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Biomedical subjects

A Golay

Publications and source records attributed to A Golay.

At least 91 records · Page 5Linked to original sources
PubMed1993

[The process of accepting a chronic disease. What is the role of caregivers in management of these patients?].

Occurrence of a chronic disease means to the patient the loss of his accustomed state of health. That is what a newly diagnosed diabetic patient experiences, when he is confronted with the necessity for a perpetual treatment in order to keep his blood sugar levels as normal as possible. Furthermore, this disease may induce severe secondary complications because adjustment is difficult. Ability and will-power to care for himself depend on the degree of acceptance of the disease by the patient himself. This implicates a period of sorrow, characteristic phases of which have been identified and described by several authors. The relation between physician and patient plays an important role in this process. The physician should not only recognize the emotional reactions of his patient but also respond adequately.

Adaptation, Psychological↗
PubMed1993

[How can compliance be ameliorated in diabetic patients?].

The compliance of diabetic patients is very poor. In addition to the knowledge of the various stages of acceptance of the disease as described by A. Lacroix in this journal, it is necessary to learn more about the patient's personality. In this article, four different personalities are proposed using the test "Persona" (Polymanagement SA, Geneva) in order to have the correct choice of therapy, corresponding to the personality. We hope that in the long term, by using this test, therapeutic compliance for the diabetic patients will be improved.

Diabetes Mellitus↗
PubMed1993

[Comparison of 2 cholesterol synthesis inhibitors (simvastatin and pravastatin)].

Inhibitors of cholesterol synthesis (HMG-CoA reductase) are the most effective cholesterol-lowering drugs. Comparison of several studies in the literature suggests that simvastatin is approximately twice as effective as pravastatin on a milligram basis. These results are confirmed by the present study, which compares treatment with simvastatin (10 mg/d) with pravastatin (20 mg/d) in the same hypercholesterolemic patients (n = 17). The reduction in LDL cholesterol is the same with twice the dose of pravastatin as with simvastatin (26 +/- 3% vs 27 +/- 2% respectively). The reductions in atherogenic ratios, total cholesterol, HDL cholesterol and ApoB/ApoA1 are similar. Undesirable effects are rare and comparable. The differences between the two inhibitors appear to be on the molecular level, in tissue selectively and regarding in vivo efficacy.

Anticholesteremic Agents↗
PubMed1993

Blunted glucose-induced thermogenesis: a factor contributing to relapse of obesity.

It is well established that the long-term effect of weight-reducing diet therapies is disappointing, since the majority of those overweight regain their previous body weight regardless of the procedure used to maintain weight reduction. Glucose-Induced-Thermogenesis (GIT) was shown to be diminished in 55 obese patients particularly in the presence of insulin resistance (r = 0.44 p < 0.001) and in obese diabetic patients (3.7 +/- 0.7% vs 8.6 +/- 0.9% p < 0.001). After weight loss the combined effect of a decreased basal energy expenditure and an attenuation of GIT resulted in a postprandial energy expenditure which was markedly lower than in the overweight state (1.48 +/- 0.10 Kcal/min vs 1.15 +/- 0.05 Kcal/min p < 0.01). With six years evolution of obesity, GIT decreased significantly in non-diabetic obese (6.8 +/- 1.1% before and 4.1 +/- 0.8% after 6 years evolution p < 0.05) and was still blunted in the diabetic group (3.1 +/- 0.8% before and 2.1 +/- 0.7% after). The decrease in GIT was accompanied by reduction in glucose tolerance and insulin response. In conclusion, the decrease in GIT after weight loss and after six-years evolution of obesity, which accompanies the worsening of glucose tolerance and occurrence of diabetes, is a mechanism which may contribute to maintain the obese state by a reduction of energy expenditure.

Adult↗
PubMed1992

[Insulin resistance. A syndrome responsible for various cardiovascular diseases].

