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Biomedical subjects

B R Zimmerman

Publications and source records attributed to B R Zimmerman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Pancreas transplantation at Mayo: I. Patient selection.

From October 1987 to December 1988, 59 patients underwent assessment for combined kidney and pancreas transplantation or pancreas transplantation after receiving a kidney allograft. We report our criteria for accepting candidates for transplantation, the results of the selection process, and the clinical and laboratory profile of those patients who underwent transplantation. Of the overall group, 22 patients (37%) were approved medically, 3 of whom were awaiting financial approval. Of the 59 patients, 15 (25%) were not approved for the transplantation program for medical reasons; in addition, 16 patients declined participation and 3 were not accepted because of lack of financial resources. Medical reasons for exclusion from pancreas transplantation were coronary artery disease in six patients, severe peripheral vascular disease in six patients, other medical problems in two patients, and noncompliance in one patient. Thus, many patients who underwent assessment for pancreas transplantation did not enter the program because of medical, financial, or personal preference reasons. In most cases, the medical reason for exclusion from pancreas transplantation was a cardiovascular disorder.

Adult↗
PubMed1990

Course of peripheral occlusive arterial disease in diabetes. Vascular laboratory assessment.

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patients with diabetes mellitus and peripheral occlusive arterial disease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.

Amputation, Surgical↗
PubMed1989

Influence of the degree of control of diabetes on the prevention, postponement and amelioration of late complications.

The relationship between hyperglycaemia and the chronic complications of diabetes has been disputed for many years. Some physicians believe that the evidence that hyperglycaemia is the primary determinant of the chronic complications is convincing; others believe the question remains unsettled. Several types of study provide information. In vitro and in vivo studies demonstrate biochemical alterations induced by hyperglycaemia which could lead to structural changes and diabetic complications. Animal models demonstrate that the complications develop with induction of hyperglycaemia and are ameliorated when blood glucose is returned toward normal. Many uncontrolled clinical studies demonstrate an association between diabetes control and complications but cannot prove causality. Controlled clinical trials have sometimes, but not always, shown functional changes suggestive of amelioration of complications with control of hyperglycaemia. A definitive clinical trial has not yet been completed. Pancreas transplantation has the potential of completely normalising blood glucose, but studies to date have been limited by small numbers of patients, the advanced state of complications, and the lack of adequate controls. On balance, the evidence is highly suggestive that hyperglycaemia is a major determinant of the chronic complications of diabetes. Even if the relationship is established, the risk involved in treatment programmes to achieve near normoglycaemia must be better defined so that potential risk versus benefit can be evaluated in the individual patient when making treatment decisions.

Animals↗
PubMed1988

Nerve glucose, fructose, sorbitol, myo-inositol, and fiber degeneration and regeneration in diabetic neuropathy.

We measured the alcohol sugars in sural nerves from 11 controls, 21 conventionally treated patients with diabetes and neuropathy, and 4 diabetics without neuropathy. The results were related to metabolic control and to clinical, neuropathological, and morphometric abnormalities in the nerves. The mean endoneurial glucose, fructose, and sorbitol values were higher in diabetic patients than in controls. Linear regression analysis revealed that nerve sorbitol content in the diabetics was inversely related to the number of myelinated fibers (P = 0.003). Mean nerve levels of myo-inositol were not decreased in the diabetic patients, with or without neuropathy, and were not associated with any of the neuropathological end points of diabetes. Our results indicate that myo-inositol deficiency is not part of the pathogenesis of human diabetic neuropathy, as had been hypothesized. Other accumulated alcohol sugars, however, were increased in diabetes and were associated with the severity of neuropathy. On repeat biopsy, six diabetics, treated for a year with the aldose reductase inhibitor sorbinil, had decreased endoneurial levels of sorbitol (P less than 0.01) and fructose (0.05 less than P less than 0.1), but unchanged levels of myo-inositol.

Adolescent↗
PubMed1988

Management of noninsulin-dependent diabetes mellitus.

Management of the patient with NIDDM requires the skill and patience of the physician and the input of a health team, including the dietitian and nurse educator. With perseverance and careful follow up, most treatment goals can be achieved in these patients. The attitude of neglect and easy treatment goals that previously characterized the care of these patients are not justified.

Continuity of Patient Care↗
PubMed1987

Neurologic evaluation and treatment of the diabetic foot.

Neuropathy is a frequent complication of diabetes and is most commonly manifest as a sensory neuropathy involving the feet. Although biochemical and experimental animal studies suggest a direct link between the hyperglycemia of diabetes and the development of neuropathy, this link is unproven in humans. Evaluation for neuropathy can usually be accomplished clinically, but in selected cases electromyography is helpful. Other testing methods have a well-defined research note, but their clinical utility is less well established. Treatment of diabetic neuropathy is empirical. Better blood glucose control is attempted and a variety of medications are used to treat the symptoms. Promising treatment methods are being investigated, but none is of proven benefit.

