[Blood coagulation parameters in insulin-dependent diabetic children at onset of the disease and after 3 months]. / Parametri emocoagulativi in bambini diabetici insulino-dipendenti all'esordio e dopo tre mesi di malattia.

Levels of factors II, V, VII, VIII C, VIII R:Ag, VIII vW, IX, X, PT, PTT, TT, TR, antithrombin III and fibrinogen were evaluated in 11 children with insulin-dependent diabetes mellitus (IDDM) at onset of disease and after 3 months and in 15 healthy age-matched controls. At onset of IDDM a significant increase was observed only in mean values of factor VIII C, VIII R:Ag and in VIII vW. After 3 months the levels of factor VIII C returned within the normal range whilst no variations of factor VIII R:Ag and vW were found. These data show that coagulation abnormalities are already present at onset of IDDM and that endothelial damage evidenced by high values of factor VIII R:Ag and vW may persist even in a phase of good metabolic control. Levels of factor VIII C seem to be related to the increased protein glycosylation of IDDM.

[Value of the method of Cerasi and Luft in checking the progression of metabolic disorders in childhood]. / Validità della metodica di Cerasi e Luft nel controllo dell'evoluzione dei dismetabolismi nell'infanzia

The method of Cerasi & Luft was evaluated after 6 months and 1 yr of dietary management in 7 children with familial diabetes and/or very slight clinical and laboratory symptoms, and one obese girl. There was a marked reduction in the blood insulin area in the obese subject, whereas the remainder of the series displayed stationary pictures. It is felt that the method deserves emphasis on account of its constant evocation of a reproducible response and the possibilities of interpretation that it offers in the field of paediatrics.

[Comparative evaluation of the results obtained with the Cerasi and Luft method and the OGGT in children]. / Valutazione comparativa dei risultati ottenuti con la metodica di Cerasi e Luft e con l'OGTT nel bambino

Results obtained with Cerasi & Luft's method and OGTT in subjects with a historical, clinical and laboratory suspicion of dysmetabolism were compared. It was found that: 1) obese subjects showed increased blood sugar and insulinase areas by comparison with normal controls; 2) subjects of normal weight displayed: a) a mean increase in blood sugar areas by comparison with normal controls; b) less evident changes in blood insulin areas; in these subjects, it was also noted that, c) an early-phase secretion irregularity detected with Cerasi & Luft's method did not involve changes in the oral loading pattern displayed by subjects classed as normal by means of such method; d) in subjects classed as "chemical diabetics" by OGTT, the response to glucagon after venous loading was defective. In border-line cases, early-phase changes were observed in the venous curve after oral glucose, whereas the response to glucagone remained efficient. It is felt that OGTT is an effective means in the diagnosis of infantile dysmetabolism. Attention is also drawn to the possibilities offered by the method of Cerasi & Luft in the detailed and specific appraisal of insulin secretion.

Increased plasma corticosteroid-binding globulin in insulin-dependent pubertal diabetics: relationships with other glycoproteins, growth hormone and prolactin.

A selected group of 13 juvenile-onset insulin-dependent diabetics in mid-late puberty (stages 3-4) and under comparable conditions of metabolic control was studied in order to evaluate the plasma levels of corticosteroid-binding globulin (CBG, transcortin: expressed as the binding capacity for cortisol) in relation to the levels of other glycoproteins and to growth hormone (GH) and prolactin (PRL) responsiveness to provocative tests (arginine infusion and TRH injection, respectively). Further evidence was provided that juvenile-onset diabetics show most frequently enhanced plasma CBG binding capacity; statistical significance with p-values less than 0.01 was attained in comparison to 25 age-matched controls. Among other variables examined, only hemoglobin A1c amd alpha 2-macroglobulin were significantly raised in the diabetic group (p less than 0.01 and less than 0.02, respectively). In our patients growth hormone response to arginine infusion was in the normal range, whereas PRL response to TRH was slightly but significantly supranormal in terms of maximum value and maximum increment above baseline value. No correlation was found between CBG binding capacity and other variables examined. We conclude that raised levels of CBG may occur as an additional alteration of the plasma glycoprotein pattern in juvenile-onset insulin-dependent diabetics. Specific regulatory factors conceivably subserve plasma concentrations of different glycoproteins.

[Use of semisynthetic human insulin in juvenile insulin-dependent diabetes mellitus]. / Impiego dell'insulina umana semisintetica nel diabete mellito insulino-dipendente giovanile.

A study was conducted on 28 paediatric patients with insulin-dependent diabetes mellitus (IDDM), followed up for 2 years from onset of the disease. In this group, 14 were treated with semisynthetic human insulin, 14 with monocomponent porcine insulin. No statistically significant difference was found between the clinical and metabolic parameters examined in the two groups.

Glycosylated hemoglobin in patients with newly discovered juvenile-onset diabetes mellitus in the days immediately following the beginning of insulin treatment.

We studied the behavior of fast hemoglobin fractions in newly discovered diabetic patients, before and in the 10 days immediately following the beginning of insulin therapy, in order to verify whether or not the rapid improvement of glycemic control involved a rapid reduction of total HbA1 and of its fractions. We observed a rapid and highly significant fall of HbA1(a+b+c) and HbA1c levels after only 1 or 2 days of insulin therapy, followed by a slower decrement in the other 3-10 days. HbA1(a+b) showed a slower decrement trend, reaching levels significantly below baseline values only after 7-10 days. These results suggest that rapid changes occurring in glycosylated hemoglobin levels after the beginning of insulin treatment in newly discovered diabetic patients involve mainly HbA1c. The kinetics of glycosylated hemoglobin reduction, with a first rapid decrement followed by a slower one, may suggest the hypothesis that rapid changes are due to reversible Schiff base de-glycosylation, the ketoamine linkage being the true index of long term glycemic control.

Course of retinopathy in children and adolescents with insulin-dependent diabetes mellitus: a ten-year study.

The prevalence and development of retinal changes were longitudinally documented from 1978 to 1987 in 112 insulin-dependent diabetic children by means of fluorescein angiography and fundus photography. At the end of the study period, 43 patients (38.4%) developed retinal changes, most of which were classified as minimal. Age, diabetes duration, puberty and long-term metabolic control were found to be independent factors affecting the development of retinopathy.