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PubMed1976

Diabetes mellitus: incidence, prevalence, survivorship, and causes of death in Rochester, Minnesota, 1945-1970.

The incidence and prevalence of diabetes mellitus in residents of Rochester, Minnesota, for 25 years (1945 to 1970) were determined from available medical records. The over-all incidence rate for diabetes is 133 new cases per 100,000 population per year (age-adjusted to 1970 U.S. white population). The rate increased with age for both men and women and was higher among men over 30 years of age. The average annual incidence rates per five-year period for juvenile-onset diabetes mellitus were low and variable and showed little change. Polyuria, polydipsia, glycosuria, lean habitus, loss of weight, and high levels of fasting hyperglycemia at initial diagnosis occurred more frequently in younger than in older patients. The peak incidence in 1960 through 1964 and the decrease in the following five years may be a reflection of the introduction of the AutoAnalyzer method for blood glucose in 1958. The average annual incidence rates for 1955 through 1959 and 1965 through 1969 were essentially the same. The over-all prevalence for diabetes mellitus is 1.6 per cent, with a higher rate among men than among women over 40 years of age; among school children the rate is 0.1 per cent. Survivorship in the diabetic population is lower than that in the general population. The leading cause of death was coronary heart disease, the death rate from it being higher than for the general population.

Adolescent↗

PubMed1984

Diabetes mellitus in sand rats (Psammomys obesus). Metabolic pattern during development of the diabetic syndrome.

It has been reported that sand rats, naturally feeding on low-caloric-value plants containing a high concentration of salt, become obese and develop hyperglycemia when fed on a standard laboratory diet. The aim of this study was to examine the long-term effects of a synthetic-chow diet on the metabolic pattern of the diabetic syndrome in a large group of sand rats. While a few animals had a fulminant reaction with markedly decreased glucose tolerance, low plasma insulin levels, and death within 3-4 wk, most sand rats developed obesity and elevated plasma insulin levels. From the third month and forward, 40% of sand rats presented with a diabetic syndrome with hyperinsulinemia, hyperglycemia, markedly decreased glucose tolerance, and insulin resistance. This diabetic syndrome can be compared with maturity-onset (type II) diabetes. When this synthetic-chow diet was given for more than 6 mo, the majority of animals lost considerable weight and showed a major depletion of fat stores. Serum immunoreactive insulin levels fell, while blood glucose rose to above 500 mg/dl with glycosuria and ketonuria. The elevated triglyceride content of plasma and the lipid deposits in the liver were greatly augmented, and no glycogen was present. Animals developed frank insulin-dependent diabetes, and diabetic animals not treated with insulin died in diabetic coma with presumed ketoacidosis. The disease was essentially confined to sand rats showing abnormal glucose tolerance, even before eating laboratory chow. This observation suggests a genetic factor. Thus, the sand rat appears to be a potentially interesting model for investigation of both maturity-onset and insulin-dependent diabetes.

Animal Feed↗

PubMed1995

Very-low-dose streptozotocin induces diabetes in insulin promoter-mB7-1 transgenic mice.

Transgenic mice that express mouse B7-1 (mB7-1, recently designated CD80) on their pancreatic beta-cells maintain normal islet architecture, have normal pancreatic insulin content, and only rarely spontaneously develop insulitis and diabetes. Nevertheless, these mice display an extreme sensitivity to streptozotocin (STZ)-induced diabetes. Female mice were administered two STZ doses intraperitoneally, 20 and 40 mg/kg body wt, each for five consecutive days. Nontransgenic but otherwise syngeneic mice responded to the STZ with a moderate diminution in pancreatic insulin content but not with persistent glycosuria. In striking contrast, STZ administered to transgenic mice resulted in a severe diminution of pancreatic insulin content and in diabetes. Notably, the lower STZ dose resulted in diabetes only after a prolonged (26- to 100-day) latency. STZ-induced diabetes appears to be T-cell dependent, since treatment with T-cell-depleting (and in particular CD8+ subset-depleting) antibodies ameliorated the response. Anti-mB7-1 monoclonal antibody administration also prevented STZ-induced diabetes. Thus, unmasked mB7-1 is a required component in the pathway resulting in beta-cell killing. Immunohistological analysis revealed that early after STZ administration, both mB7-1 transgenic and nontransgenic mice developed insulitis. While this insulitis resolved in the nontransgenic mice, the islet-infiltrating CD4+ and CD8+ T-cells in the transgenic mice were associated with complete beta-cell destruction. These data suggest that STZ-induced diabetes in mB7-1 transgenic mice is an immune-mediated process with distinct potential advantages over existing insulin-dependent diabetes models.

