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Biomedical subjects

D Simmons

Publications and source records attributed to D Simmons.

At least 127 records · Page 7Linked to original sources
PubMed1995

Frequency of diabetes in family members of probands with non-insulin-dependent diabetes mellitus.

OBJECTIVES: To describe the prevalence of known diabetes in a multi-ethnic community in South Auckland, New Zealand, in relation to family history of diabetes and past history of diabetes in pregnancy. DESIGN: A cross-sectional, household survey comparing ascertainment with local general practice diabetes registers where they existed. SETTING: An inner-city community with a high proportion of Maori, Pacific Islands people and Europeans. SUBJECTS: A total of 55,518 residents (91% response). Comparison with diabetes registers showed 91% ascertainment of known diabetic residents. More detailed interviews with 176/214 (82%) Europeans, 286/336 (85%) Maori and 495/585 (85%) Pacific Islands people with known diabetes. Fifty subjects had insulin-dependent diabetes mellitus on clinical criteria and were excluded from analyses. MAIN OUTCOME MEASURES: Prevalence of diabetes. RESULTS: Those with non-insulin-dependent diabetes mellitus were more likely to have a diabetic mother than father (Europeans, 21.7% vs. 9.9%; Maori, 17.6 vs. 11.4%; Pacific Islands, 15.7 vs. 5.3%). Diabetic women had a similar likelihood of having a diabetic father as diabetic men but were 1.84 times as likely to have a diabetic mother (95% CI, 1.27-2.69). Diabetic women with past diabetes in pregnancy had 2.05 (95% CI, 1.01-4.15) times the chance of a diabetic offspring as women who had not had past diabetes in pregnancy, who in turn had 2.69 (95% CI, 1.17-6.18) times the likelihood of having a diabetic offspring as diabetic men. CONCLUSIONS: The mother is a more important conduit for inheritance of diabetes than the father in these three ethnic groups. A history of diabetes in pregnancy confers an extra risk to the offspring above this usual maternal excess.

Adolescent↗
PubMed1995

Ethnic differences in the perception of a video developed for a multiethnic diabetes prevention programme in south Auckland, New Zealand.

Videos were developed to help increase diabetes awareness among local Maori, Pacific Islands and European communities. The Maori and Pacific Islands versions incorporated modifications to the basic content to make them more appropriate for the target audience. Lay audiences, comprising 108 Europeans, 94 Maori and 90 Pacific Islands people in 12 different sites, viewed the version of the video tailored to their ethnic group. The Maori version was also viewed by 32 Diabetes Nurse Specialists. Likert scale ratings and open-ended questions were used to evaluate the video. The video was rated highly by all audiences and most subjects were able to repeat the main messages of the video. Compared with Maori and Pacific Islands subjects, Europeans found the video the easiest to understand but gained the least information. Maori and Pacific Islands subjects would have preferred a longer video ( > 17 minutes). Different viewing sites revealed evidence of within-ethnic-group heterogeneity. Pacific Islands subjects particularly appreciated the educational components, while Maori and Europeans were more likely to comment on presentation. Audio-visual material is perceived differently by different ethnic groups, such differences need to be addressed when embarking on diabetes awareness campaigns.

Adult↗
PubMed1995

Interrelation between umbilical cord serum sex hormones, sex hormone-binding globulin, insulin-like growth factor I, and insulin in neonates from normal pregnancies and pregnancies complicated by diabetes.

Insulin concentration correlates negatively with sex hormone-binding globulin (SHBG) in adults, although the age at which this relationship develops is unknown. The present study assesses this relationship in a cohort of European, Maori, South Asian, and Pacific Islands neonates from 125 normal and 35 pregnancies complicated by diabetes. Maternal glycemia was assessed with a 3-h 100-g oral glucose tolerance test with fasting glucose and fructosamine concentrations determined at 36-38 weeks. Umbilical cord blood was taken for insulin, C peptide, fructosamine, SHBG, sex hormone, and insulin-like growth factor I (IGF-I) measurements, and neonatal anthropometry was measured 24 h after delivery. Babies from pregnancies complicated by diabetes were heavier, fatter, hyperinsulinemic (90.4 vs. 130.6 pmol/L, respectively; P < 0.01), with similar SHBG (44.0 +/- 6.5 vs. 44.2 +/- 12.0) and sex hormone levels and higher IGF-I concentrations (57.1 +/- 24.2 vs. 70.1 +/- 37.1; P < 0.05). There were no ethnic differences in cord SHBG, sex hormones, or IGF-I. SHBG correlated negatively with cord insulin concentrations [males, -0.31 (P < 0.01); females, -0.35 (P < 0.001)], birth weight [males, -0.25 (P < 0.05); females, -0.36 (P < 0.001)] and other measures of neonatal size. In both normal pregnancies and those complicated by diabetes, cord IGF-I correlated with cord C peptide levels [0.32 (0.32 (P < 0.001) and 0.42 (P < 0.05), respectively] and neonatal size, but only in normal babies was there a correlation between IGF-I and insulin [0.43 (P < 0.001) and 0.10] or SHBG [-0.28 (P < 0.01) and -0.01]. These data confirm that relationships between insulin concentration and SHBG are present at birth and are likely to be physiological.

