[Strategies for early detection of the risk of type II (non-insulin-dependent) diabetes in 1st degree relatives of patients with this disease]. / Model postepowania umozliwiajacego wczesne wykrywanie zagrozenia cukrzyca typu 2 (insulinoniezalezna) u krewnych I stopnia osób ze znana postacia tej choroby.

UNLABELLED: The present study included two groups of subjects: I. the adult offspring of parents with conjugal type 2 diabetes (n = 77; age range 18-59 yrs and mean age 38 +/- 0.8 yrs; BMI range 18.9-40.3 kg/m2 and mean value 26.6 +/- 0.6 kg/m2); and II. the adult offspring having one parent with type 2 diabetes: either father (n = 83-53%) or mother (n = 74-47%). The age range of the latter group was 21-64 yrs, mean age 41 +/- 0.8 yrs; BMI range was 17.6-46.4 kg/m2, and mean value 26.8 +/- 0.4 kg/m2. The normal glucose tolerance of the "healthy" parent was verified with the OGGT evaluated by the WHO and ADA criteria. In all offspring the same test (75 g) was performed, and glucose in venous blood and insulin (IRI) in serum were determined on fasting and at 30, 60 and 120 min of the test. In fasting state the levels of serum lipids (triglycerides, total and LDL and HDL cholesterol and apolipoprotein AI and B) were also measured. In the group I unknown diabetes mellitus was discovered in 4 cases (4%): in 3 according to the WHO/ADA criteria and in one case evaluated by the ADA criteria), in 19 subjects (25%) IGT was found in 16 isolated and in 3 associated with isolated fasting glycaemia (IFG), and only in one case (1%) the isolated IFG was ascertained. In the group II diabetes was discovered according to the ADA criteria in 4 persons (2.5%), IGT in 29 subjects (18.5%), of whom 8 had also IFG. In this subgroup 16 subjects had diabetic father and 13 diabetic mother. The isolated IFG had 7 offspring (4.4%), of whom 2 had diabetic father and 5 diabetic mother. Apart from glycaemia, other parameters didn't disclose difference between the offspring of diabetic father and diabetic mother. However, considering these parameters together for the whole group II, it was found that the offspring with IGT, isolated and associated with IFG, differed from the remaining ones with significantly higher BMI, higher systolic blood pressure, higher 2-h serum IRI, and higher levels of serum triglycerides, total cholesterol and ApoB. CONCLUSION: Measurement of isolated fasting glycaemia and its interpretation by the ADA criteria is inadequate in studies aiming at early detection of glucose intolerance in subjects with familial increased risk of type 2 diabetes and should include also the determination of the 2-h glycemia of the OGTT evaluated according to the WHO criteria. On the other hand, the determination of fasting glycaemia and its evaluation by the ADA criteria is a valuable in diabetes screening, as its elevated level may identify other metabolic disorders associated with diabetes, and unfavorable risk of cardiovascular complications of this disease.

[Glucose tolerance, function of pancreatic B-cells and blood lipids in "healthy" offspring of parents with conjugal type 2 diabetes]. / Tolerancja glukozy, czynnosc komórek B wysp trzustki i lipidy krwi u "zdrowego" potomstwa malzenstw z cukrzyca typu 2 (diabetes coniugum).

In 56 adult normoglycemic nondiabetic (WHO criteria) subjects, whose both parents had type 2 diabetes, and in 68 control probants, matched for age, sex and body mass without family history of diabetes, the OGTT (75 g) was carried out, including measurement of serum insulin (IRI) and C-peptide (CP). In fasting state also the blood lipid profile was determined: serum triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol, apolipoprotein AI (apoAI) and apolipoprotein B (apoB). In comparison with the control group, the offspring had significantly lower mean glycaemia on fasting, and non significantly elevated from the 60 min of the test, the significantly higher values of serum IRI and CP in fasting state and at the end of the test (120-180 min), and significantly lower serum CP:IRI molar ratio, expressing the reduced hepatic clearance of insulin. The offspring had significantly higher mean values of serum LDL-cholesterol, and significantly lower of serum HDL-cholesterol and apoAI, not disclosing significant differences in the serum levels of triglycerides, total cholesterol and apoB with the control group. Only serum HDL-cholesterol was significantly (negatively) correlated wit serum IRI and CP-values. The covariance analysis, eliminating the influence of age, body mass and the secretory activity of pancreatic B-cells, revealed the significant correlation of the presence of parental diabetes with serum levels of LDL-cholesterol (increase), and HDL-cholesterol and apoAI (decrease) in the offspring. These results prove indirectly, that in subjects genetically predisposed to type 2 diabetes, before the manifestation of glucose intolerance are present other effects of insulin resistance, expressed in increased activity of pancreatic B-cells, increased transfer of insulin to extrahepatic tissues, and in changes of concentration/composition of some lipoproteins dues to reduced influence of insulin on the enzymes which control their metabolism.

[Functional capacity of pancreatic B cells in patients with diabetes mellitus type 2 with late true ineffectiveness of sulfonylurea derivatives]. / Sprawnosc czynnosciowa komórek B wysp trzustkowych u chorych na cukrzyce typu 2 z pózna rzeczywista nieskutecznoscia pochodynych sulfonylomocznika.

Fasting concentration of the C peptide in serum was estimated in 150 patients with type 2 diabetes treated with insulin because of the late, true ineffectiveness of the sulphonylurea derivatives. In 36 patients selected out of the total group at random the secretion of that peptide was measured after i.v. injection of 1 mg of glucagon. Only 9 patients showed trace amounts of that peptide at morning fast (Group A--0.17 +/- 0.08 nmol/l), in 69 the secretion was normal (Sub-Group B1--0.80 +/- 0.25 nmol/l), in 48 moderately elevated (Sub-Group B2--1.67 +/- 0.10 nmol/l) and in 24 markedly elevated (Sub-Group B3--4.54 +/- 2.57 nmol/l). The increments of the peptide C concentration after glucagon stimulation were parallel to its fasting concentration, which indicated a proper reactivity of the pancreatic beta-cells in patients with normal or increased basal secretion. The patients with only trace secretion of the peptide C differed from the other by their small, normal body mass and by a longer duration of insulin treatment. Very similar insulin needs must be stressed in the patients of the Groups A and B as well as within the Sub-Groups B. In patients with hyperactivity of the beta-cells (Sub-Group B2 and B3) no differences were found, as compared with the other patients, in the prevalence of chronic diabetes complications of the micro- or macroangiopathy type, also prevalence of hypertension was equal. The results presented show that in the most patients with type 2 diabetes, with the late, true ineffectiveness of the sulphonylurea derivatives the secretory function of the pancreatic islets beta-cells remains normal or is even increased.