Metabolic control affects plasma lipid and apolipoprotein levels in women, but not in men, with IDDM

In order to evaluate if in insulin-dependent diabetes lipid and apolipoprotein levels are differently affected by metabolic control in men and women, we measured the concentrations of fasting plasma glucose, mean plasma glucose, glycosylated hemoglobin, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and apolipoproteins A and B in 94 sex matched patients. Diabetic men and women were strictly comparable as far as age, relative body weight and metabolic control were concerned. In women, total and LDL cholesterol, triglycerides and apolipoprotein A correlated positively with HbA1 but not with fasting and mean plasma glucose. In men, no correlation between metabolic control and lipid and apolipoprotein levels was found. We conclude that, in diabetic women, the degree of metabolic control may affect the concentrations of plasma lipids, thus explaining, at least in part, the increased risk for coronary atherosclerosis in these patients.

Excretion of digoxin-like immunoreactivity in urine of normal subjects: correlations with excretion of creatinine and electrolytes

To verify whether there is a variation in the 24-h urinary excretion of digoxin-like immunoreactivity (DLIS) in humans, we studied 18 normal adults, who collected their urines for 24-h in several portions. We then measured DLIS (by means of a sensitive RIA method), creatinine, sodium, and potassium concentrations in the urine samples. The mean urinary excretion rate for DLIS in the complete 24-h collection was 84.8 (SD 31.3) pg/min. The mean DLIS urinary excretion rate calculated for overnight collections was significantly lower than those of afternoon collections (P less than 0.01) and the 24-h collection (P less than 0.05). Significant positive correlations were found between urinary DLIS and excretion rates for creatinine (r = 0.347, P = 0.0016), Na+ (r = 0.232, P = 0.038), and K+ (r = 0.323, P = 0.003), respectively. Our data suggest that urinary excretion of DLIS is higher during "active" hours of the day, especially in the afternoon, than at rest, during the night.

Excretion of digoxin-like immunoreactivity in urine of normal subjects: correlations with excretion of creatinine and electrolytes

To verify whether there is a variation in the 24-h urinary excretion of digoxin-like immunoreactivity (DLIS) in humans, we studied 18 normal adults, who collected their urines for 24-h in several portions. We then measured DLIS (by means of a sensitive RIA method), creatinine, sodium, and potassium concentrations in the urine samples. The mean urinary excretion rate for DLIS in the complete 24-h collection was 84.8 (SD 31.3) pg/min. The mean DLIS urinary excretion rate calculated for overnight collections was significantly lower than those of afternoon collections (P less than 0.01) and the 24-h collection (P less than 0.05). Significant positive correlations were found between urinary DLIS and excretion rates for creatinine (r = 0.347, P = 0.0016), Na+ (r = 0.232, P = 0.038), and K+ (r = 0.323, P = 0.003), respectively. Our data suggest that urinary excretion of DLIS is higher during "active" hours of the day, especially in the afternoon, than at rest, during the night.

Urinary albumin excretion in normal subjects and in diabetic patients measured by a radioimmunoassay: methodological and clinical aspects

We have developed a radioimmunoassay method (RIA) to measure urinary albumin excretion. We determined the albumin excretion rate (AER) (micrograms/min) of 122 healthy subjects and 145 diabetic patients (115 type I, 30 type II). The results indicate that the RIA is sensitive (0.39 +/- 0.08 mg/L), precise (CV 5-8%), and gives reliable results on previously frozen urine samples. The distribution of the AER values in healthy subjects and diabetic patients was not normal. It was normalized by log or square-root transformation of the data. Seventy-three percent of diabetic patients lay within the normal range (0.6-10.6 micrograms/min). Twenty percent could be considered "at risk" to develop overt diabetic nephropathy because their albuminuria exceeded a threshold level of 15 micrograms/min chosen previously as the cutoff value for microalbuminuria. We found no correlation between AER and glycated hemoglobin, and only a weak correlation between AER and diabetes duration in type I diabetic patients.

