[Cardiac impairment of elderly patients with diabetes mellitus as studied with non-invasive myocardial scintigraphy and signal-averaged electrocardiography].

In patients more than 65-year-old with diabetes mellitus, positive late potentials on signal-averaged electrocardiograms were more common than in normal subjects (p < 0.05). This suggests that aged patients with diabetes mellitus are at risk for micromyocardial impairment. Myocardial scintigraphy with 123I-metaiodobenzylguanidine showed abnormally low uptake, in parallel with the data on SA-ECG. Thus, both methods may be clinically useful ways to noninvasively reveal micromyocardial impairment in aged patients with diabetes mellitus. Moreover, trimetazidine hydrochloride may be effective as therapy for micromyocardial impairment: the uptake of 123I-metaiodobenzyl guanidine had increased in some patients when measured 1 year after administration of trimetazidine hydrochloride (18 mg/day) and the late potential changed from positive to negative.

[Cerebral blood flow disorder in elderly patients with diabetes mellitus].

We studied changes due to aging in carotid and cerebral arterial blood flows, and compared the difference between healthy adults and diabetics using a ultrasonic quantitative blood flow measurement system (QFM 2000 XA). Aging caused the carotid blood flow, blood velocity and diameter excursion rate on the carotid wall to decrease, and its diameter to enlarge. Both cerebrovascular resistance and capacitance obtained from simulation models of blood pressure waves, increased with aging. Cerebral blood flows in aged healthy adults was not significantly different from those in aged diabetics, but clearly different from those in aged diabetics with abnormal findings on MRI. When right and left cerebral blood flows were markedly different, abnormality was observed on brain MRI. This well agreed with findings on cerebral blood flow scintigrams (SPECT) obtained from several patients. The ultrasonic quantitative blood flow measurement system is considered a useful screening tool before CT or MRI examinations.

Urinary glycylprolyl dipeptidyl aminopeptidase (GP-DAP) in insulin-dependent diabetic patients.

Urinary glycylprolyl dipeptidyl aminopeptidase (GP-DAP) concentrations were determined in 36 insulin-dependent diabetic children aged 4-18 years with a duration of diabetes ranging from 1 month to 14 years. Abnormal urinary GP-DAP concentrations were found in 19 of the 36 patients. Twelve of 27 patients without microalbuminuria also had increased urinary concentrations of GP-DAP. There was a significant correlation between urinary GP-DAP and plasma fructosamine (r = 0.52, p < 0.001). Our data suggest that urinary GP-DAP may be used as a marker for diabetic nephropathy. However, there is also a possibility that increased urinary GP-DAP concentrations are functionally related to poor metabolic control. Longitudinal studies are needed to establish the clinical usefulness of urinary GP-DAP.

Effects of angiotensin-converting enzyme inhibitor (alacepril) and calcium antagonist (nicardipine) in hypertensive non-insulin-dependent diabetic patients with microalbuminuria.

The influence of alacepril (50 mg/day) on arterial blood pressure and microproteinuria in 26 hypertensive non-insulin-dependent diabetic patients was studied for 16 weeks. Alacepril reduced blood pressure gradually from 175/88 (standard error of mean [SEM] 2.6/1.7) to 152/81 (3.3/2.0) mm Hg (P less than .005) and albuminuria from 160.6 (SEM 29.1) to 98.1 (14.1) mg/g Cr (P less than .05), while serum blood urea nitrogen, creatinine, HbA1c, and fructosamine (FRA) remained stable. No significant changes occurred in the urinary beta 2 microglobulin and N-acetyl-beta-D-glucosaminidase levels. As compared with the effects of a calcium antagonist (nicardipine, 60 mg/day) that reduced blood pressure from 170/92 (SEM 2.5/1.4) to 154/84 (2.5/1.5) mm Hg (P less than .001) and albuminuria from 162.2 (SEM 33.9) to 95.4 (25.0) mg/g Cr (not significant), it is suggested that the angiotensin-converting enzyme inhibitor (alacepril) may have an advantageous renal effect in spite of its mild antihypertensive effect.

Causes of death of diabetic patients in the past 10 years and their ECG findings.

We investigated the causes of death of 98 subjects with diabetes mellitus over the past 10 years at our hospital. As was expected, the cause with the highest incidence (48.0%) was vascular disease including cerebral vascular disease (20.4%), coronary heart disease (15.3%), aortic disease and miscellaneous (3.1%), followed by malignant tumors (39.8%), infectious diseases (4.1%) and other diseases. Only one patient died from diabetic coma. The abnormal ECG findings of these patients were analyzed according to the Minnesota Code and 57%, 31%, 26%, 24%, 19% of them showed arrhythmias, ST-T abnormalities, LVH, VPC, and abnormal Q-wave, respectively. These findings showed no statistical difference between diabetics and non-diabetics. Abnormal p-wave, especially LA-load was found more often in diabetics (35%) than in non-diabetics (21%). Q-T interval corrected by Bazett's formula (Q-Tc) was 430 +/- 3.03 (M +/- SEM) msec in diabetics and it was significantly longer (p less than 0.01) than 417 +/- 3.73 msec in patients with other diseases.