Lipoprotein(a) levels in black and white children and adolescents with IDDM.

OBJECTIVE: To examine the relationship between levels of lipoprotein(a) [Lp(a)], diabetes, and glycemic control in white and black nondiabetic control and insulin-dependent diabetic (IDDM) children and adolescents, fasting blood analyses were conducted on a subject sample drawn from referral-based diabetes and endocrine clinics and a primary-care general pediatric clinic. RESEARCH DESIGN AND METHODS: Thirty-six white and 16 black children with IDDM who volunteered to participate in this study were compared with 30 white and 42 black nondiabetic control children. RESULTS: Lp(a) protein levels were significantly higher (P less than 0.05) in both groups of black children compared with whites (black vs. white nondiabetic children 6.8 +/- 0.95 vs. 3.1 +/- 0.68 mg/dl and black vs. white diabetic children 7.5 +/- 1.52 vs. 3.0 +/- 0.64 mg/dl). Lp(a) protein levels directly correlated with the level of glycosylated hemoglobin (r = 0.46, P less than 0.01) in white diabetic children but not in black diabetic children. Well-controlled white diabetic children (n = 12, glycosylated hemoglobin less than 10%) had a mean Lp(a) protein level of 1.4 +/- 0.3 mg/dl compared with poorly controlled white diabetic children (n = 10, glycosylated hemoglobin greater than 13%) whose mean Lp(a) protein level was 5.7 +/- 1.7 mg/dl (P less than 0.01). CONCLUSIONS: We conclude that circulating levels of Lp(a) protein are increased in hyperglycemia. A genetically determined elevated level of Lp(a) is a risk factor for atherosclerotic disease in white and Asian adults. Elevated Lp(a) should be investigated as an independent risk factor for atherosclerotic disease in IDDM. It could prove to be an additional mechanism for the development of diabetic complications in selected populations.     

Total serum glycosylated proteins in detection and monitoring of gestational diabetes

The goal of this study was to determine whether serum glycosylated protein levels (i.e., fructosamine) can reliably screen for gestational diabetes and whether these levels are valid markers of short-term glycemic control in the third trimester of pregnancy. Ninety-seven pregnant women at 26-28 wk gestation were evaluated over 9 mo. HbA1c and serum glycosylated protein (serum fructosamine) were determined at the baseline venipuncture of the 100-g oral glucose tolerance test performed to detect gestational diabetes. Of the 97 women studied, 13 tested positive for gestational diabetes (National Diabetes Data Group criteria). There were significant differences in the fasting and 1-, 2-, and 3-h glucose values between nondiabetic and diabetic patients (P less than 0.005 at each time point). No difference was noted in the baseline serum glycosylated protein level (2.02 +/- 0.08 vs. 1.98 +/- 0.02 mM, NS) or HbA1c level (4.42 +/- 0.2 vs. 4.6 +/- 0.3%, NS) between gestational and nondiabetic patients. Diabetic patients were followed at 2-wk intervals, with serum glycosylated protein analysis, HbA1c, fasting glucose, and mean glucose determined by outpatient monitoring. Serum glycosylated protein correlated significantly to fasting blood glucose (r = 0.81, P less than 0.001) and mean outpatient glucose (r = 0.62, P less than 0.001) at the 2-wk follow-up visits. No correlation was found between HbA1c and fasting blood glucose (r = 0.11, NS) or mean outpatient glucose (r = -0.12, NS) during the follow-up period. The serum glycosylated protein level (serum fructosamine) is not a useful screening test for gestational diabetes. However, this assay shows potential as an objective marker of short-term control in evaluating the maternal glycemic state.     

Blood glycated haemoglobin, serum fructosamine, serum glycated albumin and serum glycated total protein as measures of glycaemia in diabetes mellitus.

