Several studies have demonstrated specific receptors for 1,25-dihydroxyvitamin D in pancreatic beta cells suggesting a role for 1,25-dihydroxyvitamin D in the regulation of insulin secretion [1,2]. Others have shown that vitamin D depleted animals exhibited impaired glucose clearance and insulin secretion, which were abolished by vitamin D supplement [3][4][5][6]. This beneficial effect appeared early after i. v. injection of 1,25-dihydroxyvitamin D.In humans the number of studies evaluating the effect of vitamin D on glucose metabolism are increasing. Recently, studies have shown that vitamin D depleted humans have reduced insulin secretion [7,8], but this was reversed after vitamin D treatment for 3-6 months. In diabetic patients bone disease is often observed suggesting that this group also suffers from impaired vitamin D metabolism. So far, however, conflicting results have been reported on the level of 1,25-dihydroxyvitamin D in diabetic patients [9,10]. This probably explains the diverging results of vitamin D treatment on glucose tolerance in this group [11,12].Others have evaluated the effect of vitamin D treatment in renal failure [13,14]. In end-stage renal failure the circulating level of 1,25-dihydroxyvitamin D decreases and at the same time impaired glucose Diabetologia (1997) 40: 40-44 Effect of 1,25-dihydroxycholecalciferol on glucose metabolism in gestational diabetes mellitus , but returned to the baseline level after 2 weeks of oral Etalpha (85 ng/l). Simultaneously, the glucose level decreased from 5.6 to 4.8 mmol/l (p < 0.01) after i. v. treatment with 1,25-dihydroxyvitamin D 3 , but did not differ significantly from inclusion following 2 weeks of oral Etalpha. There was no difference between the glucose concentrations during OGTT prior to and after i. v. or oral 1,25-dihydroxyvitamin D 3 , in contrast to the insulin levels which tended to be lower after both i. v. and oral supplementation. In a multiple regression model including 1,25-dihydroxyvitamin D 3 , insulin , weight and height against glucose, only 1,25-dihydroxyvitamin D 3 and insulin were selected for the final model (r 2 = 0.73, p < 0.0001). Our results suggest that supplements of 1,25-dihydroxyvitamin D 3 influence glucose metabolism in patients with GDM probably by increasing the insulin sensitivity. [Diabetologia (1997) 40: 40-44]
Objective To evaluate the voiding phase before and 1 year after surgery in women who underwent a tension-free vaginal tape (TVT) procedure for stress incontinence. Patients and methods The study comprised 45 women with genuine stress urinary incontinence. To assess the voiding phase, patients were asked if their voiding had changed after surgery, and objectively the uroflowmetry, residual urine measurements and pressure-flow data were compared. Results At 1 year after surgery 39 women (87%) were subjectively cured and six (13%) improved. The objective cure rate was 88%; the pad-test leakage and the number of leakage episodes decreased significantly after surgery. Subjectively, 78% of the patients reported that the voiding phase had become more difficult, and the spontaneous flow curve changed to a more obstructive pattern in 40%, with the mean urinary peak flow rate (Q max ), the corrected Q max and the mean average flow rate decreasing significantly. The residual urine volume increased significantly, although no patient had volumes of >25% of their bladder capacity. During the pressure-flow study the Q max decreased and the urethral resistance factor increased significantly. However, only one patient could be classified as obstructed. Two patients had clinical problems and used self-catheterization once daily 1 year after surgery. Conclusion There were subjective and objective changes in the voiding phase 1 year after the TVT procedure. The significance of these findings remains to be determined. Longitudinal studies are warranted to clarify whether the patients at risk can be characterized from subjective and objective findings.
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