3.52 ± 1.04 μmol/L, respectively). Improvement of the ESR measurement of oxyradical adducts has been previously obtained by addition of a new sensitive nitrone (DEPMPO), which acts as a spin-trap. However, in our experiment the ESR signal-to-noise ratio was too low to detect significative oxyradicals adducts in total venous blood of NIDDM patients having a weak production of ROS. A significant difference (p < 0.002) was observed in DMSO/AFR index between controls (24.00 ± 4.10 nmol/L) and NIDDM patients (7.28 ± 2.36 nmol/L) suggesting ascorbate depletion related to the free radical production.Conclusion: The DMSO/AFR index could be an interesting additional marker of oxidative stress during a chronic production of ROS.

Influence of Therapy with Metformin on the Concentration of Certain Divalent Cations in Patients with Non-insulin-Dependent Diabetes Mellitus

Research was performed on a group of 30 patients with non-insulin-dependent diabetes mellitus (NIDDM), who never received antidiabetic medication before, and on a group of 17 healthy adults. The patients were administered treatment with metformin, 1,000 mg/day. Plasmatic and urinary concentration of magnesium have been measured, copper and zinc along with the concentrations of glucose, HDL, LDL, cholesterol, tryglicerides, HbA1c, and total erythrocyte magnesium, in advance and after 3 months of treatment. Data showed significant differences in the NIDDM group vs the control group: for plasma magnesium-1.95 ± 0.19 vs 2.20 ± 0.18 mg/dl, p < 0.001; urine magnesium-237.28 ± 34.51 vs 126.25 ± 38.22 mg/24 h, p < 0.001; erythrocyte magnesium-5.09 ± 0.63 vs 6.38 ± 0.75 mg/dl, p < 0.001; plasma zinc-67.56 ± 6.21 vs 98.41 ± 20.47 μg/dl, p < 0.001; urine zinc-1,347.54 ± 158.24 vs 851.65 ± 209.75 μg/24 h, p < 0.001; plasma copper-111.91 ± 20.98 vs 96.33 ± 8.56 μg/dl, p < 0.001; and urine copper-51.70 ± 23.79 vs 36.00 ± 11.70 μg/24 h, p < 0.05. Treatment with metformin for 3 months modified significant erythrocyte magnesium-5.75 ± 0.61 vs 5.09 ± 0.63 mg/dl, p < 0.001 and urine magnesium-198.27 ± 27.07 vs 237.28 ± 34.51 mg/24 h, p < 0.001, whereas it did not modify significant the plasmatic and urinary concentration of the other cations. The erythrocyte magnesium concentration was inversely correlated with HbA1c (r = -0.438, p = 0.015). The plasma level of copper was positively correlated with HbA1c (r = 0.517, p < 0.003), tryglicerides (r = 0.534, p < 0.003), and cholesterol (r = 0.440, p < 0.05), and the plasma level of zinc was inversely correlated with glycemia (r = -0.399, p = 0.029). Our data show a significant action of metformin therapy, by increasing the total intraerythrocyte magnesium concentration and decreasing the urinary magnesium elimination, positively correlated with the decrease of glycemia and HbA1c in NIDDM patients.

Anti-GAD Antibody in Patients with Adult-Onset Diabetes in Korea

Background: It is well known that the clinical characteristics of diabetes mellitus in Korean people are different from those of Western people. The purpose of this study was to investigate the prevalence of the anti-GAD antibody (GADA) in a large number of Korean patients with adult-onset diabetes. Methods: The GADA was measured by radioimmunoassay for 11,472 adult-onset diabetic patients who visited the Asan Medical Center from 1998 to 2007. According to the fasting C-peptide levels, we classified the patients into an insulin dependent diabetes mellitus group (IDDM; C-peptide < 0.6 ng/mL) and non-insulin dependent diabetes mellitus group (NIDDM; C-peptide ≥ 1.0 ng/mL). Other clinical and laboratory data were obtained from medical records. Results: Among the 11,147 diabetic patients, 9,250 patients were classified as NIDDM, 922 patients were classified as IDDM and 975 patients excluded. Within the latter group 472 patients were to absolute insulin deficient (C-peptide < 0.1 ng/mL). The prevalence of GADA was 2 2.0% in the IDDM group and 4.7% in the NIDDM group. GADA was more prevalent in younger-onset NIDDM patients (25~40 years of age; 12.4%) than in older-onset NIDDM patients (≥ 40 years of age; 3.8%). The GADA-positive NIDDM patients had lower C-peptide and BMI levels, and higher rates of typical diabetic symptoms and insulin treatment. Conclusion: The prevalence of GADA in Korean patients with IDDM and NIDDM was lower than that reported in Western populations. It is thus suggested that autoimmunity is a rarer cause of diabetes in Korean people. However, since over 10% of younger-onset NIDDM patients were positive for GADA, routine GADA measurement in such patients is recommended. (Korean Diabetes J 33:16-23, 2009)

