Biomedical subjects

D K McCulloch

Publications and source records attributed to D K McCulloch.

59 records · Page 4Linked to original sources

PubMedDate not supplied

A pragmatic approach to sexual dysfunction in diabetic men: psychosexual counselling.

In order to avoid the problems inherent in the assessment of any organic component of impotence, a consecutive series of 20 diabetics were treated with psychotherapy after a detailed assessment of the psychological components of their disability. Only three patients improved in the long term and responders could not be identified from pretreatment characteristics. However, most of the patients had been impotent for several years and their successful adaptation may have limited the success of psychotherapy. There is a need to identify the impotent patient at an early stage in order to offer more effective treatment. This might also avoid the problems of adaptation and the need for detailed investigations of pelvic nervous and vascular function.

Adult↗

PubMedDate not supplied

Effect of alcohol intake on symptomatic peripheral neuropathy in diabetic men.

In a group of 541 white diabetic men aged 20--59 yr attending one clinic it was found that 91 (15%) drank heavily, while a further 39 (7%) had frank alcoholism. The prevalence of symptomatic peripheral neuropathy was much higher in the 120 men who drank excessively. It is considered important, therefore, when treating diabetic patients with peripheral neuropathy not to assume that the diabetes itself is the cause in all cases. The alcoholic intake of the patient should be ascertained and, if excessive, it should be pointed out to the patient that this may well be the predominant factor causing symptoms.

Adult↗

PubMedDate not supplied

A new approach to the treatment of nocturnal hypoglycemia using alpha-glucosidase inhibition.

Nocturnal hypoglycemia is common in the diabetic patient on twice-daily regular and intermediate (NPH or lente) insulin regimens because intermediate-acting insulins before the main evening meal produce "unopposed" free insulin peaks around 0300 h, food absorption having been completed much earlier. Fourteen insulin-dependent diabetic patients were treated for 6 wk with the alpha-glucosidase inhibitor, acarbose, in a double-blind crossover study to see whether the drug would delay absorption of the evening meal sufficiently to correct the mismatch and prevent nocturnal hypoglycemia. On 200 mg acarbose (six patients), inhibition of carbohydrate digestion was so profound as to lead to midevening hypoglycemia with severe flatulence and abdominal colic. With a smaller dose of 100 mg before the evening meal (eight patients) there was a significant reduction in MAGE and MBG coupled with a clinically significant reduction in midevening and nocturnal hypoglycemic reactions. Alpha-glucosidase inhibition therefore provides a promising new approach to the problem of nocturnal hypoglycemia although a preparation that is safe for long-term clinical use remains to be found.

Acarbose↗

PubMedDate not supplied

Group therapy in the treatment of diabetes.

The psychological burden imposed by diabetes is large but is often ignored by health care professionals who concentrate on its technical aspects. In this article we review the need for psychosocial support in the treatment of diabetes. Group psychotherapy, although most widely used in psychiatry, was in fact started by a physician almost 80 yr ago and has been used as an adjunct to the management of many medical conditions. Limited experience of group psychotherapy among diabetic patients has given encouraging results. Issues remain, however, as to which groups of patients might benefit most, who should act as group leader, and how one can best assess outcome.

Adolescent↗

PubMedDate not supplied

A population-based approach to diabetes management in a primary care setting: early results and lessons learned.

OBJECTIVE: To determine the effect of a multifaceted program of support on the ability of primary care teams to deliver population-based diabetes care. DESIGN: Ongoing evaluation of a population-based intervention. SETTING/PARTICIPANTS: Group Health Cooperative of Puget Sound, a staff model HMO in which more than 200 primary care providers treat approximately 15,000 diabetic patients. INTERVENTION: A program of support to improve the ability of primary care teams to deliver population-based diabetes care was implemented. The elements of the program are based on an integrated model of well-validated components of delivery of effective care to chronically ill populations. These elements have been introduced since the beginning of 1995, and some aspects of the program were pilot-tested in a few practice sites before being implemented throughout the organization. The program elements include 1) a continually updated on-line registry of diabetic patients; 2) evidence-based guidelines on retinal screening, foot care, screening for microalbuminuria, and glycemic management; 3) improved support for patient self-management; 4) practice redesign to encourage group visits for diabetic patients in the primary care setting; and 5) decentralized expertise through a diabetes expert care team (a diabetologist and a nurse certified diabetes educator) seeing patients jointly with primary care teams. MAIN OUTCOME MEASURES: Patient and provider satisfaction through existing system-wide measurement processes; process measures, health outcomes, and costs are tracked continuously. RESULTS: Patient and provider satisfaction have improved steadily. Interest in and use of the electronic Diabetes Registry have grown considerably. Rates of retinal eye screening, documented foot examinations, and testing for microalbuminuria and hemoglobin A1c have increased substantially. CONCLUSIONS: Providing support to primary care teams in several key areas has made a population-based approach to diabetes care a practical reality in the setting of a staff model HMO. It may be an important mechanism for improving standards of care for many diabetic patients.

Community Health Planning↗