Latest Achievements of Diabetes Research Reviewed Contents of 1984's Major Diabetes Congresses

Latest Achievements of Diabetes Research Reviewed Contents of 1984's Major Diabetes Congresses

Frontiers in Diabetes Vol. 7 Series Editor F. Belfiore, Catania karger s. Karger Basel Munchen Paris London New York. New Delhi. Singapore Tokyo Sydney

Latest Achievements of Diabetes Research Reviewed Contents of 1984's Major Diabetes Congresses Francesco Belfiore and Agata M. Rabuazzo Chair of Pathophysiology of Metabolism, III Istituto di Clinica Medica, University of Catania Medical School, Ospedale Garibaldi, Catania karger 1986 S. Karger Basel Miinchen Paris London New York New Delhi Singapore Tokyo Sydney

Frontiers in Diabetes NatIOnal Library of Medicine, Cataloging III Publication Belfiore, Francesco Latest achievements of diabetes research. reviewed contents of 1984's major diabetes congresses / Francesco BelfIOre and Agata M. Rabuazzo. - Basel; New York: Karger, 1986 - (Frontiers In diabetes, vol. 7) Consists of a survey of recent results and preliminary data presented at the 1984 meetmgs of the AmerIcan Diabetes Association and of the European Association for the Study of Diabetes BIblIography: p Includes mdex. 1. DIabetes MellItus 2. Research I. Rabuazzo, Agata M. II. American Diabetes ASSOCiatIOn III. European AssocIation for the Study of Diabetes IV. TItle V. Senes WI FR945X v 7 IWK 810 B428L] ISBN 3-8055-4261-5 Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth In this text are in accord with current recommendations and practice at the time of publication. However, in view of ongomg research, changes in government regulations. and the constant flow of information relatmg to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in mdlcations and dosage and for added warnmgs and precautions. This is particularly important when the recommended agent IS a new andlor Infrequently employed drug All rights reserved No part of this publication may be translated into other languages, reproduced or utilized In any form or by any means, electronic or mechanical, mcluding photocopying, recording, microcopying, or by any mformation storage and retneval system, Without permission In wntmg from the publisher Copyright 1986 by S. Karger AG, P.O. Box, CH-4009 Basel (SwItzerland) Printed In Switzerland by Emmentaler Druck AG, 3550 Langnau ISBN 3-8055-4261-5

Contents Preface............................................... IX Part I. Basic Aspects Hormone Secretion and Action............. Normal Pancreatic Islets.... 16 16 General Aspects......................................... 161 Ion Handling and Electrical Activity............................ 5 Islet Metabolism......................................... 9 Insulin Release by Islets in vitro.......................... 16..... Insulin Secretion and Action..................................... 20 Insulin Secretion in vivo................................... 20. Insulin Action (Including Binding)............................. 22 Other Hormones............................................ 42 Glucagon............................................. 42 Somatostatin and Other Pancreatic and Gut Hormones................ 45 Catecholamines......................................... 48 Corticosteroids.................................. 50........ Other................................................ 51 Normal Metabolism....................................... 54 Carbohydrate Metabolism............................... 54....... General Aspects......................................... 54 Carbohydrate Metabolism in the Various Tissues.................... 56 Lipid Metabolism............................................ 58 Amino Acid and Protein Metabolism............................... 59 Part II. Diabetes mellitus Etiologic Factors......................................... 61 Genetic Factors............................................. 61 HLA System........................................... 61 Other Genetic Factors..................................... 64 Environmental Factors........................................ 68

Contents VI Alterations in Hormone Secretion and Action.................. 71 Pancreatic Islets............................................. 71 Immunologic Aspects...................................... 71 Insulin Secretion and Action..................................... 84 Insulin Secretion......................................... 84 Insulin Action (Including Binding)............................. 89 Other Hormones............................................ 96 Somatostatin, Pancreatic Polypeptide, and Gut Hormones.............. 96 Counterregulatory Hormones................................ 97 Alterations in Metabolism.................................. 103 Carbohydrate Metabolism...................................... 103 General Aspects......................................... 103 Lipid Metabolism............................................ 106 Amino Acid and Protein Metabolism........................ 108....... Other................................................... 109 Diagnosis.............................................. 111. Glycosylated Hemoglobin and Other Glycosylated Proteins................. 111 Glycosylated Hemoglobin................................... 111 Other Glycosylated Proteins.......................... 112....... Other Data of Diagnostic or Clinical Relevance......................... 113 Diagnostic Data......................................... 113 Clinical Data................................... 116........ Treatment..................................... 122......... Diet.................................................... 122 Caloric Intake and Diet Composition.......................... 122.. Fibers................................................ 125 Insulin................................................... 125 Conventional Insulin Administration...................... 125...... Continuous Insulin Infusion.................................. 134 Insulin-Induced Hypoglycemia................................ 142 Pancreas orislet Transplantation.............................. 144 Antidiabetic Drugs........................................... 148 Sulfonylureas........................................... 148 Other Drugs........................................... 151 Other Therapeutic Measures............................... 156...... Physical Exercise........................................ 156 Psychological Aspects..................................... 156 Education and Self-Management.............................. 159 Other................................................ 164 Complications............................................ 166 Metabolic Complications....................................... 166 Ketoacidosis........................................... 166

Contents VII Vascular Complications............................... 167......... Microangiopathy................................ 167......... Macroangiopathy............................... 177......... Various Factors Related to Micro- and/or Macroangiopathy............ 180. Neuropathy..................................... 187........... Peripheral Neuropathy............................ 187......... Autonomic Neuropathy............................ 192........ Associated Disorders............................ 196.......... Obesity...................................... 196............ Dyslipidemia..................................... 201......... The Lipid and Lipoprotein Pattern........................ 201.... Lipoprotein Production and Clearance....................... 203... Other Conditions.................................. 205.......... Endocrine-Metabolic Disorders........................ 205....... Pregnancy, Fetus and Newborn........................ 209....... Kidney and Urinary Tract............................. 216...... Cardiovascular Disorders............................. 219...... Other..................................... 223.......... References.................................. 225......... Subject Index................................... 278........

Preface This new volume of the Series Frontiers in Diabetes consists of a survey of recent results and preliminary data presented at the 1984 meetings of the American Diabetes Association and of the European Association for the Study of Diabetes. As such, the book offers an overview of the latest achievement of the ongoing research on diabetes. In contrast to other comparable publications, in which a certain number of selected topics are reviewed, often leaving some areas uncovered and some overlapping between chapters, this book considers all the new findings discovered by the most advanced diabetes research, ordering them into a coherently structured and systematically organized review. Moreover, being based on the latest results of current research, the content of this volume should be more updated than that of reviews based on journal articles. We hope that these distinctive features will be useful to, and appreciated by, the physicians and scientists interested in diabetes and metabolism. Francesco Belfiore Agata M. Rabuazzo