Cerebrovascular reactivity is impaired in patients with non-insulin-dependent diabetes mellitus and microangiopathy

Cerebrovascular reactivity (CVR) is a hemodynamic parameter representing the increase in normal cerebral artery blood flow in response to a vasodilatory stimulus such as hypercapnia. The aim of the study was to assess CVR using transcranial Doppler ultrasound and the breath-holding test (BHT) in normotensive patients with non-insulin-dependent diabetes mellitus (NIDDM). The cerebrovascular response to hypercapnia was evaluated in relation to risk factors for cerebral microangiopathy. The study was carried out in a group of 34 normotensive NIDDM patients and a group of 31 sex- and age-matched normal controls. The NIDDM group was subdivided into 21 patients with microangiopathic complications (Group A, 12 men, 9 women; mean age 58.77 +/- 8.91 years) and 13 patients with no such complications (Group B, 8 men, 5 women; mean age 56.34 +/- 9.83 years). The control group comprised 17 men and 14 women (Group C, mean age 58.43 +/- 6.31 years). Exclusion criteria were hypertension and past or present symptomatic cerebrovascular disease. The BHT consisted of spontaneous hypercapnia induced by holding the breath for 20 seconds. CVR was estimated in relation to the increase in the mean flow velocity (MFV) compared with the basal velocity in both middle cerebral arteries during hypercapnia. In Group A, the CVR was significantly decreased in 71.42% of patients, whereas in Group B only 30.76% of patients presented with mildly to moderately impaired CVR. Predictors for impaired % increase in the MFV during the BHT demonstrated by univariate regression analysis were: duration of diabetes (r = 0.802; P < 0.0001), fibrinogen (r = 0.574; P < 0.0001), C-reactive protein (r = 0.525; P < 0.001), proteinuria (r = 0.924; P < 0.0001) and serum creatinine (r = 0.969; P < 0.0001). Multivariate regression analysis showed as predictors: duration of diabetes (P < 0.0001), proteinuria (P < 0.0001) and serum creatinine (P < 0.0001). CVR is impaired in normotensive NIDDM patients. These cerebral hemodynamic changes correlate significantly with the duration of DM, parameters of inflammation, proteinuria and serum creatinine.

Study of lipid peroxide and lipid profile in diabetes mellitus.

The study was designed to find out the correlation between lipid peroxidation, lipoprotein levels to severity and complication of diabetes mellitus. Degree of lipid peroxidation was measured in terms of malondialdehyde (MDA) along with lipid profile and blood glucose in diabetes mellitus. It is categorised into insulin dependent diabetes mellitus (IDDM), non insulin dependent diabetes mellitus (NIDDM) and diabetes mellitus(DM) with complication.Total 112 known diabetic patients and 52 non-diabetic controls were studied. These patients were grouped as per the concentration of fasting blood glucose level i.e. controlled, poorly controlled, and uncontrolled group. There are significant increase in the lipid peroxide (MDA) and lipid profile except HDL cholesterol which is decreased, has been found in all groups as compared to controls In NIDDM group lipid peroxidation was markedly increased than IDDM group and it was higher in DM with complications. Other finding observed was that the level of lipid peroxide increased as per the increase in concentration of blood glucose. The increase lipid peroxidation in the hyperglycemic condition may be explained, as the superoxide dismutase enzyme which is antioxidant becomes inactive due the formation of superoxide radical within the cell. Maximum lipid peroxidation leads to the damage of the tissue and organs which results into complication in diabetic patients. High levels of total cholesterol appear due to increased cholesterol synthesis. The triglyceride levels changes according to the glycemic, control. The increase may be due to overproduction of VLDL-TG.It is concluded that good metabolic control of hyperglycemia will prevent in alteration in peroxidation and the lipid metabolism, which may help in good prognosis and preventing manifestation of vascular and secondary complication in diabetes mellitus.

