Clinical & immunological profile of newly diagnosed patients with youth onset diabetes mellitus.

Background & objectives: There has been a rise in the incidence of diabetes mellitus in the younger population of India. There are limited data available on the immunological profile of youth onset diabetes mellitus (DM) especially in type 2. Therefore, this study was undertaken to evaluate the clinical and immunological profile of youth onset DM in north India. Methods: Fifty one consecutive patients of 8-35 yr of age with diabetes mellitus attending the Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, and Hormone Care and Research Center at Ghaziabad, Uttar Pradesh, India, were included in the study. All subjects were tested for glutamic acid decarboxylase (GAD), an islet cell antigen ICA512/IA2, and insulin antibodies. GAD and ICA512/IA2 were done by ELISA and insulin autoantibodies were tested by radioimmunoassay (RIA) method. These patients were also screened for hepatitis A to E, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) as trigger factors for onset of type 1 DM. Results: of the total 51 patients, 38 were men and 13 were women. The mean age and BMI of the subjects was 19.7 (±7) years and 21 (± 5) kg/m2, respectively. Twenty patients were below the age of 18 yr and their height was more than 75th percentile of Indian standards. All patients were symptomatic and 12 of these presented with ketoacidosis. only 48 per cent (n=24) were positive for GAD, 14 per cent (n=7) for ICA512/IA-2, and 28% (n=14) were positive for insulin antibody. Five of these patients had evidence of hepatitis E virus infection. None of the subjects had evidence of active CMV or EBV infection. Interpretation & conclusions: About half of the youth onset diabetes mellitus patients from north India had presence of pancreatic autoimmunity in the form of GAD, ICA512/IA2, and insulin antibodies or a combination of antibodies suggestive of having type 1 DM. Further studies need to be done on a large sample size in different parts of the country.

Mean platelet volume is associated with glycaemic control and retinopathy in patients with Type 2 Diabetes Mellitus / Volumen medio de plaquetas está asociado con el control glucémico y la retinopatía en pacientes con Diabetes Mellitus Tipo 2

OBJECTIVES: To investigate the relationship between mean platelet volume (MPV) and glycometabolic indices, to compare MPV according to HbA1c levels, and to analyse the difference in MPV between patients with and without microvascular complications. METHODS: This retrospective study was conducted on 60 Type 2 diabetic patients and 50 age- and sex-matched non-diabetic controls. We obtained demographic, clinical and laboratory data including MPV, platelet count, fasting and postprandial blood glucose (FBG and PBG), haemoglobin A1c (HbA1c), lipid profile, creatinine, systolic and diastolic blood pressure (BP) in patient and control groups, and diabetic microvascular complications including nephropathy, neuropathy, and retinopathy in the patient group. All analyses were performed using SPSS version 15.0 for Windows. RESULTS: Mean platelet volume in the diabetic group was higher than in the control group (p = 0.001). Mean platelet volume was positively correlated with FBG and HbA1c levels (p = 0.03 and p < 0.001, respectively). It was also negatively related to platelet count (p < 0.001). Mean platelet volume in patients with HbA1c > 7% was significantly higher than those with HbA1c < 7% (p < 0.001). Mean platelet volume was significantly increased in patients with retinopathy compared to those without retinopathy (p = 0.04). CONCLUSION: This study has shown that an increased MPV is closely associated with poor glycaemic control, which may be a risk factor for diabetic retinopathy. Nonetheless, further prospective studies are needed to assess the relationship between MPV, glycaemic indices and microvascular complications.

