Microangiopathic complications in type 1 diabetes mellitus: differences in severity when isolated or associated with autoimmune polyendocrinopathies

CONTEXT: The development and evolution of different chronic diabetic complications may present variations among the different types and conditions of this disease. OBJECTIVE: To evaluate the degree of microangiopathy in Type 1 diabetes mellitus (DM1) associated with autoimmune polyendocrinopathies (OSAD) or isolated DM1 (iDM1). PATIENTS: OSAD (n=17) and iDM1 (n=13) were over 15 years old at diagnosis of DM and were matched for diabetes duration (13.9 ± 8.2 and 13.2 ± 5.9 years, respectively) and metabolic control (HbA1c: 6.4 ± 1.9 and 6.8 ± 1.4%). MAIN OUTCOME MEASURES: Urinary albumin excretion (UAE; ELISA), the inversion of serum creatinine (1/C) level and indirect ophthalmoscopy. RESULTS: Although the prevalence of hypertension was similar in both groups, the OSAD had inferior levels of UAE (7.4 ± 2.5 vs. 17.3 ± 9.2 µg/min; p< 0.05). Nephropathy was detected in 12% of the OSAD (none of them macroproteinuric) and in 39% of the iDM1 . The UAE in the iDM1 correlated negatively with 1/C values (r= -0.7, p< 0.005), but the same did not occur in the OSAD (r= 0.2, ns). Among patients with retinopathy, the severe form was found in 29% of the OSAD and in 46% of the iDM1. CONCLUSIONS: OSAD was associated with a lower degree of microangiopathy, in spite of age at diagnosis, duration of diabetes and the metabolic control. In contrast with the iDM1 , the increase in UAE of OSAD was not associated with reductions in GFR

The imbalance of sex-hormones related to depressive symptoms in obese men

Obese men may present hypogonadothrofic hypogonadism, mainly related to higher insulinemia and aromatase activity. Our objectives were to evaluate the relationship of sex-hormones profiles and frequency of depressive symptoms in 43 obese men, in a cross-sectional study. They had 19-60 years, and body mass index 30-50kg/m(2). LH, total and free testosterone (TT and FT), estradiol (E-2), sex hormone binding globulin, estradiol/total testosterone ratio (E-2/T) were analyzed. Depressive symptoms were evaluated by beck depression inventory (BDI), and significant depression was considered if BDI16.Thirty-four (80%) presented low TT levels, but only 4 (14%) had low free testosterone and hypogonadism symptoms12 of 43 (28%) presented increased E-2. Forty five (56%) presented depressive symptoms, but 16 (28% of the 45) had significant depression. BDI correlated positively with E-2 (r=0.407p=0.001) and E-2/T (r=0.473p=0.001), but not TT or FT. Patients with significant depressive showed higher levels of estradiol (136 +/- 48 versus 103 +/- 48pg/ml, p=0.02) and E-2/T (16.0 +/- 9.9 versus 9.8 +/- 4.6p=0.002) (mean +/- SD).In conclusion, obese men may present relatively excess of estradiol and deficiency in testosterone, leading to an imbalance between these two hormones. The greater this imbalance, the more depressive symptoms had our patients.Brazilian "National Council for ScientificResearch" (CNPq)Endocrinology Outpatient Clinic of Kidney and Hypertension Hospital and Endocrinology Division, Escola Paulista de Medicina, Federal University of São Paulo, Rua Leandro Dupret 365, BR-04025011, São Paulo, BrazilEndocrinology Outpatient Clinic of Kidney and Hypertension Hospital and Endocrinology Division, Escola Paulista de Medicina, Federal University of São Paulo, Rua Leandro Dupret 365, BR-04025011, São Paulo, BrazilWeb of Scienc

Influence of autonomic neuropathy upon left ventricular dysfunction in insulin-dependent diabetic patients

Background: Diabetic cardiomyopathy is a well-defined complication of diabetes that occurs in the absence of ischemic, vascular, and hypertensive disease.Hypothesis: The study was undertaken to test the relationship among autonomic neuropathy (AN), 24-h blood pressure (BP) profile, and left ventricular function.Methods: Nineteen type-1 diabetic patients underwent autonomic tests and echocardiographic examination. Patients were divided according to the presence (AN+) or absence (AN-) of AN.Results: In the AN+ group (n = 8), the E/A ratio at echo was lower than in the AN- group (n = 11) (1.1 +/- 0.3 vs. 1.6 +/- 0.3; p < 0.005). Systolic and diastolic BP reductions during sleep were smaller in the AN+ than in the AN- group (6.6 +/- 6.6 vs. 13.0 +/- 4.3%; p < 0.03 for systolic and 12.8 +/- 6.8 vs. 20.0 +/- 4.0% for diastolic BP reduction; p < 0.03, respectively). Considering all patients, the EIA ratio correlated inversely with awake diastolic BP (r - 0.63; p = 0.005); sleep systolic BP (r - 0.48; p = 0.04), and sleep diastolic BP (r - 0.67; p = 0.002). The AN correlated with diastolic interventricular septum thickness (r 0.57; p = 0.01), sleep systolic BP (r 0.45; = 0.05), sleep diastolic BP (r 0.54; p = 0.02), and correlated inversely with systolic and diastolic sleep BP reduction (r - 0.49; p = 0.03 and r - 0.67; p = 0.002, respectively). Finally, E/A ratio and AN score correlated between themselves (r - 0.6; p = 0.005).Conclusion: Our results suggest that left ventricular diastolic dysfunction may be detected very early in type-1 diabetic patients with AN. Parasympathetic lesion and nocturnal elevations in BP could be the Link between AN and diastolic ventricular dysfunction.UNIFESP, Escola Paulista Med, Dept Med, Div Endocrinol, BR-04024000 Sao Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Cardiol, BR-04024000 Sao Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Nephrol, BR-04024000 Sao Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Endocrinol, BR-04024000 Sao Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Cardiol, BR-04024000 Sao Paulo, BrazilUNIFESP, Escola Paulista Med, Dept Med, Div Nephrol, BR-04024000 Sao Paulo, BrazilWeb of Scienc