[Insulin dependent (type 1) diabetes mellitus in advanced age]. / Inzulindependens (1. típusú) diabetes mellitus idöskorban.

In everyday praxis diabetes mellitus diagnosed over the age of fifty years, means generally type 2 diabetes. Authors present cases where diabetes, beginning in advanced age, showed typical classical diabetic symptoms, like polyuria, polydipsia, loss of bodyweight. Apart from these signs a rapid decompensation of carbohydrate metabolism characterises this diabetes form. The most significant features are the rapid decrease of serum immunoreactive insulin and C-peptide levels, what is characteristic for the diminishing insulin secretory capacity. The patients had to be switched to insulin therapy within maximum 6 weeks. These patients can be easily differentiated both from type 2 and from the slowly progressing type 1 subtype. We suppose that the pathomechanism of this type of diabetes differs from the classical insulin-dependent form, beginning in young age.

[The value of certain parameters in the diagnosis and detection of metabolic X syndrome]. / Az egyes vizsgálati paraméterek értéke a metabolikus X-szindróma diagnózisában és felkutatásában.

Authors summarise their 5-year long experiences on 343 patients about diagnostic methods of metabolic syndrome X and offer a simple possibility for screening of the jeopardized individuals. In a group of patients with hypertension and central obesity (group I: with 2 insulin resistant condition), 229 (89%) out of 255 cases met the basic criteria of the syndrome X which were hypertension, central obesity and high insulin levels for the corresponding blood sugar levels during oral glucose tolerance test (probable insulin resistance). Dyslipidemia was missing in 20% of these people. Hyperinsulinism occurred in 85%, glucose intolerance in 53%, presumable insulin resistance in 90% of cases. Insulin resistance was characterised by late hyperinsulinism (90 and 120 min.) during oral glucose tolerance test. This was the case in people with "diabetoid" glucose responses too, suggesting an early failure of glucose tolerance and/or insulin secretion. Components of syndrome X were present with a lower frequency in 24 patients with obesity (group II), in 35 patients with hypertension (group III) and in 29 patients without obesity or hypertension (group IV), as well. According to central obesity and hypertension, syndrome X could be screened by a probability of 90%. This can be helpful in prevention of NIDDM and coronary heart disease.

[Clinical picture of slow-evolving insulin-dependent diabetes mellitus]("1 1/2")]. / A lassan kialakuló inzulin dependens diabetes mellitus ("1 1/2") klinikuma.

The authors investigated the difficulties of differential diagnosis in diabetes, beginning in young age. They analysed the case records of fifteen young diabetics. The authors pointed out, that clinical diagnosis, carried out early, has utmost importance both of theoretical and practical significance, for correct classification according to the type of diabetes determines the therapy. In building the diagnosis, the clinician needs correct anamnestical, clinical data, immunogenetic markers (ICA, HLA), and the capacity of endogenous insulin secretion as well. In three patients they have observed a long period without insulin treatment that could be classified as remission phase. In eleven cases the treatment has started with oral antidiabetic drugs, one patient has got at he very beginning insulin treatment. At present, there is only one patient, still taking oral drugs. This diabetics has an ICA positivity in high titer, but he is refusing the recommended exogenous insulin treatment. In all of their cases the amount of injected daily insulin is low (0.3-0.6 IU/body weight/24 hours). Authors state by their careful analysis, that in all of their 15 diabetics there is existing a slowly developing type I IDDM, I/b, or very recently 1 1/2 diabetes form. The so called autoimmune form--described originally by Bottazzo--could have been disclosed in all of their cases.

[Hypertension and multimetabolic syndrome]. / Hipertónia és multimetabolikus szindróma.

The occurrence of multi-metabolic syndrome was studied by authors on 31 patients with obesity of android type and hypertension. Plasma glucose and plasma insulin levels were investigated during oral glucose tolerance test, plasma lipid levels were determined, furthermore body mass index and waist/hip ratio were calculated. It was considered that in 65 percent of the cases the presence of multi-metabolic syndrome could have been proved. Dyslipidemia in 22 cases, hyperinsulinemia in 20 cases, deterioration of the carbohydrate metabolism in 14 cases could be demonstrated. The negative correlation between glucose- and insulin-responses to glucose challenge may suggest the presence of insulin resistance. No significant difference was found in metabolic parameters between men and women. The multi-metabolic syndrome is regarded by authors as a process which may lead to both type 2 diabetes mellitus and atherosclerosis. According to their appearance about two third of these patients could be screened. Authors emphasize the great significance of this problem and the importance of early diagnosis and prevention.

