Errors in clinical assessment of glycaemic control in patients with non insulin dependent diabetes mellitus

Errors in the assessment of glycemic control by clinicians, using the conventional method, based on random blood glucose and clinical parameters other than HbA1, were assessed in 125 non-insulin-dependent diabetic (NIDDM) patients (Group B). The expected mean post-prandial plasma glucose concentrations (y) for these patients were obtained from their HbA1 values (x) using the regression equation y=39.6×x-157.6. This equation was derived using the data from 35 NIDDM patients (Group A), in whom mean post-prandial plasma glucose concentrations (measured twice daily), correlated excellently (r=0.82; n=100; p < 0.001) with mean HbA1 values (measured monthly) determined over a period of 3 months. A comparison of the observed and expected post-prandial plasma glucose concentrations in Group B indicated that only an overall 42% of the total (n=455) observed values (as against 60% in Group A) fell within the 99% confidence limits of the expected mean value. Fifty-eight % of the observed plasma glucose values fell outside the expected range of which 36% were underestimates and 22% were overestimates. Thus, we concluded that even in patients with stable diabetes the physician's assessment of the overall degree of glycemic control should be based on both plasma glucose and HbA1 concentrations for optimizing therapeutic measures

Anthropometric studies in diabetes in the tropics

Anthropometric studies were carried out in three groups of diabetics seen in southern India, namely fibrocalculous pancreatic diabetes (FCPD) (n=49) (a subtype of malnutrition related diabetes), insulin dependent diabetes mellitus (IDDM) (n=55) and non-insulin dependent diabetes mellitus (NIDDM) (n=104). Both FCPD and IDDM had significantly lower body mass index, skinfold thickness (triceps, biceps, subscapular and suprailiac), mid-arm circumference and fat mass compared to controls and NIDDM patients, (p<0.001 for all parameters). FCPD and IDDM males did not show any significant differences in any of the anthropometric parameters studied. Among the females, FCPD had lower triceps skinfold measurements (p=0.007) and mid-arm circumferences (p<0.05) compared to IDDM patients. Patients with NIDDM did not show any significant difference compared to the control group. This study shows that both FCPD and IDDM patients have lower body mass and fat mass compared to NIDDM patients and control subjects

β Cell function in insulin treated non insulin dependent diabetic patients

Non-insulin-dependent diabetes mellitus (NIDDM) patients, 94 in number, who were treated with insulin for various reasons for periods ranging from 2 to 10 years, were investigated to study the effect of long-term insulin therapy and also the effect of anti-insulin antibodies on the beta cell function. Insulin antibody titer and the stimulated C-peptide (CP) did not correlate with the duration of insulin therapy, dose of insulin, or the severity of hyperglycemia. The antibody titers were low in 45%, moderate in lo%, and high in 45%; no correlation was found between the antibody titers and the CP values. Satisfactory control of hyperglycemia was obtained in 54 patients after change of treatment to oral hypoglycaemic agents (OHA). The other 40 patients required continued insulin therapy. The initial CP values were similar in both the groups before initiating the new therapeutic patterns. Those who responded to OHA showed improved CP values on follow-up. The beta cell response to exogenous insulin is heterogenous in NIDDM patients. In many patients, adequate preservation of beta cell function is present even after long-term insulin therapy. Many of them respond to OHA. Insulin antibodies do not influence the secretory status of the beta cells in NIDDM patients

C-peptide responses to glucose load in maturity onset diabetes of the young (MODY)

Pancreatic beta cell responses were measured in obese and nonobese maturity-onset diabetes of the young (MODY) patients by estimating serum immunoreactive insulin (IRI) and C-peptide (CP) during oral glucose tolerance testing (OGTT). The serum CP responses were generally low in MODY patients and more pronounced in obese patients. The IRI responses were heterogenous; some patients had normal and others low responses. It was observed that in several patients there was a relatively higher IRI concentration in comparison with the CP values, as indicated by low CP and normal IRI values. This is suggestive of altered metabolic fates of insulin and CP in the MODY patients

The genetics of non-insulin-dependent diabetes mellitus in South India: an overview

