Deterioration of cardiac autonomic function over a period of one year in relation to cardiovascular and somatic neuropathy complications in type 2 diabetes mellitus.

AIMS: Progression of cardiac autonomic dysfunction (CADF) in relation to severity of diabetic autonomic neuropathy is well documented. But its progression while coexisting with somatic neuropathy (PNP) and cardiovascular disease (CVD) is less described. We monitored CADF over a period of one year in relation to PNP and CVD in patients with type 2 diabetes mellitus. METHODS: Cardiac autonomic function was assessed in 104 type 2 diabetics. Based on complications study subjects were divided into four subgroups: Group A (No complications); Group B (with CVD); Group C (with PNP); Group D (with CVD and PNP). The parameters measured were: Expiratory:Inspiratory ratio (E:I ratio) and standard deviation of all the N-N intervals (SDNN). These parameters were measured at the baseline and at follow-up. Data analysis was done by employing suitable statistical tests. RESULTS: In Group B: SDNN declined (p<0.001); E:I ratio did not change. In Group C: E:I ratio declined (p<0.01); SDNN did not change. In Group D: SDNN and E:I ratio declined significantly (p<0.001). CONCLUSION: CADF coexisting with PNP and CVD deteriorates with time. E:I ratio and SDNN are suitable markers in monitoring CADF coexisting with PNP and CVD respectively in type 2 diabetes mellitus.

Serum C peptide level and renal function in diabetes mellitus.

C peptide is an active peptide hormone with potentially important physiological effects. C peptide has the capacity to diminish glomerular hyperfiltration and reduce urinary albumin excretion in both experimental and human type 1 diabetes. The present study is aimed at correlating the serum C peptide level with that of renal clearance, urinary albumin excretion and duration of diabetes. This is a prospective cross sectional study. Patients with diagnosis of type 2 diabetes mellitus were evaluated for their baseline clinical and laboratory profile. Both males and females above the age of 18 years were included in the study. The laboratory investigations include fasting serum C peptide, HbA(1C), serum creatinine, blood urea nitrogen, urine albumin and creatinine. Creatinine clearance was calculated using modification of diet in renal disease formula from serum creatinine value. A total of 168 patients were included in the study, among them 90 were females (53.57%) and 78 males (46.43%). Mean age of the patients was 57.64 years. Pearson correlation test showed negative correlation of serum C peptide level with creatinine clearance, though statistically not significant. Negative correlation was also seen between serum C peptide, and urine albumin, urine albumin creatinine ratio, HbA(1C) and duration of diabetes. Mean urine albumin was higher in patients with subnormal C peptide level. Duration of disease was more in patients with lower serum C peptide level. The study has shown weak association of serum C peptide level with microalbuminuria and creatinine clearance. Risk of albuminuria is more in patients with low serum C peptide level.

Influencing factors of QTc among the clinical characteristics in type 2 diabetes mellitus.

AIMS: Although the clinical implications of prolonged Q-T interval have been described, the clinical determinants of Q-T interval in type 2 diabetes mellitus are not clear. We examined the influencing factors of QTc in type 2 diabetes mellitus. METHODS: This study involved 207 patients with type 2 diabetes mellitus and 141 healthy controls. QTc was estimated from resting lead II electrocardiogram. Data analysis was done using unpaired Student's 't' and Pearson correlation tests. RESULTS: Only female diabetics with somatic neuropathy had longer QTc compared to controls (p<0.01). Only in male diabetics negative correlation was found between QTc and heart rate response to deep breathing (p<0.01). Male and female study subjects with diabetic retinopathy had longer QTc compared to controls (p<0.01, 0.05). Only male diabetics with hypertension had longer QTc compared to controls (p<0.05). CONCLUSION: QTc prolongation is associated with diabetic neuropathy with sex difference in its manifestation. It is influenced by diabetic retinopathy in male and female diabetics. It is influenced by hypertension in male type 2 diabetics.

Independent predictors of cardiac parasympathetic dysfunction in type 2 diabetes mellitus.

