Neurophysiological Changes In Person With Insulin Dependent And Non Insulin Dependent Diabetes Mellitus

Background: Diabetes mellitus is a disease caused by an inability of the body to metabolize glucose properly. The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. As Insulin and non-insulin dependent diabetes shows their effect on various physiological systems includes central, peripheral and autonomic nervous systems, musculoskeletal, cardiovascular and other vital systems. A common complications due to the IDDM and NIDDM includes peripheral neuropathy, retinopathy, nephropathy and vascular complication. Insulin and non-insulin dependent diabetes mellitus, both affect the peripheral nervous system significantly. Therefore we would like to find out neurophysiological changes on peripheral nervous systems between insulin and non-insulin dependent diabetes mellitus. Aim: To find out the Neuro-physiological changes between IDDM and NIDDM. Materials and Method: 120 individuals screened with SF36 (general health good and above) were included with age limit between 25 to 60 years. Those individuals having a history of hospitalization in last 1 year, acute fever, present history of radiculopathy and open wound were excluded. They were divided into 2 groups IDDM and NIDDM. For nerve conduction study–distal latency, amplitude and NCV of sensory and motor nerves were performed. Nerve conduction studies of common peroneal, tibial and sural nerves were examined in both groups. Latency, NCV and CMAP/SNAP were taken as outcome measures. Result and Discussion: Bio-statistical analysis has been done using Mann-Whitney test. Result suggest that there is a significant difference in Neurophysiological changes (p<0.05) between IDDM and NIDDM groups. Conclusion: In context to our study and neurophysiological findings, individuals with IDDM must be taken into consideration for promotion, prevention, and care as compared to NIDDM for secondary complications.

The health related quality of life of non-insulin dependent diabetes mellitus patients admitted at Brokenshire Integrated Health Ministries, Incorporated

OBJECTIVE: The purpose of this study was to determine the quality of life of type 2 diabetic patients admitted at a private tertiary hospital in Davao City using the Ferrans and Powers Quality of Life IndexDESIGN: This study is a descriptive, cross-sectional examination to determine self-rated quality of life among diabetic patients admitted at a private tertiary hospital in Davao City using the Ferrans and Powers Quality of Life Index.RESULTS: The cross sectional study involved 37 respondents of a private tertiary hospital in Davao City. Most belong to ages 50 years and above (91.9%), are females (59.5%) and married (89.2%). All have some form of formal schooling and 51.4% are employed. Most do not adhere to recommended diet (59.5%), exercise (64.9%), have no history of smoking (56.8%) and have higher BMI however 54% had controlled glucose (54%). Majority have been diagnosed with diabetes for 5-10 years (43.2%), have complications (59%) and are under combination therapy. The mean overall quality of life and QOL subscales of patients were good. Most sociodemographic, lifestyle and medical factors did not show any statistical significance (p value >0.05). Age had positive association with overall quality of life, health and function and socioeconomic subscales. Maintenance medication and civil status had positive association with the socioeconomic and family subscales respectively.CONCLUSION: The mean overall quality of life and QOL subscales of patients were good. Older age, marriage and combination therapy were associated with high quality of life and specific subscales. Other factors showed no significant association thus further studies are recommended. Assessment of Quality of life and management of modifiable risk factors of diabetes are also recommended.

Emblica officinalis improves glycemic status and oxidative stress in STZ induced type 2 diabetic model rats

OBJECTIVE@#To evaluate the antidiabetic and antioxidant potential of Emblica officinalis (E. officinalis) fruit on normal and type 2 diabetic rats.@*METHODS@#Type 2 diabetes was induced into the male Long-Evans rats. The rats were divided into nine groups including control groups receiving water, type 2 diabetic controls, type 2 diabetic rats treated with glibenclamide (T2GT) and type 2 diabetic rats treated with aqueous extract of fruit pulp of E. officinalis. They were fed orally for 8 weeks with a single feeding. Blood was collected by cutting the tail tip on 0 and 28 days and by decapitation on 56 day. Packed red blood cells and serum were used for evaluating different biochemical parameters.@*RESULTS@#Four weeks administration of aqueous extract of E. officinalis improved oral glucose tolerance in type 2 rats and after 8 weeks it caused significant (P<0.007) reduction in fasting serum glucose level compared to 0 day. Triglycerides decreased by 14% but there was no significant change in serum ALT, creatinine, cholesterol and insulin level in any group. Furthermore, reduced erythrocyte malondialdehyde level showed no significant change (P<0.07) but reduced glutathione content was found to be increased significantly (P<0.05).@*CONCLUSIONS@#The aqueous extract of E. officinalis has a promising antidiabetic and antioxidant properties and may be considered for further clinical studies in drug development.

