Postnatal sequential changes in islet morphology and insulin secretion of normal hamsters

We have studied the postnatal development of the endocrine pancreas from normal female Syrian golden hamsters 1, 8, and 24 weeks of age. The observations were made by (a) analysis of insulin secretion in response to glucose using isolated pancreatic islets and (b) identification and quantitation of insulin-, glucagon-, somatostatin-, and pancreatic polypeptide-secreting cells. Glucose-induced insulin secretion showed typical dose-response curves. However, whereas in 24-week-old animals maximal secretion was already present with 8 mM glucose, in younger hamsters such a response was attained only with 20 mM glucose. The volume density of the endocrine pancreas and the number of islets were increased in 1-week-old hamsters compared to the older animals. The islet volume average in 8-week-old hamsters was almost three times higher than that measured in 1-week-old animals. However, the proportion and size of each cell type in the islets did not present significant differences among the groups studied. Our results show that, in hamsters, the endocrine pancreas reaches the adult general characteristics late after birth. Furthermore, the definite morphological pattern is attained far earlier than the secretory response. These observations provide basic information for further studies regarding the mechanisms and factors that control both the growth and the differentiation of endocrine cell populations as well as glucose-induced insulin secretion in a simple experimental model.

Long-term administration of a sucrose-rich diet to normal rats: relationship between metabolic and hormonal profiles and morphological changes in the endocrine pancreas

The aim of the present investigation was to study normal rats fed a sucrose-rich diet (SRD) for a prolonged period (up to 30 weeks) (1) to obtain additional data on the hormonal and metabolic patterns induced by this treatment and (2) to provide information on changes taking place in the pancreatic islet cell populations. We found that long-term feeding with a SRD resulted in a steady state of hypertriglyceridemia and hyperglycemia in which insulin levels remained unchanged and unable to compensate for the increased demands of the developing metabolic changes. The endocrine pancreas showed a significant increase of both islet number and B-cell area, as well as changes in the profile of islet cell distribution. However, these changes were not accompanied by an increase in the pancreatic content of immunoreactive insulin (IRI). It may therefore be postulated that the newly emerged B-cell mass has some sort of derangement with the increased insulin demand resulting from insulin resistance induced by the long-term SRD feeding. Thus, feeding a SRD to normal rats may prove to be an attractive animal model for studying the role of environmental nutritional factors in the unsettled issue of the relationship between insulin resistance and relative insulin deficiency. The model might provide key information for understanding the pathophysiology of human diseases such as type II diabetes, dyslipidemia, and a number of entities included in so-called syndrome X.

Topographic differences in cell populations and insulin secretion in the endocrine pancreas of the toad Bufo arenarum

We analyzed the endocrine cell topography within the amphibian pancreas and the relationship of this distribution to lobular variation in insulin content and secretion. Pancreases from adult male toad Bufo arenarum were separated into their five lobes: free, gastric, hepatic, duodenal, and jejunal. Pieces of each lobe were incubated with glucose, arginine, and K+ and the insulin concentration in the medium was measured by radioimmunoassay. In the presence of 2 or 8 mM glucose, 10 mM arginine, and 10 mM K+ the free lobe released a significantly greater amount of insulin than the other lobes, while the output of the gastric lobe was greater than that of the duodenal, hepatic, and jejunal. At 8 mM glucose, every pancreatic lobe released a significantly higher amount of insulin than at 2 mM. The insulin content of the free lobe was significantly higher than that of the others, whereas this parameter was comparable among the latter. These pancreases contained islets of variable size and irregular shape. B and non-B cells, detected by immunoperoxidase staining, were located at the central and peripheral zones of the islets, respectively. A large number of non-B cells were also scattered over the exocrine component. Morphometrical analyses revealed the following sequence of endocrine cell percentage: free lobe > gastric lobe = duodenal lobe > jejunal lobe = hepatic lobe. Some 48% of the endocrine cells were present in the islets, while the remaining 52% were found throughout the exocrine pancreas. In the free lobe, more endocrine cells were located within the islets (65%) than outside and in the gastric lobe the proportion was almost equal (48% within, 52% outside), but in the hepatic, duodenal, and jejunal lobes the majority lay outside the islets (61, 63, and 70% extrainsular, respectively). The area covered by B and D cells was far larger within the islets than outside, with the relative magnitude of this difference being free lobe > gastric lobe > duodenal lobe > hepatic lobe = jejunal lobe. In the free lobe, this relative distribution was more skewed than in the remaining lobes. PP and A cells occupied a more extensive area outside the islets than inside in every lobe. There were no significant differences among the extrainsular areas occupied by each type of endocrine cell within a given pancreatic lobe. These results constitute the first demonstration of the heterogeneity in morphology, insulin content, and secretory function among the pancreatic lobes in B. arenarum. The data further suggest that the nonuniform secretory capacities of amphibian pancreatic lobes reflect localized differences in their insulin content, which heterogeneity in turn stems from the dissimilar distribution and organization of their constituent endocrine-cell populations.

