Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus

The periodontal status of 25 patients with non-insulin dependent diabetes mellitus (NIDDM) (age range 58 to 76) was investigated and compared with 40 non-diabetic control subjects (age range 59 to 77). Surfaces with visible plaque and bleeding after probing, calculus, recessions, and pathological pockets were examined. The total attachment loss was calculated as a sum of recessions and pockets in millimeters. Mesial and distal bone loss was measured from panoramic radiographs and mean alveolar bone loss was calculated. Periodontal disease was considered advanced when mean alveolar bone loss was over 50%, or 2 or more teeth had pockets > or = 6 mm. Microbiological analysis comprised the detection of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus by a polymerase chain reaction (PCR) method. Patients with NIDDM had significantly more often advanced periodontitis than control subjects, 40.0% and 12.5%, respectively. Diabetic patients did not harbor more pathogens than the control subjects. The HbA1C level deteriorated in patients with advanced periodontitis, but not in other patients with NIDDM, when compared to the situation 2 to 3 years earlier. Advanced periodontitis seems to be associated with the impairment of the metabolic control in patients with NIDDM, and a regular periodontal surveillance is therefore necessary.     

Effects of glibenclamide on blood pressure and cardiovascular responsiveness in non-insulin dependent diabetes mellitus

1. The incubation of mouse isolated diaphragm with guanidine for 60 min produced ultrastructural changes in the neuromuscular junction, the intramuscular fascicles of the phrenic nerve and the skeletal muscle fibers. 2. The main morphological characteristics of both the end terminals and the nerve fibers were a swollen appearance and an electron-lucent axoplasm. In addition, the mitochondria in these regions were markedly swollen and showed a rarefaction of their cristae as well as a "washed aspect" of their matrix. Occasional periaxonal vacuoles were present in the myelinated axons. There was a reduction in the number of synaptic vesicles, which was accentuated by the enlarged areas of the majority of the terminals. 3. Muscle cells underwent a range of morphological alterations in the myofibrils and mitochondria. The most drastic type of necrosis affecting these cells was complete dissolution of the myofibrils, which resulted in an apparently "empty" cell with only the sarcolemma and a few mitochondria remaining intact. 4. Tetrodotoxin was unable to provide total protection against these guanidine-induced changes. 5. We conclude that the ultrastructural effects evoked by guanidine may be associated with modifications in the permeability of the axolemmal and sarcolemmal membranes as a result of changes in ionic conductance. Such ionic disturbances also interfere with the metabolism of mitochondria and the sarcoplasmic reticulum and may account for the well-known inhibitory effect of guanidine on K+ channels and consequently on Ca2+ and Na+ conductances. 6. It is also suggested that the guanidine-induced alterations in the presynaptic and postsynaptic sites could have independent mechanisms of action.     

Anserine bursitis and non-insulin dependent diabetes mellitus

OBJECTIVE: To determine the relationship between non-insulin dependent diabetes mellitus (NIDDM), knee pain, and anserine bursitis, and its relation to sex, age, or body mass index (BMI). METHODS: Ninety-four consecutive patients with NIDDM, 66 women and 28 men, and 57 nondiabetic patients, 36 women and 22 men, were examined at an outpatient clinic of a tertiary care hospital. Date of onset in patients with NIDDM was noted, and serum was analyzed for either hemoglobin A1C (HbA1C) or glycosylated hemoglobin (GHb) in 69 of these patients. Anserine bursitis was diagnosed if knee pain and tenderness at the bursal site were found on examination. RESULTS: On examination 34 (36%) patients with NIDDM were found to have anserine bursitis. Of these, 31 (91%) were women and 3 (9%) were men (p < 0.05). Age, BMI, duration of diabetes, HbA1C or GHb, and age of onset of diabetes were found not to differ significantly between patients with and those without anserine bursitis. CONCLUSION: A relationship exists between NIDDM, knee pain, and anserine bursitis unrelated to age, BMI, duration and control of diabetes, and age at the diagnosis of diabetes.     

Clinical predictors of non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus

BACKGROUND: Several studies had suggested that non-diabetic renal disease (NDRD) was common among non-insulin dependent diabetes mellitus (NIDDM) patients with renal involvement. METHODS: We prospectively studied the prevalence of NDRD among a Chinese NIDDM population. Renal biopsy specimens were evaluated with light-, immunohistological and electron-microscopy. The cohort consisted of 51 patients who had NIDDM and proteinuria > 1 g/24 h. RESULTS: Patients with both isolated diabetic nephropathy (DN, n = 34) and NDRD (n = 17) had comparable duration of DM, creatinine clearance, serum creatinine, albumin and glycosylated haemoglobin levels, as well as incidences of retinopathy, neuropathy and hypertension. Significantly more patients with NDRD had microscopic haematuria (P = 0.043) or non-nephrotic proteinuria (P = 0.004). IgA nephropathy accounted for 59% of the NDRD identified. CONCLUSIONS: In this study, microscopic haematuria and non-nephrotic proteinuria predicted the presence of NDRD among NIDDM patients presenting with renal disease.     

