Platelet function in type I diabetes: effects of supplementation with large doses of vitamin E.

Nine Type I diabetic patients were randomized to a double-blind therapeutic trial divided into two study periods of 35 d with either 1 g vitamin E/d or a placebo. Platelet function was estimated at baseline and after treatment from ADP-induced platelet aggregation tests and from generation of oxidative products (TXB2, 12 HETE, and malondialdehyde) after platelet stimulation by 14C arachidonic acid. Platelet function, plasma lipids, and apoproteins were similar before both treatment periods. The vitamin E treatment resulted in 1) diminution of platelet aggregation with ADP 2.5 microM (56 +/- 4 vs 47 +/- 4 cm2, p = 0.05) and 5 microM (70 +/- 5 vs 57 +/- 4 cm2, p less than 0.01); 2) diminution of malondialdehyde release from platelets (6.4 +/- 0.5 vs 5.0 +/- 0.7 nmol/10(9) platelets, p less than 0.02); and 3) diminution in the percentage of 14C TXB2 (38.1 +/- 2.8 vs 33.3 +/- 3.0%, p less than 0.05). No significant changes were observed on placebo. Results indicate that high doses of vitamin E diminish ADP-induced platelet aggregation in Type I diabetic patients and suggest that this effect is partly mediated through a diminution of the cyclooxygenase activity.

[Diabetes mellitus under 30 years of age. Results of 18 years experience with oral treatment (author's transl)]. / Le diabète sucré avant l'âge de 30 ans

Long term experience with the use of sulfonylurea and/or biguanide oral hypoglycemic agents in patients under the age of 30 years shows the following results: 1) Oral treatment under 30 years of age is effective only for a limited period of time, in the large majority less than 24 months;--2) The success of oral treatment of diabetics and the period of effectiveness is increased if the subject is overweight at the time of discovery of the diabetes mellitus;--3) The type of antidiabetic treatment, i.e., insulin only, oral only, or oral and insulin, does not influence the susceptibility to the complications likely to appear in this age group, such as retinopathy, coronary disease, neuropathies and urinary and dental infections;--4) Poteinuria, peripheral vascular disease and various abnormalities of plasma lipids involving cholesterol and triglycerides, are significantly more common in patients under oral therapy than in those receiving insulin. These findings suggest the necessity for serious reconsideration of therapy as soon as any of these pathological events appear, especially the proteinuria or the lipid anomalies;--5) The duration of the oral treatment preceding therapeutic insulin does not have influence on the subsequent metabolic disturbance (hypoglycemia, deto-acidosis) and thus on the ultimate control of the diabetic state;--6) The somatic growth of the diabetic child is maintained regardless of the type of treatment as long as it is effective. Growth is interrupted however very early if oral treatment becomes ineffective with regard to control of the diabetes. Monitoring of somatic growth during oral antidiabetic treatment is of obvious importance. An interruption in growth is an indication for insulin therapy even if the diabetic control appears satisfactory;--7) The course and the outcome of pregnancy do not appear to be affected by the use of oral therapy at the time of conception. This holds true also for cases in which oral treatment precedes the use of insulin, the pregnancy having commenced during the course of insulin therapy.

[Stereotaxic pituitary implantation of radio-gold in the treatment of severe diabetic retinopathy. Long term results (author's transl)]. / Rétinopathies diabétiques sévères traitées par implantation stéréotaxique intra-hypophysaire d' or radio-actif. Résultats à long terme chez 16 malades.

The ophtalmic, diabetic and hormonal outcome in 16 patients treated identically for diabetic ophtalmopathy with pituitary radio-gold implants were assessed 1, 2, 5 and 10 years afterwards. Four patients (25%) died in the first 6 years, 3 of them of severe renal insufficiency which developed after pituitary implantation. Of these remaining alive at each assessment visual acuity was either stable or improved in 78%, 58%, 64% and 42% respectively, but at very low levels since at 10 years acuity was 1/10 or less in half the population. Four patients became blind, the remaining eight had a severe proliferative retinopathy with exsudates and haemorrhages but retained useful vision. Haemorrhage and new vessel formation continued to develop with the years following implantation in all patients who at the time had one on either lesion. Cataracts were removed in 6 patients, 3 and 7 years after implantation. The mean insulin requirements of the group fall from 55 to 31 units daily. The fall in growth hormone concentration, occuring in only 45% of cases, does not account for all the improvements observed. Several hormonal deficiencies developed: 2 cases of adrenal insufficiency, 3 of hypothyroïdism and 6 of hypogonadal impotence.