Animals↗

PubMed1991

Kinetics of zinc status in children with IDDM.

OBJECTIVE: To ascertain zinc deficiency in patients with insulin-dependent diabetes mellitus (IDDM) and evaluate the relationship between zinc clearance and body height velocity. RESEARCH DESIGN AND METHODS: Six boys and 11 girls with IDDM and zincuria and glycosuria were studied. Study quality and specific descriptive information concerning relationship and outcome measurement were assessed. RESULTS: The values of total-body zinc clearance in IDDM patients were higher than in the control subjects (24.6 +/- 1.8 vs. 15.1 +/- 0.6 ml.kg-1.h-1, P less than 0.01). There was a negative correlation between body zinc clearance values and height velocity in IDDM patients. CONCLUSIONS: Patients with IDDM have a secondary zinc deficiency, and normal growth may be stunted.

Adolescent↗

PubMed1993

Glomerular hyperfiltration in NIDDM patients without overt proteinuria.

OBJECTIVE--To evaluate the frequency and correlates of glomerular hyperfiltration in NIDDM patients without overt proteinuria. RESEARCH DESIGN AND METHODS--A cross-sectional study was conducted. Seventy-one consecutive NIDDM patients attending an outpatient clinic, with Albustix-tested negative urine and a 24-h AER < 200 micrograms/min, were examined for long-term complications of diabetes. We measured their GFR (51Cr-EDTA single-injection method), 24-h AER (RIA), plasma creatinine, HbA1c, total cholesterol, triglycerides, urinary glucose, and urea. RESULTS--GFR above the upper limit of the normal range for age-matched control subjects (137.1 ml.min-1 x 1.73 m2) was present in 15 of 71 (21%) NIDDM patients. Subjects with normal and hyperfiltration did not differ in terms of age, sex distribution, BMI, duration of NIDDM, BP, AER, or frequency of long-term complications. Plasma glucose was significantly higher in subjects with hyperfiltration (mean [range]: 12.8 [4.3-18.7] vs. 8.7 [2.6-17.5] mM). HbA1c failed to reach statistical significance, although it tended to be higher in the group with hyperfiltration (10.4 [6.7-13.9] vs. 9.4 [4.2-16.5]%, P = 0.10). Age (rS -0.37, P = 0.002), FPG (rS 0.45, P < 0.0005), total cholesterol (rS -0.31, P = 0.008), and glycosuria (rS 0.40, P = 0.001) correlated significantly with GFR. In a stepwise multiple regression analysis, FPG, age, and total cholesterol emerged as significant correlates of the dependent variable GFR. CONCLUSIONS--Hyperfiltration occurred in 21% of NIDDM patients without overt proteinuria. FPG and age significant correlates of the GFR in these patients. Cholesterol is significantly (although only modestly) correlated with the GFR.

Blood Glucose↗

PubMed1996

Decreased serum 1,5-anhydroglucitol in nondiabetic subjects with a family history of NIDDM.

