Subclinical macroangiopathic target organ damage in type 1 diabetes mellitus patients.

PURPOSE: We have summarized key studies regarding the assessment of subclinical macroangiopathic target organ damage (TOD) in type 1 diabetes mellitus (T1DM). RESULTS: Although chronic complications resulting from hyperglycemia, in particular macroangiopathies, are still the first cause of death in T1DM, there has been growing recognition of the role of hypoglycemia in cardiovascular morbidity and mortality. Subclinical TOD diagnosis ensures early implementation of the complex management aiming at either partial reversal of these complications or at least its downturn. To better identify patients with early TODs, several non-invasive diagnostic techniques are employed, including the ultrasonographic assessment of the intima-media thickness (IMT), computed tomography (CT) for coronary artery calcium (CAC) scores, and pulse wave velocity (PWV) measurement for arterial stiffness evaluation. Various studies reported that T1DM patients present an increased IMT. An increasing IMT fairly correlates with the cardiovascular (CV) events risk even after the adjustment to age, diabetes duration, quality of glucose control as well as the presence of hypertension, and chronic complications. Another, well established marker of the organ damage - CAC score is recommended by ACC/AHA guidelines to assess the overall CV risk in T1DM. Also, the arterial stiffness evaluation with PWV may further improve CV risk prediction, which has been reported in multiple studies including the Framingham Heart Study. CONCLUSIONS: There is shortage of data from prospective studies which could confirm the benefits of early treatment initiation based on the presence of the subclinical organ damage in T1DM. Most evidence comes from T2DM trials, where effective preventive measures were identified i.e.: smoking cessation, reasonable blood glucose control, efficacious hypertension treatment, and dyslipidemia management, as well as renoprotection. There is still a field for further research to see if routine assessment of asymptomatic vascular damage and early implementation of aggressive treatment would reduce mortality excess from CVD in T1DM.

Changes in glucose metabolism after Kausch-Whipple pancreatectomy in pancreatic cancer and chronic pancreatitis patients.

OBJECTIVE: Although changes in exocrine pancreatic function after pancreatoduodenectomy (PD) have been thoroughly analyzed in many reports, articles concerning endocrine have been few. An investigation of glucose metabolism changes in patients undergoing PD was performed. METHODS: In the study, 20 patients were subjected to pancreatic head resection for tumorous lesions (13 neoplasmatic and 7 chronic pancreatitis) and followed-up for changes in pancreatic endocrine function. It was assessed with fasting plasma glucose measurement and oral glucose tolerance test and also the plasma insulin level during the oral glucose tolerance test. Assessment was made directly before PD followed 2 and 6 months postoperatively. RESULTS: The percentage of neoplasmatic patients with normal glucose metabolism increased from 15% preoperatively to 39% at 2 months and 45% at 6 months after PD, whereas the diabetes/impaired glucose metabolism was observed in 31%/54%, 15%/46%, and 18%/36%, respectively. In chronic pancreatitis patients, the percentage of diabetic patients increased from 0% preoperatively to 29% at 2 months and 43% 6 months postoperatively. The average plasma insulin level decreased significantly after PD. Before the PD, the insulin curve suggested the presence of insulin resistance in pancreatic cancer patients, which was not observed after the operation. CONCLUSIONS: Changes in glucose metabolism after PD depend on the etiology of pancreatic tumorous lesion with improvement in neoplasmatic patients and deterioration in chronic pancreatitis patients.