Obesity, hypertension, a high plasma level of glucose, and some lipid abnormalities (high plasma levels of cholesterol and triglycerides) often occur in the same individuals. Some authors have postulated that the elevated levels of plasma insulin in obese individuals may explain this association. To explore this hypothesis further, the relationships between body mass index, fasting plasma glucose and insulin, blood pressure, serum lipids, and apoproteins were investigated in a group of 2144 healthy middle-aged men. Analysis of the data show that the associations between body mass index and blood pressure or lipid variables are largely independent of plasma glucose and insulin. Plasma glucose is strongly related to blood pressure in nonobese subjects. Plasma insulin is not associated with blood pressure independently of body mass index and plasma glucose; however, the simultaneous elevation of body mass index, plasma glucose, and insulin is strongly associated with blood pressure. The results also confirm that plasma insulin is positively related to triglycerides and negatively related to high density lipoprotein cholesterol independently of plasma glucose and body mass index.

Age Factors↗

PubMedDate not supplied

"AICLA" controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia.

604 Patients with atherothrombotic cerebral ischemic events (transient, 16%: or completed, 84%) referrable either to the carotid or to the vertebral-basilar circulation were entered into a double blind randomized clinical trial (AICLA) to determine whether aspirin (A) (1 g/day) or aspirin (1 g/day) + Dipyridamole (225 mg/day) (AD) would produce a significant reduction in the subsequent (3 years) occurrence of fatal and nonfatal cerebral infarction. Randomization produced remarkably comparable treatment groups and this good comparability was maintained throughout the study. Adherence to the protocol and drug compliance were excellent. Side effects, particularly symptoms of peptic ulcer and hemorrhagic events were significantly (p less than 0.03) more frequent in the two treatment groups containing aspirin. With the exception of patients who withdrew from the study, each patient was followed for 3 years. At the end of the study, the number of fatal and nonfatal cerebral infarctions was 31 in the placebo (P) group, 17 in the A group and 18 in the AD group. Taking into account the duration of follow-up for each patient, these figures correspond to cumulative rates of 18% in the P group and 10.5% in each of the 2 active treatment groups. Analysis with the Mantel Method showed: 1)--A difference at the 6% level between the 3 groups and between P and AD; 2)--A difference at the 5% level between P and A; 3)--No difference between (A and AD; 4)--A difference at the 2% level between the P group and the two treated groups taken together (A + AD). Among other diseases occurring during the trial, the only significant difference concerned myocardial infarction, which was less frequent in the 2 treated groups (P less than 0.05). Subgroup analysis failed to show a significant sex difference in the efficacy of aspirin. It is concluded that, in patients comparable to those defined in the protocol, Aspirin (1 g) has a significantly beneficial effect in the secondary prevention of atherothrombotic cerebral infarction.

Adult↗

PubMedDate not supplied

Quantification of early subclinical limited joint mobility in diabetes mellitus.

Limited joint mobility (LJM) has been described in juvenile diabetic patients by Rosenbloom et al.; similar abnormalities are also present in adult diabetes. This modification may be associated with a high risk of microvascular complications. We tested the use of a goniometer in measuring subclinical joint limitation in 50 adult diabetic patients without overt, i.e., clinically evident, LJM as described by these authors. This diabetic population was compared with 118 nondiabetic adult controls. We found significant changes in hand mobility between the two groups for wrist flexion and extension of the 3rd and 5th fingers (P less than 0.001). Age was correlated to wrist flexion, wrist extension, and proximal interphalangeal flexion of the little finger. Wrist extension correlated with duration of diabetes (r = -0.37, P less than 0.01). Heavy manual activities significantly limited all motions except wrist and 5th finger metacarpophalangeal flexion. Early systematic examination by goniometry may prove to be a sensitive, quantitative, and inexpensive way of detecting joint stiffness at an early stage.

Adult↗

PubMedDate not supplied

[How to improve drug development and utilization in pediatrics].

Insufficient drug evaluation in children and the lack of adapted pharmaceutical formulations explain the importance of unlicensed and off-label prescriptions. As a consequence a regulation proposed in the USA by the Food and Drug Administration, requiring manufactures to assess the safety and effectiveness of new drugs in paediatric patients, has recently been adopted. Appropriate means to facilitate drug evaluation in children are now necessary in terms of recruitment and methodology. A ten-centre American Pediatric Pharmacology Research Unit network has been created and is being financed by the National Institute of Health. A similar trend is evolving in Europe. Appropriate drug utilization in children requires adequate formulations, administration devices and information as well as improved knowledge on the long-term potential consequences of drug use during growth and maturation.

Age Factors↗

PubMedDate not supplied

[Methodology and long-term follow-up of drug induced side effects in children (cancer, leukemia, AIDS, growth hormone)].