OBJECTIVE: To investigate the effect of a family history of NIDDM on HbAlc and serum 1,5-anhydroglucitol (AG) in nondiabetic subjects. RESEARCH DESIGN AND METHODS: A 75-g oral glucose tolerance test was performed; 258 subjects with normal glucose tolerance and 106 subjects with impaired glucose tolerance (IGT) were selected HbAlc and serum AG were compared between subjects with and without a family history of NIDDM. The relationships between age, BMI, HbAlc, serum AG, fasting and 2-h plasma glucose, and urinary glucose were also examined using principal component analysis with a varimax rotation. RESULTS: In the normal group, only serum AG was lower in subjects with a positive family history than in those with no family history. On the other hand, in the IGT group, subjects with a positive family history were younger and had a higher 2-h plasma glucose, a higher urinary glucose, and a lower serum AG than those with no family history, whereas there was no difference in HbAlc. Principal component analysis identified three factors. The first factor, a linear combination of HbAlc and fasting plasma glucose, was labeled an average glycemic factor. The second factor, which included serum AG, 2-h plasma glucose, and urinary glucose, was labeled an oscillatory glycemic factor. The third factor, which contrasted age against BMI, was labeled an environmental factor. CONCLUSIONS: Serum AG is related to glycosuria even among nondiabetic subjects, and its concentrations are decreased in those with a family history of NIDDM. Our results suggest that serum AG rather than HbAlc reflects early metabolic abnormalities in these subjects.

Analysis of Variance↗

PubMedDate not supplied

Plasma lipid levels in insulin-dependent diabetes mellitus.

Because several recent reports have indicated a high incidence of hyperlipidemia in insulin-dependent juvenile diabetes, the plasma lipid levels were measured in a population of insulin-dependent diabetic patients to determine if hyperlipidemia is necessarily associated with diabetes. Only one patient had an elevated cholesterol concentration (greater than 220 mg. per deciliter) and two patients had an elevated triglyceride concentration (greater than 140 mg. per deciliter), giving an incidence of 6.4 per cent. A normal control group had an incidence of hyperlipidemia of 5.7 per cent. The mean cholesterol level (164 "/- 38 mg. per deciliter) of the diabetic population was significantly less than that of the normal control group (183 +/- 38 mg. per deciliter). The diabetic patients were divided into groups on the basis of 24-hour urinary glucose excretion and records of glycosuria. The serum triglyceride of the patients in group 4 (highest urinary glucose content and spills) was significantly elevated above three other groups with less glucosuria. Dietary history revealed that group 4 patients consumed a significantly higher percentage of fat. Cholesterol levels did not correlate with parameters of regulation of the diabetes.

Adolescent↗

PubMed1999

Effectiveness of a prevention program for diabetic ketoacidosis in children. An 8-year study in schools and private practices.

OBJECTIVE: To shorten the period of carbohydrate intolerance preceding the diagnosis of IDDM in children. RESEARCH DESIGN AND METHODS: The incidence of diabetic ketoacidosis (DKA) was studied in newly diagnosed diabetic children aged 6-14 years, in the area of Parma, Italy, 8 years after an information program on DKA was introduced to teachers, students, parents, and pediatricians. Information was provided by displaying a poster with a few practical messages in 177 primary and secondary public schools. The pediatricians working in the same area were given equipment for the measurement of both glycosuria and blood glucose levels, as well as cards listing guidelines for the early diagnosis of diabetes, to be given to patients. A toll-free number was also provided. Clinical and laboratory features of 24 young diabetic patients diagnosed in the Parma area (group 1) were compared with those of 30 patients coming from two nearby areas in which no campaign for the prevention of DKA had been carried out (group 2). RESULTS: From 1 January 1991 to 31 December 1997, DKA was diagnosed in 3 children from group 1 (12.5%) and in 25 children from group 2 (83.0%) (chi 2 = 26.8; P = 0.0001). The three cases of DKA in group 1 were observed in 1991 (n = 1) and in 1992 (n = 2). No patients from the Parma area who had DKA were admitted to our unit after 1992. The duration of symptoms before diagnosis was 5.0 +/- 6.0 and 28.0 +/- 10.0 days (P < 0.0001), in groups 1 and 2, respectively, Metabolic derangements were less severe in patients of group 1 than in those of group 2. Hospitalization for the treatment of overt diabetes and for the teaching of self-management of the disease lasted 5.4 +/- 1.2 days in group 1 and 13.3 +/- 2.4 days in group 2 (P = 0.002). The total cost of the 8-year campaign was $23,470. CONCLUSIONS: The prevention program for DKA in diabetic children aged 6-14 years, carried out in the Parma area during the last 8 years, was successful. Thanks to this program, cumulative frequency of DKA in new-onset IDDM decreased from 78% during 1987-1991 to 12.5% during 1991-1997. None of the newly diagnosed diabetic children aged 6-14 years and from the Parma area were ever admitted to the hospital for DKA after 1992.

