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Biomedical subjects

A L Peters

Publications and source records attributed to A L Peters.

At least 37 records · Page 2Linked to original sources
PubMed1995

Management of patients with diabetes by nurses with support of subspecialists.

A program was developed for managing diabetic patients within an HMO system. The system uses physician-supervised diabetes nurse specialists and a computer system to enhance compliance and management of patients. The focus of the program is on preventing hospitalizations as well as preventing the development of the complications of diabetes, with early detection (and treatment) of any complications that do occur. The program was associated with a significant fall in glycated hemoglobin levels (12.5% to 9.5%, p < 0.005) and led to likely cost-savings by avoiding acute hospitalizations for diabetes in an estimated 244 patients over a 4-year period.

California↗
PubMed1995

Retinal detachment in black South Africans.

Rhegmatogenous retinal detachments seen in black patients attending King Edward VIII Hospital Ophthalmology Clinic over a 5-year period from January 1987 to December 1991 were reviewed. Penetrating trauma and diabetic retinopathy were excluded. There were 114 detachments in 112 patients, which gave incidence of 0.46/100,000 of the population served per annum. This confirms the low incidence of this disorder found in black patients in other series. Patients were comparatively young (37.5% less than 30 years of age), men outnumbered women 2:1, and the incidence of blunt trauma was high (29.8%). Over one-third (36.6%) presented with a blind or poorly sighted opposite eye. Late presentation was common. Large posterior breaks occurred in 15.7% of detachments with severe proliferative vitreoretinopathy in 33.3%. These last characteristics accounted for the use of vitrectomy with tamponade as a primary surgical procedure in 32.5% of cases and contributed to the relatively low success rate of reattachment (72.8%). Some of the findings may be influenced by social disadvantage, but the reason for the low incidence of retinal detachment in black patients is not known. A stronger adherence of the retina to the retinal pigment epithelium in black patients is postulated.

Adult↗
PubMed1995

Sorsby's fundus dystrophy. A South African family with a point mutation on the tissue inhibitor of metalloproteinases-3 gene on chromosome 22.

PURPOSE: The authors studied the variable expressivity of the phenotype and molecular genetics of a South African family with the fundus appearance of Sorsby's fundus dystrophy. METHODS: Seventeen members of a single family underwent examination. Five of these were affected. Clinical details of five other affected family members were obtained from their ophthalmologists. Patients were questioned about age of onset, history of night blindness, and color defects. Examination included fundoscopy, color testing, color photographs, and fluorescein angiography. Blood for molecular genetic analysis was taken from 23 family members. RESULTS: The age of onset of symptoms was 29 to 56 years, and the rate of progression was variable. Sudden decreased vision was associated with subretinal choroidal neovascularization. Slower visual decline was associated with central chorioretinal atrophy. Progressive retinal pigment epithelial atrophy and peripheral pigment clumping occurred in elderly relatives who lost ambulatory vision. DNA studies show linkage to the long arm of chromosome 22 and a point mutation in the tissue inhibitor of metalloproteinases-3 gene. CONCLUSION: This South African family presents with a dominantly inherited fundus dystrophy with clinical and molecular features compatible with Sorsby's fundus dystrophy.

Adult↗
PubMed1993

Protein and fat effects on glucose responses and insulin requirements in subjects with insulin-dependent diabetes mellitus.

The glucose responses (GR) and insulin requirements (IRs) were measured by a glucose-controlled insulin infusion system for 5 h after 12 patients with insulin-dependent diabetes mellitus consumed each of three meals: a 1890-kJ standard meal, the standard meal with 840 kJ added protein, and the standard meal with 840 kJ added fat. The GR to the protein-added meal was greater (P = 0.005) than to either the standard or fat-added meals, because of an increase in the late (last 150 min) GR. The late IR was greater for the protein-added meal (P < 0.005). The IR was not changed after the fat-added meal. Therefore, the addition of protein (but not fat) energy to a meal increases both the postprandial GR and late IR. This finding suggests that diabetic patients who inject premeal insulin may need to increase their insulin dose when protein is added to a meal.

Adult↗
PubMed1993

Cost-effective screening for diabetic retinopathy using a nonmydriatic retinal camera in a prepaid health-care setting.