The X-syndrome described by G. M. Reaven comprises several risk factors, among them obesity. Type II diabetes, hypertension and certain dyslipidemias. The frequent association of these conditions is due to insulin-resistance and hyperinsulinism. The pathophysiology of this syndrome and the possibilities for its treatment are reviewed.

Arteriosclerosis↗
PubMed1992

The effect of muesli or cornflakes at breakfast on carbohydrate metabolism in type 2 diabetic patients.

Fourteen overweight insulin-treated type 2 diabetic patients ate a breakfast, consisting of either muesli (slow release starch: SRS) or cornflakes (fast release starch: FRS), in either case with milk (46 g carbohydrate), during two consecutive randomized crossover periods of two weeks. The rest of the diet remained unchanged. At the end of each period the patients underwent a glucose tolerance test after an overnight fast without their usual evening insulin injection. Both mean plasma glucose responses curves were identical after the two dietary periods, but plasma insulin was significantly lower at zero (-17%, P less than 0.05) and 2 h (-21%, P less than 0.05) at the end of the muesli (SRS) period as compared to the cornflakes (FRS) period. The mean day-long plasma glucose level (four measurements) at the end of the muesli period was 21% (P = 0.023) lower than after the cornflakes period. These results show that switching, at breakfast only, from standard cereals to slow release starch cereals improves the carbohydrate metabolism of diabetic patients. In addition, the fact that diabetic patients could reduce their insulin requirement (P less than 0.05) with concomitant reduction of their daily blood glucose level implies that sensitivity to insulin was improved by slow release starct foods consumed at breakfast.

Analysis of Variance↗
PubMed1992

Delayed removal of 125I-labeled very low density lipoprotein from plasma of rats with insulin-deficient diabetes mellitus.

The present studies demonstrate that the removal rate of exogenously labelled 125I-VLDL-protein is prolonged when total serum from insulin-deficient rats combined with isolated 125I-VLDL is injected into normal recipient rats (6.8 +/- 0.7 vs 4.2 +/- 0.4 min; p < 0.01), but not when 125I-VLDL-protein is isolated and injected alone (4.2 +/- 0.8 vs 4.3 +/- 0.8 min). Furthermore, the present studies demonstrate that when isolated 125I-VLDL-protein is recombined with either VLDL-free (d > 1.006 g/ml), or lipoprotein-free serum (d > 1.215 g/ml) from insulin-deficient rats, the defect in removal rate of VLDL-protein observed in total serum is reestablished (125I-VLDL + VLDL-free serum from insulin-deficient rat vs that from normal rat: 7.6 +/- 1.2 vs 4.6 +/- 0.7 min, p < 0.05; and 125I-VLDL + lipoprotein-free serum from insulin-deficient rat vs that from normal rat: 6.4 +/- 0.7 vs 4.1 +/- 0.4 min, p < 0.01). These data suggest that a factor or factors exist in lipoprotein-free serum of insulin-deficient rats which interfere with the normal removal of 125I-VLDL. Since we have previously demonstrated a prolongation in the removal rate of endogenously labeled VLDL-3H-TG, the defect in removal of VLDL from the plasma of insulin-deficient rats appears to include both the lipid and protein moieties of the VLDL particles.

Animals↗
PubMed1991

Effect of trestatin, an amylase inhibitor, incorporated into bread, on glycemic responses in normal and diabetic patients.

The effect of incorporating the pancreatic alpha-amylase inhibitor trestatin into bread on postprandial plasma glucose and insulin excursions was tested in healthy volunteers and non-insulin-dependent diabetic patients. At both dose levels of trestatin (3 and 6 mg/75 g starch) the peak values of plasma glucose and insulin were reduced markedly (compared with placebo) after the ingestion of 75 g starch in the form of bread. In healthy control subjects as well as in diabetic patients, trestatin produced significantly lower insulin excretions but also significant reductions in incremental plasma glucose areas in a dose-dependent fashion. It is concluded that it is technologically feasible to incorporate trestatin into starchy foods without loss of activity or impairment of taste. Furthermore, the positive effect of trestatin on glycemic and insulinemic responses in diabetics and the lack of serious side effects offer a great potential in the dietary treatment of diabetic patients.