Blood glycated haemoglobin (HbAlc), serum fructosamine (FA), serum glycated albumin (GA), and serum glycated total protein (GTP) were determined in 61 subjects (19 pregnant women with gestational diabetes, 24 pregnant women with insulin-dependent diabetes mellitus [IDDM] and 18 nonpregnant subjects with IDDM). FA, GA, and GTP correlated with HbAlc similarly (r = 0.791, 0.816, and 0.794, respectively, p < 0.001). In a subgroup of 22 subjects data on blood glucose home monitoring was recorded and used for calculating mean blood glucose as an index of average glycaemia preceding sampling of the glycation products. Mean blood glucose levels preceding sampling of HbAlc by 2 months and FA, GA, or GTP by three weeks correlated significantly with HbAlc (r = 0.668, p < 0.001) and GA (r = 0.441, p < 0.05) whereas no significant correlation was found between mean blood glucose and FA (r = 0.003) or GTP (r = 0.252). In conclusion, such methods which measure specifically the non-enzymatic glycation of a single species of protein (i.e. FPLC for HbAlc and affinity chromatography for GA) are to be preferred for assessing glycaemia.     

糖化白蛋白在妊娠期糖尿病筛查及诊断中的价值探讨

目的：评价糖化白蛋白（GA）测定在妊娠期糖尿病诊断中的价值。方法选取2011年9月-2012年3月在我院进行产前检查并于24-28周接受50 g 葡萄糖糖尿病筛查结果异常的孕妇160例,以第7版《妇产科学》的诊断标准分为糖耐量正常组,糖耐量受损组,糖尿病组。对三组的空腹血糖（FPG）,糖化血红蛋白（HbA1c）,糖化白蛋白（GA）等进行对比研究,评价 GA 在妊娠期糖尿病诊断中的价值。结果三组的 FPG、HbA1c、GA 结果有显著性差异,三组中 GA 与 HbA1c 均具有相关性。结论糖化白蛋白（GA）的测定对妊娠糖尿病病变程度的变化具有提示作用,对妊娠期糖尿病的筛查和诊断具有价值,可作为临床应用。     

The effect of exercise on urinary excretion of different size proteins in patients with insulin-dependent diabetes mellitus

To examine whether exercise-induced proteinuria in diabetes is dependent upon the size of the excreted protein, we measured urinary excretion of beta 2-microglobulin, kappa light chains, albumin and IgG before and after 20 min of moderate ergometer exercise in 34 patients with insulin dependent diabetes mellitus (IDDM) and in eight healthy control subjects. Seventeen patients with newly diagnosed IDDM and 17 patients (seven of which had elevated albumin excretion rate) with longstanding IDDM were studied. Exercise did not significantly influence protein excretion in control and newly diagnosed IDDM subjects. In contrast, exercise enhanced excretion of beta 2-microglobulin (p less than 0.05-0.01), kappa light chains (p less than 0.001), albumin (p less than 0.005-0.001) and IgG (p less than 0.01-0.001) in patients with long-standing IDDM independently of whether the patient had proteinuria in the resting state or not. In conclusion, proteinuria induced by moderate exercise is not observed in the early stages of IDDM, and is independent of the size of the excreted protein. Therefore, moderate exercise does not appear to influence the size selectivity of the glomerular capillary wall in patients with longstanding IDDM.     

Age of onset and type of diabetes

The age of onset and the clinical type of diabetes mellitus were evaluated on the basis of a cross-sectional study of medical records of 14 municipal health centers in East Finland. Altogether 281 patients were classified as having insulin-dependent (IDDM) and 2713 as having non-insulin-dependent (NIDDM) diabetes. Nearly all patients diagnosed before the age of 19 had IDDM, but a large proportion (37%) of all diagnoses of IDDM were made after that age. Six percent of all diabetic subjects in the age group 15-19 yr were classified as NIDDM and the proportion increased rapidly in older age groups. Half of the patients with NIDDM were diagnosed over the age of 64.     

