Platelet function in male diabetics with and without macrovascular complications.

Changes of platelet aggregation in relation to macroangiopathy and to some of its risk factors were observed in microangiopathy-free, well-controlled type 1 diabetic males. Platelet aggregate ratio was generally lower in patients (n = 77) than in age-matched healthy subjects (n = 48). In the absence of cigarette smoking, hypertension, obesity and hypercholesterolemia (n = 25) in vitro platelet hyperaggregation was found induced with epinephrine, collagen or arachidonic acid, and to a lesser degree with ADP. There was no change in the presence of at least one risk factor in addition to diabetes (n = 29), but there was a further significant increase in platelet aggregation when overt coronary, cerebral or peripheral artery disease was present (n = 23).

Diurnal blood pressure variations in incipient and end stage diabetic renal disease.

Our aim was to compare the diurnal blood pressure patterns of people with Type 1 diabetes on continuous ambulatory peritoneal dialysis (CAPD, n=9) or haemodialysis (n=10) to diabetic patients with normo-albuminuria (n=12) or micro-albuminuria (n=15). Blood pressure was measured with an ABPM02 Meditech oscillometric blood pressure monitor. The micro-albuminuric group had significantly higher nocturnal diastolic and mean arterial pressures than the normo-albuminuric group. CAPD and haemodialysis patients had significantly higher day time, nocturnal mean systolic, diastolic and mean arterial blood pressures. Micro-albuminuric and end-stage renal failure patients displayed a loss of the physiological drop of systolic blood pressure, which was only significant in the normo-albuminuric group. Nocturnal drop of blood pressure characterised by diurnal indices were 7.4% in the CAPD, 8.8% in the haemodialysis, 10.0% in the micro-albuminuric and 16.5% in the normo-albuminuric group. These results suggest, that pathological circadian blood pressure variation is common in diabetic patients on dialysis, and ambulatory blood pressure monitoring can be a useful tool both in its the detection and its adequate treatment.

Myocardial systolic alterations of insulin-dependent diabetics in rest.

Left ventricular systolic function was tested in 27 insulin-dependent diabetic patients by measuring the systolic time intervals. In diabetics longer pre-ejection period, and higher PEP/LVET quotient were found showing a good correlation with the values of glycosylated haemoglobin. These findings emphasize the importance of metabolic control in the development of cardiac dysfunction.

[The value of polypeptide analysis (beta-2-microglobulin, microalbuminuria, beta-thromboglobulin) in the diagnosis of diabetic nephropathies]. / Polypeptid analízis (beta-2-microglobulin, microalbuminuria, beta-thromboglobulin) jelentösége a diabeteses nephropathia diagnosztikájában.

The value of polypeptide analyses in the diagnoses of diabetic nephropathy. Early diagnostic signs are rapidly gaining importance in the prevention and care of diabetic complications. The aim of this paper was to review the clinical significance of measurements of the serum and urine levels of beta-2-microglobulin, microalbuminuria and the plasma and urine levels of beta-thromboglobulin. We would like to emphasize their possible role in monitoring and prediction of the chronic sequelae of diabetes mellitus.

[Differences in platelet aggregation in various microangiopathic complications of diabetes mellitus]. / A thrombocyta aggregabilitas eltérései a cukorbetegség egyes microangiopathiás szövödményeiben.

In vitro platelet aggregometry with epinephrine, adenosine-diphosphate, collagen and arachidonic acid was performed in 201 patients with diabetes, and in 106 healthy subjects. Those patients who were free of nephropathy showed hyperaggregability to collagen and arachidonic acid, and also to epinephrine and adenosine diphosphate, when neuropathy occurred. Patients with nephropathy, both with and without azotaemia, had diminished platelet responses to each of the four aggregating agents as compared to age- and sex-matched controls. Aggregability was not dependent on type of diabetes. It is concluded that diabetic nephropathy is characterized by decreased in vitro reactivity of platelets. Further researches are necessary to explain in vitro hypoaggregability besides the numerous evidence of in vivo hyperfunction of platelets in diabetes.

[Correlation of thrombocyte reactivity and serum levels of HbA1c, cholesterol and creatinine in diabetes mellitus]. / A thrombocyta reaktivitás összefüggése a HbA1c, a serum cholesterin és a serum creatinin értékekkel diabetes mellitusban.

