M. Uusitupa

Medial Artery Calcification Predicts Cardiovascular Mortality in Patients With NIDDM

OBJECTIVE To study the predictive value of medial artery calcification (Mönckebergs sclerosis) in relation to 10-year cardiovascular mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS We studied the predictive value of thigh medial and intimal artery calcifications to 10-year cardiovascular mortality in a well-characterized group of 133 middle-aged, newly diagnosed patients with NIDDM (70 men and 63 women). RESULTS At baseline, medial artery calcifications were found in 17% of the patients and intimal-type calcifications were found in 23%. During the follow-up, 21% of the diabetic patients died from cardiovascular causes. The age-adjusted odds ratio for cardiovascular mortality was 4.2 (95% confidence intervals: 1.5−11.3) for medial-type and 1.6 (0.6−4.3) for intimal-type calcifications. In multiple logistic regression analysis, including age, sex, systolic blood pressure, low-density- and high-density-lipoprotein cholesterol, very-low-density lipoprotein triglycerides, smoking, body mass index, fasting serum insulin, blood glucose, urinary albumin, and ischemic ECG changes, as well as the intimal artery calcification, the medial artery calcification was the dominant factor predicting cardiovascular mortality. CONCLUSIONS In this study medial artery calcification was a strong independent predictor of cardiovascular mortality in patients with newly diagnosed NIDDM. Whether these subjects had a longer duration of hyperglycemia before the diagnosis than those without medial artery calcifications remains unknown.

Metabolic evolution of type 2 diabetes: a 10-year follow-up from the time of diagnosis

Abstract. Objectives. To investigate fasting and post‐load plasma glucose, insulin and C‐peptide levels during oral glucose tolerance tests in patients with type 2 diabetes and in control subjects, and the metabolic evolution of the diabetes.

Left ventricular systolic function in middle-aged patients with diabetes mellitus

In cross-sectional studies of asymptomatic diabetic patients, multiple abnormalities in left ventricular (LV) function have been found. Long-term significance of these abnormalities is unknown because follow-up studies have not been previously performed. LV ejection fraction (EF) by radionuclide angiocardiography was examined in middle-aged control subjects (n = 44), in patients with insulin-dependent (IDDM) (n = 32) and non-insulin-dependent (NIDDM) (n = 32) diabetes mellitus at baseline and after 4-year follow-up. At baseline, all study subjects were free from cardiovascular disease. LVEF at rest did not differ between the groups at baseline. The decrease in LVEF at rest during follow-up was 1.1 +/- 1.1% (mean +/- SEM) in control subjects, 3.1 +/- 1.3% (p = NS, compared with control subjects) in patients with IDDM, and 7.2 +/- 1.4% (p < 0.01) in patients with NIDDM. At follow-up examination, abnormally low LVEF at rest (< 50%) was found in 7% of control subjects, 13% of patients with IDDM (p = NS), and in 31% of patients with NIDDM (p < 0.05). Compared with control subjects, the prevalence of an abnormal LVEF response to exercise (an increase by < 5%, or a decrease) was higher in diabetic groups at both examinations. This prevalence increased in control subjects from 10% at baseline to 26% at follow-up examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Fructose in the diabetic diet

Fructose is an energy-yielding sweetener coming from different natural sources (fruit, berries, and vegetables) or is added to soft drinks, bakery products, and candies. The current content of fructose in the diabetic diet seems to be within recommendations. Because of the low glycemic index of fructose, fructose may be an alternative as a sweetener for those diabetic patients who like sweet foods but are liable to high postprandial glucose concentrations. In patients with mild non-insulin-dependent diabetes mellitus, fructose may result in lower postprandial glucose and insulin responses than will most other carbohydrate sources. In clinical studies, fructose has either improved metabolic control of diabetic patients or caused no significant changes. In patients susceptible to hypertriglyceridemia high doses of fructose should be avoided because of a potential hypertriglyceridemic effect. Long-term experiences about the use of fructose from large scale controlled studies on diabetic patients are lacking.