Evidence for the paracrine action of islet-derived corticotropin-like peptides on the regulation of insulin release

In view of recent evidence for the endogenous synthesis of proopiomelanocortin (POMC) by pancreatic islets, we have assessed (1) the release of POMC-derived corticotropin (ACTH)-like peptides (ACTH-LP) from isolated perifused rat islets, and (2) the potential paracrine modulatory effect on insulin output of these putative secretagogues. Islets perifused at a glucose concentration of 3.3 mmol/L secreted ACTH-LP at 0.15 +/- 0.005 ng/islet/10 min, which was increased by 17-fold at 16.7 mmol/L glucose. Islets statically incubated with different concentrations of medium glucose plus synthetic 1-39ACTH at 55 pmol/L showed a significant increase of insulin release at 8 (by 79%) and 16 (by 119%) mmol/L glucose, but not at 4 mmol/L. To determine the possible cis-directed effects of these endogenously released islet ACTH-LP on insulin secretion, we either blocked their biological action by immunoneutralization with an ACTH-specific antiserum or prevented their receptor interaction by addition of the ACTH-inhibiting polypeptide (CIP) to the incubation medium. In the presence of 16.7 mmol/L glucose, the rate of insulin output decreased by approximately 25% upon exposure to the antiserum and by approximately 50% in the presence of CIP. The foregoing observations would therefore suggest that both (1) the elaboration of ACTH-LP by isolated perifused islets and (2) the stimulation of islet insulin release by exogenous 1-39ACTH in static incubation occur as a function of glucose concentration in the incubation medium, and that (3) the newly-secreted endogenous ACTH-LP operate in a cis mode to enhance islet insulin output in a manner analogous to that of exogenously added ACTH species. These results strongly support the view that islet-elaborated ACTH-LP are important physiological paracrine modulators of insulin secretion.

[Current situation of diabetic patients in hemodialysis in Buenos Aires]

The aim of this study was to evaluate the clinical and biochemical characteristics and the different types of treatment of diabetic patients in hemodialysis (HD) due to their end-stage renal disease (ESRD). The protocol was organized as a multicentric, case-control study and comprised twenty-nine HD centres from the city and province of Buenos Aires (PRODIHEM). The population sample included all diabetic patients in HD (n = 103) and the non diabetic patients hemodialyzed in the morning hours (n = 230) as controls. In this sample, the recorded prevalence for diabetes mellitus was 12%. Among diabetic patients, 61% were non insulin dependent, 23% were insulin dependent and 16% were of the non insulin dependent type treated with insulin (Fig. 1). The results obtained in this study show that the current situation of diabetic patients in HD is far from being satisfactory: they require HD treatment at an early age; the disease is commonly associated with various comorbid factors not always appropriately treated; they show a fast deleterious progress towards ESRD, and they have a short halflife period in HD. The results also showed that there are no defined and common criteria for the treatment and control of these patients; thus, due to their poor clinical performance, only a small percentage reach a priority for a renal transplant.