Diabetic Neuropathies↗
PubMed1986

Comparison of distal sympathetic with vagal function in diabetic neuropathy.

We measured distal sympathetic and vagal function in 73 consecutive patients with diabetic neuropathy seen at the Mayo Autonomic Reflex Laboratory. Postganglionic sympathetic failure measured proximally within the foot occurred as commonly as vagal failure (58% and 55%, respectively) and occurred much more frequently than did orthostatic hypotension (26%). Either vagal or distal sympathetic abnormalities occurred in isolation in about one in six patients with diabetic neuropathy. We conclude that distal sympathetic failure and vagal failure occur with equal frequency when sensitive and quantitative recording methods are used and that it is advantageous to test both systems, as only one may be involved in some patients.

Adult↗
PubMed1986

Practical aspects of intensive insulin therapy.

Application of the principles of intensive insulin therapy in an attempt to achieve near-normal glycemia necessitates making many practical decisions for each patient. Often these decisions must be based on experience and opinion because the questions have not been studied adequately enough to be answered definitively. One approach to selection of patients, initiation of therapy, insulin management, blood glucose monitoring, and patient follow-up is reviewed.

Blood Glucose↗
PubMed1986

Sterol excretion and cholesterol absorption in diabetics and nondiabetics with and without hyperlipidemia.

Fecal neutral and acidic sterols and cholesterol absorption were measured in 12 normal control subjects, 40 diabetic subjects with and without hyperlipidemia, and 27 subjects with hyperlipidemia but without diabetes mellitus. All subjects were on a low-cholesterol diet (less than 300 mg cholesterol/day). Fecal excretion of neutral and acidic sterols was increased in patients with hypertriglyceridemia and was more marked in diabetic patients with hypertriglyceridemia. Cholesterol absorption was decreased in diabetic patients with hypertriglyceridemia. Otherwise, there were no significant differences in sterol excretion or cholesterol absorption in diabetic and nondiabetic subjects compared with control groups with similar lipid levels. The best predictors of fecal neutral- and acidic-sterol excretion and of estimated cholesterol synthesis were very low [corrected]-density lipoprotein triglycerides and high-density lipoprotein cholesterol. Correction of hyperlipidemia may be beneficial in decreasing cholesterol synthesis and, thereby, in decreasing the risk of atherogenesis.

Adult↗
PubMed1985

Reproducibility of noninvasive tests of peripheral occlusive arterial disease.

We studied the reproducibility of four tests of peripheral occlusive arterial disease in 54 subjects, 32 of whom had this disease. We found that the reproducibility of systolic blood pressures obtained at rest from the thighs, calves, and ankles approximated that of arm systolic and diastolic blood pressures, as did the ankle-to-arm systolic blood pressure ratios. The average of the tenth and ninetieth percentile ranges of the resting systolic blood pressure ankle-to-arm ratios was +/- 0.10. Systolic blood pressures from the fingers were somewhat less reproducible, and those from the toes were even more variable. Systolic blood pressure ankle-to-arm ratios measured after the patient had exercised were less reproducible than resting ratios. The average of the tenth and ninetieth percentile ranges of the 1-, 3-, 5-, and 10-minute ratios after exercise was -0.13 to +0.16. Skin temperatures from the fingers and toes were approximately as reproducible as systolic blood pressures from the arms and legs and as the resting ankle-to-arm blood pressure ratios. Pulse-volume recordings from the thighs, calves, ankles, feet, toes, and fingers were very poorly reproducible. We conclude that information on the reproducibility of these measurements is essential in the evaluation of noninvasive arterial tests that are used to determine the course of peripheral occlusive arterial disease.

Arm↗
PubMed1983

Effect of blood glucose control on peripheral nerve function in diabetic patients.

A prospective, stratified, randomized 3-year clinical trial was conducted on the effect of rigorous versus conventional glucose control on peripheral nerve function in 33 insulin-treated diabetic patients with a duration of diabetes of less than 2 years. The goals for conventional glucose control were the mean of fasting and 80-minute postprandial plasma glucose of 150 mg/dl for non-insulin-dependent diabetes and 200 mg/dl for insulin-dependent diabetes. The goal of rigorous glucose control was an approximation of nondiabetic glucose control. No significant difference in glucose control or peripheral nerve function was observed between the rigorously and the conventionally controlled groups. Eight patients in the conventional-control group spontaneously achieved glucose control in the range that was the objective for the rigorous-control group, and five patients in the rigorous-control group never achieved the desired glucose control. In the remaining 20 patients, with similar baseline glucose control and peripheral nerve function characteristics, observed over a median of 2 years, improved blood glucose control (P less than 0.01) was not associated with any significant improvement in peripheral nerve function. Nevertheless, a significant (P less than 0.05) correlation was found between the degree of abnormal nerve function at entry into the study and change in nerve function during the study. If control of hyperglycemia benefits peripheral nerve function of diabetic patients, its demonstration may require a closer approximation of normoglycemia, a larger difference in glucose control between the two study groups, a longer duration of treatment, and the use of patients with more advanced peripheral nerve function abnormalities than those in this study.