Adolescent↗

PubMedDate not supplied

Influence of smoking on insulin requirement and metbolic status in diabetes mellitus.

This study was performed in order to examine the influence of tobacco smoking on carbohydrate and lipid metabolism and microangiopathy in diabetic patients with normal serum creatinine. Among 163 adult insulin-treated patients 114 smoked daily (smokers). Compared with nonsmokers, smokers had on the average a 15--20% higher insulin requirement (P < 0.001) and serum triglyceride concentration (P < 0.05), increasing to a 30% rise in heavy smokers (P < 0.01). The degree of retinopathy was equal in the two groups, as was the average creatinine clearance [99 +/- 2 (mean +/- 1 SEM) versus 101 +/- 4 ml/min in smokers compared with nonsmokers]. Smokers and nonsmokers were comparable regarding sex ratio, age at diabetic onset, duration of diabetes, residual beta-cell function, fasting hyperglycemia, and glycosuria. Evidently, tobacco smoking represents a strain on both carbohydrate and lipid metabolism in insulin-treated diabetes mellitus.

Adult↗

PubMedDate not supplied

Control of maturity-onset diabetes by monitoring fasting blood glucose and body weight.

The feasibility of reducing the fasting blood glucose (FBG) level to < 6 mmol/L has been studied in all 84 maturity-onset diabetic (MOD) patients in three general practices. Only 35 (48%) were initially "well controlled" by this criterion, although 72 (86%) had no postprandial glycosuria. Seventy-one patients were monitored for 6 mo. With additional oral hypoglycemic therapy where necessary, the number of "well controlled" increased from 29 (41%) to 54 (76%), associated with a significant decrease in the hemoglobin A1. The patients were subsequently assessed at two 3-monthly intervals, and a fasting plasma glucose > 4 and < 6 mmol/l was usually maintained. All but two patients with a fasting glucose level < 6 mmol/l had fasting triglyceride concentrations < 2 mmol/l. The fasting blood glucose can be assayed in general practice with glucose-oxidase strips, and control by this means is simpler, cheaper, and more effective than regular urine glucose monitoring.

Adult↗

PubMedDate not supplied

Validity of urine glucose measurements for estimating plasma glucose concentration.

Both physicians and diabetic patients have traditionally relied on measurement of glycosuria as an indirect method of estimating plasma glucose concentration to guide adjustment of insulin and diet therapy. Our observations on the correlation between mean plasma glucose concentration with simultaneous urine glucose concentration or excretion rate re-emphasize the limitations of this approach. Although our observations show a significant correlation (P less than 0.0001) between plasma glucose concentration and urine glucose concentration or urine glucose excretion rate, the wide confidence limits [95% confidence limits (minimum) +/- 150 mg/dl] on plasma glucose concentration estimated from urine glucose measurements limit the clinical applicability of such estimates. Differences among subjects in the renal resorption of glucose contribute to the wide variance of estimates. However, significant variability in renal glucose resorption within individuals is documented, further reinforcing the limitations of urine glucose determinations for reliable estimates of plasma glucose concentrations. Diabetologists need to reconsider the applicability of urine glucose measurements in evaluation of adequacy of therapy and in adjustment of insulin dosage.