The thrombocyte reactivity and values of HbA1c, serum cholesterine and creatinine have been examined in 121 insulin-treated and 70 not-insulin-treated diabetic patients and in 98 healthy persons. The thrombocyte functions of patients ranged according to the microangiopathic complications and of control groups matched according to age and sex were analysed with comparative statistics. Positive correlation was found in diabetes between the serum creatinine and cholesterine levels and the aggregating agents' (adrenaline, ADP, and collagen) limit concentrations (p less than 0,05-0,001). Close correlation seems to be between the worsening of renal functions and the decrease of thrombocyte sensitivity in diabetes: The hypercholesterinemia observable in nephropathic diabetes did not lead to the hyperaggregability known in familial hypercholesterinemia. Thus it appears likely that the cholesterine-level increase in the serum does not influence directly, but rather by the effects in connection with its origin, differently the thrombocyte reactivity.

[Clinical significance of beta-2-microglobulin in diabetes mellitus]. / A beta-2-mikroglobulin klinikai jelentösége diabetes mellitus-ban.

The beta-2-microglobulin (B2M) level of the serum and urine was determined in 61 diabetics and 15 control patients by enzyme-immunoassay, to asses the value of B2M in clinical diagnosis. In patients with daily protein excretion exceeding 300 mg there was a significant positive correlation between serum creatinine, daily (24-hour) protein excretion, and B2M level of the serum and urine. In patients with less than 300 mg and in those with more than 300 mg daily protein excretion the B2M levels of the serum and urine were significantly higher than in the controls. Serum creatinine level underwent a significant rise only in patients with more than 1000 mg daily protein excretion. Determination of the B2M level is a sensitive method in the diagnosis of diabetic nephropathy. Simultaneous measurement of B2M level in the serum and urine detects nephropathy at an early stage and thus it may be of value in the prevention of the disease.

[Prospective study of cardiac autonomic neuropathy in diabetes mellitus]. / Kardiális autonom neuropathia prospektív vizsgálata diabetes mellitusban.

For assessment of clinical and prognostic values of cardiac autonomic neuropathy, 53 patients with diabetes mellitus were followed-up for five years. Parasympathetic innervation was assessed by recording heart rate variability during deep breathing, Valsalva manoeuvre and lying-to-standing while sympathetic function was evaluated by measuring postural change in systolic blood pressure. During the follow-up period 1 of 23 diabetic patients died in group without signs of cardiac autonomic neuropathy whereas 2 of 13 diabetics and 10 of 17 diabetics deceased in groups with mild and definitive signs of cardiac autonomic neuropathy, respectively. At reinvestigation, the values of tests for parasympathetic impairment worsened or did not change significantly while improvement in these tests was only exceptionally observed in 40 diabetic patients. No significant change in values of test for sympathetic function was documented during the follow-up period suggesting that parasympathetic (vagal) impairment might precede the sympathetic dysfunction during development of autonomic neuropathy in diabetic patients. No correlation was observed between changes in cardiac autonomic neuropathy and alterations in distal somatic neuropathy (assessed by measurement of motor nerve conduction velocity in peroneal nerves) during the prospective study. Definitive cardiac autonomic neuropathy--as one of the late complications of diabetes mellitus--suggests poor prognosis in diabetic patients.

[Study of 24-hour changes in blood pressure in various stages of diabetic nephropathy]. / A 24 órás vérnyomásváltozások vizsgálata a diabeteses nephropathia különbözö stádiumaiban.

The aim of the study was to compare the diurnal pattern of blood pressure in diabetic patients with normal urinary protein excretion, microalbuminuria and end stage renal failure due to diabetic nephropathy and on continuous ambulatory peritoneál dialysis. An ABPM-oscillometric blood pressure monitor was used. Cholesterol, triglicerides, HDL and LDH1 cholesterole, apolipoprotein A1 and B, endogenous creatinine urinary protein and albumin excretion, beta-2-microglobulin were measured. The mean age and the mean diabetes duration of the 12 normoalbuminuric patients 38.3 and 16.5 years, of the 12 patients treated for renal failure with continuous ambulatory peritoneál dialysis 54.4 and 19.5 years. In the group with end stage renal failure and continuous ambulatory peritoneál dialysis, the mean nocturnal and diurnal systolic and diastolic blood pressure and the average arterial mean pressure was significantly higher than in the normal and microalbuminuric groups. In microalbuminuric and dialysed patients the physiological nocturnal decline of arterial blood pressure was absent. 24 hour blood pressure monitoring may accurately identify the early stage of diabetic nephropathy, and it might be valuable in the correction of antihypertensive treatment from the early to the final stages of diabetic nephropathy.

