Diagnosis and treatment of levothyroxine pseudomalabsorption.

Many causes of malabsorption of levothyroxine in patients with hypothyroidism have been thoroughly described in literature. Pseudomalabsorption, poor compliance of the patient with the therapy regime, is the most common cause of failure of levothyroxine therapy. Pseudomalabsorption is characterised by a deficient diagnostic process, patient denial and difficulties in treatment. The present article provides guidelines in diagnosing and treating pseudomalabsorption in hypothyroidism.

Serum lipoprotein-a levels and glyco-metabolic control in insulin and non-insulin dependent diabetes mellitus.

OBJECTIVES: Conflicting results for lipoprotein-a (Lp(a)) levels in diabetic patients exist in the literature. Normal, increased, and decreased values are described, and a relation to glycometabolic control is not unequivocally established. DESIGN AND METHODS: In our study Lp(a) was measured in a large group of diabetiee (80 patients with IDDM and 90 patients with NIDDM) in relation to glycometabolic control and the presence of microalbuminuria, retino and/or neuropathy. Long-term and short-term glycometabolic control were assessed by HbA1 and fructosamine assays, respectively. RESULTS: Statistically significant differences between Lp(a) levels in IDDM and NIDDM-and a control group of 110 healthy nondiabetics could not be established. It appeared that the level of Lp(a) in IDDM and NIDDM is independent of short-term and long-term glycometabolic control or the occurrence of microalbuminuria, neuro or retinopathy. However, poor glycometabolic control affected the number of Lp(a) levels elevated above a threshold of 0.25 g/L in IDDM. CONCLUSION: These results suggest that the level of Lp(a) in serum is not influenced by diabetes mellitus, glycemic control, or the occurrence of microalbuminuria, neuro or retinopathy.

Microalbuminuria in diabetic patients: relationship to lipid, glyco-metabolic, coagulation and fibrinolysis parameters.

One hundred and sixteen insulin treated diabetic patients were evaluated for the relationship between the presence of microalbuminuria and several lipid, glyco-metabolic, coagulation and fibrinolysis factors. A significant correlation existed only between microalbuminuria and HbA1c (r = 0.23, p = 0.008) and D-dimer (r = 0.28, p = 0.002). After the subdivision of the patients in a group without (n = 85) and a group with microalbuminuria (n = 31) significant differences were found between these two groups for the HDL-cholesterol content (p less than 0.05), the HbA1c level (p less than 0.01) and for the D-dimer concentration (p less than 0.01). Comparison of the patient groups without and with microalbuminuria separately with a healthy volunteers group without albuminuria resulted in significant differences for HDL-cholesterol, triacylglycerols, HbA1c, fructosamine, fibrin monomer and D-dimer, whereas fibrinogen also was significantly different between the diabetic group without microalbuminuria and the healthy volunteers group. Several factors predisposing for atherosclerosis (decrease of HDL-cholesterol, increase of triacylglycerols, coagulation activation with relatively insufficient fibrinolysis) were noticed in both diabetic groups without or with microalbuminuria, but more pronounced in the latter group. The appliance of a Receiver Operating Characteristic (ROC) curve for HbA1c against microalbuminuria (cut-off level 20 micrograms/min) reconfirmed the value of adequate glycaemic control in diabetics for the prevention of microalbuminuria. In conclusion the results of this study show a significantly poorer glycaemic control in insulin treated diabetics with microalbuminuria than in those without microalbuminuria. The presence of lower HDL-cholesterol, higher triacylglycerols and the elevation of fibrin monomers and D-dimers is more pronounced in the microalbuminuria group.(ABSTRACT TRUNCATED AT 250 WORDS)

Glycometabolic control and fibrinolysis in diabetic patients.

We investigated 148 diabetic patients with regard to their relationship between fibrinolysis (D-dimer and plasminogen activator inhibitor; PAI) and glycometabolic control (HbA1c, HbA1 and fructosamine). The percentage of moderately controlled patients as indicated by HbA1c, HbA1 and fructosamine is relatively high (29.7, 41.7 and 30.4%, respectively). Simultaneously, the D-dimer and PAI levels turned out to be enhanced in 30.8 and 22.4% of the patients. There was a positive nonsignificant correlation between D-dimer and HbA1c, a highly significant negative correlation between D-dimer and HbA1 and a nonsignificant negative correlation between D-dimer and fructosamine. According to the upper limits of the distinct reference ranges for HbA1c, HbA1 and fructosamine, we splitted up the D-dimer results and calculated the mean D-dimer values belonging to each category. Comparing the D-dimer means for each parameter, we separately obtained significant differences of the D-dimer means between the lower and higher HbA1 and fructosamine groups, whereas in the case of HbA1c the mean D-dimer values of the categories under and over 9% showed no significant difference. For PAI, we found only weak nonsignificant positive correlations to D-dimer and fructosamine and weak but highly significant correlations to HbA1c. These results are indicative for an increase of PAI with diminished glycometabolic control as measured with the HbA1c and fructosamine level. Both D-dimer and PAI showed positive, highly significant correlations to the age of the diabetic patients, whereas HbA1c and fructosamine were age independent.(ABSTRACT TRUNCATED AT 250 WORDS)

Coagulation activation in diabetes mellitus.

One hundred and fourty-eight insulin-dependent diabetic patients were available for this study; 56 males and 92 females. For the investigation of coagulation activation we determined activated partial thromboplastin time, thrombin time, and fibrinogen besides fibrin monomers and thrombin-antithrombin III complexes (TAT-III). We assessed large percentages of increased fibrinogen levels but non-significant increases of the mean values in comparison with the reference group. The values for thrombin time were significantly prolonged, although relatively small percentages were exceeding the reference range. For the activated partial thromboplastin time, the values exceeded the upper reference limit, and the mean values were significantly higher than those of the reference group. Also for the fibrin monomers we obtained often enhanced values, and moreover, the values were significantly higher as compared with the reference subjects. The amount of TAT-III concentrations above the reference range was much smaller than for the fibrin monomers and the TAT-III levels were not significantly enhanced. The results presented here are indicative of coagulation activation in diabetics, as indicated by the fibrin monomers and more or less by the TAT-III levels. Moreover, there could be demonstrated a positive correlation between fibrin monomer levels and HbA1 concentrations.