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Biomedical subjects

A Schiffrin

Publications and source records attributed to A Schiffrin.

At least 37 records · Page 2Linked to original sources
PubMed1988

Prospective study of predictors of beta-cell survival in type I diabetes.

We conducted a prospective study to describe the course of the pancreatic beta-cell function from the time of clinical diagnosis of insulin-dependent (type I) diabetes to determine whether DR type, presence of islet cell antibodies (ICA), presence of insulin antibodies (IA), age at onset, and sex could help in the prediction of residual endogenous insulin secretion. A cohort of 68 children was followed for 18 mo after diagnosis of type I diabetes. The outcome variables selected for analysis were 1) serum C-peptide peak concentration after a Sustacal meal, 2) time of disappearance of the serum C-peptide response, and 3) time after diagnosis at which the maximal serum C-peptide response was observed. After institution of insulin therapy, serum C-peptide peak concentrations rose temporarily for 1-6 mo and declined thereafter. Multivariate analysis of the data showed that DR type (P = .2488) and presence of IA (P = .1604) had no effect on serum C-peptide over time, but sex (P = .0146), age at onset (P = .0002), and presence of ICA (P = .0147) significantly contributed to the variation of serum C-peptide over time. Furthermore, age at onset, presence of ICA, and sex were also the only significant predictors of the time of disappearance of the beta-cell function. The relative risks of beta-cell-function disappearance were 0.87 (P = .0015), 9.43 (P = .0181), and 2.25 (P = .0468), respectively. In conclusion, there are distinct variations in the natural course of the beta-cell function in type I diabetes. beta-Cell-function survival is significantly shortened the younger the subject is at disease onset, if ICA are present at diagnosis, and if the subject is male.

Adolescent↗
PubMed1988

Hyperglycemia after intense exercise in IDDM subjects during continuous subcutaneous insulin infusion.

Exercise is conventionally considered a modality for improvement of glycemia in diabetes. We have found that a short period of intense exercise (80% VO2max) in normal lean subjects produces sustained postexercise hyperglycemia 20% above basal with a corresponding 100% increase in plasma insulin. In people with insulin-dependent diabetes mellitus (IDDM) incapable of this insulin response, it was predicted that postexercise hyperglycemia would be of greater magnitude and/or duration. To investigate this possibility, the effects of the same intense exercise (80% VO2max) were studied in 8 IDDM subjects (2 on 2 occasions) in the postabsorptive state with continuous subcutaneous (abdominal) insulin infusion (CSII). When the preexercise plasma glucose was normal (n = 6, 86 +/- 4 mg/dl), there ensued a postexercise hyperglycemia to 127 +/- 7 mg/dl (P less than .001) sustained for 2 h postexhaustion. Plasma free immunoreactive insulin (IRI) was 1.43 +/- 0.12 ng/ml before exercise and did not change postexercise. When mean preexercise plasma glucose was 149 +/- 9 mg/dl (n = 4), it rose progressively throughout the 2 h of recovery to 229 +/- 28 mg/dl (P less than .025). A small but statistically significant decrease in free IRI occurred during the last 80 min of recovery. Hyperglycemia in the diabetic subjects was not explained by abnormal or differing responses of glucagon or catecholamines. Thus, with intense exercise, diabetic control deteriorates rather than improves. Therefore, different therapeutic strategies may be required for intense compared with moderate exercise in IDDM patients.

3-Hydroxybutyric Acid↗
PubMed1988

Impact of SMBG on control of diabetes as measured by HbA1. 3-yr survey of a juvenile IDDM clinic.

Three hundred twelve diabetic children and adolescents were seen in our diabetic clinic and instructed to test their capillary blood glucose (CBG) twice daily and to use an algorithm to adjust their short-acting insulin. Of this group, 219 youngsters had a full 3-yr period of observation. At each clinic visit, blood was obtained for fasting blood glucose and HbA1 and, once a year, cholesterol and triglycerides were also measured. Patient and parent accuracy in measuring CBG was found to be adequate. The changes over time in HbA1 were nondifferential across age and sex, and there was no difference in the level of HbA1 between age and sex groups, the number of tests reported to have been done by the patients, the number of injections of insulin per day, or the serum cholesterol. There was a significant relationship between the HbA1 and the fasting blood glucose (P less than .001) measured by the laboratory as well as with the serum triglyceride (P less than .01). The failure to improve diabetic control, despite measures that would have been expected to do so, was believed to relate more to a lack of compliance than to a flaw in the therapeutic approach. It was interesting to note that the adolescent patients in the study were in no worse control than the younger children in the group. Although better technical skills are available today to manage diabetes, the psychosocial approach to patient motivation requires improvement.

Adolescent↗
PubMed1987

Predicting nocturnal hypoglycemia in patients with type I diabetes treated with continuous subcutaneous insulin infusion.

