Some chemical indices of diabetic vascular disease.

Some chemical indices which could be related to diabetic complications have been assessed in 105 diabetics. In juvenile (insulin-dependent) diabetics with retinopathy, cardiovascular disease or nephropathy, levels of fibrinogen, fibrin monomer, beta-lipoprotein, cholesterol and alpha-2-macroglobulin were raised. Only in part is the explanation due to a rise of fibrinogen and cholesterol with age. Among twenty-six patients with a plasma fibrinogen over 400 mg/100 ml, eleven sustained a major cardiovascular catastrophe within the next 2 years. Alpha-1-acid-glycoprotein was raised in these eleven and beta-2-glycoprotein generally in juveniles with cardiovascular disease. Triglycerides were elevated in all groups, but notably in patients with Grade I retinopathy with venous dilation. There was a suggestion that triglycerides were related inversely to dietary carbohydrate in mature onset diabetics, and serum cholesterol in juveniles was related to insulin dosage. The part of lipids in vascular disease is then discussed. An interesting positive correlation was found between fibrin monomer, itself an indication of in vivo thrombin formation, and beta-lipoprotein. Although alpha-2-macroglobulin was elevated in juveniles, especially with complications, this did not apply to maturity onset cases and therefore no direct relation to diabetic vascular disease can be suggested. Moreover, alpha-2-macroglobulin levels were normal in acromegaly.