Role of diabetes in influencing leptin concentration in elderly overweight patients.

BACKGROUND: Leptin, the product of the ob gene, could have a significant role in the pathogenesis of obesity and non-insulin-dependent diabetes mellitus. However, it is still debated whether different degrees of glucose tolerance may affect plasma leptin concentrations in obese patients. OBJECTIVE: To investigate whether diabetes might influence leptin concentrations in obese patients. METHODS: We evaluated clinical parameters, anthropometric measures, and sex hormones, fasting plasma leptin, glucose and insulin concentrations in 100 elderly obese diabetic patients and 100 obese non-diabetic control individuals matched for age and sex. RESULTS: After adjustment for age and fat mass, plasma leptin concentrations did not differ between diabetic and non-diabetic obese individuals, in both men and women. In all patients leptin was significantly related to body mass index, fat mass and the homeostasis model insulin resistance index; moreover we observed a significant relationship with fasting plasma glucose and age in diabetic obese women, and with blood pressure values and testosterone concentrations in diabetic obese men. Multiple regression analysis revealed age and fasting plasma glucose to be the only independent determinants of fasting plasma leptin in diabetic obese women. CONCLUSIONS: These data suggest that leptin concentrations do not differ between obese diabetic and obese non-diabetic elderly patients. Among correlates of the metabolic syndrome, systolic pressure seems to be related to leptin only in men. In the postmenopausal or andropausal status, sex hormones are related to leptin concentrations only in diabetic men; in diabetic women, however, high glucose seems to be relevant in maintaining the same leptin concentrations as in non-diabetic women with similar degree of obesity.

The structural arteriolar changes in diabetes mellitus and essential hypertension. The relative contribution of ageing and high blood pressure.

AIM: To evaluate the relative contribution of blood pressure, non-insulin dependent diabetes mellitus and ageing on arteriolar structural changes in essential hypertension and diabetes mellitus. POPULATION AND METHODS: One hundred subjects, 25 with hypertension (A), 25 with hypertension and diabetes (B), 25 with diabetes (C) and 25 healthy subjects (D). Blood pressure average values, obtained with non-invasive monitoring, and minimal vascular resistance, calculated with strain-gauge plethysmography, were statistically correlated. Multiple regression analysis was performed to assess the contribution of blood pressure and age. RESULTS: Minimal vascular resistance was higher in A, B and C than in D, and higher in B than in A and C. The coefficient of blood pressure in the multiple regression analysis was significant for all the parameters in A and B but not in C and D; that of age was significant only in A and only for the average values of mean and diastolic blood pressure. CONCLUSION: Hypertension and diabetes show arteriolar structural changes of similar gravity. Age does play a role in hypertension but a smaller one than that played by blood pressure. In hypertension and diabetes the lack of significance of the contribution of age to the correlation between minimal vascular resistance and pressure could be ascribed to other neurohumoral factors. These factors play a much more important role in diabetes; where neither blood pressure nor age show any correlation with high vascular resistance.

Sudden death in diabetic subjects: evidence for a peculiar circadian variation in occurrence.

Anatomo-physiopathological and chronobiological features of 59 diabetic subjects out of 610 non hospitalized individuals observed for sudden death (SD) in an Emergency Room, over an 8-year period, were studied. Mean age and anatomopathological causes of SD were not different between diabetic (DMs) and non-diabetic subjects (NDs). However the frequency of DMs was higher among subjects who died from circulatory failure death (CFD), rather than from arrhythmic death (AD). Diabetics presented a prevalent peak incidence of SD in the afternoon-late evening; whereas in NDs two peaks were present, respectively in the morning and in the afternoon. According to anatomo-physiopathological causes, DMs presented a higher incidence of acute myocardial infarction (AMI) and CFD between 21:01 and 24:00, whereas in NDs the prevalent peak of AMI was observed in the early afternoon (13:01 to 16:00). Moreover, in DMs SD from acute myocardial failure prevalently occurred in the early afternoon (13:01 to 16:00), whereas in NDs it was uniformly distributed throughout the day. The present study seems to indicate that different anatomo-physiopathological causes of SD may present specific temporal patterns in diabetics.

Limb reduction defects in Emilia Romagna, Italy: epidemiological and genetic study in 173,109 consecutive births.

Epidemiological and genetic variables in limb reduction defects (LRD) were analysed during the years 1978 to 1987 in a case control study in Emilia Romagna, northern Italy. During the observation period, 83 neonates out of 173,109 consecutive births had LRD (4.8 per 10,000). Cases were divided into five subgroups: transverse, intercalary, longitudinal, split, and multiple types of LRD. Of all cases, 64% were upper limb, 21% lower limb, and 15% both. Coexisting non-limb malformations were found in 10 cases (12%), five with recognised syndromes and five with other associated defects. About 7.2% of first degree relatives had defects involving the skeletal system. In two cases the mother had the same type of LRD (a split). No recurrence among sibs was observed. Risk factors correlated with LRD were found to be low birth weight (2500 g or less), vaginal bleeding, and threatened abortion.

Long-term results in preventive medicine for type II diabetes.

The authors report the results of a 12-year screening for type II diabetes in their Health District (Emilia-Romagna, Northern Italy). The method consisted of two steps, following Pavel and Sdrobici, for early diagnosis of clinical diabetes and IGT. The authors found 1.03% of clinical diabetes and 2.65% of IGT cases in the population examined (200,000 subjects). Statistically significant correlations existed with regard to the various risk factors (familiarity, obesity, fetal macrosomia, occupation). Follow-up after 6 years for IGT subjects showed a 25.5% return to normal of OGTT values, 21.7% improvement, 19% unchanged, 33.8% deterioration. There was a correlation between these results and life-style (diet, reduction in calorie intake, weight loss). Twelve years after these screenings, a 2.7% drop in incidence was observed for type II diabetes in this Health District.

Pavel's "dynamic screening" for diabetes type 2: 14 years results in a district of northern Italy.

The AA. report the results of 14 years' screening for diabetes type 2 in their Health District (Emilia Romagna, North Italy), according to Pavel's method, for early diagnosis of clinical diabetes and impaired glucose tolerance (IGT). The AA. found in a first screening 1.03% of clinical diabetes and 2.65% of IGT cases in the population examined (200,000 subjects). Statistically significant correlations existed in relation to the various risk factors (hereditary factors, obesity, fetal macrosomia, job). The follow-up after 6 years for IGT subjects showed a 25.5% return to normal oral glucose tolerance test (OGTT) values, 21.7% improvement, 19% unchanged, 33.8% impairment. There was a correlation between these results and life-style (diet, physical exercise, weight loss). Fourteen years after these screening, a 2.7% negative incidence was observed for diabetes type 2 in this Health District.

[Critical analysis of the 2-hour test in mass screenings for the early detection of diabetes]. / Analisi critica del test delle 2 ore in corso di screenings di massa per la diagnosi precoce del diabete.

Out of 500 random trial subjects, taken for a mass-screening for early detection of diabetes mellitus, the Authors tried a correlation between the reliability of the "two-hour test" and the 2 h OGTT. The latter method provides more reliable results, allowing us to diagnose a high percentage of cases which is not possible if the simple two-hour test were used. Research of glycosuria in the course of OGTT did not show any real reliability, whereas it did prove useful in the preliminary phase of our research in order to distinguish the subjects for whom a deeper investigation would be advisable.