Impaired insulin stimulation of muscular ATP production in patients with type 1 diabetes.

OBJECTIVE: in type 2 diabetic patients and their first-degree relatives, insulin resistance (IR) is associated with impairment of insulin-stimulated myocellular glucose-6-phosphate (g6p) and unidirectional flux through ATP synthase (fATP), suggesting the presence of inherited abnormal mitochondrial oxidative fitness. We hypothesized that patients with long-standing type 1 diabetes may also exhibit insulin resistance as well as lower fATP. DESIGN: this single-centre trial was registered at ClinicalTrials.gov (NCT00481598). SUBJECTS: we included eight nonobese type 1 diabetic patients (mean diabetes duration: 17 years) with near-target glycaemic control [haemoglobin A1c (HbA1c): 6.8 ± 0.4%] during treatment with continuous subcutaneous insulin infusion pumps and eight healthy volunteers (HbA1c: 5.4 ± 0.2%) of comparable age, body mass and level of physical activity. OUTCOME MEASURES: myocellular fATP, g6p and intramyocellular lipid content (IMCL) were measured with (1) H/(31) P magnetic resonance spectroscopy during fasting and hyperinsulinaemic-euglycaemic clamp tests. RESULTS: fasting fATP, g6p and IMCL did not differ between groups. During stimulation by insulin, type 1 diabetic patients exhibited approximately 50% (P < 0.001) lower whole-body glucose disposal along with approximately 42% (P = 0.003) lower intramyocellular g6p and approximately25% (P = 0.024) lower fATP. Insulin-stimulated fATP correlated positively with whole-body insulin sensitivity (R = 0.706, P = 0.002) and negatively with HbA1c (R = -0.675, P = 0.004). CONCLUSIONS: despite documented near-target glycaemic control for 1 year, nonobese patients with long-standing type 1 diabetes can exhibit insulin resistance. This associates with lower insulin-stimulated flux through muscular ATP synthase which could result from glucose toxicity.

Sex-related psychological effects on metabolic control in type 2 diabetes mellitus.

AIMS/HYPOTHESIS: Women are at higher risk of diabetes-related cardiovascular complications than men. We tested the hypothesis that there are sex-specific differences in glucometabolic control, and in social and psychological factors. We also examined the influence of these factors on glucometabolic control. METHODS: We examined 257 (126 men/131 women) consecutive patients (64 +/- 9 years, means +/- SD) of a metropolitan diabetes outpatient service employing clinical testing and standardised psychological questionnaires. RESULTS: Mean HbA(1c) (7.6 +/- 1.2%) was not different between women and men. Women patients on oral hypoglycaemic agents were better informed about diabetes (p = 0.012). They employed more strategies for coping with diabetes, including religion (p = 0.0001), active coping (p = 0.048) and distraction (p = 0.007). Women reported lower satisfaction with social support (p = 0.034), but not more depression than men. Although no differences were observed in compliance, insulin-treated patients were more satisfied with their therapy (p = 0.007). Variables predicting poor metabolic control were different in men (R(2) = 0.737, p = 0.012) and women (R(2) = 0.597, p = 0.019). Major predictors of high HbA(1c) included depressive coping, lower sexual desire, quality of life and internal locus of control, but high external doctor-related locus of control in women and frequent emotional experiences of hyperglycaemia in men. CONCLUSIONS/INTERPRETATION: Lower quality of life, internal control and socioeconomic status, and higher prevalence of negative emotions probably prevented woman patients from achieving improved glucose control despite their better knowledge of and greater efforts to cope with diabetes. We suggest that women patients would benefit from individualised diabetes care offering social support, whereas men would benefit from knowledge-based diabetes management giving them more informational and instrumental support.

[The status of managing the type I diabetic patient in Austria. Organization]. / Stand der Betreuung der Typ-I-Diabetiker in Osterreich*. Organisation.

During the Annual Meeting of the Austrian Diabetes Association various diabetic centres presented their success and failure rates with respect to metabolic control and prevention of late complications in diabetic patients on a country-wide basis. The analysis revealed that only 30% of all type I diabetic patients are adequately controlled. Intensive education in diabetes self-management, capable of leading to optimal metabolic control in up to 50% of the instructed patients, is however available only to a small minority of the diabetic patients to date. Despite the enormous improvement which has been achieved in the management of pregnant diabetic women, intensive specialized care is often commenced far too late. In rural areas, in particular, even conventional therapy is not fully implemented and late complications are, thus, inevitable.

[Treatment of diabetic patients with Optisulin-Depot CR in comparison with Depot-Insulin Hoechst klar CR--therapeutic progress?]. / Die Behandlung von Diabetikern mit Optisulin -Depot CR im Vergleich zu Depot-Insulin Hoechst klar CR - ein Fortschritt in der Therapie?

During a cross-over-study in 12 ambulant patients the effects of Optisulin -Depot CR in comparison to Depot-Insulin Hoechst klar CR were examined. After a period with Depot-Insulin Hoechst klar CR patients got Optisulin -Depot CR in the same dose and with the same diet. A week later patients took Depot-Insulin Hoechst klar CR once again. The different blood-sugar-curves corresponded to each other, but Optisulin -Depot CR showed more initial effect. The use of Depot-Insulin Hoechst klar CR is an advantage, because, Optisulin -Depot CR is neutral and no depot-substances are contained. Therefore, less allergic reactions are expected.

[Massive intestinal bleeding caused by yersinia pseudotuberculosis (author's transl)]. / Infektion mit Yersinia pseudotuberculosis als Ursache eines massiven enteralen Blutverlustes.

A disease in a male 47 year old caused by Yersinia pseudotuberculosis is discussed. His fever was not responding to chloramphenicol, cephalosporine and gentamycin. During the disease a perilous gastrointestinal haemorrhage appeared. Symptoms according to an acute septic enterocolitis were observed.