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Biomedical subjects

F Meschi

Publications and source records attributed to F Meschi.

At least 37 records · Page 2Linked to original sources
PubMed1995

In vivo metabolic effects of insulin-like growth factor-I not mediated through the insulin receptor.

Patients with mutations affecting insulin receptor function may maintain some degree of metabolic control. The hypothesis has been put forth that in these patients, fuels may be metabolized through pathways (i.e. receptor activation) that become relevant in such abnormal conditions. The aim of our study was to evaluate the metabolic effects of insulin-like growth factor-I (IGF-I) in a 19-yr-old patient with homozygous mutation of the insulin receptor alpha-subunit. Her metabolic and hormonal features were marked hyperglycemia (11-33 mmol/L) and hyperinsulinemia (1000-2000 pmol/L); normal free fatty acids and lactate; low IGF-I; glycerol, alanine, and pyruvate below the normal range; and elevated beta-hydroxybutyrate. Unlike diabetic ketoacidosis, no triglyceride or protein breakdown was present, suggesting a compensatory mechanism, possibly sustained by the insulin concentration acting on IGF-I receptors. Subcutaneous administration of IGF-I (40, 80, and 120 micrograms/kg), although not affecting plasma glucose, resulted in a rapid decrease in free fatty acids and prevented the rise of beta-hydroxybutyrate levels compared to placebo. Therefore, IGF-I can exert direct metabolic effects in vivo, probably through activation of its own receptor, even at a concentration not affecting blood glucose levels. Furthermore, these findings are consistent with the hypothesis that IGF-I receptors may be activated by high insulin levels, providing lipid and protein regulation in patients with nonfunctional insulin receptors.

Adult↗
PubMed1994

Disseminated intravascular coagulation and severe peripheral neuropathy complicating ketoacidosis in a newly diagnosed diabetic child.

Disseminated intravascular coagulation is a very rare complication of diabetic ketoacidosis. Central nervous system palsy but not peripheral neuropathy has been reported in these patients. On the other hand, signs of peripheral neuropathy may also be present at the onset of diabetes, but they are usually reversible within a few days after correction of the metabolic derangement. We describe an unusual case of mononeuritis multiplex syndrome still present after 2 months of follow-up in a child with diabetic ketoacidosis complicated by disseminated intravascular coagulation at the onset of insulin-dependent diabetes. These neurological impairments may be consistent with functional neural lesions due to vasa nervorum thrombosis and prolonged ischaemia.

Blood Pressure↗
PubMed1994

Post-exercise albuminuria does not predict microalbuminuria in type 1 diabetic patients.

To investigate whether post-exercise urinary albumin excretion in Type 1 diabetic children and adolescents may prospectively predict the development of microalbuminuria, we have assessed post-exercise urinary albumin excretion before and after 6.2 +/- 1.7 years of follow-up in 66 diabetic children and adolescents. Post-exercise urinary albumin excretion rose significantly above the pre-exercise values in diabetic patients by 2.7 (-3.8 to 84.2) micrograms min-1 (p < 0.001) and in a group of 9 healthy individuals by 3.9 (-0.7 to 13.7) micrograms min-1 (p < 0.02) without significant differences between groups. Post-exercise albuminuria was greater in postpubertal than prepubertal 9.8 vs 4.3 micrograms min-1 (p < 0.03) and pubertal 9.8 vs 6.0 micrograms min-1 (p < 0.02) patients; post-exercise changes in urinary albumin excretion were also positively related to glycated haemoglobin (r = 0.293; p < 0.05). Eight out of 66 patients developed microalbuminuria at follow-up. Urinary albumin excretion at follow-up was comparable between patients with normal and abnormal post-exercise urinary albumin excretion; moreover post-exercise urinary albumin excretion was within the normal range in 5 out of 8 patients with microalbuminuria at follow-up. In conclusion post-exercise albuminuria does not seem to be a useful predictor of the onset of microalbuminuria in Type 1 diabetic children and adolescents.

Adolescent↗
PubMed1993

Decrease of glomerular hyperfiltration in short-term diabetic adolescents without microalbuminuria.

OBJECTIVE: This study has been designed to follow prospectively the GFR and UAE of young patients with short-term IDDM and normal UAE. RESEARCH DESIGN AND METHODS: The study population consisted of 19 patients with glomerular hyperfiltration and 19 patients with normal GFR, matched for duration of diabetes and age. GFR has been assessed by radioisotopic tracer and UAE by RIA at the beginning of the study and after 30.5 +/- 10.4 mo of follow-up. RESULTS: GFR decreased in the two groups btt delta GFR of patients with glomerular hyperfiltration was greater than delta GFR of patients with normal GFR (0.83 +/- 0.55 vs. 0.28 +/- 0.63 ml.min-1.mo-1; P < 0.01). UAE, BP, and prevalence of microalbuminuria were comparable between the two groups at follow-up. Rate of fall of GFR was positively correlated with initial GFR (r = 0.59, P < 0.001) but not with initial UAE, BP, or changes in HbA1C, UAE, BP, or pubertal development during follow-up. CONCLUSIONS: Investigation of kidney function in children and adolescents with IDDM over a 3-yr follow-up period shows that glomerular hyperfiltration is characterized by a greater decline in GFR without an increased rate of appearance of microalbuminuria, than in patients with normal GFR.

Adolescent↗
PubMed1992

HLA-antigens in Italian type 1 diabetic patients: role of DR3/DR4 antigens and breast feeding in the onset of the disease.

