Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent diabetes mellitus

Article Abstract:

Diabetic nephropathy is the kidney damage which is common as a long-term complication among patients with diabetes mellitus. The condition may occur in as many as half of all patients with insulin-dependent diabetes and is the single largest cause of kidney failure in the United States. The cause of diabetic nephropathy is not known, however. It is clear that early in the course of diabetes, many patients have enlarged kidneys, and the rate that fluid is filtered through the glomerular structure of the kidneys is increased. These conditions are widely believed to signal the eventual development of kidney disease. It is also known that high-protein diets tend to increase the glomerular filtration rate, and low-protein diets tend to reduce it, as well as slow the progression of kidney disease in some patients. Nevertheless, the mechanisms underlying these responses to dietary protein are poorly understood. Since proteins are reduced to individual amino acids by the digestive process, a study was conducted to determine if the amino acids themselves could elicit the abnormal physiological responses in the kidneys of diabetic patients. The responses to amino acids were evaluated in nine healthy subjects and 12 patients with insulin-dependent diabetes mellitus. In addition, the interaction between the effects of the amino acids and glycemic control was studied. Even when taking regular insulin injections, the control of blood sugar (glycemic control) tends to fluctuate in patients with diabetes; in the present study, measurements were made during a condition of high blood sugar (hyperglycemia), after an insulin infusion of 36 hours, and after three weeks of intensive insulin therapy. The results showed that the diabetic patients had normal kidney function after fasting, but the glomerular filtration rate and the physical size of the kidneys increased after infusion of amino acids. However, after careful control of blood sugar with intensive insulin, the response of the diabetic patients to amino acids was not significantly different from normal. The results indicate that not only do diabetic patients have an abnormal response to amino acids which may lead to kidney failure, but also that this abnormal response can be controlled through the fastidious control of blood sugar levels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Blood sugar, Blood glucose, Type 1 diabetes, Control, Amino acids

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Diabetic renal disease in blacks - inevitable or preventable?

Article Abstract:

A report by C.C. Cowie and others in the New England Journal of Medicine establishes that the incidence of diabetic end-stage kidney disease is excessively high among Afro-Americans. This statistic remains valid even when corrections are made for the great number of black diabetics and other factors. The physiologic basis of this racial difference and the potential for prevention has not been determined. Cowie has analyzed the blood pressure of those black diabetics that ultimately develop end-stage kidney disease and has found both diastolic and systolic pressures to be elevated significantly when compared with whites. When this fact is coupled with the long acknowledged high rate of hypertension (elevated blood pressure) in blacks, a strong suspicion arises that the increased rate of end-stage kidney disease in black diabetics may be at least partially caused by these propensities. Other studies have similarly connected familiar hypertension and insulin-dependent diabetes mellitus (IDDM) with increased rates of kidney disease. Blacks and whites also have differences in their respective levels of Vitamin D and in parathyroid hormone that may be linked to kidney disease. Although there are major physiologic differences between the races that are apparently related to differences of expression of disease and conditions, the fundamental question as to whether the rate of end-stage kidney disease in these patients cannot yet be answered. Of concern are the sociologic and economic factors that result in blacks being less well educated and otherwise economically disadvantaged; these factors often contribute to poorer health care for black patients. These barriers are not unique to blacks and may also apply to Mexican-Americans who have a similarly excessive rate of diabetic kidney end-stage disease. It is possible that this problem is social and economic as much as genetic or pathophysiological.

Research, Diabetes, Diabetes mellitus, Type 2 diabetes, editorial, Cowie, Catherine

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Racial differences in the incidence of cardiac arrest and subsequent survival

Article Abstract:

Black people may have a significantly higher risk of cardiac arrest than whites. Survival rates may also be lower among black patients after cardiac arrest. Among 6,451 patients who had an out-of-hospital cardiac arrest in Chicago, IL between Jan 1, 1987 and Dec 31, 1988, 2,910 were black, 3,207 were white and 334 were members of other races. For every age group, black individuals had a significantly higher incidence of cardiac arrest than white individuals. Less than 1% of black patients survived after cardiac arrest, compared with 3% of white patients. Significantly fewer black patients had bystander-initiated cardiopulmonary resuscitation or were admitted to the hospital. The response time of emergency medical services was similar for black patients and white patients.

Cardiac arrest

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