Effect of plasma metformin concentrations on serum lipid levels in type II diabetic patients

In this study we evaluated the relationships between plasma metformin levels, measured by reverse-phase high-performance liquid chromatography, and serum lipid levels in 20 metformin-treated, type II diabetic patients. Mean fasting plasma metformin concentration was 490 +/- 188 ng/ml. No correlation was found between daily dose of drug and lipid parameters. A significant correlation emerged between circulating metformin concentration and serum triglycerides (r = -0.574, p less than 0.01), HDL-cholesterol (r = 0.583, p less than 0.01) and HDL2-cholesterol (r = 0.670, p less than 0.05). Multiple linear regression analysis showed that the correlation between plasma metformin concentration and serum triglycerides still remained significant after correction for other clinical and metabolic parameters. Total cholesterol and HDL3-cholesterol were not correlated with metformin concentrations. These results demonstrate the clinical usefulness of measuring plasma metformin concentrations and indicate that some effects of metformin on lipid metabolism depend on the drug plasma levels.

Inappropriate growth hormone response to luteinizing hormone-releasing hormone in diabetes mellitus

We randomly administered luteinizing hormone-releasing hormone (LHRH) or thyrotropin releasing hormone (TRH) (25 micrograms and 200 micrograms, respectively, as a bolus), to 16 diabetic male subjects (9 type I, 7 type II) and to 9 healthy male controls in two different mornings. While GH in the basal state was similar in type I, type II, and normal subjects, LHRH administration surprisingly evoked a significant GH release in 7 (5 type 1, 2 type II) diabetic patients. GH-responders had higher glycated hemoglobin than non-responders (11 +/- 1 nu 8.3 +/- 0.5%) but superimposable fasting and intratest average glucose levels. Only one patient among the GH-responders to LHRH showed a GH release also after TRH. These data support the hypothesis that GH secretion in diabetes, especially when poorly controlled, is abnormal.

Effect of growth hormone-releasing hormone and clonidine on growth hormone release in type 1 diabetic patients

We administered growth-hormone releasing hormone (GHRH), clonidine or thyrotropin-releasing hormone (TRH) as intravenous boli each in three different randomized mornings to nine well-controlled Type 1 diabetic men and to six age-matched healthy men who served as controls. GHRH and clonidine evoked a prompt and brisk GH release both in diabetic and in control subjects with no significant difference being evident between the two groups. Only one diabetic subject showed a paradoxical GH release after TRH when he was under long-term poor metabolic control. These results indicate that in insulin-dependent patients with good control of the metabolic disease the response of somatotropes to pituitary- or central nervous system-directed stimuli is normal. These data are supportive of the idea that altered GH secretion in Type 1 diabetes rather than reflecting a primary hypothalamic and/or pituitary alteration may be a state-dependent phenomenon related to the metabolic state of the disease.

Clinical and metabolic study of a new pill containing 20 mcg ethinylestradiol plus 0.150 mg desogestrel

The clinical and metabolic effects of a short-term treatment with a combination contraceptive pill containing 0.150 mg desogestrel and 20 mcg ethinylestradiol were evaluated in a group of 17 healthy women. In spite of the low estrogen content, the pill exerted a good cycle control and the incidence of irregular bleedings was low. The minor side effects commonly associated with oral contraceptive (OC) use rarely occurred, and an improvement of premenstrual symptoms was reported during pill intake. As for the different biochemical parameters tested, the formulation induced a significant increase of fibrinopeptide A (FPA) plasma levels. However, the resulting increase of peptide was lower than that induced by pills containing 30 mcg ethinylestradiol. No significant modifications of plasma total cholesterol (T-CH) and low-density lipoprotein cholesterol (LDL-CH) were observed, while triglycerides (TG), high-density lipoprotein cholesterol (HDL-CH) concentrations and the HDL-CH/LDL-CH ratio significantly increased. A significant increase of apolipoproteins AI (Apo AI) and apolipoproteins AII (Apo AII) concentrations was also observed. Moreover, the pill did not alter fasting insulin and glucose levels and their response to an oral glucose tolerance test (OGTT). It may be concluded that this new formulation can be considered acceptable for clinical use, mainly in consideration of the minor or no changes in the biochemical parameters regarded as risk factors for venous and arterial diseases.