Physical Activity and Fibrinogen Concentration in Newly Diagnosed NIDDM

OBJECTIVE To evaluate whether plasma fibrinogen concentration is correlated with the level of physical activity and aerobic power in patients with newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS We studied 78 middle-aged (54 ± 6 years, mean ± SD), obese (body mass index [BMI] 32 ± 5 kg/m2) patients (45 men and 33 women) before and after a 12-month treatment period consisting of either conventional treatment given by community health centers or intensified dietary and exercise education given by a university outpatient clinic. Plasma fibrinogen concentration was measured by using a coagulometer. Physical activity was assessed by a questionnaire, and the patients were classified into a sedentary group or moderately or intensively exercising groups. Aerobic power (maximum oxygen uptake [], anaerobic threshold []) was measured by direct breath-by-breath technique. RESULTS At baseline, the sedentary patients had higher fibrinogen concentration than those with moderate or high physical activities (3.8 ± 0.8 vs. 3.3 ± 0.7 g/I, P < 0.01). Both and (ml · min−1 · kg−1) showed an inverse linear correlation with fibrinogen (r = -0.38, P < 0.001, and r = -0.29, P < 0.01, respectively). In the step wise multiple regression analysis, BMI, Vo2 max (ml/min), and smoking were the only significant independent factors explaining 23% of the variance in fibrinogen concentration. In sedentary patients, poor glycemie control was related with high fibrinogen concentration. During the follow-up period, patients maintained, on the average, good to moderate glycemie control. The originally sedentary group showed a decrease in fibrinogen concentration (to 3.3 ± 0.7 g/I, P < 0.001) that reached the same level that the physically more active groups had at baseline. This change was associated with improved glycemie control, but not with any of the other assessed factors, including fatty acid composition of serum lipids reflecting dietary intake of fats. CONCLUSIONS In addition to BMI and smoking, low reported physical activity and low aerobic power are independently associated with high plasma fibrinogen concentration in newly diagnosed NIDDM.

Therapeutic traditions in type 2 diabetes — are they changing?

The utilisation of antidiabetic drugs reflects both the prevalence of diabetes and the different therapeutic traditions of physicians. A questionnaire survey to study attitudes to the use of oral antidiabetic drugs amongst physicians and possible changes in treatment habits was carried out in a representative sample of Finnish physicians (n=454) in 1992 and the results were compared with those of a similar survey carried out in 1985, and with drug utilisation statistics.The mean fasting blood glucose level at which a physician would start pharmacological treatment was 8.7 mmol·l−1, which was significantly lower than in the 1985 survey. The responses to various case histories suggested a more active approach to pharmacological treatment compared to the 1985 survey. Insulin treatment especially seems to have gained in popularity. This change in attitude was paralled by an increase in the consumption of antidiabetic drugs in Finland during the observation period. The increase in use of oral drugs was steeper in Finland than in Norway and Sweden.Whether this active approach will improve the metabolic control and prognosis of patients with Type 2 diabetes, remains to be demonstrated.

Regular eye examinations of diabetic patients in the finnish health care system

A questionnaire about regular eye examinations of diabetic patients was sent to 1,776 physicians in eastern, western and southern provinces of Finland. The study was a part of a larger questionnaire about the medical care of high blood pressure and diabetes. Of the 1,706 doctors working actively, 950 (56%) completed the questionnaire, and 398 (42%) of them treated diabetic patients and gave their opinions of the ophthalmological care in diabetic patients. Regular eye examinations in type I diabetes were carried out annually by 79% of the physicians. In type II diabetic patients, the figure was 55%. In different provinces, these percentages varied from 61% to 81% in type I and from 38% to 74% in type II diabetes. The eye examination was performed in 54% by the physician who also treated diabetes, otherwise the examinations were performed by an ophthalmologist in a hospital, health centre or in private practice. In southern provinces of Finland, regular eye examinations were performed primarily by ophthalmologists in private practice, in western and eastern provinces they were performed by the doctors who also treated diabetes. Most of the regular annual eye examinations were reported by specialists in general practice and physicians working in health centres. The reported current practice in the regular eye examinations of type I diabetic patients is near the current European and American recommendations, but in type II diabetic patients these recommendations are not met adequately.