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Biomedical subjects

D K McCulloch

Publications and source records attributed to D K McCulloch.

At least 55 records · Page 3Linked to original sources
PubMed1984

Alcohol: another risk factor for diabetic retinopathy?

In a five year prospective study clinical features associated with the development and progress of retinopathy were sought in 296 randomly selected diabetic men aged 20-59. None had ophthalmoscopically detectable retinopathy initially, but during follow up 66 developed the condition (47 background, 10 exudative, 9 proliferative). Linear logistic analyses (two tailed tests) showed that the initial features independently predictive of retinopathy were duration of diabetes, poor glycaemic control, impotence, and--unexpectedly--heavy alcohol consumption. Poor glycaemic control in the interim and proteinuria at review were also associated with the development of retinopathy. No relation was found with smoking or obesity. Glycaemic control and alcohol consumption were therefore the only aetiologically relevant associations identified. The development of severe retinopathy (exudative and proliferative) showed a particular association with heavy alcohol consumption, occurring in nine of the 70 heavy drinkers (13%) compared with 10 (4.4%) of the rest. Alcohol consumption may be an important independent factor associated predictively with sight threatening diabetic retinopathy.

Adult↗
PubMed1984

The natural history of impotence in diabetic men.

The natural history of erectile impotence in diabetic men has been defined in a 5-year prospective study of 466 patients initially aged 20-59 years. Of the 275 who were originally potent, 78 (28%) have become impotent. Five features present at first interview were found to be independently predictive of the subsequent development of impotence; age (p less than 0.0001), alcohol intake (p less than 0.0001), initial glycaemic control (p = 0.03), intermittent claudication (p = 0.04) and retinopathy (p = 0.05). The development of impotence was also significantly associated with the appearance of neuropathic symptoms (p = 0.003) and poor glycaemic control in the intervening 5 years (p = 0.01). Only 11 out of 128 (9%) of those originally impotent regained potency; they were young, had short duration of diabetes, and often features of psychogenic impotence. Those with impotence originally but no clinically apparent micro/macrovascular or neuropathic diabetic complications developed retinopathy (p = 0.001) and neuropathy (p = 0.01) more frequently than their comparable potent counterparts. It is concluded that diabetic impotence rarely reverses, that it is strongly associated with neuropathic and vascular complications of diabetes, and that moderation of alcohol consumption and improvement of glycaemic control are possible preventative factors.

Adult↗
PubMed1983

Influence of imaginative teaching of diet on compliance and metabolic control in insulin dependent diabetes.

Dietary non-compliance is an important cause of poor metabolic control in insulin dependent diabetes. Patients are often blamed, but teaching methods may be at fault, so a prospective study was set up to compare the effect of three different teaching methods. After a three month run in, 40 adults with longstanding poorly controlled insulin dependent diabetes (mean haemoglobin A1 13.0%) were allocated at random to three teaching methods: conventional diet sheet instruction (group 1); practical lunchtime demonstrations (group 2); videotape education (group 3). Knowledge was assessed by questionnaires, compliance by seven day food records, and glycaemic control by serial glycosylated haemoglobin measurements. During six months of follow up there was no improvement in knowledge, compliance, or HbA1 in group 1, but in groups 2 and 3 both knowledge and compliance improved. In group 2 HbA1 fell to 10.6 (SD 2.1)% and in group 3 to 9.6 (2.3)%. The change in HbA1 showed an appreciable correlation with dietary compliance as judged by day to day consistency in carbohydrate intake. These findings show that new and interesting educational methods can have a major influence on knowledge, compliance, and metabolic control in insulin dependent diabetes.

Adolescent↗
PubMed1983

Effect of dietary compliance on metabolic control in insulin-dependent diabetics.

One hundred and seventy eight insulin dependent diabetics (IDDM) have been studied regarding their understanding of and compliance with a controlled carbohydrate diet. Forty per cent could not remember their dietary prescription, 35 per cent did not estimate carbohydrate and many scored badly in a 'quiz' on the carbohydrate content of common foods. Quiz scores were significantly associated with HbA1 levels (P less than 0.001). One hundred and thirty six patients completed a seven-day food record from which the pattern of eating was established. Of these 75 were injecting twice daily short and intermediate acting insulin; in this group there were significant relationships between HbA1 and both care with carbohydrate estimation and eating pattern (P less than 0.05). Thus, in IDDM, the understanding of a controlled carbohydrate diet and adherence to it are associated with better glycaemic control but adequate compliance is rare. Future dietary recommendations for insulin taking diabetics should be simple, easy to understand, acceptable in practice and of proven effectiveness if they are to appreciably influence the quality of diabetic control.

