Ambulatory blood pressure measurement in type-II diabetic patients with autonomic neuropathy.

The aim of our study was to access the 24-hr ambulatory blood pressure (BP) in diabetic patients with autonomic neuropathy (AN). Twenty-two NIDDM patients without hypertension, being treated with sulfonylureas, were studied. The 24-hr ambulatory blood pressure recordings were performed using portable non-invasive automatic system. Autonomic neuropathy was assessed by standard cardiovascular reflex tests. There were ten patients with and 12 without AN, matched for age, body mass index, duration of diabetes and glycemic control. Mean BP increased at night in four of the subjects with AN and decreased in the remaining 18 patients. The group of subjects with nocturnal increases in BP had more severe autonomic nerve dysfunction compared with those with decreases in nocturnal BP. No significant difference between clinical and ambulatory day-time measurements was found. In three patients with AN after 5 weeks intensified therapy. 24-hr BP did not show any significant difference.

Insulin-like growth factor-I and IGF-I receptors in diabetic patients with neuropathy.

Since a number of animal studies have shown that insulin-like growth I (IGF-I) stimulates nerve regeneration, the aim of our study was to evaluate the possible relationship between IGF-I and IGF-I receptors in diabetic patients with peripheral neuropathy. One hundred and four patients with Type 2 diabetes (57 with peripheral neuropathy and 47 non-neuropathic) were studied. Controls were 17 non-diabetic persons. After an overnight fast, blood was taken for IGF-I, IGF-I receptors, glucose, HbA1, C-peptide, and insulin. The neuropathy study group had significantly lower levels of IGF-I:144.5 ng ml-1 (57.5-363.0, 95% confidence limits) compared to controls: 186.2 ng ml-1 (93.3-371.5), p < 0.01, and to diabetic patients without neuropathy: 173.7 ng ml-1 (83.1-363.0), p < 0.01. The study group also had a lower number of IGF-I receptors per red cell: 22.9 x 10(3) (13.08-38.01) vs control subjects: 28.1 x 10(3) (18.62-42.65), p < 0.01, and non-neuropathic diabetic patients: 26.3 x 10(3) (16.59-41.68), p < 0.01. In diabetic subjects there was a positive correlation (r = 0.20, p < 0.05) between IGF-I and HbA1, while in the neuropathy group there was a negative correlation between the score for nerve dysfunction with the IGF-I (r = -0.39, p < 0.01) and with IGF-I receptors (r = -0.34, p < 0.01). We conclude that in diabetic patients with peripheral neuropathy there are abnormalities of IGF-I and IGF-I receptors which may contribute to impaired neuronal regeneration.