Effect of norvasc and benazepril for treatment elderly hypertensive patients with NIDDM * / 重庆医学

Objective To investigate the effect of Norvasc combined with Benazepril for treatment elderly hypertensive patients with Non-insulin-dependent diabetes mellitus .Methods 52 cases of elderly hypertensive patients with Non-insulin-dependent diabe-tes mellitus were selected as the study object and were randomly divided into the observation group and the control group ,each with 26 cases of patients .The observation group was given Norvasc combined with Benazepril while the control group was given Nor-vasc .Results After 8 weeks ,the SBP and DBP of the observation group were significantly lower than that of the control group (P<0 .05) .The FBG and 2h PBG were significantly lower than that of the control group as well as the ISI significantly higher (P<0 .05) .Conclusion Norvasc combined with Benazepril can effectively control the blood pressure and plasma glucose of elderly hy-pertensive with Non-insulin-dependent diabetes mellitus ,also improve the ISI of patients .It is deserved to be promoted widely in the clinical work .

Double-blind, placebo-controlled clinical evaluation of an Ayurvedic formulation (GlucoCare capsules) in non-insulin dependent diabetes mellitus.

Diabetes mellitus describes a metabolic disorder of multiple etiologies characterized by insulin resistance, relative insulin deficiency and hyperglycemia with disturbances of carbohydrate, fat and protein metabolism. The goal for treatment of diabetes is to prevent its acute manifestations and long-term microvascular and macrovascular complications. The present study was conducted to evaluate the efficacy and safety of an Ayurvedic formulation (GlucoCare Capsules) in non-insulin dependent diabetes mellitus. Fifty NIDDM patients of pitta-kapha prakriti attending the outpatient department of the Government Ayurvedic Medical College, Guwahati, Assam, India were included in the study, and randomly divided into 2 groups, GlucoCare and placebo. All received either GlucoCare or placebo in a dose of 2 capsules twice daily, before meals for 3 months. All 50 patients completed the study - no drop outs, withdrawals or patients lost to follow up. The GlucoCare group showed significant improvement in symptoms from the 2nd month till the end of the study. GlucoCare was well tolerated by all patients throughout the treatment period with no evidence of adverse effects. The study indicates clinical efficacy of GlucoCare Capsules in the management of NIDDM in those belonging to pitta-kapha prakriti. The formulation is well tolerated and appears safe in the dosage used.

Pathology of diabetic myocardiac microangiopathy / 老年心脏病学杂志（英文版）

Objective To investigate the cause of high cardiovascular lethality in patients with diabetics mellitus. Methods Sections from autopsied coronary arteries and myocardium of dead patients with non-insulin-dependent diabetics mellitus and 12 dead control subjects were used for histomorphometric studies. Results The coronary atherosclerotic lesion in diabetics patients was not different in severity from those in controls. Nor was there difference in number of myofibers or diameters of myocardic fibers and capillaries.But the capillary density and the ratio of capillary number to myocardic fiber number in diabetics group were significeantly reduced compared with control group(P<0.0 l),and the capillary basement membrane in the former was significantly thicker than in the latter(P<0.01).Conclision The decrease in number of capillaries and the thickening of basement membrane enhance myocardiac vulnerability to further ischemia and hypoxia,which may undelie high lethality of myocardiopathy in diabetic patients.

