Excreción urinaria de albúmina en diabéticos no insulino-dependientes: efecto de un inhibidor de la enzima convertidora de angiotensina / Albumin urinary excretion in non insulin dependent diabetic patients: effects of an angiotensin converting enzyme inhibitor

Microalbuminuria in diabetic patients is diagnostic of early renal involvement and angiotensin converting enzyme inhibitors reduce albumin excretion in these subjects. To asses the effect of ACEI on urinary albumin excretion, non insulin dependent diabetic patients with normal blood pressure were randomly assigned to receive enalapril 10 mg/day or placebo and followed during 18 months. Those with high blood pressure were randomly assigned to receive enalapril or acebutolol in doses necessary to normalize blood pressure and followed during 12 months. Every 3 month, urinary albumin excretion was measured in a 4 hour urine sample by radioimmunoassay. One hundred fifty two patients were recruited for the study and 46 were lost from follow up. In 17 subjects with normal blood pressure initial urinary albumin excretion below cutoff values (30 mg/24 h) and treated with enalapril, this parameter did not change; in 20 treated with placebo, it incresed from 5.8ñ6.1 to 18.2ñ7.5 mg/24 h. In 11 patients with normal pressure and initial urinary albumin, this parameter did not change with enalapril and increased in 10 with placebo from 87.3ñ75.1 to 253.6ñ61.1 mg/24 h. In hypertensive patients with normal urinary albumin excretion, no changes in this parameter were observed in those treated with acebutolol (n=10) or enalapril (n=14). In hypertensive with high urinary albumin excretion, it decreased from 119.2ñ8.5 to 40.0ñ4.7 mg/24 h with enalapril treatment (n=12) and no change was observed in those treated with acebutolol (n=11). In Conclusion, enalapril decreases urinary albumin excretion in non insulin dependent diabetic patients

Ejercicio y diabetes no insulinodependiente / Exercise and non-insulin dependent diabetes

La activivdad física requiere de ajustes orgánicos que se logran mediante la interacción de respuestas cardiopulmonares y cambios en la secreción de insulina y hormonas contrarreguladoras, que permiten una mayor disponibilidad inicial de glucosa y luego de ácidos grasos libres como fuentes energéticas. En el diabético no insulinodependiente (DMNID) esta adaptación metabólica tiene algunas diferencias debido a la insulinorresistencia. El entrenamiento físico en DMNID es un importante elemento terapéutico y presenta diversos beneficios, tales como un mejor control metabólico por aumento de la sensibilidad insulínica, reducción de peso y disminución del riesgo de enfermedad cardiovascular. Está contraindicado en pacientes con retinopatía severa, nefropatía moderada a severa y en DMNID descompensada. Son recomendables las prácticas aeróbicas, en sesiones de 15 a 30 min 3 veces por semana. En general, no son necesarios los ajustes de la dieta, ya que no hay riesgo de hipoglicemia, salvo en los pacientes insulinorrequirentes

Diabetes post pancreatitis: experiencia clínica en 40 casos / Diabetes secondary to pancreatitis: clinical experience in 40 cases

The clinical features and evolution of 40 patients with diabetes mellitus secondary to chronic pancreatitis were reviewed and compared with 40 insulin dependent diabetics matched for the disease duration. The diagnosis of pancreatitis was confirmed by the existence of pancreatic calcifications, surgery or autopsy and was associated to alcoholism in males and biliary diseases in females. Diabetes appeared as a mean, 3 years after the diagnosis of pancreatitis. Ninety percent of subjects required insulin and, in males, these requirements were higher than their matched controls. Episodes of ketoacidosis were less frequent than in insulin dependent patients (8 vs 48 percent p<0.001) and pulmonary tuberculosis had a higher prevalence (22.5 vs 5 percent p<0.01). Nephropathy was observed with equal frequency in both groups but the incidence of retinopathy was higher on postpancreatic diabetics (38 vs 20 percent p<0.01). It is concluded that the features of diabetes secondary to chronic pancreatitis are similar to those of insulin dependent diabetes, with some quantitative differences