[Nutritional recommendations for diabetic patients: adaptation of the recommendations defined by the Diabetes and Nutrition Study Group of EASD].

Nutritional recommendations for diabetics are nowadays more flexible and better adapted to the individual patient. They resemble those offered to the public at large. Caloric intake is determined by body size and weight as well as physical activity.

Weight-loss with low or high carbohydrate diet?

Objective: With obesity being recognized as an important cardiovascular risk factor, it is important to determine the optimal hypocaloric diet for decreasing that risk. The goal of this study was to compare the effects of two hypocaloric diets of similar caloric value, but differing in carbohydrate content (25% and 45%).

Subjects: Sixty-eight out-patients were followed for 12 w.

Risk factors associated with contrast sensitivity loss in diabetic patients.

Background: Psychophysical tests in patients with diabetes mellitus reveal deficits of central vision before the development of overt retinopathy. We evaluated the contrast sensitivity thresholds in 30 patients with type II diabetes mellitus and without retinopathy, taking into account the crystalline lens density. Risk factors for contrast sensitivity deficits were investigated.

Similar weight loss with low- or high-carbohydrate diets.

The goal of this study was to evaluate the effect of diets that were equally low in energy but widely different in relative amounts of fat and carbohydrate on body weight during a 6-wk period of hospitalization. Consequently, 43 adult, obese persons were randomly assigned to receive diets containing 4.2 MJ/d (1000 kcal/d) composed of either 32% protein, 15% carbohydrate, and 53% fat, or 29% protein, 45% carbohydrate, and 26% fat.

Insulin sensitivity in obese hypertensive dyslipidemic patients treated with enalapril or atenolol.

We evaluated the effects of enalapril [angiotensin converting enzyme (ACE) inhibitor] in comparison with atenolol (beta-blocker) on insulin sensitivity and serum lipoprotein concentration in obese hypertensive dyslipidemic patients. Twenty-eight hypertensive [mean blood pressure (MAP) 152 +/- 3/103 +/- 1 mm Hgl], obese [mean body mass index (BMI) 30 + 1 kg/m2A], dyslipidemic [total triglycerides 2.0 +/- 0.

Effect of lipid oxidation on the regulation of glucose utilization in obese patients.

The effect of changes in lipid oxidation on glucose utilization (storage and oxidation) was studied in seven nondiabetic obese patients. They participated in three protocols in which: (1) Intralipid (to raise plasma FFA concentrations), (2) beta-pyridylcarbinol [a precursor of nicotinic acid, to lower plasma free fatty acids (FFA) concentrations], or (3) isotonic saline were infused over 2 h. Thereafter, these infusions were discontinued, and a 2-h euglycemic, hyperinsulinemic clamp was performed to measure glucose uptake.

Regulation of nutrient metabolism and energy expenditure.

The requisites for energy expenditure are covered mainly by two major substrates, glucose and free fatty acids (FFA). Their regulation and metabolism differ. After carbohydrate ingestion, glucose is rapidly oxidized or stored in muscles and liver.

Cardiovascular autonomic neuropathy in diabetic patients with macular oedema.

We performed a case-control study to investigate the determinants of macular oedema in patients with diabetes mellitus. Patients with macular oedema (n = 20) were selected for study, together with a random sample of subjects without macular oedema (controls, n = 21). Both groups were similar for sex, type of diabetes, treatment and glycaemic control.

[From obesity to diabetes].

The frequent development of Type 2 diabetes in the obese suggests a relationship between obesity and diabetes. This study presents evidence for a continuum form obesity to diabetes via glucose intolerance and hyperinsulinemic diabetes. The defect which seems to be at the origin of this development resides in the increase in lipid oxidation already present in the early stages of obesity.

Effect of a novel beta-adrenoceptor agonist (Ro 40-2148) on resting energy expenditure in obese women.

The aim of this single-blind, placebo-controlled study was to investigate the effects of the new beta-adrenergic compound Ro 40-2148 on resting energy expenditure (REE) at rest and after an oral glucose load in non-diabetic obese women before and after two weeks of treatment. After one week of placebo administration and after an overnight fast and one hour rest, REE and glucose and lipid oxidation rates were measured by indirect calorimetry (hood system) before and for 6 h after a single dose of placebo solution. A 75 g oral glucose tolerance test (OGTT) was performed during this period starting 90 min after the placebo administration.