Corrlation of dorsal artery of foot with type 2 diabetes mellitus on ultrasonography / 中华医学超声杂志（电子版）

Objective To evaluate the correlation between lesions of dorsal artery of foot and type 2 diabetes on CDFI. Methods Dorsal artery of foot was examinated in 97 cases with type 2 diabetes and 46 cases without diabetes mellitus. Results There were variable changes in intima-media of dorsal artery of foot in type 2 diabetes patients.And the patients with hyperlipidemia and hypertension showed serious lesions in the dorsal artery of foot and bifurcation of the blood vessel .Simple arteriosclerosis showed not only lesions in intima-media of dorsal artery of foot but also relative mild lesions in bifurcation of the blood vessel. Blood vessel lesion incidence in type 2 diabetes was significantly higher than that of the control group (P<0.01). Conclusions There was a significant correlation between lesions of dorsal artery of foot and type 2 diabetes patient's condition. CDFI is an effective method in evaluating patient's condition, degree and prognosis of type 2 diabetes, and has an important clinical value in early diagnosis, prognosis and treatment.Simple arteriosclerosis showed focal lesions in bifurcation of the blood vessel while dorsal artery of foot showed relatively mild lesions .

Plasma total homocysteine and macrovascular complications are associated with food and nutrient intake in patients with Type II diabetes mellitus

The present study was conducted to document the association between plasma homocysteine levels and the presence of macrovascular angiopathy with food and nutrient intake patterns among patients with Type II diabetes mellitus in Korea. Plasma total homocysteine concentration was analyzed by HPLC-fluorescence detector method in 127 patients with non-insulin dependent diabetes mellitus. Logistic regression analyses were performed respectively to study the association of plasma homocysteine levels with clinical and dietary characteristics and macroangiopathy (MA). The average plasma homocysteine level of patients with MA was 14.2 micromol/l, which was significantly higher than that of patients without MA (11.4 micromol/l). The proportions of patients with MA showed a significant difference, being 32.3% in hyperhomocysteinemic (>14.0 micromol/l) patients and 13.5% in others with homocysteine levels lower than 14.0 micromol/l. Odds ratios for macroangiopathy by tertile increase of plasma homocysteine concentration were 1.633 (Q2) and 4.831 (Q3), when adjusted for age, sex, and cigarette smoking. Patients with MA consumed reduced amounts of vitamin B1, B2, and folate. The results indicate that the plasma homocysteine levels are significantly increased in NIDDM patients who have macroangiopathy. Dietary management such as increased fruits and vegetables and decreased potatoes and starches might be beneficial for the prevention of macroangiopathy in diabetic patients.

Association of the Tumor Necrosis Factor-alpha Gene Polymorphism with End-Stage Kidney Failure / 대한신장학회잡지

BACKGROUND: It is evident that cytokines play a role in the pathogenesis as well as the progression of renal diseases. The purpose of this study was to determine whether cytokine gene polymorphism is a marker of susceptibility to end-stage kidney failure (ESKF) in Korean populations. METHODS: -308 G/A polymorphism of tumor necrosis factor-alpha (TNF-alpha) gene was genotyped in 257 dialysis patients and 277 age-matched healthy controls, 86 NIDDM patients with kidney failure and 102 NIDDM controls without nephropathy. RESULTS: We found a decreased frequency of TNF-alpha allele 2 (TNF2, 2.9%) in ESKF patients compared to healthy controls (7.5%, p<0.05). We also found a decreased frequency of TNF-alpha allele 2 (TNF2, 2.3%) in NIDDM patients with kidney failure compared to NIDDM controls without nephropathy (7.6%, p<0.05). The carriage rate of TNF2 was significantly lower in NIDDM patients with kidney failure than in NIDDM controls without nephropathy (4.4% vs. 13.2%, p<0.05). In addition, allele frequency of TNF2 were remarkably different from those previously reported, indicating a significant ethnic difference. CONCLUSION: There is a significant ethnic difference in the polymorphism of TNF-alpha gene. The non-carriage TNF2 was more prevalent in the kidney failur group. But, we could not determine any association between the TNF-alpha gene polymorphism and the development of kidney failure.

Relations of Glycosylated Hemoglobin and Parameters of Nerve Conduction Study in Diabetic Peripheral Polyneuropathy

OBJECTIVE: This study was performed to determine the relations of glycosylated hemoglobin (HbA1c) and parameters of nerve conduction study (NCS) in diabetic peripheral polyneuropathy patients. METHOD: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus. RESULTS: HbA1c level had an inverse relation to CV of median motor nerve (beta= 1.272, p<0.01), ulnar motor nerve (beta= 1.287, p<0.01), posterior tibial nerve (beta= 0.982, p<0.05), and deep peroneal nerve (beta= 1.449, p<0.05). CONCLUSION: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data.