OBJETIVOS: Investigar la relación entre el volumen medio de plaquetas (MPV) y los índices glicometabólicos, comparar el MPV según los niveles de HbA1c, y analizar la diferencia de MPV entre los pacientes con y sin complicaciones microvasculares. MÉTODOS: Este estudio retrospectivo se realizó en 60 pacientes diabéticos tipo 2, y 50 controles no diabéticos pareados por sexo y edad. Obtuvimos datos demográficos, clínicos y de laboratorio - incluyendo MPV, conteo de plaquetas, glucosa en sangre en ayunas (FBG) y postprandial (PBG), hemoglobina A1c (HbA1c), perfil lipídico, creatinina, presión arterial (BP) sistólica y diastólica en los grupos de pacientes y de control, así como complicaciones microvasculares diabéticas, incluyendo nefropatía, neuropatía y retinopatía en el grupo de pacientes. Todos los análisis se realizaron utilizando el SPSS versión 15.0para Windows. RESULTADOS: El volumen medio de plaquetas en el grupo diabético fue superior al del grupo control (p = 0,001). El volumen medio de plaquetas guardó una correlación positiva con el FBG y los niveles de HbAlc (p = 0.03 y p < 0.001, respectivamente). También se observó una correlación negativa con el conteo de plaquetas (p < 0.001). El volumen medio de plaquetas en los pacientes con HbA1c > 7% fue significativamente mayor que en aquellos con HbAlc < 7% (p < 0.001). El volumen medio de plaquetas aumentó significativamente en los pacientes con retinopatía en comparación con aquellos sin retinopatía (p = 0,04). CONCLUSIÓN: Este estudio mostró que el aumento de MPV está estrechamente relacionado con un control glicémico pobre, lo cual puede ser un factor de riesgo para la retinopatía diabética. Sin embargo, otros estudios prospectivos son necesarios para evaluar la relación entre MPV, los índices glicémicos, y las complicaciones microvasculares.

Association of HbA1c level with nutritional status in community-based patients with type 2 diabetes / 中华内分泌代谢杂志

Objective To explore the possible correlation between HbA1c level and nutritional status in community.based patients with type 2 diabetes.Methods A totaI of 219 type 2 diabetes patients were assigned into 2 groups:one with HbAIc<6.5%(n:108)and HbA1f≥6.5%(n=111).Metabolic parameters,food components.and nutritional status were compared between 2 groups.Results (1)49.32% of the participants attained HbA1c<6.5%.(2)HbA1c level was positively correlated with fasting plasma glucose,postprandial plasma glucose,and homeostasis assessment for insulin resistance(HOMA-IR)(r were 0.56,0.49,and 0.20,respectively,P<0.05 or P<0.01),but negatively correlated with high-density lipoprotein-cholesterol(HDL-C)(r=0.16,P<0.05).(3)Linear regression analysis showed that energy,carbohydrate,protein,and fat were the independent risk factors of HbA1c(all P<0.05).(4)Patients with HbA1c<6.5%consumed more fruits.The intake of pure energy-providing foods and protein-,fat-,or saturated fatty acid-rich foods were more frequent in patients with HbA1c≥6.5%(P<0.05).(5)The linear regression revealed that HbA1c level were decreased 0.36%(P<0.10)or 0.46%(P<0.01)by intake of more fruits,roughage and beans,and HbA1c levels were also decreased 0.42%(P<0.05)or 0.37%(P<0.10)by intake of less meat or oils.Conclusions In communitybased patients with type 2 diabetes mellitus,the incidence of HbA1c<6.5% remains low,There exists great difference in nutritional status between the groups with high and low HbA1c levels.The impact of diet OB HbA1c level is great.It's necessary to emphasize the importance of diet therapy far better diabetes control.

Influence of out-hospital nursing with no gap on the level of HbAlc for patients with diabetes / 中国实用护理杂志

Objective To know the influence of out-hospital nursing with no gap on the level of HbAlc for patients with diabetes.Methods Divided 80 patients with diabetes into the intervention group and control group randomly,there were 40 cases in the each group.Out-hospital nursing cares with no gap were used in the intervention group,while the routine nursing cares were used in the control group.Fellowed up 1 year.Compared the FPG,2 hPG and HbAlc between the two groups at the time points of the 3rd,6th,9th and 12th month when out of hospital.Results All the indexes which had monitored were better in the intervention group than those of in control group.Conclusions Out-hospital nursing with no gap can remain the indexes in the normal level,and then promote their quality of life,which should be developed in clinical field.

Correlation between molecular weight of plasma albumin determined with mass spectrometry and glycation indices in factory workers

<p><b>OBJECTIVES</b>To determine the difference in molecular weights of albumin in factory workers caused by non-enzymatic glycation of plasma albumin using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF/MS), and examine the epidemiological validity of this method.</p><p><b>METHODS</b>Forty-eight male workers were tested by random sampling. The difference in molecular weights (ΔM) between the subjects' albumin and human serum albumin was determined by MALDI TOF/MS. Correlations between ΔM vs. fructosamine, fasting plasma glucose (FPG) and HbAlc were investigated.</p><p><b>RESULTS</b>ΔM showed a significant correlation with all of the tested glycation indices (ΔM vs. fructosamine: r=0.487, p<0.001) (ΔM vs. FPG: r=0.482, p<0.01) (ΔM vs. HbAlc: r=0.397, p<0.01).</p><p><b>CONCLUSIONS</b>Since a significant correlation between ΔM and the glycation indices was found in this investigation, further study with a larger number of subjects is needed for use in clinical applications.</p>

