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Biomedical subjects

D S Bell

Publications and source records attributed to D S Bell.

160 records · Page 9Linked to original sources
PubMedDate not supplied

C-Peptide utilization in clinical practice: effect on treatment and outcome of diabetes in a series of cases.

OBJECTIVE: To emphasize that measurement of a C-peptide level can be critical in the diagnosis and appropriate management of patients with diabetes mellitus. METHODS: We present a series of clinical cases in which glycemic control proved challenging, and we discuss the underlying pathophysiologic features of type 1 versus type 2 diabetes. RESULTS: In a series of 12 illustrative cases, suboptimal control of blood glucose levels in patients with diabetes prompted further investigation. Assessment of C-peptide levels helped determine a precise diagnosis of type 1 or type 2 diabetes, information that was pivotal in choosing treatment options and improving the outcome. These examples show that the age of the patient at the time of diagnosis of diabetes does not necessarily indicate the type of diabetes that is present. CONCLUSION: Clinicians should be aware of the importance of establishing whether patients have type 1 or type 2 diabetes mellitus and the implications of that distinction on the effectiveness of therapeutic strategies.

Journal Article↗
PubMedDate not supplied

Inflammation, insulin resistance, infection, diabetes, and atherosclerosis.

OBJECTIVE: To review the relationship between poor control of blood glucose in patients with diabetes and potential for occurrence of the acute coronary syndrome. METHODS: The role of advanced glycosylated end products in endothelial dysfunction is discussed, and the possible contributions of inflammation and infection in the rupture of atheromatous plaques are described. RESULTS: Hyperglycemia predisposes to infection by decreasing the efficacy of leukocytes and allowing increased formation of advanced glycosylated end products. The associated endothelial permeability facilitates bacterial infiltration of atheromatous plaques. Reported associations between chronic infection and coronary artery disease have involved primarily Chlamydia pneumoniae. The insulin resistance syndrome is also characterized by compromised endothelial function, which may predispose patients to unstable plaques and cardiac events. CONCLUSION: In patients with diabetes, poor glycemic control may lead to excessive advanced glycosylated end products, inflammation and infection of atheromatous plaques, and plaque rupture that can cause angina or myocardial infarction.

Arteriosclerosis↗
PubMedDate not supplied

How long can insulin therapy be avoided in the patient with type 2 diabetes mellitus by use of a combination of metformin and a sulfonylurea?

OBJECTIVE: To assess the effective longevity of combination double oral therapy before insulin or triple oral therapy is needed in patients with type 2 diabetes mellitus. METHODS: We retrospectively reviewed the outcomes of our first 100 patients with type 2 diabetes who were successfully transferred from twice-daily mixed NPH and regular insulin to a combination of metformin and a sulfonylurea. RESULTS: Of the 100 study patients, 40 had well-controlled plasma glucose (glycosylated hemoglobin levels <8.0%) with use of metformin and a sulfonylurea. Good glycemic control was achieved with triple oral therapy (a sulfonylurea, metformin, and a thiazolidinedione) in 14 patients and with a sulfonylurea, metformin, and evening-administered mixed NPH and regular insulin in 7. In addition, plasma glucose was effectively controlled with twice-daily mixed NPH and regular insulin in conjunction with metformin or a thiazolidinedione (or both) in 22 patients and with twice-daily mixed NPH and regular insulin alone in 17. The mean time (+/- standard error) from primary failure of sulfonylurea monotherapy to the time when a third hypoglycemic agent was needed was 7.9 +/- 1.1 years (95% confidence interval, 5.7 to 10.1). CONCLUSION: When oral monotherapy fails (that is, glycosylated hemoglobin values exceed 8.0%) in patients with type 2 diabetes, combination therapy with a sulfonylurea and metformin is potentially effective in maintaining glycemic control and avoiding the addition of insulin or a thiazolidinedione for a mean duration of 7.9 years.

Blood Glucose↗
PubMedDate not supplied

Improved glycemic control with use of continuous subcutaneous insulin infusion compared with multiple insulin injection therapy.

OBJECTIVE: To compare, in a long-term study, glycemic control by means of continuous subcutaneous insulin infusion (CSII or insulin pump therapy) versus multiple insulin injection therapy (MIIT) in routine clinical practice. METHODS: We identified, from a search of medical records, all active patients (N = 90) receiving CSII who had previously received MIIT. The primary objective was to compare the mean glycemic control, as documented by frequent measurements of glycosylated hemoglobin (HbA(1c)), during the 3-year period before initiation of CSII versus the mean glycemic control during the 3-year period after the first year of CSII. We included all patients for whom we had sufficient data for at least 1 year for both the pre- and post-CSII periods and only those patients who had received MIIT before CSII (N = 58). To eliminate potential biases, we excluded HbA(1c) values for the first year after initiation of CSII therapy. RESULTS: For the entire study group, the mean HbA(1c) +/- standard error for the 3-year period before insulin pump therapy (during MIIT) was 8.4 +/- 0.2% versus a mean HbA(1c) of 7.7 +/- 0.1% for the 3-year period after the first year of CSII. This 0.7% improvement in HbA(1c) was statistically significant (P = 0.001). Of the 34 patients with HbA(1c) values above 8.0% during MIIT, the mean HbA(1c) decreased from 9.2 +/- 0.2% with use of MIIT to 8.2 +/- 0.2% with CSII (P = 0.0006). In the 17 patients with HbA(1c) values above 9.0% during MIIT, the mean HbA(1c) declined from 10.0 +/- 0.3% with use of MIIT to 8.4 +/- 0.3% with CSII (P = 0.0006). CONCLUSION: We conclude that implementation of intensive insulin therapy with CSII improves glycemic control, even in patients in whom MIIT has previously been used to its maximal effect.

