The clinical course of untreated asymptomatic bacteriuria in diabetic patients--14-year follow-up.

The present study aimed at accessing the natural history of untreated asymptomatic bacteriuria in diabetic patients observed for 14 years. Two groups of diabetic patients were examined. Group I comprised 53 patients with significant bacteriuria, without clinical symptoms of urinary tract infection. Group II consisted of 54 patients with sterile urine. All patients were clinically and bacteriologically examined every 3-6 months for 14 years. The results obtained in this study have proved that clinical symptoms of acute pyelonephritis occur with similar frequency in both groups (group I-6, group II-5 cases). No deterioration of kidney function was found. Arterial hypertension did not differ significantly in both groups at the beginning and end of the follow-up. The usefulness of antibacterial treatment of asymptomatic bacteriuria in diabetic patients is not adequately documented.

[Renal hemodynamics in patients with short-lasting diabetes mellitus type I]. / Hemodynamika nerek u chorych z krótkotrwala cukrzyca typu 1.

Parameters of renal hemodynamics have been determined in 30 male patients with diabetes mellitus, lasting for 1-24 months (mean 0.9 +/- 0.7 year), and in 19 healthy men of the same age. Patients' age ranged from 17 to 33 years (mean 27.5 +/- 5.0). All examined subjects have been normotensive (according to WHO criteria). Glomerula filtration rate with the aid of 51CrEDTA, and ERPF with 125I-hippurate have been determined. Mean GFR values have been significantly higher in diabetics than that in healthy men (142.9 +/- 29 vs 118 +/- 20 ml/min per 1.73 m2). Hyperfiltration (GFR over 140 ml per minute) has been found in 15 patients (50%). ERPF has also been higher in diabetic patients (929.2 +/- 230 vs 821.5 +/- 192 ml/min). This difference has been insignificant. No correlation between arterial blood pressure and GFR, ERPF, filtration fraction (FF), and RVR has been found.

[Circadian rhythm of blood pressure and pulse rate in young men with diabetes mellitus type I depending on duration of disease]. / Przebieg rytmu dobowego cisnienia tetniczego i tetna u mlodych mezczyzn z cukrzyca typu I w zaleznosci od czasu trwania choroby.

In order to investigate the blood pressure-heart rate interrelation and their circadian pattern in type I diabetes mellitus, we performed ambulatory blood pressure monitoring in 28 normotensive patients without clinical nephropathy divided in two groups. Group A consisted of 14 males with short-term DM (mean 2 years, mean age 28 +/- 6 years), group B consisted of 14 males with long-term DM (mean 12 years, mean age 31 +/- 7 years). Ambulatory blood pressure monitoring revealed significantly higher night heart rate in B group (74 +/- 13 l/min vs. 62 +/- 11 l/min in A, p < 0.01) and day diastolic blood pressure (83 +/- 9 mm Hg vs. 74 +/- 8 mm Hg in A, p < 0.01) and night diastolic blood pressure (73 +/- 10 mm Hg vs. 62 +/- 8 mm Hg in A, p < 0.01). The linear regression SBP/HR equation were significantly different (p < 0.02) (HR = 0.48 x SBP + 21, r = 0.40 in A vs. HR = 0.29 x SBP + 69, r = 0.28 in B). We concluded that type I diabetes duration has significant influence on diastolic blood pressure and heart rate even in patients without diabetic nephropathy and could be related to changed sensitivity of the baroreceptors.

[Enalapril in patients with diabetes mellitus type I with microalbuminuria without hypertension]. / Enalapryl u chorych na cukrzyce typu I z mikroalbuminuria bez nadcisnienia tetniczego.

The studies included 18 normotensive patients with diabetes mellitus type I (mean age 29 years) and constant microalbuminuria (UAE-30 - 300 mg/24 hours). Group A consisted of 10 patients treated with enalapril, and group B--10 patients given placebo. Glomerular filtration rate, ERPF, and UAE were measured before and after 6 months of therapy. UAE decreased significantly in patients of group A (p = 0.02) after 6 months while evident proteinuria was seen in two patients of group B. Arterial blood pressure dropped in patients of group A (131/84 vs 122/78 mm Hg), and increased significantly in patients of group B (126 +/- 8 vs 136 +/- 15 mm Hg; p < 0.05). Blood flow through kidneys improved (p = 0.02) and renal vascular resistance decreased (p = 0.02) in patients of group A. The obtained results suggest that enalapril may prevent diabetic nephropathy in diabetics with constant microalbuminuria.

[Blood pressure and blood lipids in normotensive patients with diabetes mellitus type I with microalbuminuria]. / Cisnienie tetnicze i lipidy krwi u normotensyjnych chorych na cukrzyce typu I z mikroalbuminuria.

The study involved 50 normotensive men (means age = 34 years) with diabetes mellitus type I (mean duration of the disease 14 years). Group I included 29 patients with normal albumin excretion with the urine (UAE below 30 mg daily), and group II-21 patients with microalbuminuria (UAE 30-300 mg daily). Both groups were similar in relation to the age and duration of diabetes mellitus. Blood cholesterol was significantly higher in patients of group II than in patients of group I (p = 0.02) similarly to blood triglycerides levels (p = 0.01). Mean arterial pressure was lower in patients of group I than that in patients of group II (94.3 +/- 7.0 vs 99.1 +/- 6.0 mm Hg; p = 0.01). HbA1c was positively correlated with blood cholesterol (p = 0.01) and blood triglycerides levels (p = 0.05).

[Hyperglycemic hyperosmolar nonketotic coma]. / Nieketonowa, hiperosmolarna spiaczka cukrzycowa.