The expression of receptor for advanced glycation end product in gingival tissues of type 2 diabetic patients with periodontitis / 实用口腔医学杂志

Objective:To detect the distribution of the receptor for advanced glycation end products(RAGE) in gingival tissues of patients with non-insulin dependent diabetes mellitus(NIDDM) accompanying periodontitis.Methods:5 patients with chronic periodontitits(CP) and 4 patients with NIDDM accompanying periodontitis were included. Immunohistochemical staining was performed to detect RAGE and tumor necrosis factor ?(TNF-?) expression in gingival tissues.Interleukin 6(IL-6) and TNF-? levels in gingival crevicular fluid and serum of these patients were examined by ELISA.Results:More RAGE cells were observed in the gingival tissus in the patients of NIDDM with CP than in those of CP(P0.05).Conclusion:RAGE may play a role in the destruction of periodontal tissues in NIDDM patients with CP.

Relationships between Angiotensin - Converting Enzyme Gene Polymorphism and Initiation and Progression of Renal Failure in Patients with Non-Insulin Dependent Diabetes Mellitus / 대한내과학회지

OBJECTIVE: Diabetic nephropathy is an important cause of end-stage renal disease and associated with morbidity and mortality of the patients with diabetes mellitus. It has been reported that the genetic susceptibility may be an important factor in the development of nephropathy in diabetic patients, but the genes responsible for the predisposition to diabetic nephropathy are not known. The genes of the renin-angiotensin systems are plausible candidate genes and the genetic polymorphism of angiotensin-converting enzyme(ACE) gene has been extensively studied for its possible role. Recently, the association of the ACE gene polymorphism with nephropathy as well as myocardial infartion was reported in diabetic patients. To elucidate the contribution of ACE gene polymorphism to the initiation and progression of diabetic nephropathy, we typed the alleles of the ACE gene in 139 patients with non-insulin dependent diabetes mellitus (NIDDM). METHODS: After the extraction of genomic DNA from peripheral blood leukocytes, PCRs were performed using the flanking and insertion specific primers, respectively. The PCR products were electrophoresed in 1.5% agarose gels, and DNA was visualized directly with ethidium bromide staining. RESULTS: Subjects were consisted of 139 patients with diabetes mellitus and male to female ratio was 63:76, mean age 55.8+/-12.0 years, mean duration of diabetes 9.5+/-7.8 years. ACE genotypes in whole population were 37.4% DD genotype, 51.1% ID genotype and 11.5% II genotype. The ACE genotype distributions, age, sex, blood pressure and body mass index were not different in diabetic subjects with or without nephropathy. No significant differences on the clinical parameters such as age, sex, blood pressure, body mass index, duration of diabetes, incidence of hypertension, cardiovascular complication, diabetic neuropathy and retinopathy, serum creatinine and 24hour albumin excretion were noted according to the ACE genotypes. Forty-six patients with NIDDM were followed over 3 years. The mean follow-up duration was 6.4+/-2.7 years, mean age was 54.4+/-10.2 years, and mean duration of diabetes was 14.7+/-6.1 years. ACE genotypes were 36.9% DD genotype, 52.2% ID genotype and 10.9% II genotype. The ACE genotype distributions were not different in the patients among DD, II or II genotypes. There were also no significant differences in terms of age, sex, duration of diabetes, blood pressure, body mass index, prevalence of hypertension, cardiovascular complication, diabetic neuropathy and diabetic retinopathy. But the rate of decline of creatinine clearance(deltacreatinine clearance, ml/min/year) was higher in DD genotype than ID or II genotypes(3.3+/-7.2 vs 2.8+/-6.2 vs 2.7+/-9.8), and the rate of change of 24-hour protein excretion(deltaurinary protein excretion, mg/24hours/year) was higher in DD genotype than ID or II genotypes(89.3+/-220.0 vs 74.1+/-156.8 vs 70.9+/-546.3). But they did not reach to statistical significance. CONCLUSION: We found that insertion/deletion polymorphism of ACE gene is not implicated in the initiation of diabetic nephropathy of Korean NIDDM patients, but also found the possibility that progression of diabetic nephropathy may be associated with it. We need large scaled prospective follow-up studies on the effects of ACE polymorphism in the progression of diabetic nephropathy.