Adult↗
PubMed1981

A prospective study of peripheral occlusive arterial disease in diabetes. IV. Platelet and plasma functions.

Platelet factor 4-like activity, circulating platelet-aggregate ratios, ristocetin cofactor, Willebrand antigen, ADP-induced platelet aggregation-enhancing factor, and quantitative platelet aggregation response to ADP, epinephrine, and collagen in platelet-rich plasma were measured in four groups of subjects with similar age and sex distribution. Neither platelet factor 4-like activity nor circulating platelet-aggregate ratios differentiated these four groups. Platelet aggregation studies with ADP a subthreshold concentration support the concept of hypersensitivity of diabetic platelets in males. Male and female subjects differ significantly in their quantitative response to aggregating agents when such studies are done under similar conditions. Willebrand factor activity and Willebrand antigen normally increase with age. Elevation in these activities above that accounted for by age characterizes the presence of vascular disease but not diabetes mellitus in the absence of vascular disease. A plasma factor enhancing platelet aggregation could not be demonstrated in most diabetic patients in this study.

Age Factors↗
PubMed1981

A prospective study of peripheral occlusive arterial disease in diabetes. I. Clinical characteristics of the subjects.

This paper describes the clinical characteristics of a group of normal control subjects, patients with clinical peripheral occlusive arterial disease, patients with diabetes and no clinical peripheral arterial disease, and patients with diabetes and peripheral arterial disease at the time of the enrollment of all subjects in a 5-year study of the factors involved in the progression of peripheral occlusive arterial disease in diabetes. Obesity and hypertension were more common in subjects with diabetes or peripheral occlusive arterial disease (or both) than in the control subjects. Smoking was more common in both groups with occlusive arterial disease than in those without it. The diabetic patients with occlusive arterial disease had a longer duration of diabetes mellitus and a higher rate of other diabetic complications than those without arterial disease.

Aged↗
PubMed1981

A prospective study of peripheral occlusive arterial disease in diabetes. II. Vascular laboratory assessment.

Noninvasive tests of the peripheral circulation were used to quantify the presence and severity of occlusive arterial disease in the lower extremities in 707 subjects on entry into a prospective study. Four groups were studies: 124 normal subjects, 157 patients with clinically evident occlusive arterial disease, 295 patients with diabetes mellitus without clinically evident occlusive arterial disease, and 131 patients with diabetes mellitus and clinically evident occlusive arterial disease. The lower extremity-to-arm systolic blood pressure ratios at rest, ankle-to-arm systolic blood pressure ratios after exercise, and segmental plethysmographic recordings accurately identified the groups with occlusive arterial disease and quantified the spectrum of severity in each of the groups. The 1-minute postexercise ankle-to-arm systolic blood pressure ratio was the single best indicator in discriminating between normal subjects and patients with occlusive arterial disease. The exercise electrocardiogram was positive in 30 of the 583 patients and in none of the group of normal subjects. The systolic blood pressure was falsely elevated as a result of sclerotic, noncompressible arteries in the segment of the limb under the pneumatic cuffs in 12 of the patients but in none of the normal subjects.

Aged↗
PubMed1981

A prospective study of peripheral occlusive arterial disease in diabetes. III. Initial lipid and lipoprotein findings.

Lipid and lipoprotein findings are described in a group of 707 persons consisting of normal control subjects, patients with clinical peripheral occlusive arterial disease, patients with diabetes and no occlusive arterial disease, and diabetic patients with occlusive arterial disease. The mean serum triglycerides were elevated in all groups compared with the normal controls and varied, depending on the type and treatment of the diabetes and fasting plasma glucose concentration. Mean total serum cholesterol did not change among the groups. Unexpectedly, the mean level of low-density lipoprotein cholesterol was significantly lower in patients with diabetes who had no occlusive arterial disease than in normal subjects. The mean high-density lipoprotein cholesterol level was higher in normal-weight, insulin-treated diabetic patients than in obese diabetics regardless of their treatment. Disturbances in triglyceride metabolism and the related lipoproteins appear to characterize both diabetes and occlusive arterial disease, with the highest mean levels of serum triglycerides being found in subjects with both diabetes and occlusive arterial disease.

Aged↗