Adolescent↗

PubMedDate not supplied

Guar gum and glycemic control of pregnant insulin-dependent diabetic patients.

The effect of guar gum preparation on the glycemic control of 12 pregnant insulin-dependent diabetic patients was investigated. The study was performed on inpatients and lasted 3 wk (from week 32 of pregnancy and onward). Weeks 32 and 34 were control periods during which time the patients had their normal diet only. During week 33, the diet was supplemented with guar. The mean blood glucose level of week 33 was 14% lower than that of week 32 (P less than 0.01) but equal to that of week 34. Mean fluctuations of blood glucose during individual days of the 3 wk were similar. The M-value declined significantly from week 32 to week 33, but the M-value of week 33 was not different from that of week 34. The average 24-h glycosuria declined by 63% from week 32 to week 33 (P less than 0.05), whereas the values of weeks 33 and 34 were not significantly different. The mean daily insulin doses of weeks 32, 33, and 34 were similar. The results show that whereas admission of pregnant insulin-dependent diabetic women to a diabetes ward exerts a favorable influence on diabetes control, no further improvement is obtainable if the diet is supplemented with guar.

Adult↗

PubMed1978

Reversible renal side effects of intra-articular osmic acid injection.

In 101 patients treated for knee joint hydrops with intra-articular osmic acid injection, an increased incidence of proteinuria and microscopic haematuria was noted on the first day after injection. This increase subsided rapidly and had disappeared 3 days after the injection. Three patients showed transient glycosuria. No signs of permanent renal damage appeared in any patient.

Glycosuria, Renal↗

PubMed1983

Organophosphate poisoning presenting as diabetic ketoacidosis.

A 3-year-old boy was admitted to hospital following rapid-onset coma. Laboratory tests demonstrated hyperglycemia, glycosuria and keto-acidosis. Organophosphorus poisoning was the cause of the coma since he had been in contact with Parathion, serum cholinesterase activity was undetectable and his condition returned to normal under atropine therapy.

Acidosis↗

PubMed1994

Insulin reverses the protection given by diabetes against gentamicin nephrotoxicity in the rat.

Rats with untreated diabetes mellitus are protected from gentamicin-induced nephrotoxicity. In order to evaluate the role of hyperglycemia, glycosuria, and polyuria in this phenomenon, miniosmotic pumps filled with insulin were implanted for 15 days in seven female Sprague-Dawley rats with streptozotocin-induced diabetes mellitus. Plasma glucose levels were successfully maintained under 126 mg/dl. To serve as the control group, eight age-matched diabetic (plasma glucose > 400 mg/dl) rats had miniosmotic pumps placed delivering only Ringer's solution. Six days after placement of the pumps, gentamicin (40 mg/Kg/day) was administered to all animals for 9 days. The insulin-treated diabetic rats exhibited clear signs of nephrotoxicity by Day 6 of gentamicin, whereas the diabetic control group remained free from any functional or morphological evidence of proximal tubular damage throughout the 9 days of the aminoglycoside administration. At the end of the experiment, the creatinine clearance in the insulin-treated diabetic group was 45% lower than in the untreated diabetic group (P < 0.005). In addition, there was a rise in plasma creatinine (P < 0.02), muramidase appeared in the urine, and mild patchy acute tubular necrosis of the renal cortex was observed by light microscopic examination. The insulin-treated group also accumulated more gentamicin in the renal cortex than the untreated animals (P < 0.005). It is concluded that protection against the nephrotoxic effects of gentamicin is a feature of untreated experimental diabetes mellitus in the rat and that correction of the hyperglycemic state with insulin reverses this resistance.

Animals↗

PubMed2000

Acceleration of the development of diabetes in obese diabetic (db/db) mice by nicotinamide: a comparison with its antidiabetic effects in non-obese diabetic mice.