The clinical usefulness of glycated hemoglobin in monitoring diabetes mellitus: a long-term study

To assess the long-term clinical usefulness of measuring glycated hemoglobin (Hb A1), we carried out a two-year longitudinal study involving 234 diabetic patients (116 males, 118 females; 139 with type I diabetes mellitus, 95 with type II). Hb A1 values correlated significantly (p less than 0.001) with a score index based on plasma glucose in a specimen collected after overnight fasting, and urinary glucose, and ketones in a 24-h specimen. However, we found that one of every three well-controlled patients (both type I and II subjects) had high values for Hb A1. Among poorly controlled patients, only those with "brittle" diabetes had good values for Hb A1.

The clinical usefulness of glycated hemoglobin in monitoring diabetes mellitus: a long-term study

To assess the long-term clinical usefulness of measuring glycated hemoglobin (Hb A1), we carried out a two-year longitudinal study involving 234 diabetic patients (116 males, 118 females; 139 with type I diabetes mellitus, 95 with type II). Hb A1 values correlated significantly (p less than 0.001) with a score index based on plasma glucose in a specimen collected after overnight fasting, and urinary glucose, and ketones in a 24-h specimen. However, we found that one of every three well-controlled patients (both type I and II subjects) had high values for Hb A1. Among poorly controlled patients, only those with "brittle" diabetes had good values for Hb A1.

Circulating lipid levels and severity of diabetic retinopathy in type I diabetes mellitus

Plasma lipid levels have been proposed as probable risk factors of diabetic retinopathy. To clarify this question, we evaluated the apolipoprotein levels in 68 type I diabetic patients (39 +/- SD 14 years; duration of diabetes 13 +/- SD 8.4 years). By the analysis of fluorescein angiography we have classified diabetic retinopathy as follows: absent retinopathy (AR, n = 23), minimal retinopathy (MR, n = 16), exudative retinopathy (ER, n = 15), proliferative retinopathy (PR, n = 14). For all patients we measured: total, LDL- and HDL-cholesterol (T-CH, LDL-CH, HDL-CH), apolipoproteins A and B (Apo A and B), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1). The mean age of the patients with ER (47 +/- SD 14 years) was greater than those with MR (36 +/- SD 15 years) or AR (33 +/- SD 13 years) (p less than 0.05). Significant differences within groups were not found for relative body weight, daily insulin dose, FPG, HbA1% (analysis of variance, ANOVA). The groups differed between each other with regard to T-CH, LDL-CH and HDL-CH/LDL-CH ratio (T-cholesterol: AR 186 +/- SD 34, MR 191 +/- SD 32, ER 212 +/- SD 52, PR 215 +/- SD 41 mg/dl; LDL-cholesterol: AR 124 +/- SD 28, MR 122 +/- SD 18, ER 148 +/- SD 38, PR 145 +/- SD 33 mg/dl; HDL/LDL-cholesterol ratio: AR 0.38 +/- SD 0.1, MR 0.35 +/- SD 0.1, ER 0.30 +/- SD 0.1, PR 0.29 +/- SD 0.1). The total-CH levels increased and HDL-CH/LDL-CH ratio decreased along with the severity of the retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation of glucose tolerance to complications of pregnancy in nondiabetic women

