Abstract
The present investigation documents the alkaline phoshatase (ALP) isoenzyme fractions in a large number of diabetic patients, relates the findings for intestinal-type ALP isoenzyme (i-ALP) to the diabetic state, and assesses any changes in serum ALP isoenzyme patterns following treatment with diet and drug or insulin. Electrophoretic determinations were made on serum samples collected before breakfast from a group of 50 normal subjects and 286 diabetic patients, including 20 cases with ketone bodies in the urine. Samples were taken on the 2nd day and again on the 14th day following admission. Serial determinations of serum ALP isoenzymes were also carried out in a group of 9 patients with diabetic coma. The prevalence of significant amounts of i-ALP was higher in diabetics (26.2%) than in normals (10.0%). Of the 286 diabetics, 73.8% had no demonstrable i-ALP (group 1), whereas the others had significant amounts of i-ALP in the serum obtained on the 2nd admission day. However, i-ALP then disappeared from the serum in 17.1% of the total diabetics on the 14th day (group 2). In the remaining patients (9.1%, group 3), no significant changes were observed in the amounts of i-ALP between samples taken on days 2 and 14. Patients of group 3 were ABH secretors of blood group B or O.
The prevalence of i-ALP in ABH non-secretors of blood group A, AB, B or O and ABH secretors of blood group A or AB in diabetic patients was nearly the same as that in normal subiects. On the other hand, the prevalence of i-ALP in diabetic ABH secretors of blood group B or O was higher (63.9%) than that in normal subjects (20.0%). Most of the patients in group 2 were either untreated or under a poor state of control at the time of admission. i-ALP was significantly more frequent in diabetic patients with ketone bodies in the urine (35.0%) and diabetic coma (55.6%) than in those without ketones, and the incidence of i-ALP observed on electrophoresis increased in proportion to the aggravation of the diabetes mellitus. The i-ALP found in patients with diabetic coma disappeared on treatment and improvement of the diabetes mellitus. These results indicate that not only a genetic predisposition but also metabolic disorders of diabetes mellitus due to lack of insulin, appear to be concerned with the appearance of i-ALP in the serum.