Plasma endothelin-1 levels in non-insulin dependent diabetes mellitus patients with macrovascular disease

BACKGROUND: Endothelin-1 (ET-1) with its well-known vasoconstrictive and mitogenic action and through its interaction with insulin, blood glucose, and lipids might play an important role in the accelerated atherogenic process in diabetes mellitus. OBJECTIVE: To determine whether ET-1 levels are indicative of macrovascular disease in diabetes mellitus. METHODS: In the present cross-sectional study, plasma ET-1 concentrations were measured in members of three groups. The first group consisted of 20 patients (15 men and five women; aged 56.3 +/- 12.5 years) with non-insulin-dependent diabetes mellitus and coronary artery disease, the second group of 20 patients (16 men and four women, aged 56.9 +/- 11.2 years) with coronary artery disease only, and the third group of 10 healthy subjects who served as controls. ET-1 levels were determined by a radioimmunoassay. RESULTS: The mean plasma ET-1 levels for the three groups were 3.59 +/- 1.88, 4.31 +/- 1.32, and 4.42 +/- 1.01 pmol/l respectively, and there was no statistically significant difference among the groups (P = 0.23). There was also no correlation between the plasma ET-1 concentration and age, sex, body mass index, triglyceride, total cholesterol, high-, low- and very-low density lipoprotein levels, for all groups, and, for the first group, hemoglobin A1c (HbA1c), the duration of diabetes mellitus. CONCLUSION: The plasma ET-1 concentration is not elevated in non-insulin-dependent diabetes mellitus patients with macrovascular disease, which might reflect the fact that its action occurs in a paracrine or an autocrine rather than an endocrine fashion and suggests that ET-1 levels are not necessarily indicative of macrovascular disease in diabetes mellitus.     

Pedigree investigation of familial non-insulin dependent diabetes mellitus

To discuss the inheritant mode of familial NIDDM. METHODS: According to WHO criteria of DM, 100 NIDDM Probands with family history of DM were diagnosed and 100 persons were chosen at random for controls. The survey of DM was performed in both groups, including FBG, HbAlc, FINS. Some members had insulin release test. RESULTS: The prevalance rates of DM in familial DM group were 26 times of the control group (34.3% and 1.3%). The prevalance rate of DM among first-degree relation was 18 times higher than that in general population (28.3% and 1.5%). The rate of diabetes in the siblings and in the off-springs was 44.4% and 9.7% respectively. The pedigree analyses showed that 83.9% affected families had one diabetic parent, one half siblings had DM, and there was a successive transmission of DM through at least three generations in sixteen large families. Besides, the incidence of DM was much higher in females than in males (40% and 28%). Among affected parents, diabetlic mothers were much more than diabetic fathers (50.8% and 27.6% P < 0.01). CONCLUSION: Familial NIDDM had a familial aggregation. It was inherited in the manner of Mendelian autosomal dominant inheritance. The difference between the rate in DM mothers and fathers was probably due to unequal prevalance rate in females and males.     

Acarbose controls postprandial hyperproinsulinemia in non-insulin dependent diabetes mellitus

Older adults who become acutely confused when hospitalized present challenges to nurses because of their increased care needs and risk for injury. This study evaluated the feasibility of introducing the NEECHAM Confusion Scale as part of usual nursing care as a first step in improving nurses' ability to assess, prevent, and manage acute confusion in hospitalized older adults. By addressing several of the factors that influence adoption and continuation of a new practice, this study found that staff nurses could successfully use the NEECHAM Confusion Scale.     

Factors involved in noncompliance with drug treatment in non-insulin dependent diabetes mellitus

OBJECTIVE: To find the level of non-compliance with treatment with oral hypoglycemics, its causes and the profile of non-compliant patients. DESIGN: Prospective study. SETTING: Primary Care Centres in the province of Alicante. PATIENTS: 107 diabetics not dependent on insulin on the lists of five General Medicine practices and all receiving pharmacological treatment. MEASUREMENTS AND MAIN RESULTS: The method used to value compliance was a surprise count of pills in the patient's home. Patients achieving 80-110% compliance were considered compliant. The level of non-compliance was 51.5% (C.I. 42.1%-61%), 36.5% being hypocompliers and 15% hypercompliers. Forgetting (40.7%) and lack of knowledge (29.5%) were the most frequent reasons for non-compliance. The factors associated with non-compliance were: over four years evolution of the disease (p = 0.02), the diet not properly observed (p = 0.03), over a year in regular treatment (p = 0.006), poor control of the disease valued by HbA1C (p = 0.003). CONCLUSIONS: A high level of non-compliance with pharmacological treatment was found for patients with Diabetes Mellitus not dependent on insulin. Its causes were identified and factors associated with poor compliance were profiled.     