Evolution from obesity to diabetes.

The relationship between obesity and Type 2 diabetes mellitus is so closely related that it is worth questioning the possibility of obesity being more than just one diabetes risk factor among others but a factor which participates causally to the development of Type 2 Diabetes on a genetic background. In this review, the evolution of normal glucose tolerance towards impaired glucose tolerance corresponds to the development of compensatory metabolic changes. These compensatory mechanisms are hyperinsulinaemia and postprandial hyperglycaemia which prevents a defect in glucose uptake and especially glucose storage.

The effect of the gastrointestinal lipase inhibitor, orlistat, on serum lipids and lipoproteins in patients with primary hyperlipidaemia.

The effect of orlistat, a nonabsorbed inhibitor of gastric and pancreatic lipases, was examined in patients with primary hyperlipidaemia (serum cholesterol > or = 6.2 mmol.l-1 and triglycerides < or = 5.

[How can compliance be ameliorated in diabetic patients?].

The compliance of diabetic patients is very poor. In addition to the knowledge of the various stages of acceptance of the disease as described by A. Lacroix in this journal, it is necessary to learn more about the patient's personality.

[The process of accepting a chronic disease. What is the role of caregivers in management of these patients?].

Occurrence of a chronic disease means to the patient the loss of his accustomed state of health. That is what a newly diagnosed diabetic patient experiences, when he is confronted with the necessity for a perpetual treatment in order to keep his blood sugar levels as normal as possible. Furthermore, this disease may induce severe secondary complications because adjustment is difficult.

[Comparison of 2 cholesterol synthesis inhibitors (simvastatin and pravastatin)].

Inhibitors of cholesterol synthesis (HMG-CoA reductase) are the most effective cholesterol-lowering drugs. Comparison of several studies in the literature suggests that simvastatin is approximately twice as effective as pravastatin on a milligram basis. These results are confirmed by the present study, which compares treatment with simvastatin (10 mg/d) with pravastatin (20 mg/d) in the same hypercholesterolemic patients (n = 17).

Blunted glucose-induced thermogenesis: a factor contributing to relapse of obesity.

It is well established that the long-term effect of weight-reducing diet therapies is disappointing, since the majority of those overweight regain their previous body weight regardless of the procedure used to maintain weight reduction. Glucose-Induced-Thermogenesis (GIT) was shown to be diminished in 55 obese patients particularly in the presence of insulin resistance (r = 0.44 p < 0.

Delayed removal of 125I-labeled very low density lipoprotein from plasma of rats with insulin-deficient diabetes mellitus.

The present studies demonstrate that the removal rate of exogenously labelled 125I-VLDL-protein is prolonged when total serum from insulin-deficient rats combined with isolated 125I-VLDL is injected into normal recipient rats (6.8 +/- 0.7 vs 4.

Interaction of lipid and carbohydrate metabolism after infusions of lipids or of lipid lowering agents: lack of a direct relationship between free fatty acid concentrations and glucose disposal.

The present work was planned to study the effects of changes in lipid metabolism irrespective of FFA concentrations (FFA) on the regulation of oxidative and nonoxidative disposal of a glucose infusion during hyperinsulinaemia. Fifteen normal volunteers participated in the 3 protocols, in which 1) Intralipid 2) beta-pyridylcarbinol or 3) isotonic saline were infused during 2 hours. Thereafter, these infusions were discontinued and a two-hour euglycaemic hyperinsulinaemic clamp was performed.

The effect of muesli or cornflakes at breakfast on carbohydrate metabolism in type 2 diabetic patients.

Fourteen overweight insulin-treated type 2 diabetic patients ate a breakfast, consisting of either muesli (slow release starch: SRS) or cornflakes (fast release starch: FRS), in either case with milk (46 g carbohydrate), during two consecutive randomized crossover periods of two weeks. The rest of the diet remained unchanged. At the end of each period the patients underwent a glucose tolerance test after an overnight fast without their usual evening insulin injection.

[Insulin resistance. A syndrome responsible for various cardiovascular diseases].

The X-syndrome described by G. M. Reaven comprises several risk factors, among them obesity.