[Structure and ultrastructure of the endocrine pancreas in diabetic transgenic mice]

The aim of the present study was to confirm the structural changes and to establish the ultrastructural alterations that occur in the endocrine pancreas of mice with an induced insulin-dependent diabetes mellitus (IDDM) syndrome. For that purpose, we used transgenic mice (OVE 27) that overexpress a calmodulin gene in the beta cells of the endocrine pancreas. In these animals, the excess of calmodulin decreases the cytosolic calcium levels in beta cells, leading to morphological and functional alterations that produce a severe IDDM. Sections of pancreas (tail) from 4 male 5-week-old diabetic mice (glycemia: 376 +/- 2 mg/dl) and from 4 normal age-matched males (glycemia: 113 +/- 13 mg/dl) were processed. Light microscopic immunohistochemical observations confirmed a decrease in the number and size of pancreatic islets in transgenic mice, together with a disruption in their architecture, without an associated inflammatory response. The ultrastructural studies revealed diverse degrees of injury in the beta cells, such as the presence of membrane interdigitations and alterations in their organelles and secretory granules. These findings are in agreement with the quantitative and functional impairment of beta cells, coexisting with a normal appearance of non-beta cell populations within the pancreatic islets. Our results demonstrate the existence of ultrastructural changes in the pancreatic beta cells of the experimental model studied. Such changes, together with the immunohistochemical alterations previously described, contribute to explain the appearance of a diabetic syndrome in these animals.

Evaluation of the effectiveness of an ambulatory teaching/treatment programme for non-insulin dependent (type 2) diabetic patients

The aim of this study was to evaluate the effect of a structured teaching/treatment programme on the clinical and metabolic control of non-insulin-dependent (type 2) diabetic patients. The programme was aimed at improving the overall treatment quality in these patients through measures involving self-care, diet, exercise and weight reduction. Four theoretical-practical teaching units were given once a week to group of 5-8 ambulatory patients by previously trained general practitioners. Clinical and biochemical parameters were recorded at the beginning of the course and 1 year after its completion in 40 patients attending the programme and in 39 patients of similar clinical characteristics under conventional diabetes treatment, but receiving no structured teaching before or during the survey period (control group). The drop-out percentage in the intervention group (25%) was significantly lower than in the control group (45%, P < 0.05), suggesting an incentive toward greater compliance in the former. At the end of the 1-year follow-up, the mean differences observed in the control and in the intervention groups were: body weight loss -2.4 +/- 0.5 kg vs -0.4 +/- 0.5 (P < 0.001); haemoglobin HbA1 -0.2% +/- 0.4% vs +0.8% +/- 0.4% (NS); number of daily oral hypoglycaemic agent intake -1.4 +/- 0.2 vs +0.9 +/- 0.2 tablets (P < 0.001). Our results strongly suggest that this programme, applied through family doctors, may constitute an efficient tool to improve the compliance and clinico-metabolic control of type 2 patients at the primary health care level.

An in vitro model suitable for studying insulin secretion in amphibians

The aim of this work was to develop an in vitro model suitable for studying insulin secretion in amphibians and for identifying agents capable of either blocking or stimulating such a process in this group. For this purpose, pancreases from the toad Bufo arenarum were incubated for 60 min at 25 degrees with several insulin secretagogues and blockers, and the immunoreactive insulin released into the medium was measured by radioimmunoassay. Under these experimental conditions, metabolic (glucose, ketoisocaproic acid, and arginine) and nonmetabolic (K+ and tolbutamide) agents as well as glucagon and acetylcholine significantly stimulated the release of immunoreactive insulin. Conversely, somatostatin and nifedipine blocked its secretion. All these agents exerted similar effects on the mammalian pancreas. These results prove that our model is a useful tool with which to study in vitro insulin secretion in amphibians and to identify agents which affect hormone release in this group.