Macrovascular dysfunction detected by comparison of serum FDP detected by simplified venous occlusion test in patients with NIDDM and CVA / 대한내과학회지

OBJECTIVES: In diabetic patients, the incidence of atherosclerotic disease are increased, which may be due to decreased fibrinolytic activity. The aim of study is to elucidate the relationship between angiopathies and vascular function evaluated by simplified venous occlusion test in patients with non-insulin dependent diabetes mellitus (NIDDM) and cerebrovascular accident (CVA). METHODS: The study was conducted on 63 patients who were hospitalized during the period from March 1, 1994 to May 30, 1997. The serum concentration of fibrinogen degradation products (FDP) was measured before and 5 min after venous occlusion in 31 NIDDM patients, 16 CVA patients and 16 age-matched control subjects. FDP was measured with the anti-fibrinogen- coated latex particle agglutinin assay system. RESULTS: 1) The basal serum FDP level was higher in diabetic patients with macroangiopathy (12.3+/-5.8 ug/ml) and patients with CVA (11.2+/-5.1 ug/ml) than in control subjects (5.7+/-1.8 ug/ml) (p<0.05). 2) The increment of serum FDP level after venous occlusion in diabetic patients with microangiopathy (6.6+/-2.2 to 10.3+/-4.1 ug/ml) and control subjects (5.7+/-1.8 to 11.4+/-4.3 ug/ml) was significantly higher than basal serum FDP level (p<0.05). But the increment of serum FDP level after venous occlusion in diabetic patients with macroangiopathy (12.3+/-5.8 to 15.2+/-5.1 ug/ml) and patients with CVA (11.2+/-5.1 to 13.7+/-4.8 ug/ml) wasn't significantly higher than basal serum FDP level. 3) The increment rate of serum FDP after venous occlusion in diabetic patients with macroangiopathy (24.4+/-29.3%) and patients with CVA (29.4+/-34.5%) was significantly lower than diabetic patients with microangiopathy (66.3+/-71.7%) and control subjects (84.1+/-69.3%) (p<0.05). CONCLUSION: The responsiveness of fibrinolytic activity to venous occlusion was significantly lower in diabetic patients with macroangiopathy, as in patients with CVA, compared with that in control subjects. We conclude that measurement of the increase in serum FDP concentration 5 min after venous occlusion may be useful to detect vascular dysfunction in patients with macrovascular disease caused by atherosclerosis.

The effects of angiotensin converting enzyme ingibitors on proteinuria and lipoprotein(a) in non-insulin dependent diabetic patients / 대한내과학회지

BACKGROUND: We determined the serum Lipoprotein(a) [Lp(a)] level in patients with NIDDM and evaluated the relationship between serum Lp(a) level and proteinuria, and the efficacy of angiotensin converting enzyme inhibitor(ACEI) in reducing serum Lp(a) level in NlDDM patients. METHOD:A total of 86 patients with NlDDM(age: 61.2 +/- 1.2 years) was divided into ACEI treatment group (n=45) and control group(n=41). The changes of the amount of proteinuria and serum Lp(a) were analyzed in both groups. Mean duration of follow-up in control group or ACEI administration in ACEI group was 8.4 months. RESULTS: 1) Befare ACEI treatment, the positive correlation between serum Lp(a) level and amount of proteinuria was present in ACEI group, but not in total subjects and control group. ACEI treatment was associated with decrease in serum Lp(a) level, but not with change in the amounts of proteinuria. 2) Serum Lp(a) levels decreased significantly by ACEI treatment, not only in patients whose diastolic blood pressure(DBP) decreased by more than 10mmHg, but also in patients whose DBP did not response to ACEI administration. 3) Patients with overt proteinuria(> 500rng/day) had higher serum Lp(a) level than patients without overt proteinuria before ACEI treatment. After ACEI treatment, serum Lp(a) levels and amount of proteinuria decreased significantly in patients with overt proteinuria, but not in patients without overt proteinuria. 4) In both subgroups of patients with serum Lp(a) level 30mg/dl and patients with serum Lp(a) level <30mg/dl, serum Lp(a) levels decreased significantly after ACEI treatment, but the amount of proteinuria did not change in both subgroups. 5) In the analyses of subgroups of patients whose amounts of proteinuria definitively decreased (responder group) or increased (non-responder group) after ACEI, serum Lp(a) levels decreased even in the non-responder group. CONCLUSION: NIDDM patients with overt proteinuria have higher level of serum Lp(a) than patients without overt proteinuria, and ACEI treatment could reduce serum Lp(a) level as well as proteinuria. Although decrease in Lp(a) is thought to be associated with decreased proteinuria, there may be another effect of ACEI that should be clarified further.