Non-insulin-dependent diabetes mellitus affects approximately 10% of urban Indian and Indian migrant populations and as such carries major health implications for these groups. Whilst a strong genetic component to the aetiology of non-insulin-dependent diabetes mellitus is incontestable, progress in identifying the specific genetic determinants involved in its pathogenesis has been slow. In studies of South Indian pedigrees, preliminary segregation analysis indicates that non-insulin-dependent diabetes mellitus is likely to be a polygenic disease. A number of candidate genes have been studied with the aim of demonstrating either association or linkage with the disease; in South Indians the only positive results thus far have been associations between non-insuiin-dependent diabetes mellitus and the genes for insulin, apolipoprotein D and complement component C4B. However, it seems likely that these genes contribute only a small proportion of the genetic susceptibility to non-insulin-dependent diabetes mellitus in this ethnic group and that the major genes underlying glucose intolerance remain to be determined

Diabetes in the tropics: differences from diabetes in the West

This article does not have abstract

High prevalence of maturity onset diabetes of the young (MODY) among Indians

This article describes the high prevalence of maturity-onset diabetes in the young (MODY) in an Indian clinic population of diabetic patients. MODY appears to be more common among Indians than among Caucasians. Only 27% of MODY patients had definite autosomal-dominant inheritance. In 73% the mode of inheritance was not definite. Microvascular complications were common and macrovascular complications rare. The high prevalence of MODY in this diabetes clinic might suggest an ethnic variation in diabetes

Ultrasonographic evaluation of the pancreas in tropical pancreatic diabetes

Ultrasonography was performed in three groups of young diabetics in the tropics, namely MODY, IDDM and tropical pancreatic diabetes (TPD). Several morphological abnormalities of the pancreas such as fibrosis and shrinkage of the gland, increased echogenicity and ductal dilatation were found in patients with TPD. It also helped to localize the site of calculi in the pancreas. MODY and IDDM patients did not show any significant changes except a slight reduction in size of the gland. Ultrasonography is a useful tool in differential diagnosis of young diabetics in tropical countries

Decreased insulin binding in Asian Indian women with gestational diabetes

Insulin binding to erythrocyte insulin receptors was studied in 10 women with gestational diabetes and compared with 10 matched, normal, pregnant women and 10 normal, non-pregnant controls, with no family history of diabetes. Pregnant women had higher mean fasting and postglucose plasma immunoreactive insulin (IRI) compared to non-pregnant controls (p<0.001). Women with gestational diabetes had higher mean fasting and post-glucose plasma glucose levels and a lower mean specific binding of insulin when compared with the other two groups (p<0.001). The decreased insulin binding was significant only at lower insulin concentrations (0.2 − 2 ng/ml) when compared with those of normal pregnant women (p<0.01), suggesting decreased receptor affinity with no change in receptor number. In addition, an increased mean ED50 value for 50% inhibition of maximal binding and a lower mean average affinity constant Ke (empty site) obtained in gestational diabetes in comparison to the other two groups also suggested decreased affinity of the receptor. The finding that pregnancy with normal glucose tolerance was not accompanied by changes in insulin binding as against decreased insulin binding and affinity observed in gestational diabetes suggested a pathogenetic role for impaired insulin binding as one of the factors responsible for insulin resistance and hyperglycemia in gestational diabetes

Rapid improvement in insulin binding to erythrocyte insulin receptors in non insulin dependent diabetes mellitus during therapy

Insulin binding to erythrocyte receptors was studied in 36 newly diagnosed male subjects with NIDDM, treated with diet alone (Group I; n=10) or diet + glibenclamide (Group II; n=12) or diet + glibenclamide + metformin (Group III; n=14). Fourteen matched non-diabetic subjects were also studied as controls. Initially, mean (± SD) specific insulin binding was lower in NIDDM patients than in controls (p<0.001), due to decreased receptor number and affinity. Control of diabetes with short-term therapy (10 ± 2 days) resulted in significantly increased specific insulin binding in Groups II and III (p<0.001). A marginal increase was observed in Group I (p<0.01). The improved insulin binding observed in Group II and III patients after short-term therapy was maintained even after long-term therapy (9±1 months). Analysis of the insulin binding data by Scatchard plots and average affinity profiles indicated increased receptor number and affinity after short-term therapy. However, changes in affinity were reversed with long-term therapy in Groups II and III and the predominant effect appeared to be an increase in the number of binding sites