Comparative antidiabetic activity of different fractions of methanolic extract of Zingiber officinale Roscoe in streptozotocin induced NIDDM rats

Earlier we have reported the antidiabetic activity of fresh juice of rhizomes of Zingiber officinale (Z. officinale) and its correlation with 5-HT receptor antagonism. Since 6-gingerol the marker compound of Z. officinale is reported to posses 5-HT anatgonistic activity, the present investigation, was undertaken to find out the concentration of 6-gingerol present in methanolic extract of Z. officinale and its different fractions (petroleum ether, toluene and chloroform). We also evaluated these fractions for antidiabetic activity in streptozotocin (STZ)-induced neonatal type 2 diabetic rats. Fasting glucose and insulin levels in non insulin dependent diabetes mellitus (NIDDM) rats were found to be significantly (P < 0.05) higher than control rats and these were significantly decreased by treatment with methanolic extract of Z. officinale and its fractions. The results of oral glucose tolerance test (OGTT) showed that methanolic extract and its fractions significantly (P < 0.05) decreased both STZ-induced increase in <TEX>$AUC_{glucose}$</TEX> and <TEX>$AUC_{insulin}$</TEX> values in NIDDM groups. Treatment with petroleum ether fraction produced a greater reduction in elevated glucose and <TEX>$AUC_{glucose}$</TEX> levels as compared to treatment with other fractions. Treatment with methanolic extract of Z. officinale and its fractions also produced significant reduction in the elevated lipid, serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) levels in NIDDM rats. The effect of petroleum ether fraction on elevated lipid, SGOT and SGPT levels was significantly greater as compared to treatment with other fractions. The concentration of 6-gingerol was found to be maximum in petroleum ether fraction (11.430%) and minimum in chloroform fraction (0.973%). The methanolic extract and toluene fraction was found to contain 3.080% and 2.191 %, 6-gingerol respectively. In conclusion, our data suggest that methonolic extract and its fractions possess significant antidiabetic activity in NIDDM rats. The extent of activity appears to be dependent on the concentration of 6-gingerol present in the extract or its fractions.

Experimental study of excitability and autorhthmicity in urinary bladder detrusor of diabetes rats

The changes in excitability and autorhthmicity of bladder detrusor in experimental non-insulin dependent diabetes mellitus (NIDDM) rats were observed. Sixty-nine NIDDM rats as NIDDM group and 69 normal rats as control group were enrolled into this experimental study. At 6th, 10th, 14th, 18th, 22nd and 26th week after the rats were injected last time, the changes in the excitability and autorhthmicity of detrusor strips in vitro were observed. The results showed that the threshold of the tension which made the detrusor strips contract was significantly higher in NIDDM group (0.716 +/- 0.325 g) than in control group (0.323 +/- 0.177 g) (F = 59.63, P < 0.001). At different stages, the threshold of the tension resulting the contract of the detrusor strips in NIDDM group was also higher than in control group. At 18th week after STZ injection, the frequency of spontaneous contract of the detrusor strips in NIDDM was significantly higher than in control group (P < 0.05), whereas at 22nd week, that in NIDDM group was significantly lower than in control group (P < 0.05). It was concluded that the decreased excitability of the bladder detrusor was the earliest and most obvious changes in bladder function in diabetes rats and the autorhthmicity had also changed at the early stage of diabetic bladder.

Scotopic Threshold Response in Noninsulin-dependent Diabetes Mellitus Patients with Good HbA1C Level and Ophthalmoscopically Intact Fundus

To evaluate behavior of the scotopic threshold response(STR) and the oscillatory potentials(OPs) of the electroretinogram in noninsulin-dependent diabetes mellitus(NIDDM) patients without retinal abnormalities. The STR and the OP 1-3 were recorded from 15 eyes of 15 NIDDM patients aged from 45 to 63 years old with good HbA1c level and ophthalmoscopically intact fundus. As a control group, 8 eyes of 8 age-matched normal subjects were used. The amplitude and the implicit time of the STR as well as the amplitudes and the peak latencies of OP 1-3 were measured. The mean amplitude and the mean implicit time of the STR in the NIDDM group did not differ significantly from those in the control group. The mean amplitudes and the mean peak latencies of the OP 1-3 also showed no significant differences between the NIDDM and control groups. The STR in NIDDM patients remains normal with good HbA1c level and ophthalmoscopically intact fundus.