Adult↗
PubMed1991

Evolution of glucose induced thermogenesis in obese subjects with and without diabetes: a six-year follow-up study.

The thermogenic response to a 100 g oral glucose load was measured prospectively (by indirect calorimetry) in three groups of obese subjects: (1) normal glucose tolerance (n = 12, initial weight 86.4 +/- 3.9 kg, BMI 30.4 +/- 1.1 kg/m2; (2) impaired glucose tolerance (n = 8, initial weight 105.3 +/- 7.6 kg, body mass index (BMI) 37.6 +/- 2.9 kg/m2; (3) diabetes (n = 12), initial weight 102.1 +/- 5.3 kg, BMI 36.2 +/- 2.0 kg/m2). The thermogenic response to glucose averaged 6.8 +/- 1.1 and 7.0 +/- 1.0 per cent, in the two non-diabetic obese groups respectively, and was significantly lower in the obese diabetic group (3.1 +/- 0.8 per cent). With the evolution of obesity (i.e. 6 years later), the glucose-induced thermogenesis (GIT) was significantly reduced in the non-diabetic groups (P less than 0.05) to 4.1 +/- 0.8 and 3.0 +/- 1.1 per cent respectively, and was still blunted in the diabetic group (2.1 +/- 0.7 per cent). The decrease in GIT was accompanied by a reduction in glucose tolerance and insulin response with no change in fasting plasma insulin. These effects were observed despite the fact that the body weight of the subject did not change significantly over the 6-year period. It is concluded that the decrease in GIT which accompanies the worsening of glucose tolerance and the occurrence of diabetes is a mechanism which may contribute to maintain the obesity state by a reduction of energy expenditure.

Adult↗
PubMed1990

[Dyslipidemia in diabetes mellitus: significance, diagnosis and treatment].

Dyslipidemias are frequent in diabetic subjects: they increase the risk for atherosclerosis, in addition to the risk of diabetes mellitus per se. The pathogenesis of dyslipidemias differs between type I and type II diabetes: untreated type I diabetic subjects demonstrate frequently increased triglyceride concentrations due to diminished removal of triglyceride-containing particles, as a result of diminished activity of lipoprotein lipase. In addition, more triglycerides are produced due to increased lipolysis and increased free fatty acid supply to the liver. Type II diabetic subjects demonstrate very low density lipoprotein (VLDL) over-production due to obesity, insulin resistance and caloric overconsumption. In addition, triglyceride removal may be diminished due to diminished lipoprotein lipase activity when diabetes mellitus is poorly controlled. In addition, high density lipoprotein (HDL) is frequently lowered. During decompensation low density lipoprotein (LDL) concentrations may also increase. LDL particle composition is frequently abnormal. A severe dyslipidemia in diabetes mellitus is frequently a combined effect of diabetes mellitus and a congenital lipoprotein abnormality. The evaluation and treatment of dyslipidemias in diabetic subjects should be performed similarly to non-diabetics according to the guidelines published recently by the Working Group 'Lipids' of the Swiss Foundation of Cardiology. Additional accents in diabetic subjects are necessary. It is recommended that serum cholesterol, triglycerides and HDL are determined in every patient when diabetes mellitus is diagnosed. If serum cholesterol is greater than 6.5 mmol/l and the cholesterol/HDL-ratio is greater 6.5, dietary treatment should be reinforced; if its effect is insufficient, drug therapy should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed1990

Impaired glucose tolerance and diabetes in obesity: a 6-year follow-up study of glucose metabolism.