Effect of pH upon Ca(2+)-ATPase activity of rat pancreatic islets: its possible contribution to the inhibitory effect of different insulin secretagogues

This work was undertaken in an attempt to elucidate the possible mechanism by which insulin secretagogues produce a fast and transient drop in the Ca(2+)-ATPase activity of the pancreatic islet membrane. For this purpose, the enzyme activity was measured in either homogenates or partially purified membranes of islets previously incubated under different experimental conditions. Ca(2+)-ATPase activity measured in homogenates of islets preincubated with 8 mM glucose decreased significantly compared to control islets incubated with 2.8 mM glucose. The inhibition was also observed when the enzyme activity was measured in homogenates of islets preincubated with 2.8 mM glucose plus 20 mM propionic acid as well as with glucose 2.8 mM in a buffer equilibrated with a gas mixture of O2 and either 12% or 30% CO2. Ca(2+)-ATPase activity decreased significantly in partially purified islet membranes preincubated for 3 min with glucose (2 and 8 mM), 15 mM KCl and 2 mM tolbutamide. These substances did not affect the Ca(2+)-ATPase activity when added directly to the enzyme assay medium. The enzyme activity also decreased when measured in membranes preincubated at pH 6.5. The addition of 1 mM ATP to the preincubation medium protected the Ca(2+)-ATPase activity from the inhibition induced by glucose, KCl and tolbutamide as well as from the one produced by acidic pH in the medium. On account of these results, we suggest that insulin secretagogues, as well as either acidification of B-cell cytosol or islet membrane incubation medium, produce changes at the islet membrane level which promote a decrease in the Ca(2+)-ATPase activity. A shift of the E1-E2 equilibrium of the phosphoenzyme towards E1 may account for such decreased activity. Changes in Ca(2+)-ATPase activity could either favour the decrease or the increase in the cytosolic concentration of Ca2+ in B-cells. Therefore, negative and positive modulation of its activity might allow Ca(2+)-ATPase to play a role in the switch-on and -off mechanism for intracellular Ca2+ signal regulation of B-cell secretion of insulin.

Modulatory mechanism of ACTH on insulin secretion: effect on cytosolic Ca2+, membrane potential and Ca(2+-ATPase activity

The aim of this work was to get some insight into the mechanism by which ACTH produces its enhancing effect on glucose-induced insulin secretion. For this purpose we have determined: a) the release of insulin by isolated rat islets incubated with 3.3 or 16.6 mM glucose with or without the addition of 500 pg/ml ACTH, together with the changes induced by ACTH on b) cytosolic [Ca2+] of isolated B cells, c) islet plasma membrane Ca(2+)-ATPase activity and d) changes in membrane potential of single mouse islets. ACTH significantly enhanced the release of insulin elicited by either 3.3 or 16.6 mM glucose. This hormone concentration also induced a significant increase in the cytosolic [Ca2+] in isolated B cells. ACTH did not produce B cell membrane depolarization. Conversely, ACTH produced a significant decrease in islet plasma membrane Ca(2+)-ATPase activity. These results suggest that ACTH in concentrations similar to those attained by the endogenous peptide at the islet interstitium exerts its positive modulation on glucose-induced secretion of insulin, at least partly through its increasing effect on cytosolic [Ca2+] of B cells. The latter might be the consequence of the decreasing effect of ACTH on Ca(2+)-ATPase activity rather than to stimulation of voltage-dependent Ca(2+)-channels.

Changes induced by non-enzymatic glycosylation of IGF-binding protein-3: effects on its binding properties and on its modulatory effect on IGF-I mitogenic action

