[Development of angiopathies in type 2 diabetes mellitus--results of a prospective 10 year study]. / Angiopathieentwicklung beim Typ 2-Diabetes mellitus--Ergebnisse einer prospektiven 10-Jahres-Studie.

In 150 newly detected type 2 diabetics the formation of macro- and microangiopathic complications during a 10-year control period was prospectively analysed, in order to demarcate possible factors of influence for the vascular prognosis under preventive points of view. Already at the time of manifestation there was with 34.3% an above average high prevalence of the coronary heart disease, particularly in the female sex. The prevalence of the coronary heart disease further increased to 49.7% in the course of diabetes and showed a correlation to the initial age, to the existence of overweight, hypertension, hyperlipoproteinaemia and nicotine consumption. The PMA was found comparatively more infrequent in the manifestation of diabetes (9.7%), but in the course of the disease highly significantly and independently of sex increased to 61.9%. The development of PMA was correlated with the age, the existence of hypertension and overweight. The frequency of retinopathy increased from initially 3.7% to 18.7%, the prevalence of nephropathy from 4.0% to 22.2%, without having found prognostic influence factors at the date of the diagnosis of diabetes.

Lipoprotein pattern in long-term diabetes of an at least 35 years' duration. Results of the Erfurt Study.

All diabetic patients suffering from the disease for at least 20 years and living in the closed area of the Erfurt district in 1970 have been followed prospectively since that time. In 47 of them still alive in 1985, i.e. after more than 35 years of diabetes, serum lipid and apolipoprotein concentrations were measured and compared to those of non-diabetic subjects without cardiovascular diseases (n = 47) pair-matched by sex, age, and body weight. In males (n = 27) significantly (p less than 0.01) higher levels of HDL cholesterol and apolipoprotein A-I as well as lower concentrations of triglycerides and a lower total cholesterol/HDL cholesterol risk ratio than in nondiabetic control subjects could be found. In long-term diabetic females (n = 20), apolipoprotein A-I levels were also increased (p less than 0.02). Trends in HDL cholesterol and triglycerides were similar to those found in males but did not reach statistical significance. Higher concentrations of total cholesterol (p less than 0.02), LDL cholesterol (P less than 0.05), and apolipoprotein B (p less than 0.02), however, did not fit in with a beneficial lipoprotein pattern. The frequency of pathological lipoprotein patterns was not higher than among the non-diabetic control subjects (32% and 40%, respectively). According to these findings an antiatherogenic lipoprotein pattern might be considered, at least in males, as one of the determinants causing the multifactorial event of long-term survival in diabetes.

Serum lipids and apolipoproteins in relation to glycaemic control and diabetic nephropathy in long-term survivors of diabetes: results of the Erfurt Study.

Follow-up data of all 208 long-term diabetics (duration of the disease at least 20 years) living in the closed area of the Erfurt district in 1970 had demonstrated the importance of lipoprotein pattern for longevity. Now the dependence of lipoprotein levels on both the diabetes-related conditions nephropathy and glycaemic control has been examined in 47 of them, still alive in 1985 that means 35 or more years after the onset of diabetes. Glycaemic control was assessed by measuring the glycosylated haemoglobin (n = 44). Diabetic nephropathy was assumed in case of persistent proteinuria. Poor glycaemic control (n = 16) was associated with increased levels of atherogenic lipoproteins as reflected by higher concentrations of total cholesterol, LDL cholesterol, apolipoprotein B, and triglycerides, as well as a changed HDL composition indicated by a decreased HDL cholesterol/apolipoprotein A--I ratio. Higher ratios of total cholesterol to HDL cholesterol and apolipoprotein B to apolipoprotein A--I point to an increased risk of developing atherosclerotic diseases in poorly controlled diabetics. 86% of the well controlled long-term diabetics had non-pathological values of LDL cholesterol, triglycerides, apolipoprotein B, HDL cholesterol, and apolipoprotein A--I but only 31% of the poorly controlled patients did so. Diabetic nephropathy in the absence of chronic renal failure (n = 10) was characterized by higher values of LDL cholesterol, triglycerides, total cholesterol/HDL cholesterol, and apolipoprotein B/apolipoprotein A--I. 80% of the subjects with a pathological lipoprotein pattern were proteinuric or in poor glycaemic control or both. Therefore, it is concluded that prevention of these two conditions might help to delay atherosclerosis via its beneficial influence on lipoprotein metabolism.