INTRODUCTION: Although the clinical implications of diabetic autonomic neuropathy have been described, the clinical determinants of parasympathetic dysfunction in type 2 diabetes mellitus are not clear. We investigated the clinical determinants of heart rate response to deep breathing in type 2 diabetes mellitus. METHODS: This study involved 207 randomly selected patients with type 2 diabetes mellitus and 141 healthy controls. Heart rate response to deep breathing was measured in all the subjects. Heart rate response to Valsalva manoeuvre and active standing was measured in lesser numbers. Data analysis was done using unpaired Student's t-test, Pearson's correlation test and multiple regression. RESULTS: Heart rate response to deep breathing, Valsalva manoeuvre and active standing was lower in patients with diabetes mellitus than in controls (p-value is less than 0.0001, 0.01 and 0.01, respectively). Age, female gender and presence of somatic neuropathy were the independent predictors of reduced heart rate response to deep breathing (p-value is 0.001). Independent positive correlation was found between resting heart rate and heart response to deep breathing (p-value is 0.02). Factors associated with depressed heart rate response to deep breathing, but not independently predictive, were duration of diabetes mellitus, presence of hypertension, coronary artery disease, foot ulcer and retinopathy. Mean heart rate response to deep breathing of 47 patients with diabetes mellitus free of all complications was lower compared to controls (p-value is less than 0.01). CONCLUSION: Our data suggests that parasympathetic dysfunction mainly coexists with somatic neuropathy. It may be isolated, or precede detection of other complications. Age and female gender are the other predictors of reduced heart rate response to deep breathing in type 2 diabetes mellitus.

An open comparative clinical trial to assess the efficacy and safety of losartan versus enalapril in mild to moderate hypertension.

OBJECTIVES: To compare the efficacy and safety of losartan with enalapril, in mild to moderate hypertension. METHODS: An open, enalapril controlled study was conducted in 30 patients with mild to moderate hypertension. Losartan 50 mg was administered to patients for eights weeks. Throughout the study blood pressure was measured every two weeks. Routine laboratory investigations were performed before entering the trial, fourth week and at the end of the study. Adverse effects were recorded. After eight weeks losartan was stopped and enalapril 10 mg daily was administered to the same patients after two weeks washout period. The same methodology that was followed for losartan trial was repeated for enalapril trial also. RESULTS: Losartan treatment resulted in a highly significant reduction in the mean sitting diastolic blood pressure. Comparison with enalapril showed that both drugs are equally efficacious in reducing blood pressure in mild to moderate hypertension. The percentage of responders was slightly more with losartan than enalapril (86.7% vs 76.7%). Adverse events reported with losartan were mild. Enalapril also was well tolerated like losartan but there was high incidence of dry cough, which was reported in nine patients (30%). CONCLUSIONS: Losartan is an effective antihypertensive drug with an excellent safety and tolerability profile. It shows similar blood pressure lowering efficacy to that of enalapril. In contrast to enalapril, losartan does not cause dry cough.

Haemorrhagic pneumonitis: A rare presentation of leptospirosis.

Leptospirosis is an uncommon zoonosis. As a systemic disease, it presents itself by multisystem involvement. Pulmonary involvement with leptospirosis often is manifested by respiratory symptoms; but pneumonia commonly is not a prominent clinical manifestation of the illness. We report a case of leptospiral pneumonia in which pulmonary manifestations were primary clinical features of the illness. The prompt resolution of chest x-ray on institution of treatment is noteworthy.

Changing profile of diabetic ketosis.

Forty-three cases of diabetic ketosis were analysed to determine the mode of presentation, treatment modalities and outcome. Among these cases 62.8% were non-insulin dependent diabetes mellitus (NIDDM) patients and 37.2% belonged to the insulin dependent diabetes mellitus (IDDM) group. Six patients had blood glucose levels of more than 250 mg/dl but less than 300 mg/dl who were grouped separately for analysis under the term "euglycaemic diabetic ketoacidosis (EGDK)". Infection was the commonest precipitating factor in diabetic ketosis in all groups. Abdominal pain and vomiting occurred with NIDDM and EGDK cases. Drowsiness was common and coma was rare. Acute myocardial infarction (MI) and pulmonary oedema occurred with NIDDM cases. Shock, acidosis, acquired respiratory distress syndrome (ARDS) and mucor mycosis were seen with IDDM cases. Mortality was 7 out of 43(16.3%). Saline requirement was lower in NIDDM and EGDK cases. Intensive insulin therapy with hourly intravenous doses were needed for IDDM cases while majority of NIDDM cases could be managed with 6 hourly doses of insulin given subcutaneously or intramuscularly.