Polymorphisms in the von Willebrand Factor Gene Are Not Associated with Proliferative Retinopathy in Non-Insulin-Dependent Diabetes mellitus

Von Willebrand factor, a multimeric glycoprotein synthesized mainly by endothelial cells, is involved in platelet adhesion and aggregation and has an important role in the process of angiogenesis. Increased levels of von Willebrand factor, reflecting activation or damage of endothelial cells, have been described in association with proliferative diabetic retinopathy (PDR). We investigated the relationships of two polymorphisms (–1793G/C and Thr789Ala) in the von Willebrand factor gene with PDR. Genotypes were detected by polymerase chain reactions with subsequent restrictions with specific endonucleases. Allele frequencies were determined in an association study (n = 371) comprising three groups of subjects (diabetics with and without retinopathy and nondiabetics). Allele frequencies of the –1793G/C and Thr789Ala did not differ between the non-insulin-dependent diabetes mellitus (NIDDM) + PDR and the NIDDM non-PDR groups (p > 0.05). However, a statistically significant difference in allele and genotype frequencies of the –1793G/C was proved between all NIDDM versus nondiabetic subjects (p = 0.024 and 0.0065, respectively) with allele G and genotype GG being significantly more frequent in the NIDDM group. Calculated odds ratio for the GG genotype was 1.20 (95% CI, 0.77–1.86). Although significantly higher plasma von Willebrand factor antigen levels in NIDDM patients with PDR have been described in several studies, our findings indicate that no association exists between the two polymorphisms and PDR. However, the –1793G/C polymorphism might affect the risk of NIDDM.

Effect of non-insulin-dependent diabetes mellitus on pulmonary function and exercise tolerance in chronic congestive heart failure

In chronic congestive heart failure (CHF), backward effects of left ventricular dysfunction alter pulmonary volumes and gas diffusion. Some of these disorders are detected in some patients with diabetes mellitus, possibly due to a microangiopathic process and nonenzymatic glycosylation of lung tissue proteins. We explored the possibility that coexistence of non-insulin-dependent diabetes mellitus (NIDDM) may potentiate the deterioration of lung function in CHF. In 20 normoglycemic patients (group 1) and in 20 patients with NIDDM (group 2), with New York Heart Association class II to III CHF due to idiopathic or ischemic cardiac disease, and in 20 controls (groups were age- and gender-matched), we investigated cardiac function, pulmonary volumes, carbon monoxide diffusion (DL CO) and its alveolar-capillary membrane (D M) subcomponent, oxygen uptake and dead space-to-tidal volume ratio (pVD/VT) at peak exercise (individualized ramp test), and slope of ventilation-to-carbon dioxide production ratio (VE/VCO 2) during exercise. Although, compared with reference subjects, both patient groups had similar variations in left ventricular diastolic volume, ejection fraction, and pulmonary wedge pressure; in group 2 lung volumes, DL CO, D M, and oxygen uptake were significantly more reduced; in this group there was no overlap of individual results of DL CO and D M with those in controls; VE/VCO 2 slope and pVD/VT also were significantly increased, and inversely correlated with D M. Thus, coexistence of NIDDM makes pulmonary dysfunction worse in CHF, and significantly enhances exercise intolerance.

Prostanoid release and constrictor responses to noradrenaline in the rat mesenteric vascular bed in non-insulin-dependent diabetes mellitus.