OBJECTIVE: To assess the efficacy of using a nonmydriatic Polaroid retinal camera as a method for screening diabetic patients for treatable diabetic retinopathy. RESEARCH DESIGN AND METHODS: All 522 diabetic patients followed in a health maintenance organization-affiliated diabetes program had retinal photos taken. Compliance with the routine referral to one of two retinal specialists (the examiners) was 74%. The results from the examiners were compared with the results of the reader of the retinal photos. RESULTS: Sensitivity was 100% and specificity was 82% for the diagnosis of serious diabetic retinopathy (preproliferative or proliferative retinopathy or macular edema) by the examiners compared with the diagnosis of any diabetic retinopathy by the reader. No patient had serious diabetic retinopathy inside or outside the photographic field that was missed because all patients with serious diabetic retinopathy showed some diabetic retinopathy within the photographic field. The reader tended to underrate the severity of the diabetic retinopathy, but when the reader diagnosed serious diabetic retinopathy, it was always present on exam. CONCLUSIONS: The nonmydriatic retinal camera is easy to use, inexpensive, and can be used as part of a general diabetes exam, independent of a physician, in patients who should, but may not, be referred to an ophthalmologist. Any patient with abnormal findings on photos should be referred to an ophthalmologist, and any patient with findings of serious diabetic retinopathy on the photos should be referred immediately for possible laser therapy.

California↗
PubMed1991

Insulin plus a sulfonylurea agent for treating type 2 diabetes.

PURPOSE: To review the recent literature on the efficacy of combined insulin and sulfonylurea therapy in patients with type 2 diabetes. DATA SOURCES: Pertinent articles were obtained through an English-language MEDLINE search from 1979 to 1990 and from the references of these articles. STUDY SELECTION: We reviewed the studies in which patients with poorly controlled diabetes received insulin and a sulfonylurea agent and in which insulin treatment alone (usually given in conjunction with a placebo) was compared with insulin plus sulfonylurea therapy. DATA EXTRACTION: Pre- and post-treatment insulin doses, blood glucose levels, glycated hemoglobin values, C-peptide levels, and insulin levels were analyzed. Other data were analyzed separately. RESULTS OF DATA SYNTHESIS: Data from similar trials were compared. Data from concurrent trials were analyzed separately from data derived from cross-over trials. Weighted mean fasting blood glucose levels, glycated hemoglobin levels, insulin dosage, and fasting C-peptide concentrations were determined for insulin plus placebo and insulin plus sulfonylurea agent groups for both types of studies. In concurrent trials, the weighted mean post-treatment glycated hemoglobin level was 11.1% after insulin plus placebo compared with 10.0% after insulin plus a sulfonylurea agent. In cross-over trials, the corresponding values were 10.6% and 9.8%. CONCLUSIONS: Combination therapy with insulin and a sulfonylurea agent only slightly improved glycemic control in patients with type 2 diabetes. When a sulfonylurea agent was used, less exogenous insulin was needed, but fasting serum insulin levels were not different between the treatment groups. Such therapy did not produce nearly normal blood glucose concentrations and therefore should not be used in patients with poorly controlled type 2 diabetes receiving insulin.

Clinical Trials as Topic↗
PubMed1990

Effect of isocaloric substitution of chocolate cake for potato in type I diabetic patients.

Traditional dietary advice given to people with diabetes includes eliminating simple sugars (primarily sucrose) from the diet. Many people have difficulty following this recommendation. Because patients with type I (insulin-dependent) diabetes do not need overall calorie restriction, there is no caloric reason to restrict sucrose. In this study, we looked at the effect of the isocaloric substitution of a piece of chocolate cake for a baked potato in a mixed meal to determine whether this would increase the blood glucose in patients with type I diabetes. The glucose response to a cake-added meal was significantly greater than to a standard meal. The glucose response was no different between a cake-substitution meal and a standard meal. The reproducibility studies showed no difference between repeated standard meals. The urinary glucose excretion was significantly greater after a cake-added meal but was no different with the other pairs. There were no significant differences in the counterregulatory hormone responses at baseline between any of the paired studies. In conclusion, patients with type I diabetes may substitute a sucrose-containing dessert for another carbohydrate in their diet without compromising their postprandial glucose response. These data suggest that a dessert exchange may be helpful and not harmful in the management of diabetic patients. There is an inherent variability (at least 16%) in an insulin-requiring patient's response to a meal, making self-monitoring of blood glucose and adjustment of insulin doses necessary to achieve near euglycemia.

Adult↗
PubMed1990

Use of sulfonylurea agents in older diabetic patients.