Ten patients with the syndrome of non-ketotic hyperosmolar coma are described. The mean age of the patients was 62.3 +/- 17.12 years. One patient was 16 years old. In 9 cases the patients had type II diabetes, one had type I diabetes. In 7 cases the coma was the first sign of diabetes. The factor predisposing in most cases was infection. In the treatment-acting insulin and hypotonic solutions were given. In 2 cases clinical signs of the DIS syndrome were observed manifesting themselves with local changes, including mental disturbances. Heparin was given with good effect. Three patients (30%) died in hospital. The cause of death was serious disease associated with this coma: pancreatitis and myocarditis, purulent bronchopneumonia, myocardial infarction.

[Analysis of the cause of death in diabetic ketoacidosis based on 5 years of personal observation]. / Analiza przyczyn smiertelnosci w przebiegu kwasicy cukrzycowej na podstawie wlasnych 5-letnich obserwacji.

The authors observed 53 cases of diabetic ketoacidosis treated with low doses of insulin. Mean age of the patients was 41 +/- 17 years, duration of diabetes mellitus 7.5 +/- 6.4 years. Ketoacidosis was due to: infections in 36%, other diseases in 7%, and cessation of insulin therapy in 25% of cases. Ketoacidosis was a first sign of diabetes mellitus in 19% of cases while causative factor was not detected in 13% of cases. At the admission to hospital mean blood pH was 7.02 +/- 0.15, mean bicarbonate concentration 6.17 +/- 3.45 mM/l, and glycaemia 40.6 +/- 16.8 mM/l. Therapy of ketoacidosis was complicated by hypopotassemia in 1 patient and transient hypoglycaemia in another patient. Five patients (9.6%) died. Infections, myocardial infarction, acute pancreatitis, pulmonary edema, and disseminated intravascular coagulation were the causes of deaths.

[Clinical examination of diabetic patients treated with monocomponent insulin manufactured by MP Polfa]. / Badania kliniczne chorych na cukrzyce leczonych insulina jednoszczytowa MP Polfa.

An effect of replacing conventional forms of insulin by the monocomponent insulin manufactured by "Polfa" was studied in the group of 22 diabetics. The patients were followed up for 12 months. An effect of monocomponent insulin on daily requirement of insulin, levels of anti-insulin, monocomponent and pancreatic peptide antibodies, compensation of diabetes mellitus, and lipodystrophy were investigated. New insulin preparation decreased anti-insulin and pancreatic peptide antibodies level and markedly diminished lipodystrophy. However, daily insulin requirement, degree of diabetes mellitus compensation, and anti-proinsulin antibodies level remained unchanged.

[Effects of isometric exercise on left ventricular function assessed with polycardiography in patients with early type I diabetes]. / Wplyw wysilku izometrycznego na czynnosc lewej komory serca oceniana metoda polikardiograficzna u chorych z krótkotrwajaca cukrzyca typu I.

15 patients with controlled type 1 diabetes lasting up to 24 months underwent the study. The control group consisted of 22 healthy men. Noninvasive examinations were carried out at rest and during a 3-minute isometric exercise of a load equal to 30% maximal effort. Rest systolic and diastolic blood pressures (SBP and DBP) were almost the same in both groups. Also exercise peak SBP and DBP did not significantly differ in examined groups. Rest PEP/LVET ratio were significantly lower in diabetics (means = 0.313 vs means = 0.348 in the control group; p less than 0.002). Peak isometric exercise PEP/LVET ratio significantly increased to 0.333 in diabetics, comparing with its rest value, whereas significantly decreased to 0.333 in the control group. Results indicate increased resting left ventricular contractility in patients with early, type 1 diabetes and impairment of a left ventricular adaptation for the isometric exercise in comparison with the control group.

[Echocardiographic assessment of left ventricular function in patients with early type I diabetes]. / Echokardiograficzna ocena funkcji lewej komory serca u pacjentów z wczesna cukrzyca typu I.

M-mode, resting echocardiographic examination has been performed under 2-D control in 19 patients (mean age-26 years) with controlled, type 1 diabetes lasting up to 2 years (D group). The control group (C) consisted of 20 healthy men (average age-25 yrs). Greater cardiac index has been stated in D group (p less than 0.05). Left ventricular systolic function parameters such as: ejection fraction, percentage of fractional shortening and a mean rate of circumferential shortening indicate greater contractility in D patients. Left ventricular mass also has been significantly greater (p less than 0.04) and the total peripheral resistance significantly lowered (p less than 0.05) in the D group. Stated alterations in left ventricular function and structure are probably due to adaptation for increased peripheral flow.

[Autonomic regulation of the circulatory system in early type I diabetes]. / Odruchowa regulacja ukladu krazenia w krótkotrwajacej cukrzycy typu I.

In the group of 16 men with controlled, type I diabetes lasting up to 24 months, simple tests for assessment of autonomic regulation of the circulatory system such as a deep breathing test, Valsalva's manoeuvre and a tilt trial have been performed. Variations of systolic and diastolic blood pressures as well as heart rate have been studied. The control group consisted of 22 young, healthy men. Rest heart rate has been significantly increased prior the all tests but its alterations during deep breathing have been significantly decreased in diabetics (EM index mean = 1.44 vs 1.74 in the control group; p less than 0.01). Also Valsalva's index has been significantly increased in them (1.67 vs 1.42; p less than 0.02). Significant reduction of a delay index at the early tilt test period has been stated in diabetics (1.31 vs 1.57; p less than 0.01) as well as significant lowering of diastolic blood pressure in 1st and 5th minute of a tilt test. Performed tests indicate that even short duration of diabetes changes the autonomic regulation of the circulatory system due to inequality of para- and sympathetic system tones and/or the early autonomic neuropathy.