To investigate the time course of glucose metabolism in obesity 33 patients (21 to 69 years old; body mass index [BMI], 25.7 to 53.3 kg/m2) with different degrees of glucose intolerance or diabetes who had been studied initially and 6 years later were submitted to the same 100-g oral glucose tolerance test (OGTT) with indirect calorimetry. From a group of 13 obese subjects with normal glucose tolerance (NGT), four developed impaired glucose tolerance (IGT); from a group of nine patients with IGT, three developed non-insulin-dependent diabetes mellitus (NIDDM); five of six obese NIDDM subjects with high insulin response developed NIDDM with low insulin response. Five patients had diabetes with hypoinsulinemia initially. As previously seen in a cross-sectional study, the 3-hour glucose storage measured by continuous indirect calorimetry remained unaltered in patients with IGT, whereas it decreased in NIDDM patients. A further decrease in glucose storage was observed with the lowering of the insulin response in the previously hyperinsulinemic diabetics. These results confirm cross-sectional studies that suggest successive phases in the evolution of obesity to diabetes: A, NGT; B, IGT (the hyperglycemia normalizing the glucose storage over 3 hours); C, diabetes with increased insulin response, where hyperglycemia does not correct the resistance to glucose storage anymore; and D, diabetes with low insulin response, with a low glucose storage and an elevated fasting and postload glycemia.

Adult↗
PubMed1990

Cholesterol-lowering effect of skim milk from immunized cows in hypercholesterolemic patients.

The effect of skim milk from cows immunized against a variety of human intestinal bacteria on serum cholesterol concentrations was examined in 11 patients with primary hypercholesterolemia in a 24-wk, randomized, double-blind, placebo-controlled, crossover study. After a 4-wk baseline period, patients were treated for 8 wk either with skim milk from immunized cows (active) or with control skim milk (placebo) followed by an 8-wk period with the treatment order reversed. Eight weeks of active treatment with skim milk from immunized cows reduced serum total cholesterol concentrations by 0.52 +/- 0.59 mmol/L (mean +/- SD; P less than 0.025), or 8%, LDL cholesterol by 0.16 +/- 0.59 mmol/L (NS), or 4%, and the atherogenic index (total cholesterol/HDL cholesterol) by 0.42 +/- 1.85 (P less than 0.05), or 8%, compared with the placebo treatment. Reversal of the favorable development occurred upon cessation of active treatment. We conclude that daily supplementation of a normal diet with skim milk from immunized cows can result in a significant reduction of elevated blood cholesterol concentrations.

Adult↗
PubMed1990

Effect of central obesity on regulation of carbohydrate metabolism in obese patients with varying degrees of glucose tolerance.

It has been proposed that central obesity, by virtue of the enhanced lipolytic activity of abdominal adipose tissue, leads to higher plasma FFA concentrations, which, in turn, decrease both hepatic removal of insulin and insulin-stimulated glucose uptake by peripheral tissues. In short, the predicted consequences of abdominal obesity are elevations in circulating FFA and insulin levels as well as insulin resistance. The goal of this study was to evaluate the relationships predicted by the overall hypothesis; this study was carried out in 31 obese females, defined as having normal glucose tolerance (n = 12), impaired glucose tolerance (n = 8), or noninsulin-dependent diabetes mellitus (n = 11). Abdominal obesity was estimated by determining the ratio of waist to hip girth, fasting and postprandial plasma FFA and insulin concentrations were measured at hourly intervals from 0800-1600 h, and insulin-stimulated glucose disposal was quantified by the euglycemic hyperinsulinemic clamp technique. The first step in the postulated sequence of events to be tested was that the greater the WHR, the higher the total integrated plasma FFA response. The correlation coefficient between these two variables was 0.29, indicating that the results did not support the prediction. Furthermore, we could not demonstrate any relationship between the magnitude of the plasma FFA and insulin responses (r = 0.20; P = NS). However, there was a modest inverse relationship between height of circulating plasma insulin concentration and a decrease in insulin-stimulated glucose uptake (r = -0.43; P less than 0.03) in the group as a whole. On the other hand, when the three groups were analyzed individually, a significant inverse relationship was only seen in the control group (r = -0.67), and a direct relationship was actually seen in patients with impaired glucose tolerance (r = 0.88). Furthermore, when the mean responses for the variables in each of the three groups were compared, it was apparent that the postulated relationships between abdominal obesity, plasma FFA concentration, and insulin secretion and action were not present. Thus, the data presented do not support the hypothesis that differences in the degree of central obesity play an important role in regulation of plasma concentrations of either FFA or insulin or in modulation of insulin-stimulated glucose uptake in the patients we studied.