The aim of this study was to demonstrate the feasibility of in vitro non-enzymatic glycosylation of IGF-binding protein-3 (IGFBP-3) and whether this process affects its binding properties and its modulatory effect on IGF-I mitogenic activity. Swiss 3T3 fibroblasts were cultured and the IGFBP-3 released into the medium (CM) glycated with either labelled or unlabelled glucose. Parallel glycation studies were performed using standard human IGFBP-3. Both species of IGFBP-3 became effectively glycated in a dose-dependent manner. Glycated IGFBP-3 bound larger amounts of 125I-labelled IGF-I than its non-glycated form. According to Scatchard analysis this effect might be due to an increase in the number of binding sites of the IGFBP-3 molecule rather than to changes in its affinity constants, which remain unchanged. Preincubation of fibroblasts with CM containing IGFBP-3 for 16 h before the addition of IGF-I enhanced the stimulatory effect of the hormone on thymidine incorporation into cell DNA. This potentiation was blunted when in vitro glycated instead of non-glycated IGFBP-3 was employed. These results provide further evidence of the in vitro glycation of IGFBP-3 and demonstrate that this process affects both its binding properties and its enhancing effect on IGF-I mitogenic activity. These changes may explain, at least partially, the development of many alterations observed in poorly controlled diabetic patients.

Quantitative immunocytochemical study of islet cell populations in diabetic calmodulin-transgenic mice

The present study describes the changes in the endocrine pancreas of severely diabetic calmodulin-transgenic mice using light microscopic immunocytochemical and morphometric techniques. A marked reduction in the number and volume of islets, together with distortion of their normal architecture, was found in diabetic mice. In addition, the volume density of both endocrine tissue and B-cells was decreased. An irregular distribution of non-B-cells was also observed in diabetic animals. The volume density and the percentage of A-cells appeared increased. However, when quantified per area unit, the number of all the islet cell types diminished, although only the decrease in B-cell number was statistically significant. The decrease in B-cell mass might account for the diabetic state developed in this animal model.

Glucose-induced secretion of ACTH-like products by rat pancreatic islets

This work was performed to study the release of proopiomelanocortin (POMC)-derived peptides from isolated pancreatic islets and the effect of ACTH--a member of that peptide family--on insulin secretion. Islets were incubated with 3,3 and 16.6 mM glucose and insulin and ACTH-like products (ACTH-LP) were measured by radioimmunoassay. Glucose stimulated the simultaneous release of insulin and ACTH-LP, the ACTH-LP concentration being higher when assayed with an antibody reacting with the N-terminus of ACTH. However, the increment in this release in the presence of the higher glucose concentration was larger when measured with an antibody against the ACTH mid-portion. Thus, although the islets would release more of a smaller ACTH-LP, 16.6 mM glucose would selectively increase the release of peptides of larger molecular size. Islets incubated with different concentrations of synthetic ACTH (50-500 pg/ml) increased the release of insulin in a dose-dependent manner. These results suggest that the release of endogenous ACTH-LP could contribute to the paracrine regulation of insulin secretion.

Rapidly induced modulation of beta-N-acetylglucosaminidase activity in pancreatic islets

The aim of this work was to determine the possible rapid modulatory effect of glucose on the activity of pancreatic islet lysosomal enzymes. For this purpose, beta-N-acetylglucosaminidase and beta-galactosidase activities were measured in homogenates of isolated rat islets after a 5, 15, 30 or 60-min exposure to either 3.3 or 16.6 mM glucose. The enzyme activities were determined spectrofluorometrically by means of their respective 4-methylumbelliferyl derivatives as substrates. beta-N-acetylglucosaminidase activity measured in freshly isolated non-incubated islets was 5.482 +/- 0.281 mumol/mg protein/h at 37 degrees C. In islets incubated with 3.3 mM glucose, this activity dropped significantly after 5 min and remained almost constant until the end of the incubation period. In islets incubated with 16.6 mM glucose, beta-N-acetylglucosaminidase activity also decreased significantly at 5 min, and attained its lowest value after 15 min of incubation. After this interval, the activity began to recover and thereafter gained a value close to that measured in non-incubated islets by 60 minutes' time. Despite this ultimate recovery, the enzyme activities measured were significantly lower than those found in islets incubated with 3.3 mM glucose. beta-galactose activity in freshly isolated non-incubated islets was 0.515 +/- 0.094 mumol/mg protein/h at 37 degrees C. This value remained almost unchanged throughout the incubation period in the presence of either 3.3 or 16.6 mM glucose. These results show that beta-N-acetylglucosaminidase activity, a lysosomal hydrolase of pancreatic rat islets,--and only this enzyme--is modulated by glucose.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative study of IGFBP properties in toad and rat sera