Adult↗
PubMed1994

The development of community orientated recommendations for diabetes care in south Auckland. South Auckland Community Diabetes Planning Group.

Growing numbers and costs associated with diabetes and its tissue damage are of increasing concern. We describe the development of community orientated recommendations aimed at primary and secondary prevention of diabetes in an area with a high proportion of Maori and Pacific Islands people. Preliminary results from structured face-to-face interviews with patients (n = 555), general practitioners (n = 163) and other health professionals were discussed by a core group of elected or selected community and health professional representatives. Twelve meetings and one full day workshop were held over a 7 month period. Formal and informal consultation occurred among community and health groups between meetings. The 68 recommendations included the need to: empower communities and diabetic patients; improve coordination and standardisation of care and the importance of the general practitioner in this process; improve access to care by removing transport, cultural and language barriers to care; subsidize preventative treatment costs; improve foot and eye services; improve monitoring of those with past diabetes in pregnancy or impaired glucose tolerance; improve detection of diabetes by increased high risk screening linked to ongoing diabetes care programmes. Implementation requires quality information systems and a cooperative partnership approach between hospital, general practitioner and the community, particularly local Maori and Pacific Islands communities.

Community Health Services↗
PubMed1994

CD44H expression by human neuroblastoma cells: relation to MYCN amplification and lineage differentiation.

The human CD44 cell surface glycoprotein has been involved in a variety of functions including lymphocyte homing, extracellular cell matrix attachment, and tumor metastasis. Due to the alternative splicing of the single gene, a large family of different variants or isoforms is generated. Several reports have indicated an up-regulation of CD44 variant (v) isoforms in malignant process, conferring metastatic potential to non-metastatic cells. Neuroblastoma is a tumor characterized by an aggressive and metastatic behavior in advanced stages with amplification of the MYCN protooncogene. In this report we show that the CD44 standard molecule is highly expressed in 100% of stage I-III, IVs neuroblastomas and ganglioneuromas but only in a subset of stage IV tumors. In contrast, no expression of CD44 was detected on MYCN amplified stage IV tumors, thus demonstrating a highly significant negative relationship between MYCN amplification and CD44 expression in neuroblastoma. The expression of CD44 on neuroblastoma cultured cell lines was not shown to be related to MYCN amplification but rather linked to the S-type, schwann/glial differentiation lineage. Immunochemical analysis of tumor samples with anti-CD44v3 and -v6 antibodies and Northern blot analysis of mRNA from cell lines with probes spanning exons 4-10 did not reveal any expression of splice variants on neuroblastomas of all stages and cell lines, thus ruling out a major role of these isoforms in neuroblastoma progression and metastasis.

Blotting, Northern↗
PubMed1994

Prevalence of known diabetes in a multiethnic community.

AIMS: To describe the prevalence of known diabetes in an area of New Zealand with a large Pacific Islands and Maori population. METHOD: A cross sectional door to door census with identification of those with known diabetes was conducted between April and October 1992. The data was validated by comparison with available local general practice diabetes registers and data from a repeat visit to a randomly selected 5% of houses. RESULTS: Interviews were completed at 92.7% of the 5081 households, containing 22,651 residents (1417 European, 5606 Maori, 14,802 Pacific Islands). The Pacific Islands population was 40% larger than that predicted from the 1991 census. The age adjusted prevalence of known diabetes in adults (aged > or = 20 years) was 2.8% (95% CI 1.9-3.9) in Europeans, 6.9% (95% CI 6.0-7.9) in Maori and 4.6% (95% CI 4.1-5.1) in Pacific Islands people. The greatest differences in prevalence were found in those aged 40-59 years. Interviews at 185/280 houses revisited showed that 13% of households had moved completely in the 2-8 months between visits. Comparison between participating general practice registers and the door to door survey database showed that 11.2% (26/232) of diabetic individuals were missed by the door to door survey, and 23.7% (55/232) were not on the register of the named general practitioner. CONCLUSIONS: The prevalence of known diabetes in the community is much higher than that in the workforce. Differences between Maori and Pacific Islands people may be due to more undiagnosed diabetes or a lower risk of diabetes in the latter.