HLA-A, B, C, DR and DQ typing was performed in 381 Italian insulin-dependent diabetic patients and in 905 normal Italian subjects. The diabetic patients had significantly higher frequencies of HLA-Cw7, B8, B18, DR3, DR4, DQw2 and DQw3 and significantly lower frequencies of HLA-B17, Bw51, DR2, DR7 and DRw11. The frequency of heterozygosity for HLA-DR3/DR4 was significantly higher in patients who developed the disease in the first 2 years of life and DR3+/DR4-, DQw2 and DQw3 alleles were higher in those aged less than 14 years at onset. The HLA-DR4 allele was associated with onset of diabetes in autumn and HLA-B18 with onset in Autumn-winter. Diabetic children who were breast fed had a later onset of insulin-dependent diabetes mellitus than those who were bottle fed but these differences were independent of HLA typing (11.8 +/- 0.72 years vs 9.23 +/- 0.42 years; mean +/- SEM). We conclude that: (1) in general, HLA distribution in Italian insulin-dependent diabetic patients reflects previous data reported in other European and North American populations; (2) HLA-DR3 and DR4 are strongly associated with insulin-dependent diabetes in Italy as well, and these alleles seem to predispose to an earlier onset of the disease; and (3) breast feeding may delay the onset of the disease.

Age Factors↗
PubMed1990

[Blood sugar response to administration of bran or guar added to pasta in children with type I diabetes].

Blood sugar profiles after administration of pasta with (PG) and without (P) guar have been evaluated in 30 young type I diabetic children. Maximum increase of blood sugar was observed at 30' (mean = 21 mg/dl) after P and at 90' (mean = 6 mg/dl) after PG. Maximum decrease in blood sugar levels was reached at 180' in both groups (50 mg/dl after P and 25 mg/dl after PG). Blood sugar level was significantly different only at 180'. No significant difference was observed analyzing rates of increase.

Blood Glucose↗
PubMed1989

Early diagnosis of subclinical complications in insulin dependent diabetic children and adolescents.

212 insulin dependent young diabetics with mean age of 16 yr and mean diabetes duration of 9 yr, have been examined for prevalence of subclinical signs of microvascular disease. Prevalence of retinopathy is increased in subjects of older age when matched for diabetes duration. Subclinical abnormalities of peripheral nervous system, identified by neurophysiological techniques, are present in about 20% of patients. These abnormalities are mainly related to metabolic control as evaluated by HbA1c determination. Albumin excretion rate over 10 mcg/min is observed in about 40% of subjects and is related to increased blood pressure values and poor metabolic control.

Adolescent↗
PubMed1986

Visual evoked potentials in diabetic teen-agers: influence of metabolic control and relationship with peripheral neuropathy.

85 type 1 diabetics aged between 8 and 20 years (mean: 15.06) performed Pattern Reversal Visual Evoked Potentials (PRVEP). In addition all of them were investigated for peripheral neuropathy and 63 subjects for retinopathy. Our study disclosed a subclinical involvement of optic nerve pathways in about 1/4 of diabetic teen-agers. P100 mean latency was delayed in diabetics for both 30' (112.8 +/- 7.7 msec versus 109.1 +/- 4.8 msec) and 15' check size (119.1 +/- 10.5 msec versus 112.8 +/- 5.2 msec). The N75-N140 interpeak latency was also significantly delayed and the mean N75-P100 amplitude was significantly reduced in diabetics. No correlation was found between PRVEPs latency and age, HbA1, and insulin requirement. The mean P100 latency significantly increased with the duration of diabetes. A negative correlation was found at the 30' check size between P100 latency and motor and sensory conduction velocity in all the examined nerves. 10 out of 63 patients, who had been examined with fluorangiography, showed abnormalities; only 2 of these 10 subjects had abnormal PRVEP. The association of prolonged P100 latency, prolonged N75-N140 interpeak latency and reduced N75-P100 amplitude can be considered consequent to a desincronisation of the impulses travelling along the optic pathways.

Adolescent↗
PubMed1984

Metabolic control in newly diagnosed type 1 diabetic children. Effect of continuous subcutaneous infusion.

15 insulin-dependent diabetic children at onset were randomly allocated to one of two different therapeutical protocols: continuous subcutaneous insulin infusion (CSII) and intensified conventional insulin treatment with three daily insulin injections (CIT). Both treatments were performed for 10 days; the initial insulin dose was 1.5 U/kg/day and thereafter the insulin dosage was modified in order to obtain a satisfactory control. Near-normal blood glucose levels were obtained after 24 h in the CSII group, and after 3 days in the CIT group. All subjects underwent 1 year of follow-up. HbA1 levels and insulin requirements decreased similarly in the two groups; C-peptide secretion did not increase significantly in both groups. A clear advantage of CSII cannot be assumed, and the usefulness of this therapeutical approach needs to be confirmed by further investigations.

Adolescent↗
PubMed1982

Insulin resistance in a child with Acanthosis nigricans type A.

The patient, a female 6 years 4 months old, diagnosed as affected by Acanthosis nigricans and diabetes mellitus was referred to our Clinic for further investigation of her glucose metabolism. She had a typical face with hypertelorism, prognathism, macroglossia and large auricles. The skin was hyperpigmented, verrucous, hyperkeratotic especially in the folds and flexural areas with small papillomatous or nodular growth; diffused hypertrichosis and hypertrophic clitoris were also present. Biochemical and hormonal investigations revealed no major abnormalities apart from glucose metabolism. After an unsuccessful trial with conventional insulin therapy, endovenous continuous insulin infusion was started: even with 32 U/kg/h it was not possible to achieve normoglycemia. Insulin receptors were studied on erythrocytes: 125I-insulin binding (specific) was clearly lower than normal. The concentration of insulin receptors was reduced, while the average affinity profile was normal. The study of erythrocyte insulin receptors has demonstrated that insulin resistance in this patient is due to a decrease in the number of receptors, i.e. Acanthosis nigricans type A.

Acanthosis Nigricans↗