Acute effects of 20 mg oral enalapril (E), and angiotensin-converting enzyme inhibitor, on renal function and the renin-angiotensin-aldosterone system were investigated in 13 patients with type II ...diabetes mellitus (8 female, 5 male) and 10 hypertensive controls using a radionuclide method. Plasma glucose control was evaluated with fructosamine (F) determinations. After intravenous administration of 370 MBq 99mTc-DTPA, sequential images were recorded. Glomerular filtration rate (GFR), perfusion index (PI), time to maximum activity and reno index values of the kidneys were calculated. Two days later, renal scintigraphy was repeated after oral administration of E. Plasma levels of renin, angiotensin II and aldosterone were analyzed using RIA. Basal GFR values (mean: 92.6 ml/min) correlated with F (r = 0.364; p < 0.05). In the diabetic group, 5 patients had a decrease in GFR and an increase in PI after oral E. The mean percent change of GFR was 12 +/- 32 for patients and 20 +/- 12 for controls, respectively. Percent change of GFR had a slightly negative correlation with F values (r = -0.51; p < 0.05) and with PI (r = -0.65; p < 0.001). The patients with good metabolic control had an increase in GFR and a decrease in PI indicating an increase in renal blood flow and glomerular filtration. In patients with proteinuria and poorly controlled diabetes, in response to E-induced efferent arteriolar dilation, there is a decrease in GFR and an increase in PI which indicates a fall in filtration and renal blood flow. This glomerular hemodynamic pathology precedes morphological changes due to diabetes.
Neurotrophic factors in diabetic neuropathy Vinik, Aaron I; Pittenger, Gary; Park, Tae Sun ...
Current opinion in endocrinology & diabetes,
2001-August, Letnik:
8, Številka:
4
Journal Article
There is a reduction in the availability of neurotrophic factors in diabetes. These factors are important for the maintenance of neuron health and the ability to resist apoptosis, and to regenerate ...damaged nerves. The best studied is nerve growth factor (NGF). Clinical trials with NGF have had variable results. Nerve growth factor still holds promise for sensory and autonomic neuropathies. The insulin-like growth factors (IGFs), IGF-I and IGF-II, exert profound effects on developing neurons and are deficient in certain tissues in diabetes. Their possible role in the treatment of neuropathy in diabetes is obscured by a complex interaction with various binding proteins and the interaction with different receptors whose disposition in diabetes is not yet clearly established. Laminin, a large heterotrimeric protein present in the basal lamina of nerves, appears to be important in nerve regeneration. Laminin also exerts antiapoptotic properties against the neurotoxicity of sera of patients with diabetes. There are new compounds including cytokines, immunophilin ligands, and inhibitors of programed cell death that are capable of affecting the plasticity of nerves. They stimulate the differentiation of nerve cells in culture and the extension of neurite outgrowth or they inhibit apoptosis, but none of these compounds have been evaluated clinically. The development of growth factor therapy for diabetic neuropathies is a genuine possibility.
The primary objectives of this study were to assess the efficacy and safety of Lys(B28), Pro(B29) in the treatment of patients with diabetes mellitus and to compare Lys(B28), Pro(B29) to currently ...available regular insulin with respect to quality of life. This study was designed as an open-label, non-comparative one. The number of patients enrolled in the trial was 39. At Visit 1 (week 0), blood samples for fasting, 1- and 2-hour postprandial blood glucose, and HbA1c were taken. At Visit 2 (week 6) and Visit 3 (week 12), fasting, 1- and 2-hour postprandial blood glucose, and HbA1c levels were measured again. There was no significant change in HbA1c, fasting blood glucose and 1- and 2-hour postprandial blood glucose levels. The 1- and 2-hour postprandial blood glucose excursions decreased significantly from Visit 1 to Visit 3. There were no serious adverse events during the study. Half of the patients had less hypoglycemia with LysPro insulin, while 25% had an increase in episodes. Thirty percent of patients were more satisfied with LysPro insulin than with the short-acting insulin that they had previously used. In conclusion, LysPro therapy can be regarded as safe, since there were no unexpected adverse events and no changes in the usual physical parameters.
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