Adolescent↗
PubMed1994

Ethnic differences in diabetes knowledge and education: the South Auckland Diabetes Survey.

AIM: To compare the knowledge of diabetes, and diabetes education provision/preferences among European, Maori and Pacific Islands diabetic patients in south Auckland. METHOD: The 331 European, 86 Maori and 123 Pacific Islands patients who were interviewed attended local diabetes services and a stratified subsample of general practitioners. Interviews included closed and open questions of diabetes knowledge, age, sex, diabetes treatment, employment status, weekly household income, school/further education received and the actual and preferred format of diabetes education. RESULTS: Pacific Islands patients knew least, and Europeans most, about diabetes from both open and closed diabetes knowledge questions. The majority of Pacific Islands patients could not name the nature, symptoms or complications of diabetes. This was unaffected by duration of diabetes, place of birth or time in New Zealand, although insulin treated Pacific Islands patients knew more than noninsulin treated patients (closed score 71 SD (4)% vs 61 SD (2)% p < 0.05). Pacific Islands patients were least likely to have received diabetes education (European 69%, Maori 70%, Pacific Islands 49%, p < 0.001). Knowledge scores were higher in those who had received education at diagnosis. Europeans were least likely to want further education (Europeans 52%, Maori 69%, Pacific Islands 63%, p < 0.01). The preferred sources for ongoing education were the lay educator/diabetes nurse specialist service (Europeans 28%, Maori 37%, Pacific Islands 76%), and the hospital based clinic among Europeans (27%) and Maori (36%). No Pacific Islands patients preferred a hospital based ongoing education service, while few diabetic patients of any ethnic group preferred to receive education via their general practitioner. In all ethnic groups, patients wanting more education knew more than those who did not. CONCLUSION: The local delivery of diabetes education is uneven. Among Pacific Islands people, it is grossly inadequate. In order for all patients to receive such education, the diabetes services need to be better coordinated and integrated with primary health care.

Aged↗
PubMed1994

Differences in umbilical cord insulin and birth weight in non-diabetic pregnancies of women from different ethnic groups in New Zealand.

Many ethnic groups at high risk of non-insulin-dependent diabetes mellitus are hyperinsulinaemic by early adult life. This study assessed whether such hyperinsulinaemia is present at birth. Cross sectional comparisons of maternal biochemistry, umbilical cord biochemistry and neonatal anthropometry were made between one 'low risk' and three 'high risk' ethnic groups, without diabetes in pregnancy in Auckland, New Zealand. The study comprised 123 European, Polynesian (Maori and Pacific Islands) and Indian normal pregnancies. Indian mothers were the smallest, with the highest insulin and non-esterified fatty acid concentrations. Polynesian mothers were the most obese with a higher fructosamine concentration. From these pregnancies, Indian neonates were smaller, slimmer, with the highest cord triglyceride (0.6 mmol/l vs 0.4 mmol/l, p < 0.01), and lowest cord insulin concentrations (7.1 mU/l vs 8.6 mU/l (European), 9.2 mU/l (Polynesian), p < 0.05). Polynesian babies had a high cord insulin: C-peptide ratio (52.5 mU/nmol vs 44.4 mU/nmol (European), 44.1 mU/nmol (Indian), p = 0.05). Although reduced intrauterine growth may contribute to the excess of diabetes and heart disease in Indians, it cannot explain the excess of diabetes in Polynesians. Exposure to minor relative maternal hyperglycaemia in the mother and abnormal neonatal insulin handling (as demonstrated by the higher insulin: C-peptide ratio) may be of long-term significance in Polynesians.

Anthropometry↗
PubMed1994

Sex and ethnic group differences in fat distribution in young United Kingdom South Asians and Europids.