Non-diabetic renal disease in patients with non-insulin dependent diabetes mellitus

The diagnosis of diabetic nephropathy (DN) is almost always based on clinical grounds. The diagnosis is supported by a long history of diabetes, evidence of target organ damage and proteinuria preceding azotemia. The validity of this clinical approach is well established in insulin dependent diabetes mellitus but not in non-insulin dependent diabetes mellitus (NIDDM). It is thus important to determine which patients with NIDDM accompanied by non-diabetic renal disease (NDRD) should have a biopsy. However, factors clinically associated with NDRD in patients with NIDDM remain unclear. Therefore we reviewed clinical data, laboratory data and renal biopsies from 22 NIDDM patients who underwent renal biopsy between 1992 and 1998 in Wonju Christian Hospital. From this data, we identified important features that would discriminate between DN and NDRD. There were 8 women and 14 men. Age ranged from 33 to 68 (51.2 +/- 10.7) years. The duration of diabetes at biopsy ranged from 0 to 13 (4.2 +/- 4.2) years. Nephrotic syndrome was present in 13 patients. The patients with NDRD (n = 14) and DN (n = 8) had comparable 24-hour proteinuria, 24-hour albuminuria, creatinine clearance, serum creatinine, albumin, as well as incidences of neuropathy and hypertension. The significant factors that predict the NDRD included a short duration of the diabetes mellitus, the presence of dysmorphic red blood cells in urine, the absence of retinopathy and HbA1c below 9% (p < 0.05, respectively). NDRD included IgA nephropathy (n = 6), minimal change disease (n = 3), membranous nephropathy (n = 3), membranous lupus nephritis (n = 1) and acute interstitial nephritis (n = 1). Multiple logistic regression analysis revealed that the short duration of DM and the absence of retinopathy were factors significantly associated with NDRD. In summary, when there is a short duration of diabetes mellitus, or an absence of retinopathy seen in patients with NIDDM, then renal biopsy in diabetic patients aids in the detection of NDRD.

Glucokinase gene mutation in non-insulin-dependent diabetes mellitus (NIDDM), and secondary diabetes in Koreans / 대한내과학회지

OBJECTIVES: Mutations in the glucokinase (GCK) gene are considered a possible cause of maturity-onset diabetes of the young. The purpose of this study was to evaluate the contribution of this gene to the development of non insulin dependent diabetes mellitus (NIDDM), gestational diabetes mellitus (GDM) and post-renal transplantation diabetes mellitus (PTDM). METHOD: Identification of GCK mutation was attempted on 39 NIDDM patients, 2 GDM patients and 58 selected renal allograft recipients with PTDM and 45 normal controls. The exons in the GCK gene were examined by polymerase chain reaction (PCR), followed by analysis of single-stranded DNA conformational polymorphism (SSCP). The abnormal bands were also confirmed by DNA sequenc- ing analysis. The exons of affected family members were also investigated for mutations of the GCK gene. RESULTS: Two of the 58 PTDM patients (3.4%) were found to have GCK mutations. One had the mutation on exon 5 and the other on intron 7. One control subject had the mutation on intron 9. The mutation of exon 5 was identified as a substitution of CCT(proline) for CTT (leucine) at codon 164, which has not ever reported before. The family members of the PTDM patient with mutation of exon 5 were analyzed by PCR followed by SSCP, and two of them revealed the same mutation. The abnormal band on the SSCP analysis of exon 7 was identified as the insertion of base C/T at the 39th nucleotide in intron 7. Two family members of this patients also had same band on SSCP. The one mutation of 45 normal controls was CT located at the 8th nucleotide in intron 9, which was a common polymorphism. CONCLUSON: We found GCK mutations in subjects with PTDM and we speculate that these mutations may be one of the contributing cause of PTDM.