Non-enzymatic glycosylation of immunoglobulins in diabetic nephropathy

BACKGROUND: Diabetic nephropathy is a relatively common microvascular complication in people suffering from diabetic mellitus. Chronic hyperglycemia leads to the accumulation of advanced glycosylation end products (AGEs) that covalently trap extravasated serum proteins such as immunoglobulins, albumin, and LDL through glucose derived cross-linking to the extra vascular matrix. METHODS: Serum fructosamine, glycosylated hemoglobin and percent glycosylation of IgG, IgA, IgM were measured in five different groups of human subjects: 50 normal individuals; 40 type 2 DM patients; 42 type 1 DM patients; 40 type 2 DM patients with nephropathy and 37 type 1 DM patients with nephropathy. RESULTS: Patients with long-term history of diabetes and chronic hyperglycemia as well as suffering from diabetic nephropathy showed an increased glycosylated hemoglobin level and serum fructosamine as compared to those with diabetes mellitus and to the normal individuals. Glycosylation of IgG, IgA and IgM showed an increase in both type 1 and type 2 DM patients with nephropathy as compared to the diabetic patients without any complication. A positive correlation has been observed between glycosylated IgG and glycosylated hemoglobin (R2=0.522, 0.5113, 0.7117, 0.673) in type 1 and type 2 DM without and with diabetic nephropathy, respectively, whereas correlation between glycosylated IgG and serum fructosamine was observed only in type 1 and type 2 DM without nephropathy (R2=0.7318, 0.5767). CONCLUSION: The present study suggests that glycosylation of IgG is an equivalent marker for advanced glycosylation as GHb and may have some role to play in the on onset of diabetic nephropathy by altering their immunoreactivity leading to microvascular complications.     

Dopaminergic and cholinergic control of argininevasopressin secretion in type I diabetic men

Abstract. Enhanced cholinergic and dopaminergic controls of anterior pituitary function have been described in insulin-dependent diabetes mellitus (IDDM). In order to verify whether similar neurotransmitter alterations also affect the regulation of posterior pituitary hormone secretion, the argininevasopressin (AVP) responses to the dopaminergic agonist apomorphine and in a different occasion to physostigmine, an acetylcholinesterase inhibitor, were evaluated in normal ( n =10) and type I diabetics ( n = 16). In addition, a control test with normal saline was performed in all subjects. None of the diabetic patients were affected by neuropathy or other diabetic complications. They were divided into two groups according to the duration of their disease (less than 10 years: group 1, n = 8; more than 10 years: group 2, n = 8). Physostigmine (12.5 μg kg^-1) was infused intravenously over 10 min; apomorphine (60 μg kg^-1) was injected subcutaneously. Basal AVP concentrations were similar in all groups and remained constant during the control test. In contrast, both drugs induced significant increments in plasma AVP levels in the normal controls and diabetic subjects. However, physostigmine- and apomorphine-induced AVP increments were twofold higher in diabetics than in control subjects. No significant differences were observed between diabetics of groups 1 and 2. No significant correlations between duration of diabetes and peak AVP responses to physostigmine or apomorphine were found within each group or when all diabetic subjects were considered together. These data indicate enhancement of both dopaminergic and cholinergic stimulatory regulations of AVP secretion in patients with uncomplicated IDDM, regardless of the duration of diabetes.     

Hyperzincuria in IDDM women. Relationship to measures of glycemic control, renal function, and tissue catabolism

Eighteen women with insulin-dependent diabetes mellitus (IDDM) and 15 nondiabetic women participated in a study of the relationship of zincuria to measures of glycemic control, renal function, and tissue catabolism. In the IDDM women, mean +/- SE glycosylated hemoglobin was 9.8 +/- 0.5%, and fasting plasma glucose was 189 +/- 19 mg/dl; duration of diabetes averaged 15 yr. In comparison with control women, the IDDM women excreted four times as much zinc in the urine. However, the total plasma zinc concentration was significantly higher in the IDDM than in the control women (14.7 vs. 13.4 microM). The increased urinary zinc loss in the IDDM women was not related to urine volume, urinary glucose excretion, fasting plasma glucose concentration, percent glycosylated hemoglobin, or an increased glomerular filtration rate. Total urinary protein losses were four times higher in the IDDM women than in the control women, and these urinary protein losses correlated with the urinary zinc losses (P less than .007). There was no relationship between urinary zinc and the excretion of any of the amino acids, urea, or ammonia. The results of this study show that hyperzincuria in diabetes is not associated with lower plasma zinc levels. An increased zinc absorption, decreased intestinal zinc excretion, or increased tissue catabolism may support higher plasma zinc levels.     