The levels of IGF-I have been simultaneously measured by radioimmunoassay in samples of the toad Bufo arenarum and of normal male Wistar rats. In addition, the different fractions of IGF-I binding proteins (IGFBP) and their binding properties have been identified by ligand blot and Scatchard analysis in the serum of both species. In the toad, we have measured levels of IGF-I (2.78 +/- 0.48 ng/ml) similar to those previously reported in amphibians but far below those found in rats. IGFBP levels were estimated at 129 +/- 23 and 4249 +/- 321 pg/ml in toad and rat serum samples. Two main IGFBP fractions of 30-34 kDa, accompanied by a minor component of 24 kDa and seldom by another of 40 kDa, were identified in toad serum. In rat serum--as already reported--three bands of 40, 30, and 24 kDa were identified, the first being the main component and the last the minor one. The Scatchard analysis of a competitive binding assay showed two types of binding sites in toad serum: one of high affinity-low capacity (Ka1 = 1.6 x 10(10) M-1; R1 = 1.2 x 10(-11) M) and another with low affinity-high capacity (Ka2 = 1.9 x 10(8) M-1; R2 = 1.9 x 10(-10) M). The percentage fraction of these binding sites occupied by IGF-I was 13.5%. The figures for K1 and K2 were lower and those for R1 and R2 were higher in rat than in toad serum. The percentage fraction of occupied rat IGF binding sites was 3.6%.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunocytochemical detection of bromodeoxyuridine in tissues of the toad Bufo arenarum Hensel

We present a modified protocol for the immunocytochemical identification of 5-bromo-2'-deoxyuridine (BrdU) as an indicator of cell replication in different tissues of the toad, Bufo arenarum Hensel. Animals were sacrificed 60 min after BrdU (5 mg/100 g body weight) was injected into the dorsal lymph sac. The tissues were fixed in Carnoy's fluid and stained by the immunoperoxidase method using an anti-BrdU monoclonal antibody. This protocol can be used safely for the study of cell replication in toads and other Anura amphibia.

Changes induced by hypothyroidism in insulin secretion and in the properties of islet plasma membranes

This work was aimed at elucidating the effect of thyroid function on the physiology and biochemistry of the islet-cell population within the endocrine pancreas. To this end, we performed a comparative study of the physiochemical properties of islet-cell membranes and of the dynamics of glucose-induced insulin secretion in isolated pancreatic islets prepared from euthyroid i.e. control (C), hypothyroid (H), and thyroxin-supplemented hypothyroid (HT) rats. H rats were obtained by injecting normal rats with 131iodine, while HT rats consisted of H rats treated with thyroxin (T4). Insulin secretion was studied in isolated islets perifused with 3.3 and 16.6 mM glucose. Physicochemical properties of the partially purified islet plasma membranes were assessed by measurements of fluorescence polarization with the fluorophore 1,6-diphenyl-1,3,5-hexatriene (DPH) as a lipidic molecular probe. Insulin output during either the first or second phase of insulin secretion in H islets was significantly lower than in C islets. The slope of the curve in the second phase of insulin secretion was also lesser in H than in C islets, suggesting an additional defect in their velocity of hormone release. T4 administration of H rats reversed the decrease in insulin output to the range found in C islets but was incapable of correcting the defect in the hormone-secretion velocity. Several changes were found in the physicochemical properties of the membranes obtained from H islets as compared to C islets.(ABSTRACT TRUNCATED AT 250 WORDS)

The erythrocyte calcium pump is inhibited by non-enzymic glycation: studies in situ and with the purified enzyme