Adipose Tissue↗
PubMed1989

[Swiss simvastatin multicenter study: 1. Efficacy of 10 mg simvastatin daily in patients with primary hypercholesterolemia].

In a Swiss multicenter study with determination of lipid and lipoprotein parameters in a central laboratory, the efficacy of simvastatin, MSD, was evaluated in patients with primary hypercholesterolemia. Lipid and lipoprotein values were determined in 109 patients before and after 6 weeks' therapy with 10 mg simvastatin per day. A significant decrease in total cholesterol, LDL-cholesterol and apo B, of 21.1, 25.8 and 24.1% respectively, was observed. No influence of simvastatin on apo A-II was found, but HDL-cholesterol and apo A-I were slightly increased (+6.1 and 4.4% respectively). The data show that HMG-CoA reductase inhibitors constitute a new class of effective drugs for the treatment of hypercholesterolemia.

Adult↗
PubMed1989

[The dual protective effect of fish oil in preventing coronary diseases].

We studied the effect of incorporation of eicosapentaenoic and docosahexaenoic acid into the normal Western diet in nine human volunteers for 6 weeks. They received 1.5 g per day of omega 3-polyunsaturated fatty acids (W3-PUFA) for 3 weeks followed by 3 weeks with supplementation of 3.0 g per day. A control period of 3 weeks preceded PUFA supplementation. A significant effect on lipids was found in the total triglycerides and VLDL-triglyceride fractions (p less than 0.025). The ratio VLDL-triglyceride over HDL-cholesterol was also significantly diminished after 6 weeks of treatment (0.86 +/- 0.15 vs 1.01 +/- 0.19, p less than 0.02). Prolongation of the bleeding time was clearly demonstrated after 6 weeks of supplementation (10.6 +/- 1.3 min vs 6.2 +/- 0.6 min). Platelet aggregation stimulated by either ADP or collagen was significantly diminished after W3-PUFA supplementation (p less than 0.025 and p less than 0.005 after ADP and collagen respectively). The lag time of platelet aggregation was significantly prolonged (94 +/- 12 vs 56 +/- 2 sec, p less than 0.005) and the maximum speed reaction of the primary phase of the reaction was significantly diminished (1.3 +/- 0.2 vs 1.6 +/- 0.2 mm/sec, p less than 0.02). In conclusion, in the light of this study W3-PUFA supplementation leads to two different benefits in cardiovascular prevention. First, a significant diminution of total plasma triglyceride has been shown and, second, prolongation of the bleeding time and diminution of the platelet aggregation have been demonstrated.

Adult↗
PubMed1989

Phospholipids and other lipids in angiographically assessed coronary artery disease.

Lipoprotein subclasses and their composition in cholesterol, triglycerides and in 5 types of phospholipid as well as apolipoproteins A-I and B were determined in blood of 114 patients undergoing coronary angiography for suspected or confirmed myocardial ischaemia. Lipid concentrations of lipoproteins were measured after preparative ultracentrifugation; high performance thin-layer chromatography was used to separate phospholipid subfractions. Patients with angiographically defined coronary artery disease (CAD) significantly differed from those without CAD in 25 different lipid or phospholipid parameters. Using discriminative analysis, apo A-I/apo B ratio was the only parameter with more than 70% success in reclassifying the patients in the CAD group. When correlated with a coronary atheromatous score reflecting either the number and degree of stenoses (Jenkins score) or the number of diseased vessels alone, only LDL-cholesterol was found to correlate with the Jenkins score. We conclude that serum phospholipid fractions may differ significantly in CAD group as compared with controls, but they are, however, no better predictors of CAD than other lipids.

Adult↗