South Asians (Asians) have a high prevalence of non-insulin-dependent diabetes (NIDDM) and a high incidence of ischaemic heart disease (IHD). To investigate whether this predisposition can be detected in young adult life, metabolic risk factors for these diseases were compared in U.K. Europid and Asian students. Among the 80 Europid and 80 Asian students aged between 20 and 23 years and well matched for body mass index (BMI), Asians were found to be relatively hyperglycaemic [5.1 (5.0-5.2) vs 4.6 (95% CI: 4.5-4.7) mmol/l] and hypercholesterolaemic [5.3(5.2-5.4) vs 4.9 (4.8-5.0) mmol/l] and to have a higher waist/hip and subscapular/triceps ratio. The waist/hip ratio was found to be a better predictor of glucose and cholesterol than calliper measurements in both ethnic groups although the subscapular/triceps ratio was independently related to both glucose and cholesterol. Predictors of both IHD and NIDDM are present at an early age in U.K. Asians.

Adipose Tissue↗
PubMed1994

Random blood glucose as a screening test for diabetes in a biethnic population.

Screening asymptomatic subjects for diabetes is often undertaken using a random capillary whole blood sample for glucose estimation. The test characteristics of this method for screening were assessed using a glucose oxidase method among 3425 Europeans and 3469 South Asians who gave such a sample during the Coventry Diabetes Study, a house-to-house diabetes prevalence study. Glucose tolerance test were performed on those with a high blood glucose and 10% of others. Previously undiagnosed diabetes was found in 73 Europeans and 110 South Asians. If the random glucose was > or = 7.0 mmol l-1, 8.0% of Europeans and 6.7% of South Asians would need a further diagnostic test and the sensitivity of this cut-off was 51.7 (95.0% CI: 43.5-59.9)% in Europeans and 68.4 (60.6-76.2)% in South Asians. Sensitivity was increased in South Asians but not Europeans by defining the time since last meal (South Asians < 2 h: 83.9 (72.3-92.0)%; > or = 2 h: 54.9 (42.7-66.8)%). Sensitivity was poorest among Europeans aged > or = 65 years (40-64 years 69.0 (49.2-84.7)%, > or = 65 years 49.4 (38.2-60.6)%). Screening asymptomatic individuals using an isolated capillary random whole blood glucose measure is a poor test for diabetes, although slight improvement can be obtained among South Asians by testing within 2 h of a meal.

Adult↗
PubMed1994

Sex differences in umbilical cord serum levels of inhibin, testosterone, oestradiol, dehydroepiandrosterone sulphate, and sex hormone-binding globulin in human term neonates.

The contribution of the fetus to inhibin production in human pregnancy is unclear. Previous studies have reported inhibin concentrations in cord blood but on limited sample numbers. The present study is a more extensive examination of sex differences in immunoreactive inhibin and steroidal hormones in term umbilical cord blood. Venous serum concentrations of inhibin were found to be significantly higher in males (mean +/- SD 2,168 +/- 914 pg/ml, n = 62) than in females (1,761 +/- 951 pg/ml, n = 63) (p < 0.01). Male concentrations of total testosterone (p < 0.005), free testosterone (p < 0.005), and estradiol (p < 0.05) were also significantly higher. The concentration of dehydroepiandrosterone sulphate (DHEAS) and the sex hormone-binding globulin (SHBG) capacity were similar in males and females. Multivariate regression analysis showed that the inhibin concentration in males correlated with the testosterone concentration and in females it correlated not only with testosterone concentration but also with gestational age at delivery and SHBG capacity (all p < 0.001). Inhibin concentrations in cord arterial serum in a subgroup of 24 males and 31 females were higher than in the venous serum in both sexes but the differences were not statistically significant. Concentrations of DHEAS determined in 22 female cord arterial blood samples (6.0 +/- 2.5 mumol/l) were significantly higher than the venous concentrations (5.2 +/- 1.8 mumol/l) (p < 0.05). Inhibin did not correlate with DHEAS either in their arterial serum concentrations or in the arteriovenous concentration differences. The findings of this study are consistent with the placenta being the principal source of inhibin circulating in the human fetus in late pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Dehydroepiandrosterone↗
PubMed1994

Diabetic nephropathy and microalbuminuria in the community. The South Auckland Diabetes Survey.