Destruction of pancreatic beta cells has been implicted in the progression to hyperglycemia in type 1 diabetes. While there is evidence of beta-cell loss in type 2 diabetes, its contribution to the development of the diabetic state is undecided. Nicotinamide has defensive effects against toxic insults to the pancreatic islets and confers protection in both human and animal models of type 1 diabetes, but its effects on type 2 diabetes are less well documented. This report describes a comparison of the outcome of chronic oral administration of nicotinamide on the development of diabetes in obese diabetic (db/db) and non-obese diabetic (NOD) mice models of type 2 and type 1 diabetes, respectively. Nicotinamide was administered in the diet (5 g/kg diet) for 12 (db/db) or 24 (NOD) weeks. Over the 12 weeks of the study, control diabetic (db/db) mice became progressively more hyperglycemic and glycosuric, while serum and pancreatic insulin levels decreased compared with those on day 0. In mice treated with nicotinamide, there was a pronounced acceleration in the development of hyperglycemia and glycosuria, as well as a decrease in pancreatic insulin levels, compared with time-matched controls. In addition, the morphology of the pancreatic islets of nicotinamide-treated diabetic (db/db) mice showed an enhanced islet disorganization. By comparison, in NOD mice, nicotinamide prevented the decline in serum and pancreatic insulin levels and maintained normal islet architecture and insulin content. Our data shows that in contrast to its preventative effects on the development of autoimmune diabetes in NOD mice, chronic nicotinamide administration to obese diabetic (db/db) mice markedly accelerated the progression of diabetes. The results of our study caution against the use of nicotinamide in insulin-resistant states, such as type 2 diabetes.

Animals↗

PubMed1979

[Treatment of diabetes without biguanides. Observation on the course after changing treatment (author's transl)].

In 56 patients with maturity onset diabetes receiving combined therapy with different oral hypoglycemic drugs, biguanide treatment was stopped while sulphonylurea compounds were continued without major changes. In four patients insulin therapy had to be initiated rapidly. In 14 other patients follow-up observations could not be performed for various reasons. The reamining 38 patients were divided into four groups according to their treatment. On the average, chemical control could not be maintained in any group after discontinuation of biguanide therapy. Blood glucose concentrations and glycosuria increased. Later, in 6 of 38 patients secondary failure of sulphonylurea treatment became apparent.

Adult↗

PubMed2001

Abnormal glucose levels found in transportation accidents.

BACKGROUND: The Federal Aviation Administration's Office of Aerospace Medicine is responsible for the certification of pilots with diabetic conditions. The present study evaluated the use of postmortem vitreous humor and urine glucose levels in transportation accident fatalities as indicators of potentially incapacitating medical conditions or performance impairment. METHODS: Vitreous humor and/or urine from 192 accident fatalities were analyzed for glucose using a hexokinase method. Cases with values below the lower limit of detection (10 mg x dl(-1)) and above 3 standard deviations (SD) from the mean were not included in the final statistics. All cases more than 5 SD above the mean were deemed abnormal and a full case history was evaluated based on the available medical history. RESULTS: The mean vitreous humor glucose concentration was 30+/-21 mg x dl(-1) (N=98), while it was 27+/-16 mg x dl(-1) in urine (N=127). Of the 192 cases, 9 were identified as having abnormal glucose levels. Abnormal glucose levels were found in 5 of the 8 cases with a known diabetic condition. Glycosuria or low renal threshold was reported in 2 fatal pilots; 1 of these pilots had an abnormal glucose level. CONCLUSIONS: Hyperglycemia can be established from the vitreous humor and urine glucose levels. All of the abnormal glucose cases detected were previously identified during the medical certification process or had a medical reason for the abnormal level. Elevated vitreous humor and urine glucose levels have proven useful in identifying individuals with a pre-existing diabetic condition that might have been a factor in the accident.

Accidents, Aviation↗