Utility of Serum Fructosamine as a Measure of Glycemia in Elderly Diabetic Patients

BACKGROUND: Glycemic profile has traditionally been with the use of HbAlc over a 2 to 4 month period. Recently, serum fructosamine is highly sensitive to acute metabolic deterioration(period 2 to 3 weeks), and is suitable for automation, allowing multiple assays with minimal effort. In some report, despite evidence suggesting a reduction in serum albumin level with increasing age, serum fructosamine was strongly correlated with HbAlc in elderly diabetic patients. This study was conducted to define the correlation between fructosamine and other parameters in elderly diabetic patients. METHODS: The study group consisted of 56 elderly patients(age range : 66-85 years, group A) and 58 adult patients(age range: 18-64 years, group B), who were stable over recent 2 months in fasting glucose values and serum albumin levels. Fructosamine was measured in 114 diabetic patients. The measured levels were related to HbAlc and fructosamine/albumin index(FAI). RESULTS: 1) There was significant correlation between HbAlc and fructosamine in all diabetic patients(r=0.705, p=0.0001). The correlation between HbAlc and fructosamine was stronger in group A than in group B [group A: r=0.831, group B: r=0.367, p=0.0001](p<0.05). 2) The correlation between HbAlc and FAI was significantly stronger compared to that between HbAlc and fructosamine in elderly diabetic patients(p<0.05). 3) Glycation ratio provides a vector-like insight into the recent trend of glycemia, and Glycation ratio was stable in all diabetic patients. CONCLUSIONS: Our study suggests that correlation between HbAlc and fructosamine in elderly daibetic patients was significantly lower in adult diabetic patients. Further studies are needed to determine the ultimate values of this test in the clinical management of elderly patient with diabetes.

Serial Changes of Blood Glucose Levels in IDDM Patients Using Intermediate-acting Insulin only Therapy

PURPOSE: We investigated the clinical characteristics of IDDM patients, treated with NPH only, and evaluated current problems by measurement of serial blood glucose, insulin, C-peptide for 12 hours after administration of intermediate-acting insulin. METHODS: We studied 19 IDDM patients who had been diagnosed and followed up on a regular basis at Severance hospital. They were assigned into 2 groups, one(HbA1c high group) with HbA1c above 12%, the other(HbA1c low group) showing HbA1c below 12%. Their Heights, DM durations, HbA1c, basal C-peptides were primarily measured. Using continuous withdrawal pump, samples were taken every hour for 12 hours from 7:00 am. And serial blood glucose, insulin, C-peptide were assayed. RESULTS: 1) The mean HbA1c of the high group was 16.5+/-3.5% and that of the low group was 11.0+/-0.6%. There were no differences in clinical characteristics. 2) In HbA1c high group, fasting blood glucose, and mean blood glucose levels for 3hours were 156+/-85mg%, 284+/-125mg%(8,9,10am), 250+/-133mg% 11,12am,1pm), 252+/-122mg%(2,3,4pm), and 182+/-105 mg%(5,6,7pm), respectively. In low group, fasting blood glucose, and mean blood glucose levels for 3hours were 130+/-71mg%, 275+/-109 mg%(8,9,10am), 249+/-129mg%(11,12am,1pm), 231+/-81mg%(2,3,4pm), 158+/-62mg%(5,6,7pm), respectively. 3) Fasting blood insulin level was 51+/-47 U/l in high group, 62+/-62 U/l in low group. Thereafter low HbA1c group showed higher insulin levels than high HbA1c group. 4) Fasting blood C-peptide was 0.16+/-0.20 g/l in the high group, and 0.34+/-0.14 g/l in low group. Thereafter low group developed higher C-peptide responses than high group. The curve of C-peptide showed similar change of blood glucose, and maximal response followed 1-2 hours after maximal level of blood glucose. CONCLUSIONS: We concluded that short-acting insulin should be included for good control of blood glucose. Although fasting & dinner blood sugar seemed to be under fair control, intermediate-acting insulin used alone was not effective in preventing severe blood sugar elevation after morning meal.