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OBJECTIVE: To identify the frequency and factors associated with therapy noncompliance in type-2 diabetes mellitus patients. MATERIAL AND METHODS: A cross-sectional study was carried out in 79 patients with type-2 diabetes mellitus seen in major hospitals of Mexico City. Patients were visited at home, from March 1998 to August 1999, to measure compliance with prescribed therapy. Complying patients were defined as those taking at least 80% of their pills or 80% of their corresponding insulin dose. The degree of compliance with therapy components (diet, amount of exercise, and keeping appointments) was measured. RESULTS: The average age of study subjects was 59 years (SD 11 years); 73% (n=58) were female subjects. The overall frequency of noncompliance was 39%. Noncompliance rates were: 62% for dietary recommendations, 85% for exercise, 17% for intake of oral hypoglycemic medication, 13% for insulin application, and 3% for appointment keeping. Hypertension plus obesity was the only factor significantly associated with noncompliance (OR 4.58, CI 95% 1.0, 22.4, p=0.02). CONCLUSIONS: The frequency of therapy noncompliance was very high, especially for diet and exercise.

Dyslipidemia and possibly lipid peroxidation play important roles in the development of macro- and microvascular disease in type 1 diabetes mellitus. Little is known, however, of the role of aerobic exercise in dyslipidemia and resting and exercise-induced lipid peroxidation in type 1 diabetes. Despite the well-known effect of leisure-time physical activity (LTPA) on components of the metabolic syndrome, little is known of the association of LTPA and cardiorespiratory fitness (maximal oxygen consumption, VO2max) with development of the metabolic syndrome itself. A randomized controlled trial assessing the effect of a 12-16 week aerobic exercise program on VO2max and the lipid profile was carried out in otherwise healthy young men with type 1 diabetes. The effect of acute physical exercise on oxidative stress and antioxidant defenses and the relation to VO2max in men with type 1 diabetes was also evaluated. To test four recently proposed definitions by the World Health Organization (WHO) and National Cholesterol Education Program (NCEP) of the metabolic syndrome, the sensitivity and specificity of the definitions for prevalent and incident diabetes were assessed in a population-based cohort of middle-aged men. We also studied the associations of LTPA and cardiorespiratory fitness with prevalent and incident cases of the metabolic syndrome. A 12-16 week endurance exercise program produced antiatherogenic changes in lipid, lipoprotein and apolipoprotein levels in 20 type 1 diabetic men who for the most part were already physically active at baseline. The most favorable training-induced changes in the high-density lipoprotein cholesterol (HDL)/low-density lipoprotein cholesterol (LDL) and apolipoprotein A-I/apolipoprotein B ratios were in patients with low baseline HDL/LDL levels, likely the group with the most benefit to be gained by such changes. Plasma thiobarbituric acid reactive substances (TBARS), a measure of lipid peroxidation, was higher in nine healthy young men with type 1 diabetes than in control men both at rest and after exercise, suggesting increased oxidative stress. An inverse correlation between resting plasma TBARS and VO2max was found in the diabetic men, which could imply a protective effect of physical fitness against lipid peroxidation. The nine young diabetic men also had lower erythrocyte Cu,Zn-superoxide dismutase and catalase activity, but higher glutathione reductase activity. Coupled with increased plasma TBARS and blood total glutathione levels in the diabetic men, these changes may reflect increased susceptibility to oxidative stress and compensatory adaptations of glutathione homeostasis in response to increased oxidative stress. The WHO and NCEP definitions of the metabolic syndrome appear valid, identifying individuals of a population-based cohort of middle-aged men (n=1005) with a 5-9 -fold increased likelihood of developing diabetes during follow up. The modified WHO definition based on waist-hip ratio >0.9 was the most sensitive in detecting prevalent and incident diabetes and had good specificity. The NCEP definition of the metabolic syndrome with adiposity defined as waist girth >102 cm was the most specific, but did not detect most cases of incident diabetes. In a subset of men without diabetes or the metabolic syndrome at baseline, those who engaged in more LTPA, especially vigorous, or who were more fit were less likely to develop the metabolic syndrome during the four-year follow up. These findings support promotion of moderate and vigorous leisure-time physical activity in otherwise healthy type 1 diabetic men to improve dyslipidemia and cardiorespiratory fitness and possibly decrease lipid peroxidation, and in middle-aged non-diabetic men, to decrease the risk for development of the metabolic syndrome and thereby chronic and progressive diseases such as diabetes and atherosclerosis.