1. The administration of streptozotocin (STZ) to 2-day old rats induced a non-insulin-dependent diabetes mellitus (NIDDM)-like state, with mild hyperglycaemia and no alterations in body weight at the adult age. 2. In the isolated and perfused mesenteric vascular bed of NIDDM animals, the constrictor responses to either noradrenaline (NA) or potassium chloride (KCl) were not modified as compared with age-matched non-diabetic controls. 3. The reduction in NA contractions induced by the cyclooxygenase inhibitor, 10 microM indomethacin in the control group was absent in the NIDDM rats. 4. The increase in the NA-induced contractions caused by endothelium removal was suppressed by indomethacin in the controls but not in the NIDDM group. 5. The prostanoid release from the mesenteric vascular beds of NIDDM rats was markedly reduced as compared with non-diabetic controls. Noradrenaline increased production of the constrictor prostaglandin (PG) F2alpha in control but not in NIDDM rats. 6. In summary, these results show that in STZ-induced NIDDM rats, there is an impairment of the prostanoid production, as well as a suppression of the role of prostanoids in the contractile effects of NA in the mesenteric vascular bed. These alterations are more severe than those previously observed in a model of insulin-dependent diabetes mellitus (IDDM), in which hyperglycaemia and reduction of body weight were more marked. The conclusion is that, in these models of diabetes and in the preparation studied, vascular alterations and modifications of glycaemia and body weight are not closely related.

Differences in juvenile atherosclerosis between patients with a novel low density lipoprotein receptor mutation and other patients with familial hypercholesterolemia

Genotypic abnormalities of the renin-angiotensin system have been suggested as a risk factor for the development of microangiopathic complications in diabetic patients. We studied the relationship of either an insertion-deletion polymorphism in the angiotensin-converting enzyme (ACE) gene and the M235T and T174M variant polymorphisms of the angiotensinogen (AGT) gene in non—insulin-dependent diabetes mellitus (NIDDM) patients and its relationship with cardiovascular complications. A total of 193 NIDDM patients (89 men and 104 women aged 59.2 ± 10.0 years; diabetes duration, 13.2 ± 6.2 years) and 90 control subjects (42 men and 48 women aged 45.4 ± 12.6 years) were recruited for the association study. Distribution of the genotype or allelic frequencies for all the studied polymorphisms did not differ significantly between controls and NIDDM patients. ACE and AGT genes did not display any difference in clinical or metabolic parameters according to each gene's genotype for either the control or the NIDDM group, For evaluation of nephropathy and retinopathy, NIDDM patients were matched with subjects not having microangiopathic complications. Thus, a total of 60 patients had diabetic nephropathy and were compared with 100 patients with normoalbuminuria. Sixty-eight NIDDM patients had diabetic retinopathy, and 92 patients presented no signs of retinopathy. There were no differences in genotypic or allelic distribution between NIDDM patients for either the presence or absence of retinopathy or nephropathy. We conclude that the ACE and AGT polymorphisms do not contribute to the genetic susceptibility to diabetic nephropathy and retinopathy in a caucasian Mediterranean population.

Influence of diabetes mellitus on patient and graft survival in recipients of kidney transplantation.

To investigate the outcomes in patients who have pre-existing diabetes and those who develop post-transplant diabetes mellitus (PTDM). We retrospectively reviewed the charts of 939 patients who received a first functioning renal transplant in the cyclosporine (CyA) era between 1984 and 1999. Sixty-six (7%) patients had renal failure due to insulin-dependent diabetes mellitus (IDDM) and 7 (0.8%) patients due to non-insulin-dependent diabetes mellitus (NIDDM). Ten (1.1%) patients had coexistent diabetes and 48 (5.1%) recipients developed PTDM. The mean graft survival for the patients with PTDM was 9.7 yr versus 11.3 yr for the non-diabetic patients, while mean graft survival was 10.1 yr for patients with IDDM and 2.9 yr with NIDDM and 8.3 yr for those with coexistent diabetes (p=ns). However, there was a statistically significant difference in patient survival between patients who developed PTDM and in those who did not develop this complication. The mean survivals of patients with IDDM, NIDDM, coexistent diabetics and PTDM were 8.4, 3.7, 8.6 and 10.3 yr, respectively. The mean survival of the patients without pre-existing diabetes or PTDM was 12.8 yr (p<0.001). The survival of patients older than 55 yr with PTDM was no different to the control group. However, in those younger than 55 yr, PTDM was associated with a higher risk of death (relative risk of 2.54, p<0.001). Fifty percent of patients with IDDM developed acute rejection episodes, whereas rejection rate was 57.1% in NIDDM group, 50.0% in the PTDM group, 20.0% in the coexistent diabetes group and 44.3% in the control group (p=ns). Patient survival, but not graft survival, was adversely affected by both pre-existing diabetes and by PTDM, particularly in those with an age less than 55 yr.