Adolescent↗
PubMed1982

The effects of diabetes on male sexual function.

Diabetic men are prone to a variety of sexual problems. It is probable that most of these sexual difficulties are the result of a progressive physical disorder upon which a psychological reaction is superimposed. Assessment needs to take account of both the physical and psychological components of the problem. The aim of management is to help the patient and his partner enjoy sexual function to the full within whatever limits are set by irreversible factors. Management therefore involves correcting potentially reversible physical and psychological factors, and helping the patient and his partner adapt to the remaining irreversible changes in sexual function. Using this approach it may be possible to improve the prognosis of what in the past has been dismissed as an intractable clinical problem.

Adolescent↗
PubMed1982

The clinical features of diabetic impotence: a preliminary study.

Twenty-seven diabetic men with erectile impotence were given physical and psychosexual assessments. Physical assessment included vascular and neurological evaluation. Psychosexual assessment was by means of a semi-structured interview. Seven potent diabetic men formed a control group. Patients with erectile failure had a varied clinical picture which differed from the stereotype of diabetic impotence: morning erections were preserved in over a half (55 per cent), eight patients (30 per cent) had intact spontaneous erections, and sexual interest was reduced in 12 patients (44 per cent). In 13 patients (48 per cent) ejaculation was disturbed and a further four patients (15 per cent) described unusual disorders of sexual function. Within the group there were no differences in clinical picture between those with and without autonomic neuropathy, retinopathy or potential psychogenic factors.

Adult↗
PubMed1981

Medically serious self-poisoning in West Fife, 1970-1979.

Two thousand two hundred and four patients with acute poisoning admitted between 1970 and 1979 to an acute District Medical Unit were reviewed with special regard to the serious medical consequences of overdosage. The incidence of barbiturate and methaqualone poisonings declined but benzodiazepines, tricyclic antidepressants, and dextroproproxyphene were more commonly taken. As a result, there was no overall change in the proportion of patients admitted unconscious or requiring respiratory support. The dangers of dextropropoxyphene poisoning have become increasingly apparent, and poisoning with paracetamol has become as frequent as salicylate poisoning. In view of these changing trends, measures to limit the morbidity and mortality from self-poisoning are suggested.

Adult↗
PubMed1980

The prevalence of diabetic impotence.

In a survey of 541 diabetic males, aged 20-59 years, 190 (35%) had erectile impotence. Using linear logistic regression models for analysis the five most significant associations with impotence were age (p < 0.001), treatment with either insulin or oral hypoglycaemic agents (p < 0.001), retinopathy (p < 0.001), symptomatic peripheral neuropathy (p < 0.001) and symptomatic autonomic neuropathy (p < 0.005). The greatest correlations were found in patients with severe microangiopathy, as demonstrated by proliferative retinopathy and symptomatic autonomic neuropathy. In addition the duration of diabetes and the presence of ischaemic heart disease, nephropathy and poor diabetic control may also be associated with diabetic impotence. It is concluded that diabetic impotence is still a common problem and may have a multifactorial aetiology.

Adult↗
PubMedDate not supplied

Patient-reported experience with Velosulin human insulin in continuous subcutaneous insulin infusion.

A multicenter, retrospective survey of 339 patients with insulin-dependent diabetes mellitus was done to evaluate patient experience with Velosulin Human insulin, a regular insulin in a phosphate buffer, used in continuous subcutaneous insulin infusion. Patients had used this insulin exclusively for 3 months preceding the survey. Responses were elicited through interviews conducted by physicians or nurses. Patients were queried as to the occurrence of specific complications associated with pump therapy that occurred while using Velosulin Human insulin, including hypoglycemia, diabetic ketoacidosis, unexplained hyperglycemia, tubing obstruction, and infection or abscess at the infusion site. Most patients reported that they did not experience any of these complications during the preceding 3 months. The most frequently cited complication was hyperglycemia unexplained by dosage, exercise, or dietary changes, reported by 110 (32%) patients. The second most frequently reported complication was tubing obstruction, reported by 99 (29%) patients. The reported frequencies of the other complications were: severe hypoglycemia, 45 (13%) patients; diabetic ketoacidosis, 28 (8%) patients; and infection or abscess at the infusion site, 26 (8%) patients. The low morbidity reported by the patients in this survey probably was due in large part to careful patient selection, a high level of motivation on the part of the patients, and experience and education on the part of the health care team, as well as to the use of buffered regular human insulin.

Adolescent↗