In a previous paper we demonstrated that incubation of either intact erythrocytes or erythrocytes membranes with glucose decreases the activity of the membrane Ca(2+)-ATPase [González Flecha, Bermúdez, Cédola, Gagliardino and Rossi (1990) Diabetes 39, 707-711]. The aim of the present work was to obtain information about the mechanism of this inhibition. For this purpose, experiments were carried out with purified Ca(2+)-ATPase, inside-out vesicles and membranes from human erythrocytes. Incubation of the purified Ca(2+)-ATPase with glucose led to a decay in the enzyme activity of up to 50% of the control activity under the conditions used. The decrease in ATPase activity was concomitant with labelling by [6-3H]glucose of the purified Ca2+ pump; the kinetic properties of both processes were almost identical, suggesting that inhibition is a consequence of the incorporation of glucose into the Ca(2+)-ATPase molecule. In inside-out vesicles, glucose also promoted inhibition of Ca(2+)-ATPase activity as well as of active Ca2+ transport. Arabinose, xylose, mannose, ribose, fructose and glucose 6-phosphate (but not mannitol) were also able to inactive the ATPase. The activation energy for both the decrease in ATPase activity by glucose and the labelling of the pump with [6-3H]glucose was about 65 kJ/mol. Furthermore, inorganic phosphate enhanced the inactivation of the Ca(2+)-ATPase by glucose. This evidence strongly suggests that inhibition is a non-enzymically catalysed process. Inactivation of the Ca(2+)-ATPase by glucose was enhanced by reductive alkylation with sodium borohydride. Aminoguanidine, an inhibitor of the formation of the advanced end products of glycosylation, did not prevent the deleterious effect of glucose on the enzyme activity. Therefore it is concluded that inactivation of the Ca2+ pump is a consequence of the glycation of this protein.

A simple economic evaluation model for selecting diabetes health care strategies

The aim of this work was to develop a simple model to evaluate the health care cost of diabetes in order to help decision-makers in selecting strategies for the prevention, control, and treatment of the disease. The model assesses the cost of full coverage of health care of diabetic patients free of chronic complications and in comparison with those of the treatment of acute and chronic complications. For that purpose, standardized cost figures were obtained from both annual control and treatment of uncomplicated diabetic patients and the treatment of one episode of ketoacidosis, acute myocardial infarction, and amputation of two toes. The treatment/prevention cost ratio obtained showed that prevention of a single episode of any of these late-complication-related events would provide enough funds to cover either the total or partial annual cost of control and treatment of several uncomplicated diabetic patients. These facts would favour the allocation of funds in such a way as to allow adequate control and treatment of diabetic patients to keep them free of the chronic complications of the disease. This would be a wise investment of funds, which would result in a reduction in the socioeconomic cost of the disease and in a better quality of life for the diabetic patients and their families.

Correlation between Ca(2+)-ATPase activity of rat islet cells and insulin secretion

Using medium with a low ionic strength, a low concentration of Ca2+ and Mg2+ and devoid of K+, we have measured Ca(2+)-ATPase activity in the homogenates of rat islets preincubated for 3 min with several hormones in the presence of 3.3 mmol glucose/l. Insulin secretion was also measured in islets incubated for 5 min under identical experimental conditions. Islets preincubated with glucose (3.3 mmol/l) and glucagon (1.4 mumol/l) plus theophylline (10 mmol/l), ACTH (0.11 nmol/l), bovine GH (0.46 mumol/l), prolactin (0.2 mumol/l) or tri-iodothyronine (1.0 nmol/l) have significantly lower Ca(2+)-ATPase activity than those preincubated with only 3.3 mmol glucose/l. All these hormones increased the release of insulin significantly. Dexamethasone (0.1 mumol/l) and somatostatin (1.2 mumol/l) enhanced the Ca(2+)-ATPase activity while adrenaline (10 mumol/l) did not produce any significant effect on the activity of the enzyme. These hormones decreased the release of insulin significantly. These results demonstrated that islet Ca(2+)-ATPase activity was modulated by the hormones tested. Their inhibitory or enhancing effect seemed to be related to their effect on insulin secretion; i.e. those which stimulated the secretion of insulin inhibited the activity of the enzyme and vice versa. Hence, their effect on insulin secretion may be due, in part, to their effect on enzyme activity and consequently on the concentration of cytosolic Ca2+. These results reinforce the assumption that Ca(2+)-ATPase activity participates in the physiological regulation of insulin secretion, being one of the cellular targets for several agents which affect this process.