Plasma and erythrocyte magnesium levels are correlated with oxygen uptake in patients with non-insulin dependent diabetes mellitus

The excavation of a 23 year-old aircraft crash site in the Socialist Republic of Vietnam and the transformational processes preceding its excavation in 1995-1996 are detailed. The history of the site involved an initial catastrophic event, with subsequent reclamation and disturbances. Ultimately, a recovery effort by a joint U.S. team from the Central Identification Laboratory, Hawaii (CILHI). Joint Task Force-Full Accounting (JTF-FA) and a Socialist Republic of Vietnam contingent yielded numerous human remains, personal effects, and life-support items from the crash site. This case study should be of interest to the increasing number of forensic anthropologists who carry out work in international contexts. The application of forensic anthropology in human rights abuse cases, for example in Rwanda, Argentina, and Bosnia, provide examples of such cross-cultural endeavors. Cultural factors act in the development of a site and should not be overlooked as significant taphonomic agents. The approach that an indigenous person takes to a crash site or mass grave may be quite different from our own approach, involving Western science. Holland, Anderson, and Mann (I) describe the postmortem alternation of exhumed and/or curated bone caused by indigenous South-east Asian peoples; the examples provided by these authors demonstrate how culture affects the treatment of what we would call "evidence." The international nature of an incident can add complicating "filters" to the reconstruction of events, since reclamation responses by indigenous people vary according to their interpretations of the scene. An investigating forensic anthropologist needs to understand the emic viewpoint (the insider's view), as cultural anthropologists do, when attempting to recover and reconstruct such an incident. In response to the cultural (and natural) taphonomic agents at work on such a site, the use of dual forensic recovery methods--simultaneously treating the investigation scene like an aircraft crash and a clandestine burial site--is advised. Employing a flexible set of methods will allow for maximal recovery of evidence.     

Cerebrovascular reactivity in non-insulin dependent diabetes mellitus (preliminary results)

AIMS: Previously numerous investigators reported about impairment of cerebrovascular reserve capacity in Type I, diabetes mellitus. However, no similar data are available about patients suffering from Type II diabetes. The goal of the study was to assess cerebrovascular reserve in Type II diabetic patients. PATIENTS AND METHODS: 14 NIDDM patients and 20 healthy controls were studied. Middle cerebral artery mean blood flow velocity was measured at rest and during 20 minutes after i.v. administration of 1 g. acetazolamide. Velocities measured after acetazolamide were compared to resting values and were expressed as the percent increase of the mean velocity. Data obtained in diabetics and healthy persons were compared using Student's t-test. The correlation between age of the patients, diabetes duration, actual blood glucose-, insulin-, glycosylated hemoglobin-, urine microalbumin concentrations and resting blood flow velocity and cerebrovascular reserve capacity was assessed using linear regression analysis. RESULTS: Resting cerebral blood flow velocities, cerebrovascular reactivity and reserve capacity did not differ from that of healthy controls. No correlation has been found between obtained laboratory parameters and resting cerebral blood flow velocities and cerebrovascular reserve capacity. CONCLUSIONS: Vasodilatory ability of the cerebral arterioles in NIDDM-patients did not differ from that of healthy control persons. Further studies are needed to find out an accurate screening method for detection of cerebral microangiopathic changes in Type II diabetes mellitus.     

Effect of dietary fish oil supplementation on peroxidation of serum lipids in patients with non-insulin dependent diabetes mellitus

Target 17 of the Health Policy for Europe calls for the health-damaging consumption of dependence-producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, it is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member States is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.     

