[Prevalence of antinuclear antibodies in hypertensive diabetics treated with acebutolol]

Acebutolol may induce the development of antinuclear antibodies and, exceptionally, of a lupus-like syndrome. The purpose of this study was to evaluate the prevalence of antinuclear antibodies in hypertensive diabetics under long-term treatment with acebutolol. Seventy-eight normal subjects, 75 diabetics under antidiabetic therapy only, and 75 hypertensive diabetics who received acebutolol in mean doses of 478 +/- 242 mg/day for at least one year were investigated. The 3 groups were comparable with regard to age and sex. Antinuclear antibodies were detected in 18.6% of diabetics under acebutolol, as against 3.8% and 1.3% respectively of subjects in the other groups (p less than 0.01). There was no correlation between the levels of antinuclear antibodies and the dosage or duration of acebutolol treatment. None of the sera tested contained antinative DNA antibodies, and none of the hypertensive diabetics exhibited signs of lupus-like syndrome.

Abnormal color vision and reliable self-monitoring of blood glucose

Color vision was assessed in 103 insulin-dependent diabetic patients using the Farnsworth-Münsell 100-Hue Test. All showed color vision impairment. Thirty-four had true dyschromatopsia while 22 suffered from tritanopia or other axial defects. We evaluated how accurately diabetic patients could monitor their own blood glucose by asking them to read a series of 30 precalibrated BM Test Glycemic Strips (Chemstrip, Boehringer, Mannheim, West Germany) without a meter. Patients with axial defects performed least well regardless of 100-Hue scores. Reading accuracy of patients with no axial defects was strongly correlated to 100-Hue scores, although patients having dyschromatopsia were consistently hesitant about their readings. Our results suggest that self-monitoring of blood glucose without a meter is indicated only after color vision has been examined by the 100-Hue Test. Self-monitoring should be voided with patients suffering from axial defects or having unsatisfactory 100-Hue scores.

[Influence of arterial hypertension on diabetic retinopathy]

The influence of arterial hypertension on the prevalence of diabetic retinopathy was evaluated by a cross-sectional study in 882 diabetic patients of whom 337 were insulin-treated and 505 were non insulin-treated. Arterial hypertension was defined by blood pressure values higher than 160-90 mmHg. Retinopathy was considered to be present when at least 2 microaneurysms were observed at the posterior pole. When duration of the diabetes was taken into account the prevalence of retinopathy in hypertensive subjects (69%) was not significantly higher than in normotensive subjects (47%) among the insulin-treated patients. However among non insulin-treated patients retinopathy was significantly more frequent in hypertensive (39%), than in normotensive subjects (25%; p less than 0.05).

[Prevalence of smoking among diabetics and influence of tobacco on diabetic retinopathy]

Among 647 patent diabetics regularly followed who attended the out-patient clinic of a hospital Diabetology Department between December 1st, 1979 and June 30th, 1980, 35% were habitual smokers, 20% ex-smokers and 45% non-smokers. Insulin-treated diabetics did not smoke more than non insulin-treated diabetics. Only one-half of the smokers declared that they had been advised by a doctor to stop smoking. This study failed to demonstrate any effect of tobacco on the prevalence or severity of diabetic retinopathy.

[Adiastole caused by a secondary cardiac hemochromatosis. Successful treatment with an iron chelating agent]

Severe congestive cardiac failure developed in a few weeks in a 44 year old man who had undergone porto-caval anastamosis for post-hepatitis cirrhosis one year previously and then treated for anaemia by repeated blood transfusion and chronic daily oral iron therapy. Infiltrative, congestive and restrictive cardiomyopathy was diagnosed in the presence of global cardiomegaly, electrocardiographic changes (microvoltage, diffuse ST-T wave changes), echocardiographic appearances (dilatation of the left ventricle, with hypertrophic and hypokinetic walls), and hemodynamic signs of adiastole with equalisation of filling pressures at 15 mmHg and a cardiac index of 1,88 l/min/m2. Cardiac haemochromatosis was confirmed by the laboratory (serum iron: 35 mumol/l; siderophilin saturation: 100 p. 100; serum ferritin: 1854 ng/ml; induced siderouria: 51 mg/24 hours) and histological findings (endomyocardial biopsy showing pigment overload). The absence of a family history, of homozygote A3 antigen, of diabetes, of iron overload on hepatic biopsy one year previously, excluded the diagnosis of familial idiopathic haemochromatosis. A secondary form of the disease was diagnosed on a possible genetic predisposition (heterozygote A3 antigen) and on environmental factors (blood transfusions, iron therapy, cirrhosis, alcoholism and perhaps the porto-caval anastamosis. Cardiac haemochromatosis was cured in this case by iron chelating therapy comprising daily subcutaneous infusions of 2 g of desferrioxamine for 2 months. The cure was confirmed by regression of the signs of clinical cardiac failure and of cardiomegaly, the increase in QRS voltages and the near normalisation of the hemodynamic and laboratory findings.