糖化血红蛋白胱抑素C及视黄醇结合蛋白在糖尿病肾病早期诊断中的表达

目的探讨血清胱抑素C(Cys C)、视黄醇结合蛋白(RBP)及糖化血红蛋白(HbA1c)联合检测对糖尿病肾病早期诊断的诊断价值。方法同时检测106例单纯糖尿病患者(DM组)、95例糖尿病肾病患者(DN组)和108例健康者(健康对照组)血清Cys C、RBP及HbA1c,按照HbA1c的含量分成高、中、低组,并进行相关统计学分析。结果 DM组HbA1c(高值为10.80%±1.80%)与健康对照组(4.70%±0.98%)比较,差异有统计学意义(P<0.01),Cys C、RBP差异无统计学意义(P>0.05);DN组HbA1c高值组HbA1c12.8%±1.8%、Cys C(1.52±0.28)mg/L、RBP(180.4±81)mg/L与健康对照组HbA1c4.70%±0.98%、Cys C(0.58±0.15)mg/L、RBP(42.30±8.63)mg/L比较,差异均有统计学意义(P<0.01)。结论 HbA1c、RBP及Cys C在糖尿病肾病早期诊断中的表达是非常敏感和特异的。     

Inpatient rehabilitation of diabetic patients--immediate metabolic effects

In 1981 the Rehabilitation Centre Laab (A-2381 Laab im Walde, Austria) had admitted a total of 1149 patients. These included 968 patients with diabetes mellitus (431 male, 537 female), of whom 428 (44.21 percent) had been insulin-dependent (IDDM) and 540 (55.79 percent) non-insulin-dependent (NIDDM). The mean blood glucose (MBG) levels present at the time of admission indicated that glycemic control was better in patients with IDDM than those with NIDDM. The poorest glycemic control was encountered in NIDDM of (A) age 31-40 (MBG = 187 mg/dl) and (B) over age 70 (MBG = 194 mg/dl); it had been possible in these patients to lower MBG to (A) 138 mg/dl and (B) 147 mg/dl. Juvenile IDDM patients (under age 30) had poorer glycemic control (MBG = 190 mg/dl) than the older IDDM patients (MBG = 181 mg/dl), and therapeutic success was greater in the latter group. Concluding from the glycohaemoglobin changes found, improvements in glycemic control were achieved in 35.32 percent (IDDM: 15.39 percent; NIDDM: 19.93 percent); in 62.08 percent (IDDM: 26.65 percent; NIDDM: 35.43 percent) it had remained unchanged, and had deteriorated in 2.16 percent (IDDM: 1.75 percent; NIDDM: 0.41 percent). For 13 patients treated so far by diet alone, oral medication had to be started; 2 patients (0.2 percent) required immediate introduction of insulin. In 126 patients (12.9 percent) on oral medication, insulin therapy had to be initiated, whereas in 32 cases (3.3 percent) oral medication was discontinued in favour of purely dietetic control.     

Radioimmunoassay of glycosylated albumin with monoclonal antibody to glucitol-lysine

An immunoassay specific for glycosylated albumin was developed by the use of beads coated with antibody to human serum albumin (beads) and 125I-labelled monoclonal antibody to reduced bovine glucosylated low density lipoprotein. One bead was capable of binding 100 ng of serum albumin which had been treated with sodium borohydride (NaBH4) to reduce the Schiff base in the protein. The monoclonal antibody reaction with glucitol-lysine epitopes on the reduced glucosylated proteins and amino acids studied, including human serum albumin (HSA), bovine serum albumin and hippuryl-L-lysine. The detection limit of this assay was 100 pmol/mg HSA, which was sensitive enough for clinical use. The mean serum reduced glycosylated albumin concentration measured by this new method was significantly higher in diabetic patients (2.63 +/- 0.35 nmol/mg HSA, n = 32) than in healthy subjects (0.53 +/- 0.05 nmol/mg HSA, n = 38). The serum reduced glycosylated albumin concentration correlated with both hemoglobin A1c (r = 0.69, p less than 0.005) and the fasting blood glucose level (r = 0.51, p less than 0.005) in diabetic patients.     

