Diabetic retinopathy is associated with early autonomic dysfunction assessed by exercise-related heart rate changes

Diabetic retinopathy has been associated with cardiac autonomic dysfunction in both type 1 and type 2 diabetes mellitus (DM) patients. Heart rate (HR) changes during exercise testing indicate early alterations in autonomous tonus. The aim of the present study was to investigate the association of diabetic retinopathy with exercise-related HR changes. A cross-sectional study was performed on 72 type 2 and 40 type 1 DM patients. Autonomic dysfunction was assessed by exercise-related HR changes (Bruce protocol). The maximum HR increase, defined as the difference between the peak exercise rate and the resting rate at baseline, and HR recovery, defined as the reduction in HR from the peak exercise to the HR at 1, 2, and 4 min after the cessation of the exercise, were determined. In type 2 DM patients, lower maximum HR increase (OR = 1.62, 95 percentCI = 1.03-2.54; P = 0.036), lower HR recovery at 2 (OR = 2.04, 95 percentCI = 1.16-3.57; P = 0.012) and 4 min (OR = 2.67, 95 percentCI = 1.37-5.20; P = 0.004) were associated with diabetic retinopathy, adjusted for confounding factors. In type 1 DM, the absence of an increase in HR at intervals of 10 bpm each during exercise added 100 percent to the odds for diabetic retinopathy (OR = 2.01, 95 percentCI = 1.1-3.69; P = 0.02) when adjusted for DM duration, A1c test and diastolic blood pressure. In conclusion, early autonomic dysfunction was associated with diabetic retinopathy. The recognition of HR changes during exercise can be used to identify a high-risk group for diabetic retinopathy.

Proliferative diabetic retinopathy is associated with microalbuminuria in patients with type 2 diabetes

Diabetic retinopathy is one of the leading causes of blindness in working-age individuals. Diabetic patients with proteinuria or those on dialysis usually present severe forms of diabetic retinopathy, but the association of diabetic retinopathy with early stages of diabetic nephropathy has not been entirely established. A cross-sectional study was conducted on 1214 type 2 diabetic patients to determine whether microalbuminuria is associated with proliferative diabetic retinopathy in these patients. Patients were evaluated by direct and indirect ophthalmoscopy and grouped according to the presence or absence of proliferative diabetic retinopathy. The agreement of diabetic retinopathy classification performed by ophthalmoscopy and by stereoscopic color fundus photographs was 95.1 percent (kappa = 0.735; P < 0.001). Demographic information, smoking history, anthropometric and blood pressure measurements, glycemic and lipid profile, and urinary albumin were evaluated. On multiple regression analysis, diabetic nephropathy (OR = 5.18, 95 percent CI = 2.91-9.22, P < 0.001), insulin use (OR = 2.52, 95 percent CI = 1.47-4.31, P = 0.001) and diabetes duration (OR = 1.04, 95 percent CI = 1.01-1.07, P = 0.011) were positively associated with proliferative diabetic retinopathy, and body mass index (OR = 0.90, 95 percent CI = 0.86-0.96, P < 0.001) was negatively associated with it. When patients with macroalbuminuria and on dialysis were excluded, microalbuminuria (OR = 3.3, 95 percent CI = 1.56-6.98, P = 0.002) remained associated with proliferative diabetic retinopathy. Therefore, type 2 diabetic patients with proliferative diabetic retinopathy more often presented renal involvement, including urinary albumin excretion within the microalbuminuria range. Therefore, all patients with proliferative diabetic retinopathy should undergo an evaluation of renal function including urinary albumin measurements.

Abnormalities in gallbladder dynamics of type 1 (insulin-dependent) diabetic patients with autonomic neuropathy

The aim of this study was to evaluate gallbladder dynamics in insulin-dependent diabetic patients with and without autonomic neuropathy. Gallbladder dynamics was studied by a scintigraphicmethod after a test meal in 26 insulin-dependent diabetic patients and 10 normal individuals. The presence and severity of autonomic neuropathy were defined according to the number of abnormal cardiovascular reflex tests: absent (no abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the begnning of gallbladder emptying was longer (P = 0.01) in diabetic patients with mild (N = 11,12.1 ñ 7.6 min) and severe neuropathy (N = 8,11.0 ñ 10.6 min) than diabetic patients without autonomic neuropathy (N = 7,3.9 ñ 4.4 min) and controls (N = 10,4.8 ñ 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8,5.1 ñ 3.3 percent/min) than diabetic patients with mild (N = 11,2.) ñ 1.0 percent/min) or without autonomic neuropathy (N = 7,1.8 ñ 0.8 por cento/min) and controls (N = 10,2.6 ñ 1 percent/min). Thirty-two percent of the diabetic patients with autonomic neurpathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlation of ejection rate with the presence of these symptoms (biserial point correlation test = 0.67,P<0.01) was also observed. These data suggest that insulin-dependent diabetic patients with autonomic neuropathy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal sumptoms

Análise de fatores associados à recorrência de bócio pós-tiroidectomia / Analysis of the factors associated to recurrence of post-thyroidectomy goiter