A Case of diabetic patient with intractable pain successfully treated with Mao-bushi-saishin-to and Hochu-ekki-to / 日本東洋医学雑誌

A 43-year-old diabetic man with a diabetic history of 8 years had been treated with insulin (Penfil 30R), 12μ in the morning and 4μ in the evening, for two months. The patient had only slight numbness and pain of the inferior limbs until **********, when he complained of intractable pain in the left back. The pain spread generally except for the face, bilateral palms and the pen-anal area in a few days. Although vitamin E, epalrestat, nonsteroidal anti-inflammatory drugs (NSAIDs) and Gosha-jinki-gan were not effective, Mao-bushi-saishin-to was very effective for the intractable pain, Hochu-ekki-to was effective at reducing succeptibility to fatigue, but had no effect on the intractable pain. Diabetic control gradually became good with combination of Mao-bushi-saishin-to and Hochu-ekki-to in two months. HbAlc improved from 10.2 to 6.5% about two months after the beginning of treatment with Mao-bushi-saishin-to and Hochu-ekki-to. Therefore, insulin was discontinued five months later. In conclusion, combination of Mao-bushi-saishin-to and Hochu-ekki-to was useful for diabetic control in a patient with intractable pain.

The Effects of Exercise Therapy Applied in an Efficacy Expectation Promoting Program on Self-Efficacy and Metabolism: in NIDDM(Non-Insulin Dependent Diabetes Mellitus) Patients / 간호학회지

This study was conducted to investigate whether exercise therapy applied in an efficacy expectation promoting program based on the self-efficacy theory of Bandura(1977) would increase self-efficacy and metabolism in NIDDM patients. The study design was a nonequivalent control group pre-test post-test quasi-experimental design. The exercise therapy applied in the efficacy expectation promoting program was composed of a staged exercise program, a small booklet relating personal experience with diabetes mellitus and a telephone coaching program on performance accomplishment, vicarious experience and verbal persuasion, which are all induction modes of efficacy expectation. The subjects of the study were twenty eight NIDDM patients who received follow-up care regularly through the out-patient department of endocrine medicine in one general hospital which had a diabetic clinic. Fourteen were assigned to the experimental group and fourteen to the control group. The experimental group participated in the exercise therapy applied in the efficacy expectation promoting program from three to five times per week for four weeks and the control group did not have the program. The collected data were analyzed using the x2-test, t-test, paired t-test, and Cronbach's Alpha using SPSS/PC+. The results are summarized as follows : 1. Experimental group had higher efficacy score than control group(t=5.98, p=.00). And, There was a significant different in the efficacy score before exercise therapy applied in the efficacy expectation promoting program and after in experimental group(t=-6.42, p=.00). 2. Experimental group did not have lower level of glucose metabolism than control group(FBS : t=.32, p=.75, HbA1C : t=.60, p=.55, pc 2hrs. glucose : t=-.29, p=.78). But, There was a significant different in the amount of glucose metabolism before exercise therapy applied in the efficacy expectation promoting program and after in experimental group(FBS : t=3.63, p=.003, HbA1C : t=4.20, p=.00 2hrs . glucose : t=1.93, p=.001). 3. Levels of lipid metabolism were partly a significant different between Experimental group and control group(triglyceride : t=-1.87, p=.07, HDL cholesterol : t=-.29, p=.77, body weight : t=1.78, p=.09, Total cholesterol : t=-2.17, p=.04). And, There was partly a significant different in the amount of lipid metabolism before exercise therapy applied in the efficacy expectation promoting program and after in experimental group(triglyceride : t=2.50, p=.03, HDL cholesterol : t=-.43, p=.67, body weight : t=5.34, p=.00, Total cholesterol : t=2.26, p=.04). In conclusion, it was found that exercise therapy applied in an efficacy expectation promoting program was an effective nursing intervention for increasing self-efficacy and metabolism.