OBJECTIVE: To compare the clinical, anthropometric, and metabolic characteristics of New Zealand Europeans, Maori, and Pacific Islanders with non-insulin-dependent diabetes mellitus (NIDDM) with emphasis on risk factors for the development of diabetic nephropathy. RESEARCH DESIGN AND METHODS: A cross-sectional survey of 555 (74% of 750 available) diabetic patients attending diabetes clinics and randomly selected primary care centers was conducted in Auckland, New Zealand. RESULTS: Among those with NIDDM, Maori and Pacific Islanders were younger at diagnosis, more obese, and had poorer glucose control when compared with the Europeans (fructosamine in mumol/l: Maori 335 +/- 78, Pacific Islanders 367 +/- 90, Europeans 318 +/- 55; overall P < 0.001). Systolic blood pressure (sBP) was higher in Maori (145 +/- 31 mmHg) and lower in Pacific Islanders (135 +/- 25 mmHg) when compared with Europeans (141 +/- 25 mmHg; overall P < 0.005). Mean estimated daily urinary albumin excretion (UAE) was 18.2 (15.5-1.3) mg/day in Europeans, 94.8 (60.5-148.7) mg/day in Maori, and 44.2 (32.3-60.3) mg/day in Pacific Islanders. The prevalence of proteinuria and end-stage renal failure were also higher in Maori and Pacific Islanders. The excess prevalence of microalbuminuria and proteinuria in Maori was present within 5 years of diagnosis. Europeans with impaired renal function were least likely to have associated proteinuria or microalbuminuria. Microalbuminuria and nephropathy were not consistently associated with either higher blood pressure or worse glucose control. CONCLUSIONS: NIDDM in Maori and Pacific Islanders is associated with a greater degree of proteinuria and end-stage renal failure than that in Europeans. This observation is not explained by conventional risk factors.

Adolescent↗
PubMed1994

Carboplatin and granulocyte colony-stimulating factor as first-line treatment for epithelial ovarian cancer: a phase I dose-intensity escalation study.

A phase I study of frequently administered carboplatin with recombinant human granulocyte colony-stimulating factor (filgrastim) has been performed in patients with newly diagnosed epithelial ovarian cancer. Recombinant human granulocyte colony-stimulating factor was administered at a dose of 5 micrograms/kg/d for days 1 through 12 after carboplatin treatment. Carboplatin doses were calculated using a pharmacokinetic formula on an area under the curve (AUC) basis. Four doses of carboplatin were planned for each patient. The first cohort of patients received an AUC of 5 mg/mL x min every 3 weeks. Subsequently four additional cohorts received AUCs of 5, 7, 9, and 8 every 2 weeks. Non-hematologic toxicities were mild and not significant. The dose-limiting toxicity was thrombocytopenia and occurred at an AUC of 9. Most patients could complete treatment at an AUC of 7. Results for AUC 8 are awaited. Complete and partial responses were seen in most patients at all dose levels.

Adenocarcinoma↗
PubMed1993

Criteria for gestational diabetes: a cautionary tale.

The diagnosis of gestational diabetes was developed to predict neonatal outcome (particularly perinatal mortality, macrosomia and hypoglycaemia) and future maternal diabetes. A variety of criteria for this diagnosis have evolved over time, assessed predominantly among European women. We describe a Pacific Islands woman with multiple risk factors for future diabetes yet a borderline 100 g glucose tolerance test result, who delivered a stillborn macrosomic baby weighing 6.7 kg at 38 weeks' gestation. Six weeks postpartum, diabetes was diagnosed by 75 g oral glucose tolerance test. This case highlights the need for caution when interpreting the glucose tolerance test in pregnancy and suggests that closer fetal monitoring and involvement of the diabetes team may be necessary among women with a borderline glucose tolerance test in the presence of additional risk factors for future diabetes (eg obesity, ethnic group).

Adult↗
PubMed1993

Importance of diabetic foot admissions at Middlemore Hospital.

AIMS: To investigate the costs and mortality associated with admission for diabetic foot problems. METHODS: Identification of patients by codes for diabetes and peripheral vascular disease from routinely collected hospital discharge data. Information was collected retrospectively from charts. Post discharge outcome was assessed by discussion with general practitioners. RESULTS: 357 patients accounted for 503 admissions. 11-15% of patients (n = 49) were admitted for diabetic foot problems. Patients with type 1 diabetes had shorter lengths of stay than those with type 2 diabetes, were more likely to be admitted with chronic renal failure and less likely to be admitted with ischaemic heart disease. Maori and Pacific Island patients with type 2 diabetes were admitted at a younger age than Europeans (53 (SD12) vs 56 (11) vs 69 (13) years respectively, p < 0.001). Admissions for diabetic foot problems resulted in the longest hospital stay in comparison with other causes (19 (1-184) days vs 8 (1-116)) days. Average cost per diabetic foot admission was $12,500 with a total annual cost of over $600,000. CONCLUSION: The diabetic foot is expensive and yet these costs are largely avoidable with improvement in patient education, motivation, monitoring and earlier intervention. It would be better to have in place improved community and hospital care before the predicted growth in the diabetic population associated with ageing.

Adult↗