Effects of vanadyl sulfate on carbohydrate and lipid metabolism in patients with non-insulin-dependent diabetes mellitus

Mechanisms for the cell-free activation of NADPH oxidase by sodium dodecyl sulfate (SDS) and arachidonate were compared in relation to their responsiveness to short chain diacylglycerols. The plasma membrane and cytosol prepared from guinea pig neutrophils were used for the cell-free system. The activation of NADPH oxidase by SDS was enhanced about 5- to 10-fold by 1,2-dioctanoylglycerol (diC8), but not by either 1,2-dihexanoylglycerol (diC6) or 1,2-didecanoylglycerol (diC10). However, none of these diacylglycerols potentiated the NADPH oxidase activation by arachidonate. The maximal extent of activation by the combination of SDS and diC8 was similar to that by arachidonate alone. In the presence of sufficient amounts of diC8 and SDS, GTP gamma S potentiated the activation of NADPH oxidase. The potentiating activity of diC8 was preserved in the membrane fraction, not in the cytosol fraction. These results suggest that arachidonate may possess the functions of both SDS and diC8 in the activation. In addition, diC8 and GTP gamma S seem to independently enhance the NADPH oxidase activation.     

Angiotensin-converting enzyme gene polymorphism in non-insulin dependent diabetes mellitus and its relationship with diabetic nephropathy

The effects of prolactin (PRL) on proliferation of cultured human uterine leiomyoma-derived smooth muscle cells (SMC) and its mechanism of action were investigated. PRL stimulated DNA synthesis and the expression of PRL receptor was identified by ribonuclease protection assay. Moreover, the regulation of mitogen-activated protein (MAP) kinase by PRL in leiomyoma-derived SMC was investigated. PRL stimulated MAP kinase activity, as detected by 32P incorporation into MAP-2, in a dose-dependent manner. PRL also rapidly stimulated MAP kinase phosphorylation as detected by in vivo phosphorylation using 32P labeling and phosphotyrosine immunoblotting. These results suggest that PRL stimulates the proliferation of human leiomyoma cells via the MAP kinase cascade.     

Apolipoprotein AI-CIII, B, and CII gene polymorphisms in patients with non-insulin dependent diabetes mellitus. Association with hyperlipemia

BACKGROUND: Dislipidaemia is an usual feature in patients affected by non insulin dependent diabetes mellitus. Several studies show that this disease could be genetically determined. The aim of this study was to ascertain whether any of the genetic polymorphism remaining in three apolipoprotein loci (apolipoprotein AI-CIII, B100 and CII) is related with the presence of dislipidaemia in non insulin dependent diabetes mellitus patients. PATIENTS AND METHODS: 53 non insulin dependent diabetes mellitus patients with less than 5 years evolution and treated only with diet, were included. 86 healthy persons were included as the control group. The lipidic parameters analyzed were: cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apolipoprotein AI, B and lipoprotein (a). The following polymorphic variants were analyzed: RFLP-Sacl of the apolipoprotein AI-CIII-AIV cluster, RFLP-Xbal of the apolipoprotein B100 region and the RFLP-Taql of the apolipoprotein E-CI-CII cluster. RESULTS: There were no genetic nor allelic differences in the distribution of the genes, between controls and diabetic patients. Regarding the apolipoprotein CII gen, the diabetic patients with the T2T2 genotype had higher triglyceride levels (p < 0.01) compared with the remaining genotypes and compared with the control group having the same genotype (p < 0.01) matched for sex, age and body mass index. There was no difference in the metabolic parameters' distribution related to the genotypic distribution of the apolipoproteins AI-CIII and B100 genes. CONCLUSIONS: The apolipoprotein CII can be related with the presence of hypertriglyceridaemia in non insulin dependent diabetes mellitus patients.     

Hepatocyte nuclear factor-4 alpha gene mutations in Japanese non-insulin dependent diabetes mellitus (NIDDM) patients

OBJECTIVE: To assess the effect of pregnancy, maternal position, and cardiac output on intrapulmonary shunting (Qs/Qt) in normotensive nulliparous women near term. METHODS: Ten normotensive nulliparas between 36 and 38 weeks' gestation underwent pulmonary artery catheterization (via the subclavian route) and radial artery canalization. Baseline assessments were made with subjects in the left lateral recumbent position after a 30-minute stabilization period. Measurements were obtained sequentially in the left lateral, right lateral, supine, knee-chest, sitting, and standing positions. Each position change was followed by a 10-minute pre-measurement stabilization period. Cardiac output was measured via the thermodilution technique. Blood samples were obtained simultaneously from the pulmonary and radial arteries and analyzed in duplicate for oxygen content with a blood gas analyzer. Qs/Qt was calculated using the classic shunt equation. Statistical analysis was performed by analysis of variance of repeated measures of Qs/Qt and maternal position. The relationship of Qs/Qt to maternal cardiac output was evaluated by the correlation coefficient. Significance was defined as P < .05. RESULTS: Directly measured Qs/Qt averaged 15.3% in left lateral, 15.2% in right lateral, 13.9% in supine, 12.8% in knee-chest, 13.8% in sitting, and 13.0% in standing positions. There was no statistically significant correlation between Qs/Qt and cardiac output (R2 = 0.11, not significant). CONCLUSION: This is the first report of directly measured Qs/Qt in normal pregnant women in the third trimester. Qs/Qt values reported in pregnancy are higher than those reported in nonpregnant individuals.     

