[ Herbal Remedies ]

Renal disease and hypertension in non–insulin-dependent diabetes mellitus

This cross-sectional study compared the prevalence of candidiasis in 405 subjects with IDDM and 268 nondiabetic control subjects. The diagnosis of NIDDM is usually made after the age of 50 years in Europids, but it is seen at much younger age in these high prevalence populations, which also include Pacific Islanders, Native Americans, and migrant Asian Indians and Chinese. (1996) carried out multipoint linkage analysis in 48 Italian families with at least 2 sibs affected with IDDM. Case-control comparisons identified an independent association signal for type 1 diabetes at rs17696736 in the C12ORF30 gene on chromosome 12q24 (p = 1.51 x 10(-14)). Diabetics (n = 343) and controls (n = 607) attended a clinic where an oral glucose tolerance test or current hypoglycemic therapy confirmed or diagnosed non-insulin-dependent diabetes mellitus. Results. In a screen of the human genome for type I diabetes susceptibility genes, Davies et al.

Elevation of glucose concentration up to 27.8 mmol/1 in the culture medium did not suppress the [3H]thymidine uptake and IL-2R expression by activated lymphocytes from healthy subjects. The collaborative network now established provides a framework for further studies to examine the complex interaction between genetic and environmental factors in the cause and pathogenesis of IDDM. However, there was a nonsignificant correlation between anticardiolipin IgG and IgM levels and HbA1c levels, insulin dose, and fasting blood sugar. Le taux sérique du 1,25(OH)2 D n’a été trouvé abaissé que chez les diabétiques en acidocétose, mass il s’est normalisé après disparition de celle-ci. Treatment recommendations include early screening for hyperlipidemia, appropriate exercise and a healthy diet. Cornerstones of management should also include: (1) educating the medical community and more widely disseminating data supporting the value of early treatment of microalbuminuria; (2) developing a comprehensive, multidisciplinary team approach that involves physicians, nurses, diabetes educators and behavioral therapists; and (3) intensifying research in this field. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in the United States, Japan, and most of industrialized Europe1., 2.

and 3.. IL2RA type 1 diabetes susceptibility genotypes were associated with lower circulating levels of soluble IL2RA (p = 6.28 x 10(-28)), suggesting that an inherited lower immune responsiveness predisposes to type 1 diabetes. Molecular Genetics Guo et al. Encouraging results following delivery of Treg cells have demonstrated prevention of experimental diabetes. The epidemiology, natural history, genetics, pathogenesis, and spectrum of renal lesions differ in patients with NIDDM versus IDDM. Because poorer quality of life and symptoms of depression may both result form complications, prospective follow-up is needed to clarify their temporal interrelationships, and to determine whether type A personality affords any protection against complications or is diminished as a result of developing complications. (2008) genotyped 311 Spanish patients with type 1 diabetes and 723 ethnically matched controls for a SNP in the STAT4 gene (rs7574865) on chromosome 2q32 and found an association with type 1 diabetes (p = 0.008; odds ratio 1.36).

Between 1982 and 1992, patients with diabetes as the cause of their ESRD rose from 27% to 36% in the United States and from 11% to 17% in Europe7. Data from the 1995 United States Renal Data System showed that nearly 40% of patients receiving renal replacement therapy (RRT) in 1992 had diabetes. In addition, 36.3% of the incident ESRD cases in 1992 were diabetic1. A high incidence of diabetic ESRD also was evident in Canada (24%)8, Australia (14%)9, Europe (17%)10, and Japan (28%)2 in the same year. Diabetic nephropathy is due predominantly to NIDDM. The prevalence of NIDDM-related ESRD is probably underestimated. Incorrect reporting of NIDDM patients as IDDM when they require insulin therapy complicates classifying diabetes.

Indeed, 35% to 45% of NIDDM patients receive insulin11. Regional studies suggest that NIDDM contributes significantly to diabetic ESRD. In data from the Michigan Kidney Registry12, most black patients with diabetic ESRD had NIDDM (77%), whereas white patients more often had IDDM as a cause of diabetic ESRD (58%). In Pima Indians, 95% of diabetic ESRD is due to NIDDM13. Similarly, 61% of diabetic ESRD in Australia is due to NIDDM14, with a larger percentage in the aboriginal population [85%]. In Europe, NIDDM accounts for 43% of diabetic ESRD. These results not only provided sufficient justification for analysis of the gene content of the D11S1917 region for positional candidates, but also showed that, in the mapping of genes for common multifactorial diseases, analysis of both affected and unaffected sibs is of value and that both predisposing and nonpredisposing alleles should be anticipated.

In Italy (national) and Lombardy (regional), NIDDM accounted for 67% and 50% of diabetic ESRD, respectively15,16. Several explanations may account for the growth of NIDDM-related nephropathy. According to a National Health Interview Survey, there was an increase in diabetes in the United States in 19935. The prevalence for all ages was 3.1%, compared with 0.93% in 1958. NIDDM accounted for almost 95% of this new diabetic population. Similarly, in former communist Germany, the prevalence of diabetes increased from 1% in 1965 to 4% in 198817. Western societies are also aging.

Given the increased incidence of NIDDM with age18, older patients with ESRD are more likely to have NIDDM. Finally, NIDDM patient survival has improved. In regions of Germany formerly under communist rule, where anti-hypertensive treatment and treatment for coronary heart disease was not available in the early 1970s, 45% of NIDDM patients died less than four years after the diagnosis of NIDDM19. In Heidelberg20, the five-year survival for NIDDM patients after the onset of proteinuria increased from 35% to 75% between 1966 and 1985, allowing a greater percentage of these patients to experience progression to ESRD. NIDDM-associated nephropathy varies widely among racial and ethnic groups. NIDDM is more prevalent among African Americans, Hispanic Americans, and Native Americans. African American males have twice the incidence of diabetes, and African American women have four times the incidence of diabetes compared with European Americans21., 22., 23.

and 24.. Pugh et al found a sixfold higher incidence of diabetic-related ESRD in Mexican Americans compared with non–Hispanic whites and found a fourfold increase in blacks 23. Cowie et al also showed that diabetic ESRD was more common in blacks 12. Race-dependent risks of nephropathy may be related to glycemic control, hypertension, or other factors such as differences in the quality and access to medical care25,26. Gender may also affect the prevalence of NIDDM-related nephropathy. According to the EDTA registry27, 55% of NIDDM patients who began RRT in 1990 were male. These data are similar to those from Minnesota28 and Heidelberg4.

However, gender may interact with race. Data from the 1988 United States Renal Data System reported that the relative risk of diabetic ESRD for females compared with males was 1.20 in blacks and 0.85 in whites29.

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