[Long-term effect of combination glibenclamide-insulin treatment in the secondary failure of sulfonylurea therapy--results of a one-year double blind study]. / Langzeiteffekt der Glibenclamid-Insulin-Kombinationsbehandlung beim Sekundärversagen der Sulfonylharnstofftherapie--Ergebnisse einer einjährigen Doppelblindstudie.

The long-term efficacy of combined insulin-glibenclamide treatment was investigated in 79 secondary drug failure patients by means of a double-blind, randomized placebo-controlled study. During a one-year follow-up period the patients on insulin plus glibenclamide required significantly lower exogenous insulin doses. Coincidentally, C-peptide concentrations were significantly raised in the verum versus the placebo group. Additionally, the administration of glibenclamide resulted in a decreased level of hyperglycaemia during the first six months of the observation period. Glibenclamide withdrawal after six and again after twelve months of the combined therapy provoked a deterioration of glycaemic control, as well as a lowering of the C-peptide concentrations. The findings demonstrate a prolonged beneficial effect of the combined treatment, in contrast to the solely short-term effects predicted by numerous studies. The metabolic improvement must be ascribed in part to the beta-cytotropic effect of glibenclamide. Extrapancreatic pathways via receptor/postreceptor mechanisms cannot be excluded.

[Prospective follow-up studies in long-term diabetes. Results of the Erfurt study]. / Prospektive Verlaufsbeobachtungen beim Langzeitdiabetes. Ergebnisse der Erfurt-Studie.

In 1970, in cooperation with the 14 district diabetic consultation centers of the Erfurt region (German Democratic Republic), all 208 known diabetics of the region with a known history of diabetes of at least 20 years (maximally 42 years) were registered and underwent multidisciplinary investigations. They were followed prospectively for at least 15 years. At the end of this period of observation, in 1985, 135 patients had died, 59 were still alive, the course of 14 is unknown. Of the 59 patients who were still alive in 1985, 49 (44 type I) were re-examined. There was a 2.1 times excess mortality rate compared with metabolically normal, interindividually paired (by age, sex and weight) controls. Cause of death in 89 patients (69.9%) was arteriosclerosis, predominantly of the coronaries, renal failure in only 9 (6.7%). Nearly all those patients who already in 1970 had evidence of advanced microangiopathies (proliferating retinopathy; persistent proteinuria) and/or macroangiopathy (authors' scoring system for coronary, cerebral and peripheral vascular disease) died during the observation period. Ophthalmoscopically normal or only mildly abnormal fundi revealed little tendency towards progression, despite the 35-55 years' duration of diabetes. Similar observations were made in the survivors as regards initially normal ECGs. The prognosis of long-term diabetes was decisively influenced by age and the severity of any arteriosclerotic disease, but not by the duration of diabetes.

[Acute course of schistosomiasis with pulmonary and hepatogenic localization]. / Akuter Verlauf einer Schistosomiasis mit pulmonaler und hepatogener Lokalisation.

On the basis of a case report the acute course of a bilharziasis with pulmonary and hepatogenic localisation is described. The importance of an exact geomedical compilation of the anamnesis and the consideration of geoepidemiological facts in diseases of foreigners and returners from tropic countries is emphasized. The treatment of bilharziasis should be performed with Niridazol or Praziquantel.

[Intensified therapy of newly detected maturity onset diabetes]. / Ergebnisse einer Intensivierung der Therapie des neuentdeckten Maturity onset-Diabetes.

In a prospective study 150 newly detected maturity onset-diabetics were randomized in 2 biostatistically comparable groups and underwent a treatment of different intensity. While the patients of the control group were treated according to the routine method used up to now in the dispensary for diabetics, in the intervention group an intensifying of the therapy took place, taking particular into consideration the body weight as well as the carbohydrate and fat metabolism. The decrease of body weight achieved by dietary intensive care proved to be the decisive factor for the tendency towards normalisation of glucose tolerance, hyperlipoproteinaemia and IRI-secretion, which could be registered in the intervention group after 2 years of observation. Following the preceding strong phase of diet, by Biguanides and Clofibrate a further significant improvement of the carbohydrate and fat metabolism could not be achieved. The decisive reserve in the treatment of obese maturity onset-diabetes could be seen in a permanent and continuous reduction of body weight. The results of this treatment depend highly on an intensive education as well as on frequent control of the patients' metabolism and their cooperation.