Protein glycation: its role in the changes induced by diabetes in the properties of the serum insulin-like growth factor-I binding proteins

The purpose of this work was to study the effect of diabetes on 125I-labelled insulin-like growth factor (IGF) binding to specific serum binding proteins (IGFBPs) and the possible role of protein glycation in such an effect. Accordingly, ligand blotting and fructosamine assays were performed in serum samples from diabetic and non-diabetic eSS rats as well as in samples of normal rat serum previously incubated with different concentrations of glucose. IGFBPs with molecular weights of 24, 30 and 40 kDa were identified in samples from diabetic and non-diabetic rats. 125I-Labelled IGF-I binding to each of these fractions increased significantly in the serum of diabetic rats. IGF-I binding to IGFBP-40 increased significantly as a function of the degree of glycation of serum proteins. Conversely, the increased binding of IGFBP-24 and IGFBP-30 was related only to the glucose concentration attained at 120 min during the oral glucose tolerance test. Glycation of proteins of normal serum and the binding of labelled IGF-I increased as a function of glucose concentration in the incubation media. In these in-vitro glycated normal sera, only the binding to IGFBP-40 increased significantly; this increase was closely related to the amount of protein glycation. No clear and reproducible changes occurred with the binding of 125I-labelled IGF-I to IGFBP-24 and IGFBP-30 fractions. These results confirm the increase in the binding capacity of IGFBPs reported in diabetic animals. They also show that the increase in IGF-I binding to each IGFBP fraction is regulated by a different mechanism; whereas protein glycation induces changes in IGFBP-40, this mechanism does not affect the binding properties of the other two IGFBPs. The increased binding of IGFBP might affect the availability of free IGF-I, and the consequent alterations in IGF-I-dependent metabolic processes could explain the role of this growth factor in the pathogenesis of chronic complications of diabetes.

Costs of temporary and permanent disability induced by diabetes

OBJECTIVE

To evaluate the indirect costs of diabetes and show their relationship to the chronic complications of diabetes.

RESEARCH DESIGN AND METHODS

The cost of temporary and permanent disability for diabetic patients was studied in a group of La Plata University employees and in a second group at the government institutions of the Buenos Aires Province during 3 consecutive yr (1984-1986).

RESULTS

Absences due to temporary disability were similar for the diabetic group without chronic complications and an age- and sex-matched nondiabetic control group. Conversely, diabetic patients with chronic complications had major increases in absences compared with the control subjects. Diabetes mellitus was the third leading cause of permanent disability mainly due to macrovascular and retinal lesions. This disability resulted in an average of 11 yr of work production loss per patient.

CONCLUSIONS

These results suggest that diabetic individuals without complications incur few additional costs compared with nondiabetic individuals. However, once complications appear, the indirect costs are very high, suggesting that secondary preventions of the diabetic complications might be an optimal approach for reducing the health-care burden of diabetes.

Effect of insulin on the lytic action of lysophosphatidylcholine in lipid bilayers

The effect of insulin on the bilayer properties of dimyristoylphosphatidylcholine liposomes at the gel and the liquid crystalline state was measured by differential scanning calorimetry and absorbance at 450 nm. It is found that insulin promotes a decrease in the enthalpy of the gel-liquid crystalline transition without displacing the transition temperature. Under these conditions the lytic action of monomyristoylphospatidylcholine is enhanced, decreasing the critical lytic concentrations to values comparable to the bilayer at the gel state. The effect of the lysoderivate on liposomes in contact with increasing concentrations of insulin promotes a reorganization of the lipids into smaller particles as inferred from fluorescence dequenching, turbidity and exclusion chromatography assay. It is concluded that the action of lysoderivates can be enhanced, at temperatures above the transition temperature, by proteins that without spanning the lipid bilayers can perturb the bilayer interface.