c-peptide and Blindness

Even recipients with satisfactory function of transplanted pancreas and kidney may show physical and/or social disability due to diabetic complications. Our aims were to evaluate diabetic complications influencing recipient quality of life and to assess patients' psychosociological status. Nineteen patients with functioning grafts who consented to take part in the study, underwent clinical evaluation and answered questions regarding their quality of life. Results showed excellent endocrine pancreatic function in 17 patients. In most recipients, insulin activity and C-peptide levels were elevated owing to systemic venous drainage. Opthalmological examination revealed blindness in 7 patients (in 4 cases with onset following SPKTx) and retinopathy in 13 patients (in 5 cases it appeared after SPKTx). Assessment of the cardiovascular system revealed satisfactory cardiac function in 16 of 19 patients; 4 patients underwent amputation of a lower limb following SPKTx. All 19 recipients admitted to a great benefit of transplantation; most patients declared ability to organize their life activity and social functions and 4 had regular employment. Conversely, most patients were afraid of graft loss, and half were often sad and even depressed.

Topics: Blindness; Blood Glucose; C-Peptide; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Diabetic Retinopathy; Employment; Humans; Insulin; Insulin Secretion; Kidney Failure, Chronic; Kidney Transplantation; Pancreas Transplantation; Postoperative Complications; Quality of Life

To identify the clinical characteristics of early-onset NIDDM patients with severe diabetic complications.. The clinical cases of a large number of diabetic patients who visited a diabetes center within the period 1970-1990 were reviewed. Of a total of 16,842 diabetic patients, 1,065 (6.3%) had early-onset NIDDM (diabetes diagnosed before 30 years of age). These 1,065 patients were divided into two groups, those who developed proliferative retinopathy before the age of 35 (n = 135) and those who did not (n = 930). Development of proliferative retinopathy, nephropathy, renal failure, blindness, and atherosclerotic vascular disease were compared between the two groups.. The subgroup of 135 patients was characterized by poor glycemic control, often requiring insulin therapy and a higher familial prevalence of diabetes, and contained a greater proportion of women than the subgroup of 930 patients. Of the 135 patients, 99 (67%) developed proliferative retinopathy before the first visit. The 135 patients developed severe progressive complications in contrast to the 930 patients. A total of 81 patients (60%) developed diabetic nephropathy at a mean age of 31 years, 31 (23%) developed renal failure requiring dialysis at a mean age of 35 years, 32 (24%) became blind at a mean age of 32 years, and 14 (10%) developed atherosclerotic vascular disease at a mean age of 36 years.. Some Japanese early-onset NIDDM patients develop severe diabetic complications in their youth. Most of them had no symptoms nor regular treatment regarding diabetes until they were noticed to have developed severe diabetic complications. Although the relevant prevalence and the pathogenetic mechanism underlying the rapid onset of the complications remain to be determined, prolonged inadequate treatment of and familial predisposition to diabetes may be contributing factors. Careful diabetes care in the twenties, not only for IDDM but also for NIDDM patients, is warranted.

Topics: Adult; Age Factors; Age of Onset; Arteriosclerosis; Blindness; Body Mass Index; C-Peptide; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Nephropathies; Diabetic Retinopathy; Female; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Japan; Kidney Failure, Chronic; Male; Middle Aged; Retrospective Studies

We describe five patients with Wolfram syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). Three of the patients appear to have had very gradual onset of diabetes mellitus at an early age yet all patients when tested for C-peptide response to glucagon were severely deficient. All patients are registered blind from primary optic atrophy, two have severe hearing difficulties and three high tone sensorineural hearing loss on audiometry. Four patients have cranial diabetes insipidus which in two cases is partial and of gradual onset and was attributed to poor control of the diabetes mellitus. In one case treatment of the insipidus relieved enuresis. All five patients have evidence of dilatation of the urinary tract and one patient is managed in the long-term by self-catheterisation which has resulted in one episode of bacteraemia. One patient has marked testicular atrophy and investigation reveals this to be due to primary hypogonadism and not to hypothalamic-pituitary dysfunction. One female patient had her menarche delayed until the age of 19 years but has subsequently had the only successful pregnancy in a patient with this syndrome of which we are aware.

Topics: Adolescent; Adult; Audiometry; Blindness; C-Peptide; Diabetes Insipidus; Female; Humans; Long-Term Care; Male; Menarche; Pregnancy; Puberty; Testicular Diseases; Urinary Catheterization; Urography; Wolfram Syndrome