The incidence of low nocturnal blood glucose values (i.e., less than 65 mg/dl) was assessed in 20 insulin-dependent diabetic patients treated with continuous subcutaneous insulin infusion supported by capillary blood glucose monitoring before each meal and the evening snack. Patients were randomly assigned to a control or experimental group. Both groups followed an identical protocol for the first part of the study (baseline). Patients were instructed to determine capillary blood glucose measurements five times during the night for three consecutive nights. The same procedure was repeated one week later, but this time the subjects in the experimental group were instructed to have an extra snack if capillary blood glucose levels at 10:30 P.M. were 120 mg/dl or less. The control group continued with the usual routine of one evening snack at 9 P.M. At baseline, the incidence of capillary blood glucose values of less than 65 mg/dl was 13 percent. The ingestion of an extra snack at bedtime resulted in the absence of capillary blood glucose values of less than 65 mg/dl in the experimental group, whereas the incidence of capillary blood glucose values of less than 65 mg/dl in the control group remained 13 percent (p = 0.038). The capillary blood glucose concentration at 10:30 P.M. was highly predictive of the risk of nocturnal blood glucose values below 65 mg/dl (p = 0.015) and fasting capillary blood glucose values above 140 mg/dl (p = 0.0001). These data show that nocturnal hypoglycemia may be a considerable problem during continuous subcutaneous insulin infusion therapy even if the basal infusion rate is adjusted in the hospital on the basis of nocturnal blood glucose concentrations. The ingestion of an extra snack at bedtime for capillary blood glucose values below 120 mg/dl has the potential to minimize this risk. The capillary blood glucose concentration at 10:30 P.M. is a significant predictor of nocturnal hypoglycemia.

Adolescent↗
PubMed1986

An autosomal dominant form of adolescent multinodular goiter.

Eighteen members of an extended pedigree have been found to have a form of euthyroid adolescent multinodular goiter. Histological examination showed multiple adenomata with areas of epithelial hyperplasia, hemorrhage, and calcification. In two subjects there were focal areas of epithelial hyperplasia reminiscent of low-grade papillary carcinoma, but capsular and vascular invasion was not found. The pattern of inheritance appeared to be autosomal dominant, with diminished penetrance in males. Although the patients were euthyroid, the likely basis for this disorder is an abnormality in thyroglobulin structure and function.

Adolescent↗
PubMed1983

Feasibility of strict diabetes control in insulin-dependent diabetic adolescents.

Nineteen insulin-dependent diabetic adolescents who had poor control on twice daily injections and home glucose monitoring participated in a study assessing the feasibility of improved control. Using a randomized crossover protocol, we examined the relative efficacy of continuous subcutaneous insulin infusion and of intensive conventional therapy with three or four daily injections of insulin. Both therapies were regulated with home glucose monitoring. A marked improvement in control with both therapies was observed when mean blood glucose and glycosylated hemoglobin A1 were compared with conventional therapy. However, pump therapy resulted in significantly lower HbA1 than intensive therapy (P less than 0.05), despite a significantly lower total insulin dose (P less than 0.01). We conclude that in adolescents with type I diabetes, continuous subcutaneous insulin infusion is more effective in achieving improvement of diabetes control than is intensive conventional therapy in the outpatient setting.

Adolescent↗
PubMed1982

Comparison between continuous subcutaneous insulin infusion and multiple injections of insulin. A one-year prospective study.

Twenty insulin-dependent diabetic patients participated in a 1-yr prospective randomized cross-over study comparing multiple subcutaneous injections (MSI) and continuous subcutaneous insulin infusion (CSII) complemented by home blood glucose monitoring. While 4 patients dropped out early, 16 patients completed the study. Patients had severe insulin deficiency documented by absent C-peptide response to glucagon stimulation. A marked improvement in control was observed when mean blood glucose and glycosylated hemoglobin A1 were compared with conventional therapy. No significant differences in the degree of metabolic control achieved, as measured by mean fasting, preprandial, and postprandial capillary blood glucose (CBG), M values, glycosylated hemoglobin A1 concentration, cholesterol and triglyceride levels were seen between MSI and CSII in the sixteen patients who completed the study. However, individual comparisons showed that fasting CBG and M-values were lower under CSII than MSI in seven patients (P less than 0.05). In contrast, two patients exhibited lower M values under MSI than under CSII (P less than 0.01), while for the remaining seven patients the results were similar. After completion of the study, two patients went back to conventional insulin therapy, seven patients remained on the pump, and seven patients chose to stay on MSI. In conclusion, on a long-term basis, the two methods can produce comparable levels of blood glucose and glycosylated hemoglobin in ambulatory insulin-dependent diabetics.

Adolescent↗
PubMed1979

Partial short arm deletions of the X chromosome and spontaneous pubertal development in girls with short stature.