Os fatores associados à recidiva de bócio pós-tiroidectomia por doença benigna da tiróoide ainda näo estäo completamente definidos, especialmente o uso profilático de hormônio tiroidiano. Objetivo. Determinar a prevalência, características e fatores associados à recorrência de bócio em pacientes submetidos à tiroidectomia por doença benigna. Métodos. Foram incluídos 66 pacientes, 53 mulheres e 13 homens (idade média = 51 anos, variaçäo = 20-82 anos) submetidos previamente (5,6 + or - 1 anos) à tiroidectomia (lobectomia, n = 50; nodulectomia, n = 5; tiroidectomia subtotal, n = 11). Na ocasiäo do estudo foi realizada ecografia de tiróide e dosagens séricas de T3, T4, TSH e anticorpos antimicrossomal. Definiu-se como recorrência de bócio a presença de volume residual >20mL e/ou novos nódulos >0,5mL à ecografia e näo previamente detectados durante a cirurgia. Resultados. SEte pacientes (10 por cento) apresentaram recorrência de bócio. O tempo de acompanhamento foi mais longo no grupo com recorrência (p < 0,5) e näo foi observada diferença em relaçäo a idade, sexo presença de história familiar de tiropatia e diagnóstico pré-operatório entre os dois grupos. Na análise de regressäo múltipla, apenas o tmepo de acompanhamento pós-tiroidectomia foi significativamente associado à recorrência de bócio (ß = 0,02;//2 = 0,16; p < 0,05), influenciando em 14 por cento a taxa de recorrência. História familiar de tiropatia, uso de hormônio tiroidiano e níveis séricos de T4 e TSE näo influenciaram a recorrência. Conclusäo. A recorrência de bócio pós-tiroidectomia por doença benigna de tiróide ocorre numa minoria de pacientes e estáa relacionada com o maior tempo de acompanhamento após a cirurgia. O uso de hormônio tiroidiano em doses näo supressiva após a cirurgia näo se relaciona à prevençäo de recorrência

Risk factors for development of proteinuria by type II (non-insulin dependent) diabetic patients

1. Renal involvement in non-insulin dependent diabetes mellitus patients is the single most important cause of renal failure. The aim of this study was to evaluate the clinical features and to assess the risk factors for the development of proteinuria by non-insulin dependent diabetic patients. 2. Risk factors (expressed as an odds ratio) were calculated by multiple logistic regression analysis taking into account age, sex, body mass index, known duration of diabetes, presence of arterial hypertension, fasting plasma glucose, cholesterol and triglycerides as independent variables and proteinuria as the dependent variable. Sixty-four normoalbuminuric (24-h albumin excretion rate < 30 micrograms/min, 27 females, mean age 53.7 years) and 53 proteinuric (24-h proteinuria > 0.5 g, 31 females, mean age 59.3 years) were studied. 3. Proteinuric patients were older, with a longer mean known duration of diabetes (12.4 vs 5.6 years), higher mean fasting plasma glucose (214 vs 168 mg/dl) and plasma creatinine (1.5 vs 1.1 mg/dl) and more frequently presented diabetic retinopathy (94 per cent vs 23 per cent ), peripheral neuropathy (94 per cent vs 23 per cent ) and arterial hypertension (73 per cent vs 16 per cent ) than normoalbuminuric patients. Age > 50 years, body mass index > 28.6 kg/m2, known duration of diabetes > 10 years, presence of arterial hypertension, and fasting plasma glucose > 160 mg/dl were significantly and independently associated with development of proteinuria

Effect of age and sex on glomerular filtration rate measured by 51Cr-EDTA

The effect of age and sex on glomerular filtration rate (GFR) was measured by the 51 Cr-EDTA radioisotopic method in 76 normal individuals (43 women and 33 men). Age has a significant effect on GFR. Subjects aged 41 to years have GFR values [104,5 ñ 16.5 ml min-1 (1.73 m2)-1, N=43] lower than younger individuals aged 20 to 40 years [116.6 ñ 11.2 ml min-1 (1.73 m2)-1, N=33]. GFR decreases after 40 years of age by approximately 6.0 ml min-1 (1.73 m2)-1 per decade. GFR values in women [105.9 ñ 16.0 ml min-1 (1.73 m2)-1, N=43] were lower when compared to men [114.8 ñ 14.3 ml min-1 (1.73 m2)-1, N=33]. We conclude that the effect of sex and age must be taken into account when establishing reference values for GFR

A short-term low-protein diet reduces glomerular filtration rate in insulin-dependent diabetes mellitus patients

1. The effect of a 7-day low-protein diet on renal function was studied in 17 normotensive, normoalbuninuric, insulin-dependent diabetes (IDDM) patients. Glomerular filtration rate (GRF) and urinary albumin excretion (UAE) were measured after 7 days on an isocaloric low-protein diet (0.5g protein/Kg per day). 2. Compliance was confirmed by 24-h urinary urea levels, GFR was measured after a single injection of 51Cr-EDTA and UAE by radioimmunoassay. 3. GFR was reduced by 13.8% on the low-protein diet (139ñ 27.7 vs 120.4 ñ 25.1 ml min-1 (1.73m2) (P < 0.05). This effect was of the same magnitude as that obtained by others after long-term strict metabolic control. No changes were observed in UAE (5.6 ñ 6.4 vs 5.7 ñ 6.8 microng/min) during the study. The patients were classified as hyperfiltering (N = 9; GFR = 160.3 ñ 16.6 ml min-1(1.73m2)-1 or normofiltering (N = 8; 117.1 ñ 17.6 ml min-1(1.73m2)-1) on the basis of GFR, and no diference in the reduction of GFR was observed in either group. 4. The reduction in GFR is probably caused primarily by the reduction of protein intake since other factors that might influence the GFR such as glucose control and blood pressure did not change during the study