The elderly patient with type II diabetes should be treated in much the same fashion as a younger person with the same disease, although emphasis needs to be placed on minimizing side effects, drug interactions, and hypoglycemia. Chlorpropamide should not be used in these patients, unless there is no other choice. The remaining agents--tolbutamide, acetohexamide, tolazamide, glyburide, and glipizide--should be started at low doses and gradually increased until optimal diabetic control is reached. The initial treatment goal is a FPG level of less than 180 mg/dl and a final goal is a 1- to 2-hour PPG concentration between 140 and 180 mg/dl. The glycosylated hemoglobin value should be no greater than 1.5% above the upper limit of normal, and should be lower, if possible. It must be kept in mind, however, that the closer diabetic patients are to achieving euglycemia, the more likely is hypoglycemia. Treatment goals therefore may have to be relaxed in someone at increased risk of hypoglycemia (e.g., patients with irregular eating habits or renal insufficiency) or when hypoglycemia may pose a greater hazard (e.g., patients with coronary artery or cerebral vascular disease). Patients on sulfonylurea agents should have blood glucose values measured once a month and glycosylated hemoglobin levels determined once every 3 months to alert the clinician to the possible need to adjust therapy. In this way, potential hypoglycemia can be avoided if blood glucose levels are drifting too low and chronic hyperglycemia can be identified and treated within a short period of time. When a patient's status changes--e.g., he is placed on new medication, becomes depressed and anorexic, or develops another medical problem--care must be taken to re-evaluate his diabetes management. Drugs such as sulfonamide antibiotics can potentiate the action of the sulfonylureas and cause hypoglycemia, renal insufficiency may necessitate changing the type of sulfonylurea agent or decreasing the dose, and malnutrition may obviate any need for therapy with an oral hypoglycemic agent. If these guidelines are kept in mind, the older diabetic patient can be managed on a sulfonylurea agent in conjunction with the appropriate diet. Should these measures prove to be ineffective, then insulin therapy should be instituted. Controlling chronic hyperglycemia will help improve the quality of life for patients with diabetes and decrease the probability of developing some of the devastating complications associated with this disease.

Aged↗
PubMed1989

Lack of glucose elevation after simulated tube feeding with a low-carbohydrate, high-fat enteral formula in patients with type I diabetes.

PURPOSE: Commercially available enteral formulas frequently cause hyperglycemia. This often leads to difficult and complex diabetes management with glucosuria and urinary losses of calories, fluid, and electrolytes. In this study, we compared a new product, EN-8715 (8% soluble fiber, 18% Polycose, 7% fructose, 50% fat, 17% protein), with a standard feeding product, Ensure HN (53% simple carbohydrates, 30% fat, 17% protein), to determine whether the new product would lower the glucose response. PATIENTS AND METHODS: Ten subjects (four women and six men) with type I diabetes were evaluated in paired, simulated tube feeding studies. After an overnight fast, a Biostator (artificial endocrine pancreas) was attached to each subject, and a steady-state blood glucose level of 150 mg/dL (8.4 mM) was established. The Biostator was then programmed to deliver a small basal amount of insulin (0.1 mU/kg/minute [718 pmol/kg/minute]), and the patients were given 20 mL of the randomly assigned formula every 15 minutes for 240 minutes (320 mL). Counterregulatory hormone responses to bringing the initial glucose response to the two enteral feeding formulas were measured and compared. RESULTS: The glucose response (mg/dL/four hours +/- SEM) essentially did not rise after EN-8715 (-2 +/- 33 mg/dL/four hours [-0.11 +/- 1.83 mM/four hours]) compared with that for Ensure HN (190 +/- 32 mg/dL/four hours [10.64 +/- 1.79 mM/four hours]). Urinary glucose losses (g +/- SEM) were significantly (p = 0.01) less after the new product (1.4 +/- 0.6 g [7.8 +/- 3.3 mmol] versus 5.7 +/- 1.5 g [30.2 +/- 8.3 mmol]). There were no significant differences in counterregulatory hormone responses. Side effects were minimal and product acceptance was similar. CONCLUSION: A low-carbohydrate, fiber-containing enteral feeding formula can limit hyperglycemia in patients with type I diabetes.

Adult↗
PubMed1989

Disorders of water metabolism: hyponatremia and hypernatremia.

Patients with disorders of sodium and water metabolism are seen frequently in Emergency Departments, but in most cases these disorders do not require treatment. Severe hypo- and hypernatremia are relatively uncommon but can result in severe neurologic sequelae or death. Appropriate therapy, based on an understanding of the physiology involved, can reduce the morbidity and mortality associated with these disorders. A systematic approach to the assessment and management of patients with hypo- and hypernatremia is presented.

Humans↗