Blood Glucose↗
PubMedDate not supplied

Use of soy protein supplement and resultant need for increased dose of levothyroxine.

OBJECTIVE: To report a case of difficulty in achieving suppressive serum levels of thyroid hormone because of malabsorption of exogenous levothyroxine attributable to daily ingestion in close temporal relationship to the intake of a soy protein-containing food supplement. METHODS: We present the relevant history and laboratory data of the current case and provide supportive documentation from the literature. RESULTS: A 45-year-old woman who had hypothyroidism after a near-total thyroidectomy and radioactive iodine ablative therapy for papillary carcinoma of the thyroid required unusually high oral doses of levothyroxine to achieve suppressive serum levels of free thyroxine (T(4)) and thyrotropin (thyroid-stimulating hormone or TSH). She had routinely been taking a "soy cocktail" protein supplement immediately after her levothyroxine. Temporal separation of the intake of the soy protein cocktail from the administration of the levothyroxine resulted in attainment of suppressive serum levels of free T(4) and TSH with use of lower doses of levothyroxine. CONCLUSION: Administration of levothyroxine concurrently with a soy protein dietary supplement results in decreased absorption of levothyroxine and the need for higher oral doses of levothyroxine to attain therapeutic serum thyroid hormone levels.

Absorption↗
PubMedDate not supplied

Biomedical equipment information management for the next generation.

Recent restructuring of the quality assurance standards of the JCAHO and the benefits to be gained from assurance indicators are requiring clinical engineering support groups to manage their equipment inventories with greater precision. Technological enhancements in the database industry have provided these groups with a mechanism with which they can manage. Assessments of equipment reliability, departmental management, and quality assurance give supervisory staff an important tool for feedback.

Biomedical Engineering↗
PubMedDate not supplied

The dynamics of trends in drug use in Australia.

Drug use tends to follow cycles. Monitoring may be used to establish the trends over time and to analyse their dynamics. An approach is described which establishes the stage of adoption or discontinuance of drug use in the community and a method for the prediction of future trends. Monitoring in New South Wales from 1971 to 1973 provided data which are analysed to show that alcohol was in the phase of majority adoption and tobacco had reached a plateau, but with the worrying anomaly that heavy use among young people continued to rise. Sedatives and analgesics had also reached a plateau stage of use. The data on marijuana are subject to more than one interpretation, but in any case point to a continuing rapid increase in use; predictions are made about future trends. Hallucinogens seemed to be in the phase of late adoption and stimulants to have entered a phase that is of particular interest, discontinuance. Narcotics seemed to be in the phase of late majority adoption.

Adolescent↗
PubMedDate not supplied

Increased responsiveness to exogenous insulin administration in the hyperglycemic obese person with type II diabetes.

This study was undertaken to investigate whether obese persons with type II diabetes mellitus showed less of a response to the hypoglycemic effect of insulin treatment than did lean type II diabetic patients. Forty-three patients (lean, n = 17; obese, n = 22; obese on hypercaloric diets, n = 4) were treated with insulin and placed on a diet calculated to maintain ideal body weight. A rapid decrease in the mean serum glucose concentration was seen in both the lean and obese groups following the initiation of insulin therapy. The glucose concentration of the lean patients plateaued after the second day of insulin treatment, whereas the obese patients' levels continued to fall after the third and fourth days. A difference was noted in the caloric intake of the two groups. Lean patients ingested 28 kCal/kg/day; obese patients ingested 17 kCal/kg/day. An additional group of four obese diabetic patients who ingested 28 kCal/kg/day was studied to determine if the hypocaloric intake of the first group of obese patients had altered their responsiveness to insulin. Despite the higher caloric intake, the mean serum glucose concentration of this group of patients fell more rapidly than did that of the lean patients. Caloric intake during the initiation of insulin therapy does not seem to influence the increase in insulin responsiveness of obese insulin-requiring type II diabetic patients.

C-Peptide↗
PubMedDate not supplied

Efficacy of a premixed semisynthetic human insulin regimen.

Sixty-one insulin-requiring non-insulin-dependent (type II) diabetic patients who had been transferred from a regimen of mixed intermediate and short-acting insulin to a fixed regimen of premixed insulin (70% neutral protamine Hagedorn and 30% regular, human semisynthetic insulin) given twice daily were studied retrospectively. The average age was 65 years (range, 35 to 84) and the average duration of their diabetes was 13.8 years (range, 1.5 to 33 years). Thirty-one percent were men, 69% women. Hemoglobin A1c (HbA1c) dropped significantly after transfer from a mean of 12.3% to a mean of 9.2% (P less than 0.001). After an average of 14.1 months, 40 patients still had a lower HbA1c (P less than 0.01), showing sustained improvement. The mean HbA1c at the last visit was 10.2% (normal range, 5.5% to 8.5%) with the average reduction in HbA1c being 2.1%. This sustained improvement occurred without a significant gain in weight (P = 0.63) or a significant increase in total insulin doses (median, 2 units), and was independent of the type of insulin used previously. Hypoglycemic episodes actually declined from an average of 1.0 to 0.6 per month. Of those patients who had previously not reported hypoglycemia, only 28% reported hypoglycemic events, and of those reporting previous hypoglycemia, 57% experienced a reduction. This surprising improvement in glycemic control was not due to compliance with insulin injections or remote premixing of insulin but possibly due to the increased accuracy of measuring the premixed insulin dose. The convenience and stability of a premixed insulin regimen results in better glycemic control in the insulin-requiring non-insulin-dependent diabetic population.

Adult↗