The relationships of urinary albmnin excretion rate to ambulatory blood pressure and erythrocyte sodium-lithium countertransport in NIDDM / 中华肾脏病杂志

Objective To investigate the potential association among urinary albumin excretion rate(U_(AER)), 24h ambulatory blood pressure(ABP) and erythrocyte sodium-lithium countertransport(SLC) in non-insulin dependent diabetes mellitus (NIDDM). Methods U_(AER), SLC were determined with radioimmunoassay and modified method of Canessa respectively, and 24h ABP profiles were recorded in 69 NIDDM subjects. Results NIDDM patients with increased U_(AER) had higher prevalence of hypertension and higher prevalence of abnormal circadian rhythm of blood pressure. Blood pressure(BP), particularly nighttime systolic BP was also significantly increased. U_(AER) was positively correlated to mean nighttime BP, mean daytime and 24h systolic BP, while inversely related to day-night dip in systolic BP. However, there was no significant difference in SLC between NIDDM subjects with and without increased U_(AER). Futhermore, neither U_(AER) nor all ABP indices were correlated to SLC. Conclusion Close association exists among diabetic nephropathy and increased BP and abnormal diumal BP rhythm, while either SLC and U_(AER) or SLC and BP is significantly correleted. Increased rate of SLC is not likely a marker for diabetic nephropathy in NIDDM, and it seems not to be involved in the pathogenesis of diabetic hypertension.

Diabetes mellitus durante la gestación y morbimortalidad perinatal / Gestacional diabetes and perinatal morbimortality in Medellín, Colombia

El análisis retrospectivo de 166 pacientes embarazadas y con diagnóstico de diabetes mellitus, atendidas en el Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, permite apreciar un registro inadecuado de la información, lo que le resta confiabilidad, y la carencia de protocolos apropiados de manejo. La diabetes gestacional (DMG) se presentó en 81 pacientes (48.8 por ciento), seguida por la diabetes mellitus no insulino dependiente (DMNID) (69 pacientes; 41.5 por ciento) y por último la diabetes insulina dependiente (DMID) en 16 pacientes (9.6 por ciento). Se halló una tasa de morbilidad perinatal del 52.2 por ciento (72 casos de los 138 en que se dispuso de información), inaceptable para esta población, distribuida así por entidades: macrosomía (16 casos; 22.2 por ciento), sufrimiento fetal agudo (15 casos; 20.8 por ciento), sufrimiento fetal crónico (10 casos; 13.9 por ciento), polihidramnios (9 casos; 12.5 por ciento), hipoglicemia (8 casos; 11.1 por ciento), trauma fetal (6 casos; 8.3 por ciento), síndrome de dificultad respiratoria (5 casos; 6.9 por ciento) hiperbilirrubinemia (5 casos; 6.9 por ciento) e hipocalcemia (1 caso). Cabe resaltar que las entidades potencialmente prevenibles (macrosomía, sufrimiento fetal agudo y crónico, polihidramnios, trauma fetal y síndrome de dificultad respiratoria ) fueron más frecuentes en la población de DMNID y DMG, lo que refleja un manejo clínico inadecuado. La mortalidad fetal fue del 3.6 por ciento (5 casos) y en tres de ellos se asoció a hipertensión materna. Se puso en evidencia la urgente necesidad de un protocolo interdisciplinarlo de manejo clínico, con el cual se puedan establecer un registro adecuado y pautas de manejo conforme a las necesidades de la población de riesgo que atiende esta Institución de referencia

Retrospective analysis of 166 pregnant women with gestational diabetes mellitus, at San Vicente de Paúl Hospital, Medellín, Colombia, evidenced inadequate registration of information and lack of clinical management protocols, despite the fact that this is a reference institution. Gestational diabetes mellitus (GDM) was found in 81 patients (48.8%), non-insulin-dependent diabetes mellitus (NIDDM) in 69 (41.5%) and insulin-dependent diabetes mellitus (IDDM) in 16 (9.6%). Perinatal morbidity rate was 52.2% (72 cases among the 138 in which information was available), distributed as follows: macrosomy (16 cases; 22.2%), acute fetal distress (15 cases; 20.8%), chronic fetal distress (10 cases; 13.9%), polyhydramnios (9 cases; 12.5%), hypoglycemia (8 cases; 11.1 %) and delivery fetal trauma (6 cases; 8.3%). It was remarkable that the potentially preventable entities (macrosomy, acute and chronic fetal distress, polyhydramnios, fetal trauma and respiratory failure syndrome) were more frequent in NIDDM and GDM groups, indicating an inadequate clinical management; fetal mortality was 3.6% (5 patients) mostly associated to maternal hypertension. These results point out to the urgent need of establishing in this third level hospital an interdisciplinary management protocol of gestational diabetes, with apropriate registration of information and clear clinical guides