Five additional examples of partial deletion of the short arm of the X chromosome are reported. All of the patients had short stature. The presence of the other stigmata of Turner syndrome, including ovarian dysfunction, appeared to depend on the location of the deletion. Chromosomal analysis of girls with short stature (less than 140 cm), normal pubertal development, and regular menses may reveal that minor deletions of the short arm of the X chromosome are more frequent than has been previously reported.

Adolescent↗
PubMed1978

Increased plasma somatomedin reactivity in chronic renal failure as determined by acid gel filtration and radioreceptor assay.

Plasma Somatomedin (SM) reactivity has been determined in patients with chronic renal failure and in normal children by radioreceptor assay (RRA) following acid gel filtration on Sephadex G-100. Total small molecular weight SM reactivity was obtained by the summation of all values between Kav 0.55 to 0.75. The mean SM reactivity (+/-SE) for the renal failure group (N = 9) was 154 +/- 10 ng/ml and for the normal subjects (N = 9) was 91 +/- 5 ng/ml (p less than .001). The renal failure group also had significantly increased mean levels of insulin, GH and PRL, but individual increases were not always concordant. Our data reveal that small molecular weight SM reactivity as determined by RRA of column eluates is increased in chronic renal failure compared to normal controls. Thus SM reactivity is not low in chronic renal failure, supporting the suggestion that peripheral antagonism to SM action contributes to the growth failure observed in these patients.

Adolescent↗
PubMedDate not supplied

Stabilizing blood glucose with a novel medical expert system.

In health, metabolism is elegantly coordinated. Failure of an underlying process (as occurs in diabetes) disrupts the coordination and impacts on the global status of the affected individual. It takes a medical expert to intervene and restore order. Chaotic processes prevail at all times in biological systems and their behaviour in sickness degenerates between medical interventions. We have explored the use of an expert system to substitute for the physician between interventions and demonstrated its ability to maintain order and thus significantly improve control of blood glucose.

Adolescent↗
PubMedDate not supplied

Improved control in diabetes with continuous subcutaneous insulin infusion.

Nine insulin-dependent diabetic patients were treated with continuous subcutaneous (s.c.) insulin infusion, using a portable battery-driven infusion pump and home monitoring of capillary blood glucose. The infusions were maintained for 4 days during an acute in-hospital study and for up to 150 days on ambulatory patients. No significant changes in growth hormone and cortisol secretory patterns were found at the end of the acute study. Mean plasma glucose, M values, and glycosylated hemoglobin A1 (HbA1), as well as the patients' sense of well-being, improved significantly. However, absolute normalization of metabolic control was not achieved, since patients presented occasional, albeit minor, swings of blood glucose. The possibility that the same improvement in control could be achieved with multiple s.c. injections of insulin and similar monitoring of blood glucose in the home is discussed. It remains to be seen whether the degree of control obtained will influence the development of the late complications of diabetes mellitus.

Adolescent↗
PubMedDate not supplied

Combined continuous subcutaneous insulin infusion and multiple subcutaneous injections in type I diabetic patients.

Seven insulin-dependent diabetic patients (aged 16-34 yr) were treated for 10 mo with a combination of continuous subcutaneous insulin infusion (CSII) during the night and premeal boluses of insulin during the day. The technology and strategy of the system are discussed. Three of these patients had been on CSII for 1 yr before the start of this study. Mean fasting (126 +/- 44 mg/dl), mean preprandial blood glucose (131 +/- 54 mg/dl), and mean postprandial blood glucose (216 +/- 73 mg/dl) before starting this treatment fell to 86 +/- 12 mg/dl, 83 +/- 19 mg/dl, and 132 +/- 17 mg/dl, respectively, after 1 mo of treatment. Glycosylated hemoglobin (10.8 +/- 2.9% before the study) reached normal values (7.8 +/- 0.6%) after 2 mo of treatment. Improvement of glycemic control may be achieved with this form of insulin administration, which is of immediate practical application, until an ideal system of insulin delivery becomes available. This technique provides the conditions for testing the hypothesis that near normalization of glycemic control prevents or minimizes the degenerative complications associated with diabetes mellitus.

Adolescent↗
PubMedDate not supplied

Multiple daily self-glucose monitoring: its essential role in long-term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections.

Twenty-one insulin-dependent diabetic patients, previously treated with continuous subcutaneous insulin infusion (CSII), multiple subcutaneous insulin injections (MSI), and a combination of CSII and MSI (combined CSII-MSI) all supported by frequent capillary self-blood glucose (CBG) determinations (5-7 times daily) participated in a program to assess the importance of frequent CBG monitoring. We used a crossover design where diabetic control as measured by mean blood glucose and glycosylated hemoglobin were compared during periods of frequent and infrequent capillary blood glucose monitoring. Diabetic control was significantly better during periods of frequent self-glucose monitoring. We conclude that in compliant, motivated young adults with insulin-dependent diabetes, frequent self-glucose monitoring is critical for the long-term maintenance of glycemic control.

Adolescent↗