[Is it permissible to treat young diabetics with oral antidiabetics?]. / Szabad-e fiatal cukorbetegeket orális antidiabetikumokkal kezelni?

Authors analyzed the case history of 25 young diabetic patients, whose disease has been diagnosed before the age of thirty. The question that has been raised: is it allowed to treat young diabetics with oral drugs? By classifying the patients, they stated followings: In the 1. group they classified 16 verified MODY/NIDDY patients. In the second group they classified 3 young diabetics, whose disease had been evaluated as slowly progressing IDDM (autoimmune form). 3 patients belonged to the 3 group. They had been classified as MODY/NIDDY patients, however an extremely long lasting remission period--due to the short observation time--can not be excluded. The remaining 3 diabetic patients belonged to the IDDM group, with a long remission period. They were treated incorrectly with oral hypoglycemic drugs. Young diabetics can be treated with oral drugs only in case, when they are proven MODY/NIDDY patients. The precise differential diagnosis between this form and autoimmune IDDM, as well as long lasting remission periode, is extremely important.

Insulin metabolism in hypothalamic obesity.

Serum C-peptide and Immunoreactive Insulin (IRI) level was measured during per os glucose tolerance test as well as fasting specific insulin binding percentage and capacity of erythrocytes in hypothalamic obesity and in obese children due to hypercalorization, and was compared with ideal-weight controls. Integral values of curves (sigma) and sigma C-peptide/sigma IRI ratios were calculated. In 4 cases fasting C-peptide content was substantially increased as compared to the other groups. The data suggest that hyperinsulinism in diencephalic obesity is primary. The ratio of the two peptides was normal or increased: insulin binding % of erythrocytes corresponded to that of the control group, which explains in these cases normal or favourable glucose metabolism. It is thought that in obese children high fasting C-peptide levels with an adequate clinical picture can indicate the functional examination of the hypothalamic-pituitary system. Sigma C-peptide/sigma IRI ratio differing from normal indirectly shows the changes of receptor function.

[Long-term remission in diabetes mellitus diagnosed at an early age]. / Tartós remisszió fiatalkorban felismert cukorbetegségben.

The authors deal with the clinical picture of total remission in diabetes, among young patients (below 30 years). In their interpretation "complete remission" means total withdrawal of insulin treatment for at least 2 months. Out of 14 patients with complete remission, the classified 7 patients--by clinical and immunogenetical parameters--as noninsulin-dependent diabetes in the young (MODY-NIDDY). 1 diabetic patient belongs to the autoimmune-subgroup of IDDM. The remaining 6 patients could be classified as IDDM-s. However their clinical and immunogenetical parameters were rather atypical. In conclusion they raised the possibility that this subgroup is heterogenous with in IDDM.

[Is diabetes mellitus, diagnosed between the ages of 30-45, a special sub-type?]. / Onálló alcsoport-e a 30-45 éves kor között kórismézett diabetes mellitus?

Diabetes diagnosed in the so-called middle age of life is debated from the typological point of view. The authors investigated 45 diabetics, whose disease had been diagnosed between the age of 30-45 years. As a result of their observations they state that diabetes in this age range is heterogenous. Patients can be classified into insulin-dependent and non-insulin-dependent types of diabetes. Two of their patients could be classified into a newly described subtype (early onset diabetes, EOD). For the time being it seems that the exact delineation of this new diabetic subtype needs more detailed observations.

Alteration of insulin-binding receptors in non-insulin dependent diabetes of the young.

The behaviour of insulin binding receptors is rather unelucidated in non-insulin-dependent diabetes mellitus of the young. Authors in continuing their previous work studied the behaviour of insulin binding receptors of erythrocytes and monocytes in 9 MODY patients. They observed that specific insulin binding of circulating blood cells was significantly decreased in all cases as compared to the controls despite of a good state of metabolism (in the case of erythrocytes 4.63 +/- 1.1% vs. 6.03 +/- 1.7%, p less than 0.05, in the case of monocytes 2.3 +/- 1.2% vs. 3.6 +/- 1.4%, p less than 0.05). The lower value of insulin binding resulted from the decrease of receptor concentrations (in the case of erythrocytes 2.36 +/- 0.78 pmol/l vs. 3.81 +/- 1.14 pmol/l, p less than 0.05).