Oxidative stress is associated with Alzheimer's (DAT) and vascular (VD) dementias, as well as Type II diabetes mellitus (DIAB) and affected by hypoglycemic therapy. The population ( n=122; males=60; mean age=72.57±7.06) consisted of controls (CTR), DAT and VD patients, with (DAT+DIAB, VD+DIAB) and without concomitant DIAB, resulting in six groups where the antioxidant profile was determined: copper–zinc superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS), and total antioxidant capacity (TRAP). The results were analyzed using a two-way ANOVA design and Bonferroni statistic. The ANOVAs yielded significant differences between groups for all components of the profile: SOD, p=0.00000006; TBARS, p=0.0000012; TRAP, p=0.0000003. The significance level for comparisons between groups was set at α=0.05. The comparisons DIAB vs. CTR, DAT+DIAB vs. DAT, and DIAB demented vs. DIAB non-demented resulted significant for all variables. VD+DIAB vs. VD resulted significant for all variables except TRAP. The antioxidant profiles of DIAB and CTR are different. The differences cannot be directly related with what is observed in dementias. The differences in profiles of demented and non-demented are somewhat hidden when demented patients are affected by a concomitant DIAB condition and/or hypoglycemic treatment, thus conditioning the diagnostic value for dementias of the profiles. Fil: Serra, Jorge A.. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Marschoff, Enrique Ricardo. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina Fil: Dominguez, Raúl. Hospital Sirio-Libanés; Argentina Fil: Guareschi, Eduardo M.. Laboratorio Especializado para las Investigaciones Clínicas; Argentina Fil: Famulari, Arturo L.. Hospital Sirio-Libanés; Argentina Fil: Pagano, Miguel Angel. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; Argentina Fil: Sacerdote de Lustig, Eugenia. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Unidad documental simple

BACKGROUND Heredity, obesity and fat distribution may interact with each other in their association with diabetes risk. Therefore we tried to elucidate the role of familial diabetes as effect modifier in the association of obesity, glucose metabolism and lipoproteins with non-insulin-dependent diabetes mellitus. METHODS A cross-sectional study was carried out among 468 elderly men. Within strata of family history, men with diabetes and normal glucose tolerance were compared with respect to anthropometry, characteristics of glucose metabolism and serum lipids. RESULTS Of the participants, 14.5 percent were diabetic. In diabetic men a family history of diabetes occurred more often (22.1 percent) than in men with normal (6.8 percent, P < 0.001) or impaired glucose tolerance (8.5 percent). In diabetic men with a family history, the ratio of fasting insulin to glucose and the ratio of areas under the insulin and glucose curves during oral glucose tolerance testing were lower compared to men with normal glucose tolerance. In men without a family history, these differences were smaller (interaction P = 0.06). In diabetic men without a family history, fasting insulin levels were markedly elevated (P < 0.001), whereas in men with a family history there was only a slight elevation. The presence of a family history resulted in more severe deteriorations in lipids, especially in fasting triglycerides (interaction P = 0.075). No interaction between indices of obesity and a family history was observed. CONCLUSIONS Our findings suggest that elderly diabetic men with a family history of diabetes represent a different subgroup than elderly men without such a history, characterized by larger deteriorations in indices for beta-cell function and higher triglyceride levels.

The Na+-pumping activity of the erythrocyte plasma membrane in diabetic subjects was studied together with the lipid composition. Insulin-dependent diabetes mellitus (IDDM) patients (n = 25) were divided into young (28.1 ± 7.4 yr old, mean ± SD; n = 16) and old (71.7 ± 9.8 yr old; n = 10) subjects; the age of non-insulin-dependent (NIDDM) patients was 70.7 ± 11.5 yr (n = 10). The Na+-pumping activity, estimated from both Na+-K+-ATPase and ouabain binding, was significantly decreased in IDDM and NIDDM subjects, but its insulin sensitivity was retained only in young IDDM subjects. The total cholesterol and phospholipid content of the erythrocyte plasma membrane was lowered in IDDM subjects, and cholesterol-to-phospholipid molar ratio was significantly decreased. In NIDDM subjects the significant decrease of the two lipid components did not alter their ratio. The analysis of major phospholipid components of erythrocyte membranes revealed that only phosphatidylcholine is significantly increased in young diabetic subjects. The fatty acid composition of major phospholipid classes was significantly altered in all cases: the unsaturation index appeared to be increased in phosphatidylserine and sphingomyelin for both IDDM and NIDDM subjects and was also increased in phosphatidylcholine in the latter group.