Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function

The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged >/= 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group

[Insulin edema about 3 cases]

Insulin edema is known since a long time as a rare complication of insulin therapy. However, even today its pathogenesis remains unclear. Possible mechanisms involved are increased sodium retention by the kidney [2, 3] and increased loss of albumin from the circulation because of an insulin-induced increase in vascular permeability. We report three cases of adult patients, which presented with edema under insulin treatment. The first observation is a 52-year-old woman with diagnosed diabetes for 1 year, who developed edema a few days after initiation of insulin treatment [0, 9 Ul/kg/d]. The second observation is a 54-year-old woman who developed, ten years after initiation of insulin, generalized edema and two episods of cardiac failure, The third observation is a 42-year-old woman with type 1 diabetes since she was 20 years old. She presented an edema 20 years after the beginning of insulin treatment. In the two first cases, the stopping of insulin treatment resulted in resolution of edema. In the third one, any another cause of edema had been found. Insulin edema is a rare complication that always must be kept in mind, even after a long period of insulin treatment. In almost all the cases, it is not clinically evident. However, it sometimes leads to severe complications like cerebral edema or cardiac failure. A precocious diuretic treatment may prevent those complications

[Microangiopathte among the patients type 2 diabetes at diagnosis]

Chronic complications may he preset at the moment of diagnosis in type 2 diabetes. To study the retinopathy and the nephropathy among recently diagnosed patients, we analyzed data of 194 patients admitted in our department and who underwent screening for these two complications. The mean age was 56.0 +/- 12.9 years and 52.6% of patients were female. Retinopathy was diagnosed in 7.2% of patients and was associated with lower BMI compared to patients without retinopathy. Nephropathy was identified in 7.7% of patients, who had higher systolic and diastolic blood pressure and higher serum cholesterol levels than patients without nephropathy. These results confirm the high, frequency of retinopathy and nephropathy at the time of diagnosis in type 2 diabetes in adulthood and the lack of link between these complications. They underline the importance of their independent detection at the initial investigation