Abstract. The aim of this study was to compare the intensity of typical late complications in diabetic patients (/? = 65, 28 type I, 37 type II) who were not on glycoside drugs with low vs. high serum levels of digoxin-like immunoreactive factor (DLIF: group I, n = 42, DLIF ^ the detection limit of 0*2 ng ml 1 ; and group II, // = 23, meaniSEM: H7±0-31 [0-25-4-96] ng ml" 1 ). For detection of nephropathy, urinary albumin excretion (24 h) and creatinine clearance tests were used. For coronary heart disease a questionnaire and standard ECG; for peripheral occlusive vascular disease a questionnaire; for eye disease a fundoscopy; for neuropathy a neurological score system; and for autonomic neuropathy a standardized test battery was employed. Patients with high DLIF levels showed better test results in vibratory perception (95-7±l-5 vs. 82-8±3-8%, normal finding = 100%, 2p = 0016), had better percentile localizations concerning maximal pupillary area in darkness (28-4±6-6 vs. 8-1 ±1-8%, 2p = 0-0004), contraction velocity at 1 s (21-5±5-8 vs. 8-0±2-2%, 2p = 0-012), and dilation velocity at 6 s (23-0±6-8 vs. 10-5±2-5%, 2p = 0-041), had less retinopathy (with retinopathy: 26-1% vs. 64-3%, 2p = 0-0028), and better percentile localizations in the respiratory sinus arrhythmia test (68-4±7*3 vs. 44-1 ±49%, 2p = 0-0064). There was no difference concerning nephropathy, blood pressure, coronary heart disease and peripheral vascular disease. Separate analysis according to the type of diabetes confirmed the results in each group. This would indicate that DLIF is a possible protective endogenous substance for eye disease, and peripheral (large sensory fibres) and autonomic neuropathy in diabetic subjects independent of the type of diabetes.
In diabetic patients, several factors contribute to volume expansion and have to be counteracted by humoral and neuronal feedback control systems. We investigated N-terminal proatrial natriuretic factor (ANF1-98) and digoxin-like immunoreactive factor (DLIF), which are two counteracting hormones, and their interrelationship, with additional consideration given to autonomic nervous function in diabetic patients. ANF1-98 and DLIF were measured in 64 diabetic patients. Autonomic nervous function was assessed using nine autonomic nervous function tests. The patients were subdivided into two groups, one with four or more (group 1) and one with less than four abnormal results in autonomic function tests (group 2). Compared with group 2, group 1 demonstrated detectable DLIF levels less often (17.2 vs. 45.7, P = 0.0195) and increased levels of ANF1-98 (mean +/- SEM: 850.0 +/- 108.8 vs. 554.8 +/- 45.9 pmol/L, P = 0.0099). However, the groups did not differ in blood pressure, daily sodium, and daily potassium excretion. The number of abnormal autonomic function tests correlated significantly with ANF1-98 (P = 0.0002). In patients with detectable DLIF, DLIF correlated with ANF1-98 (P = 0.0080). These results demonstrate close interactions between the autonomic nervous system and the two natriuretic hormones. In patients with autonomic nervous dysfunction, higher levels of ANF may possibly compensate for the lack of the natriuretic DLIF to counteract hypertension and chronic volume expansion.
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