The effect of pindolol on carbohydrate and fat metabolism in diabetes mellitus

Twenty-seven diabetic patients, nine treated with insulin, nine treated with tolbutamid, and nine placed on diet, were given either pindolol or placebo 5 mg, three times daily during a 6-week period. The following 6-week period those receiving pindolol in the first 6 weeks received placebo and vice versa. Pindolol had no influence on the concentration of blood glucose, free fatty acids, triglycerides, or total cholesterol. The effect of pindolol on carbohydrate and fat metabolism appears to be of no clinical relevance in diabetic patients receiving their usual therapy.     

Plasma PAF acetylhydrolase in non-insulin dependent diabetes mellitus and obesity: effect of hyperinsulinemia and lovastatin treatment

Insulin resistance is characterized principally by impaired insulin-mediated glucose uptake which provokes a compensatory increase in pancreatic beta-cell secretory activity. For a time this may produce well-controlled plasma glucose levels but as the insulin resistance worsens the augmented insulin production becomes inadequate to keep plasma glucose at euglycemia leading to the development of non-insulin dependent diabetes mellitus (NIDDM), accompanied by hyperinsulinemia and hyperglycemia. A number of metabolic defects are associated with NIDDM including obesity, hypercoagulability, cardiovascular disease risk factors such as hypertension and dyslipidemia and these constitute the insulin resistance syndrome. The identity of the biochemical factor that might link all these defects is not yet known. We have hypothesized that platelet-activating factor (1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine, PAF) may be such a link. In this study, we measured plasma acetylhydrolase (EC.1.1.48), which degrades PAF to the inactive metabolise lyso-PAF, as a surrogate for PAF activity in three groups of hypercholesterolemic subjects: lean controls (n = 9), non-diabetic obese (n = 6) and NIDDM subjects (n = 6). The ages and body mass indices of the subjects were 46 +/- 3.1 and 24.2 +/- 2.2 for the lean controls, 52 +/- 2.5 and 28.7 +/- 0.9 for the NIDDM subjects and 60 +/- 2 and 27.6 +/- 2.1 for the obese, non-diabetic subjects (mean +/- S.E.M.). The measurements were made before and after therapy with the cholesterol-lowering drug lovastatin, a 3-hydroxy 3 methylglutaryl (HMG) coenzyme. A reductase inhibitor (40 mg/day) for 3 months. Fasting plasma glucose (FPG) levels were 91 +/- 11, 96 +/- 3 and 146 +/- 11 mg/dl, for the lean, obese and NIDDM subjects, respectively, before therapy began. Lovastatin did not affect FPG in any of the three subject groups. Before treatment, the fasting plasma insulin (FPI) levels were 6.1 +/- 0.92, 10.83 +/- 2.03 and 14.68 +/- 3.64 mU/l for the lean, non-diabetic obese and NIDDM subjects, respectively. After lovastatin therapy only the obese group exhibited a significant change in FPI (15.35 +/- 2.47 mU/l) (P < 0.05). Total cholesterol levels were similar in all three groups both before and after lovastatin therapy but within each group lovastatin therapy significantly reduced the total cholesterol by 32, 29 and 34% in the lean, obese and NIDDM subject groups respectively (P < 0.0001). Lovastatin therapy reduced LDL-cholesterol levels by 40, 32 and 46% in the lean, obese and NIDDM subjects, respectively, but produced no significant effect on HDL or triglyceride levels. Before therapy, the plasma acetylyhydrolase activities were 104 +/- 7, 164 +/- 7 and 179 +/- 7 nmol/ml per min in the lean, obese and NIDDM subjects, respectively. Lovastatin therapy reduced plasma acetylhydrolase levels to 70 +/- 7, 87 +/- 6 and 86 +/- 7 nmol/ml per min in the lean, obese and NIDDM subjects, respectively. Plasma acetylhydrolase activity was predominantly (> 80%) associated with LDL cholesterol both before and after lovastatin treatment. Also, plasma acetylhydrolase activity significantly correlated with fasting plasma insulin levels before lovastatin therapy but not after. Taken together, this study clearly implicates PAF metabolism in three defects associated with the insulin resistance syndrome: hypercholesterolemia, obesity and NIDDM. Additionally, we conclude that chronic hyperinsulinemia may play a significant role in the production of plasma acetylhydrolase.