联合检查D-二聚体纤维蛋白原和C反应蛋白在2型糖尿病肾病中临床应用价值

目的 探讨联合检测血D-二聚体(DD)、纤维蛋白原(FIB)、C反应蛋白(CRP)水平对2型糖尿病肾病(DN)并发症的临床应用价值.方法 对已确诊的180例2型糖尿病患者同时检测其清晨空腹血DD、FIB、CRP水平,并同时收集24h尿液进行尿微量白蛋白(MA)测定,按24h尿白蛋白排泄率(UAER)将糖尿病组分3组:单纯糖尿病组(SDM组,UAER＜30mg/24h);早期糖尿病肾病组(EDN组,UAER 30～300mg/24h);临床糖尿病肾病组(CDN组,UAER＞300mg/24h).结果 2型糖尿病组患者DD、FIB和CRP水平在单纯糖尿病组已升高,与对照组比较差异有统计学意义(P＜0.01),且随UAER增加而增高,呈正相关.三组之间各指标比较,差异均有统计学意义(P＜0.01).结论 联合检查DD、FIB和CRP水平,可明显提高糖尿病早期肾脏损伤检出率,同时还发现其与糖尿病肾病的发生、发展关系密切.     

糖化白蛋白在妊娠期糖尿病监测中的研究进展

妊娠期糖尿病是孕期最常见的并发症之一, 严重威胁母婴健康, 故孕期血糖监测及控制至关重要。糖化白蛋白反映测定前2~3周平均血糖水平, 是短期血糖监测指标。与其他血糖监测指标相比, 糖化白蛋白在妊娠糖尿病中的应用更具优势, 可作为孕期血糖监测及预测母婴并发症的良好指标。然而糖化白蛋白在妊娠妇女中的应用较少, 其正常值参考范围尚未统一。本文对糖化白蛋白在妊娠期糖尿病中的研究进展进行综述。     

Comparison of two indices of glycemic control in diabetic subjects: glycosylated serum protein and hemoglobin

Glycosylated serum protein (GSP) and glycosylated hemoglobin (GHb) were measured in 263 insulin-dependent and 41 non-insulin-dependent diabetic subjects. Both indices provided useful information in type II diabetes, but were extremely poor in judging control in type I diabetes. In both groups, there was poor correlation of the fasting serum glucose with either GSP or GHb. Only 4% of type I diabetic subjects had normal values for both GSP and GHb. Of subjects with elevated GSP, 98% had elevated GHb; 25% of subjects with elevated GHb values had normal values for GSP.     

探究睡眠质量对孕产妇妊娠期糖尿病的影响

目的:探究睡眠质量对孕产妇妊娠期糖尿病的影响.方法:选取2018年1月至2019年1月邹平市妇幼保健院收治的妊娠期糖尿病孕妇100例作为观察组,选取同期的未合并妊娠期糖尿病的孕妇100例作为对照组.对照组给与基础护理干预,观察组给予心理护理干预,对2组孕妇进行糖耐量(OGTT)试验,检测血液生化指标,分析2组孕妇影响睡...     

生化检测在糖尿病肾病早期诊断中的应用及临床意义

目的：探讨生化检测在糖尿病肾病早期诊断中的应用价值及临床意义。方法将武钢总医院收治的60例糖尿病肾病患者作为观察组,同期健康体检者60例作为对照组。分别检测对照组与观察组尿清蛋白/肌酐（UALB/Cr）、血清中α1-微球蛋白（α1-MG）、C-反应蛋白（CRP）、血清胱抑素C（CysC）、糖化血红蛋白（HbA1C）含量,并进行比较,同时分析联合检测与单一检测阳性率的差异。结果观察组尿UALB/Cr、血清α1-MG、CRP、Cy-sC、HbA1C均显著高于对照组,差异有统计学意义（P＜0．05）。联合检测阳性率为93．0％,显著高于单项阳性率,差异有统计学意义（P＜0．05）。结论糖尿病肾病患者各项生化指标均可于不同时期发生变化,掌握各种生化指标的变化规律对于糖尿病肾病早期诊断及治疗意义重大。     

