(From the book, in advanced preparation: "*Semeiotica Biofisica. Microangiologia Clinica* ", with some modifications)
Due to the use of Biophysical Semeiotics in day-to-day practice, in order to diagnose endocrine-metabolic disorders, diabetes mellitus diagnosis has become a “clinical” one, since its really initial stages, i.e. hyperinsulinaemia-insulin resistance and, then, Impaired Glucose Tolerance (IGT), as it is described later on (1, 2, 3, and in the site: www.semeioticabiofisica.it).
Diabetes Mellitus (DM), one of the most common human diseases, particularly in highly developed countries, from the socio-economic view-point, shows a persistent and worrying annual incidence. For instance, although official data are lacking, in Italy there are 2-3 millions of diabetics, with yearly increasing of 6%, including all diabetic types, really different from both aetiopathogenetic and clinical point of view. In fact, DM represents a syndrome, metabolic in origin, very complicated in its aetiopathogenesis, surely genetically based, characterized by relative or absolute insulin-deficiency.
Due to diagnostic failure of traditional physical semeiotics, DM is very often recognized by chance, e.g., in routine blood laboratory examinations, made due to insurance, school, work, sport reasons or in the course of examinations due to numerous other diseases, i.e. events which are nowadays really frequent without any justification.
At this point, it is important to say that the assessment of glycemia of a patient on an empty stomach as well as urine examination early in the morning are frequently misleading (2, 3); certainly post-prandial glycemia provides more informations (2-3 h. after the meal). In fact, in our opinion, Glycemology, which is now a science largely spread all over the world, due particularly to economic reasons, has to be considered a part from Clinical Diabetology, less known around the world and, first of all, cause of great responsibility for doctor, but also of greatest satisfaction.
We absolutely neglect the first discipline. On the contrary, we consider exclusively the later, mainly as regards diabetic constitution, whose knowledge is essential in DM “primary” prevention.
Glycemic blood level and diabetic complications: a relation until now to be determined.
All around the world, there is not general agreement among the authors about the relation between the increase of glycemic blood-level and increase of diabetic complications, accepted mainly by the authors (4), particularly over the last decades. In fact, other authors did not observe amelioration of diabetic complications because of decreasing high glycemic blood-levels (5).
On the other hand, it is notoriously difficult to maintain in the normal ranges the value of glycemia in diabetics, since episodes of dangerous hypoglycemia occur really frequently.
In the above-mentioned research, the decrease of glycosilated hemoglobin of 1% was not followed by deads reduction of 21%, as maintain other researchers. The death-rate of diabetics intensively treated appeared to be not statistically significant, underlining the lack of positive results with the aid of this treatment.
In other words, hyperglycemia seems to be not the “actual” cause, but an aggravating cause. Therefore, doctors might pay all attention at other factors (11), as hypertension, for instance, since decreasing hyperglycemia by itself has little or no value in preventing well-known complications of DM (5).
Analyzing this important relation between high glycemic blood concentrations and diabetic complications is really interesting, as regards its influences on the real value of “clinical” and “quantitative” evaluation of the various initial phases of DM, including obviously the diabetic constitution, by using Biophysical Semeiotics, which fortunately allows doctor to go beyond the mere glycemic level.
We are very delighted remembering, without any possibility of confutation, that over the last two-three decades the authors reproached us for not having admitted the high glycemic concentration as “primary” and “direct” cause of organ damage. Nowadays, at least, authors suspect that the relation between diabetes and hyperglycemia – assessed as glycosilated hemoglobin – on the one hand, and, heart-vascular diseases, on the other hand, has not yet been solved. In other words, nowadays the authors doubt the statements, which appeared as truth until ’80 years.
At this point, interesting are the data, referred above, about beneficial results obtained with metformin therapy (this drug ameliorates insulin receptors sensitivity) a part from decreasing glycemic blood level.
In a few words, in these years authors speak abundantly of hyperinsulinaemia-insulin resistance, that is a “clinical” diagnosis with the aid of Biophysical Semeiotics (3), as a “cause” of macro- and micro-vascular disorders.