Relation of diabetic control to development of microvascular complications

Tchobroutsky, G

doi:10.1007/bf00421230

Cited by 401 publications

(106 citation statements)

References 104 publications

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“…The trends of diabetic death rates, even though analysed over a relatively short period, certainly give no indication that recent developments in the management of diabetes, particularly concern over the quality of diabetic control [26], are having a rapid impact on diabetic mortality. What is certain is that diabetes, as a contributor to overall mortality, is being underestimated at least four-or fivefold when reliance is placed on underlying cause of death alone and this emphasizes the need for continued monitoring of all conditions mentioned at death in diabetic subjects.…”

Section: Discussionmentioning

confidence: 99%

Diabetes mortality: New light on an underestimated public health problem

Fuller

Elford²,

Goldblatt³

et al. 1983

Diabetologia

163

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Summary. Mortality from diabetes is underestimated four-tofivefold by methods of analysis of death certification data which use only underlying cause of death. This problem is partially overcome by coding all conditions mentioned on death certificates. For a sample of deaths in England and Wales over the years 1972-1977, the observed proportion of certificates with specific underlying causes of death for certificates mentioning diabetes was compared with the expected proportion for all certificates. These observed/expected ratios were significantly increased in each sex for circulatory diseases and were significantly reduced for neoplasms. For 'nephritis' they were also increased, especially below 45 years of age. These results were confirmed by an analysis of underlying cause of death in a cohort of nearly 6,000 members of the British Diabetic Association. Of the 2,134 deaths in this coholt, diabetes was not mentioned on 33% of the death certificates. For the period 1972-1977, death rates for circulatory diseases associated with diabetes increased by 6% for males but remained constant for females.

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Section: Discussionmentioning

confidence: 99%

Diabetes mortality: New light on an underestimated public health problem

Fuller

Elford²,

Goldblatt³

et al. 1983

Diabetologia

163

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“…In insulin-treated diabetic patients who nowadays hope for a long life expectancy without physiological or social handicaps, an improvement of control will probably be beneficial in lowering the occurrence and severity of microangiopathy [15], although the relationship between blood glucose control and the evolution of microvascular disease in diabetes is still under discussion [1,2]. The results of this study may indicate that the desire for better control does not increase the social restrictions placed on the diabetic or the risk of more frequent hypoglycaemic reactions.…”

Section: Discussionmentioning

confidence: 99%

The risk of diabetic control: A comparison of hospital versus general practice supervision

Basdevant

Costagliola

et al. 1982

Diabetologia

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Summary. Two groups of insulin-treated outpatients (one followed up at the Hotel-Dieu Hospital and the second mainly supervised by general practitioners) were chosen at random in 1978. The two populations were comparable in age, age at diagnosis, sex, level of education, overall activity and socio-professional and economic status. Outpatients followed up in the diabetic unit had better blood glucose control, with about the same number of hypoglycaemic reactions as patients followed up in general practice. This better control was associated with more social activity and less visits to the physician, despite the fact that patients attending the hospital spent more money on their diet and had more daily insulin injections. All these differences remain significant after adjustment for the duration of diabetes. It may be inferred that attempts to improve control in insulin-treated patients are associated with a more active life and with no increase in the frequency of hypoglycaemic reactions.

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“…Although there is indirect evidence in man of a correlation between the severity of diabetic retinopathy and the degree of metabolic disturbance [1], there is little indication as to which, if any, of the biochemical disturbances might be responsible. An elevated and fluctuating blood glucose is common to all diabetic syndromes and raises the possibility that hyperglycaemia itself may have an effect on retinal vascular function.…”

mentioning

confidence: 99%

The effect of acute hyperglycaemia on the retinal circulation of the normal cat

et al. 1980

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Summary. The retinal microcirculation of anaesthetised normal cats was studied during hyperglycaemia (15 to 55 mmol/1) induced by intravenous infusion of glucose, using high speed cine fluorescence angiography. Saline (0.150 mmol/1) was infused as a control for the volume effect of glucose solution and equiosmolar mannitol was infused as a control for the osmotic effect. The mean retinal arteriolar inflow rate increased from 34 + 1 mm/sec to 41 + 4 mm/sec during glucose infusion, and from 46 + 1 mm/sec to 56 + 3 mm/sec during mannitol infusion. The blood pressure similarly increased from 105 + 5 mmHg to 125 + 2 mmHg during glucose infusion and from 110 + 7 mmHg to 129 + i mmHg during mannitol infusion. During mannitol infusion the increased inflow was accompanied by a reduction in the arteriolar width so that the volume flow remained unchanged. During glucose infusion this constriction did not occur, resulting in a significantly increased volume of retinal blood flow (9 + 1 ~tl/min to 12 + 1 ~d/min).Key words: Diabetic retinopathy, glucose, vessel calibre, fluorescence angiography, autoregulation, cats.Although there is indirect evidence in man of a correlation between the severity of diabetic retinopathy and the degree of metabolic disturbance [1], there is little indication as to which, if any, of the biochemical disturbances might be responsible. An elevated and fluctuating blood glucose is common to all diabetic syndromes and raises the possibility that hyperglycaemia itself may have an effect on retinal vascular function. In the present study we have thus investigated the effect of acute short-term hyperglycaemia induced by intravenous infusion on retinal perfusion in the normal cat, using high speed cine fluorescence angiography to measure arteriolar inflow and vessel calibre [2]. This technique allows repeated estimations of blood flow during the course of an experiment with an accuracy adequate to register confidence limits varying between approximately 5-15% of the mean [2]. Materials and MethodsThe techniques of cat selection and preparation were as previously described in detail by Hill and Young [2] with some modifications. Healthy domestic cats of either sex weighing between 2.5 and 5.0 kg were anaesthetised with intravenous sodium pentobarbitone (30 mg/kg) following an intramuscular injection of chlorpromazine (2 mg/kg) given 45 min previously as a premedication. Anaesthesia was maintained by continuous IV infusion of sodium pentobarbitone, 9 mg/kg/h. After trachteostomy, respiration of mixed gases (70% N2, 30% OJ was maintained with a Palmer 'Ideal' pump operating at 37 strokes/min with a stroke volume of 9 mi/kg body weight. Blood pressure was monitored continuously using a blood pressure transducer connected to a cannula in one femoral artery and thence to a multichannel recorder. Rectal temperature was similarly monitored continuously using a rectal thermocouple. Blood gases were analysed every 15 minutes from a 0.5 ml arterial blood sample using a Technicon blood gas analyser. Deviations of th...

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Relation of diabetic control to development of microvascular complications

Cited by 401 publications

References 104 publications

Diabetes mortality: New light on an underestimated public health problem

Diabetes mortality: New light on an underestimated public health problem

The risk of diabetic control: A comparison of hospital versus general practice supervision

The effect of acute hyperglycaemia on the retinal circulation of the normal cat

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