C-reactive protein levels in non-obese pregnant women with gestational diabetes

A low-grade systemic inflammation is concomitant in diabetes. There is a pathophysiological relation between gestational diabetes mellitus and type 2 diabetes mellitus, which was further supported by significantly elevated risk of type 2 diabetes in women with a history of previous gestational diabetes mellitus. We investigated the relation between low-grade systemic inflammation expressed as C-reactive protein and gestational diabetes in non-obese pregnant women. This study included 20 non-obese pregnant women with gestational diabetes mellitus and 30 non-obese pregnant women without gestational diabetes mellitus as a control group. The body mass index of all the subjects were < 25 kg/m2. During 26-28 gestational weeks 100-g oral glucose tolerance test was performed and simultaneously fasting C-reactive protein levels were measured. Serum median C-reactive protein level was higher in patients with gestational diabetes mellitus (p = 0.0001). C-reactive protein was strongly associated with glycemic parameters and weight gain during pregnancy. A model consisting of glucose intolerance, age, parity, and weight gain during pregnancy accounted for 61% of the variance in log C-reactive protein. We demonstrated that serum C-reactive protein level was related with gestational diabetes mellitus and weight gain during pregnancy in late second and early third trimesters.     

Early detection of neurological involvement in IDDM and NIDDM. Multimodal evoked potentials versus metabolic control

Clarification of the extent and mechanisms of damage to the central nervous system in diabetes is a frontier of current neurological research. Our aim was to obtain ample electrophysiological documentation of possible neurological abnormalities in both insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetic patients with a short duration of disease and without overt complications, taking into account metabolic control. Group 1 comprised 11 IDDM patients, and group 2 included 14 NIDDM patients treated with diet alone; the duration of disease was less than 4 yr, and no concomitant clinical complications were present. Age- and sex-matched normal subjects formed groups 3 and 4. Pattern visual evoked potentials (VEP), brain stem auditory evoked potentials (BAEP), and somatosensory evoked potentials (SEP; after the stimulation of both median and tibial nerves) were recorded in all subjects, and metabolic control was evaluated in terms of glycemia and glycosylated hemoglobin. In group 1, significant abnormalities were found in the latency values of VEP, median SEP, and tibial SEP compared with control subjects. Similar latency abnormalities were shown in group 2 for VEP, median SEP, and tibial SEP values and for wave I latency of BAEP. Glycosylated hemoglobin values were correlated with BAEP and SEP abnormalities in many patients in both groups. Furthermore, in group 2, glycemic values correlated with SEP abnormalities. We therefore conclude that neurophysiological abnormalities are present at different levels in IDDM and NIDDM patients only a few years after clinical diagnosis and before the appearance of overt complications, and these abnormalities seem to be correlated with metabolic control status.     

Oral candidiasis in patients with diabetes mellitus: a thorough analysis

It has generally been assumed that oral candidiasis occurs with increased frequency in patients with diabetes mellitus. To evaluate this, we compared the frequency and severity of oral Candida colonization in 60 patients with insulin-dependent diabetes mellitus (IDDM) admitted to a low-intensity-care diabetes unit with those in 57 age- and sex-matched controls. Swabs taken from the tongue and buccal mucosa were examined by cytology rather than culture because of the discrimination provided by the former. Cytological smears were classified according to the presence and morphology of the Candida organisms. Overall, a significant difference in Candida species colonization was found between patients with diabetes (75.0%) and controls (35.1%) (P less than .005). In the diabetic group, no relationship was found to recent use of antibiotics, total or differential white blood cell count, serum glucose, presence of diabetic retinopathy, or glycosylated hemoglobin values. We conclude that in IDDM there is a predisposition to oral candidiasis and that this predisposition is independent of glucose control.