[Correlations between cardiorespiratory reflex impairment and distal neuropathy in diabetics free of clinical symptoms of autonomic neuropathy]. / A kardiorespiratorikus reflexkárosodás és a distalis típusú neuropathia összefüggésének vizsgálata autonom neuropathia klinikai tüneteitöl mentes cukorbetegekben.

Signs of autonomic cardiac neuropathy and its association with distal symmetrical polyneuropathy were investigated in adult diabetic patients free from clinical symptoms of autonomic neuropathy. Cardiorespiratory reflexes were assessed by non-invasive tests (deep-breathing, Valsalva manoeuvre and lying-to-standing) evaluating parasympathetic function of cardiac innervation. Measurement of motor nerve conduction velocity in both peroneal nerves and neurological physical examination were carried out for assessment of distal somatic neuropathy. Among 64 diabetics, definitive signs of cardiac autonomic neuropathy were found in 28 patients (44%), early signs of cardiac autonomic neuropathy were observed in 19 patients (30%) while no alterations were documented in 17 patients (26%). The values of motor nerve conduction velocity in peroneal nerves (41.8 +/- 0.7 m/s) were significantly (p less than 0.01) lower in patients with definitive cardiac autonomic neuropathy (n = 28) than those (45.8 +/- 1.1 m/s) of patients without any signs of cardiac autonomic neuropathy (n = 17). These latter values were, however, significantly (p less than 0.001) lower than those (53.7 +/- 0.7 m/s) of control subjects (n = 50). Abnormal results of non-invasive tests for autonomic neuropathy, i.e. alterations of cardiorespiratory reflexes indicating parasympathetic impairment in cardiac innervation could be often found in diabetics without clinical signs of autonomic neuropathy. These alterations could be frequently observed in diabetics with distal symmetrical neuropathy as well as in diabetic patients with one or more late specific complications.

[Relationship between platelet hyperactivation and dyslipoproteinemia in diabetic nephropathy]. / A diabeteses nephropathiát kísérö dyslipoproteinaemia és a thrombocyta aktiváció összefüggése.

The relationship between the secundaer hyperlipidaemia and pathological platelet activation was examined in 40 insulin-treated diabetic patients without nephropathy and 21 with nephropathy. Diabetic nephropathy was recorded with the measurements of serum creatinine, serum beta 2-microglobulin, and urine albumin excretion. Haemostasis and lipoprotein metabolism were characterized with determination of platelet aggregation, plasma beta thromboglobulin, thromboxane-B2, serum triglyceride, HDL and LDL cholesterol concentration, respectively. In the normalbuminuric group serum triglyceride and thromboxane-B2 positively correlated. In the nephropathic group serum cholesterol and beta thromboglobulin, as well as LDL and beta thromboglobulin, finally, LDL and thromboxane-B2 showed significant positive correlation. In diabetic patients without nephropathy platelet aggregate ratio was in positive correlation with the serum triglyceride, while the ED50-S elevated with the increase of serum cholesterol and LDL. The nephropathic group exhibited no such parallelisms. However, there were significant correlations of LDL with serum creatinine in both groups of diabetic patients. Our results seem to indicate that the increase of LDL could be associated with the change of LDL structure. Interactions of modified LDL and the platelet membrane might contribute to the platelet hyperactivation both in the nephropathy-free and nephropathic cases.

[Plasma and urine beta-thromboglobulin determination in the detection of thrombocyte hyperactivation in diabetic nephropathies]. / A plasma és a vizelet béta-thromboglobulin meghatározás a diabeteses nephropathiát kísérö thrombocyta hyperaktiváció kimutatásában.

Serum creatinine, immunoreactive serum and urine beta-2-microglobulin, plasma and urine thromboglobulin, plasma thromboxane-B2 levels and daily protein excretion were determinated in 61 insulin treated diabetic patients, comparing the different patient groups (complication free, nephropathy without azotaemia and nephropathy with azotaemia) with the control subjects. In the groups of all diabetic patients plasma and urine beta-thromboglobulin and plasma thromboxane-B2 levels were higher that in the controls. There was a positive significant correlation between urine beta-thromboglobulin and beta-2-microglobulin in the group without complication, and between the plasma beta thromboglobulin and beta-2-microglobulin, and plasma beta thromboglobulin and thromboxane levels in the diabetic group with azotaemia. In contradiction to some previous assumptions, the increased level of plasma beta-thromboglobulin reflects a real platelet hyperactivation also in patients with diabetic nephropathy. At the same time urine beta-thromboglobulin also increases. Determination of urine beta-thromboglobulin is more simple with less possibility of methodological error.