An increase in fetal and maternal complications has been documented in cases of gestational diabetes, but the glucose levels that predict an increased risk have not been clearly defined. We evaluated the frequency of several neonatal complications (macrosomia, congenital anomalies, perinatal mortality, and prematurity) and maternal complications (toxemia, cesarean section, or both) in relation to glucose tolerance in 249 women in the third trimester of pregnancy. None of the women had previous evidence of diabetes, and all had normal results on an oral glucose-tolerance test, according to accepted criteria. On the basis of their two-hour plasma glucose levels, women were divided into three groups: A (glucose less than 100 mg per deciliter), B (glucose 100 to 119 mg per deciliter), and C (glucose 120 to 164 mg per deciliter). The higher two-hour plasma glucose levels were associated with a significant increase in the incidence of macrosomia (9.9, 15.5, and 27.5 percent in Groups A, B, and C, respectively), congenital abnormalities (0.7, 3.5, and 5.0 percent), and toxemia, cesarean section, or both (19.9, 25.9, and 40.0 percent). A significant correlation between the infant's weight and the mother's two-hour plasma glucose level was also observed. These data indicate that even limited degrees of maternal hyperglycemia, which are currently considered to be within the normal range, may affect the outcome of pregnancy.

A computerized information system for diabetes services

The utilization of a computer-assisted information system may be both useful and efficacious in the care and follow-up of diabetic patients. The model developed by us operates under GCOS-6 on a Microsystem 6/10 Honeywell computer (20 MB hard-disk storage, 512 kb central memory) and allows the creation of clinical data files for individual patients, statistical analysis of the data, and a print-out of clinical records. The package, which may be employed on a multi-user system, is supplied with an easy to understand user's manual. It represents an effective tool for the precise management of the care of diabetic patients and also provides several opportunities for research.

Guar-pasta: a new diet for obese subjects?

A pasta containing 10% guar-flour was successfully prepared and administered to ten obese women in a seven-day experimental design which included: a control meal (day 1) containing alimentary wheat-pasta, a first guar-pasta meal (day 2), to assess the acute effects of guar-pasta, a second guar-pasta meal (day 7), performed after four days of a weight-maintenance diet containing one guar-pasta meal per day. Compared to wheat-pasta, guar-pasta significantly lowered glucose and insulin response, as well as fasting total cholesterol. Moreover, it had excellent palatability and no gastrointestinal side-effects.

Serum angiotensin-converting enzyme in diabetes mellitus: a negative report

Serum angiotensin-converting enzyme (ACE) was measured by a direct photometric method in 78 normotensive diabetic patients and in 34 controls. For comparison, ACE was also assayed in 24 subjects by a radiometric procedure. We found no ACE elevations in diabetics and no significant difference in mean ACE levels between diabetics and normals. Within the diabetic group, enzyme levels were not affected by duration of disease, degree of metabolic control, or presence or not of microangiopathy. Only type I subjects had mean ACE significantly (p less than 0.05) higher than type II, very likely due to their younger age. Serum ACE data from photometric and radiometric methods significantly correlated. ACE measurement seems to be of scarce significance in diabetes mellitus.

Factitious hypoglycemia in an insulin-dependent woman in the eighth week of gestation

An extremely rare case of factitious hypoglycemia in a young insulin-dependent pregnant woman in the first trimester of pregnancy is reported. Pregnancy resulted in the birth of a normal child. The clinical and laboratory procedures used to ascertain this diagnosis together with the psychological dynamics of the case are discussed.

Prevalence of sexual dysfunctions in non-insulin dependent (type II) diabetic males

Since previous papers about the frequency of sexual dysfunctions (SD) in diabetic males did not consider the genetical and clinical heterogeneity of diabetes mellitus, we studied the prevalence and the pathogenesis of SD in 77 non insulin dependent diabetics (NIDD). The diagnostic procedures consisted of physical and psychological examinations, compilation of a questionnaire, evaluation of autonomic and peripheral nervous systems, measurement of penile arterious flow, dosage of hormonal and metabolic parameters. SD were present in 52% of patients: 24% of them had organic impotence, 28% psychological sexual impairment. Age, duration of diabetes and metabolic control were superimposable in the patients with and without SD. Most patients with organic impotence had an alteration of parasympathetic nervous system; less frequently a reduced penile arterious flow was observed. The relief of such a high prevalence of SD in NIDD males suggests that future studies should consider the various groups of diabetics separately.