Long-term follow up for medicines used in children is necessary in some therapeutic areas. Long-term effects (e.g. in cancer) may be detected many years after the treatment period. Growth, development and maturation specific to children can make these effects particularly harmful. The development plan of a paediatric drug should include, long term follow up on the basis of pharmacological-toxicological and safety data. These aspects should be taken into account when modifying the protocol (lower dosage, withdrawal of some associations etc). The follow up period may be very long, as in cancer (e.g. second tumour after treatment for cancer). A cohort is the best choice for this follow up, but other alternatives may be useful, including a specific follow-up Unit. Long-term follow-up is nevertheless difficult and expensive, manpower-dependent and the risk of failure is great especially in the teenage years.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Assessment of the use of hemoglobin AIc in diabetes mellitus screening].

A population of 495 volunteer subjects who applied to the screening diabetes Centre of Hôtel-Dieu hospital in Paris has been studied and divided into two samples. In the first 300 subjects sample the sensitivity and the specificity of different fasting blood glucose threshold values, of different glycosylated hemoglobin threshold levels and of various combinations of the above mentioned parameter have been evaluated as a test for diabetes diagnosis defined by a 2-hr OGTT value greater than or equal to 200 mg/dl. The predictive values for both positive and negative diagnosis were also evaluated. The combination of a fasting blood glucose greater than or equal to 120 mg/dl with a glycosylated hemoglobin greater than 5.8% was found to be the best association with a good relative specificity (97.9%), a fair sensitivity (64.7%) and a fair predictive value for a positive diagnosis (64.7%). A second sample includes 195 subjects. These were classified according to either the above criterion or either the 2-hr OGTT value greater than or equal to 200 mg/dl. A great majority of subjects (95.4%) was classified in concordance by the two methods. The characteristics of the subjects that were identically classified as diabetic subjects (n = 5) were compared to those of differently classified subjects (n = 9). Longitudinal surveys are needed in order to assess the validity of HbA1c measurement as a tool for diabetes screening by reference to unquestionable criteria of the disease.

Adult↗

PubMedDate not supplied

[Study of blood glucose regulation in 103 cases of adult acquired hypothyroïdism (author's transl)].

Systematic studies of blood glucose regulation have been performed in 103 cases of adult acquired hypothyroïdism. The results were the following: 11 cases of overt diabetes were discovered. The diagnostic was made when fasting blood glucose was superior to 120 mg/100 ml and glucosuria was present. 22 cases of asymptomatic (chemical) diabetes. The diagnosis was based on the abnormalities of the oral glucose tolerance test (OGTT). The criteria were those of Fajans and Conn. In 70 cases the results were normal. The comparison of these results with these obtained in a matched population of normal subjects did not show significative differences. Particularly the proportion of "flat curves" during the OGTT were not higher in cases of hypothyroïdism. Plasma insulin levels were determined in 20 cases of hypothyroïdism during OGTT. The results were the same as in non-hypothyroïd subjects. The abnormalities of glucose regulation observed in hypothyroïdism were not related to sex, age, overweight or cause of the disease. The number of diabetic patients is not significatively more important in cases of hypothyroïdism of immunological origin (especially Hashimoto's disease.

Adult↗

PubMedDate not supplied

Estimation of the prevalence of diabetes mellitus in Israel based on hypoglycemic drug supply and consumption.

In recent years, the estimation of drug utilization has become an efficient instrument for the evaluation of health services. The Defined Daily Dose (DDD) method, standardized by the WHO, using consumption data, provides a basis for comparison of morbidity between different places and over different periods of time. The aim of this study was to validate the estimated prevalence of Diabetes Mellitus in Israel obtained by the DDD method. We compared this estimate with data from medical records and from medication cards for the chronically ill. The study focused on Kupat Holim insurees, aged 30 years and older, registered in three Beer Sheva primary care clinics in 1985. By the DDD method we predicted 319 cases of diabetes; record review and medication cards disclosed 353 and 379 cases respectively. Most of this discrepancy was due to oral treated cases of diabetes by the DDD approach. For insulin treated, diabetes the DDD method predicted 108 cases as compared to 102 and 125 by chart and medication review. Because the review of medical records is expensive and medication cards for chronic patients are not always available, the DDD approach is a cheap, efficient and simple way to estimate prevalence of diabetes. Improved knowledge of prevalence may serve as a basis for monitoring therapeutic practices and therefore improving the quality of health services.

Adult↗

PubMedDate not supplied

Is glucose self-monitoring beneficial in non-insulin-treated diabetic patients? Results of a randomized comparative trial.

To study if self-monitoring of glucose, urinary or capillary, could help them to improve their metabolic control through better compliance to diet and/or hypoglycaemic agents, 208 non-insulin-treated poorly controlled diabetic patients were randomized to: group A--regular HbA1c determinations but no self-monitoring, group B--self-urine glucose monitoring, twice every other day, group C--self blood glucose monitoring, twice every other day, and followed six months. At the end of the study period, the decrease of HbA1c over six months--main endpoint--was not significantly different between the three groups (mean +/- SEM; group A: -0.5 +/- 0.2%; group B: -0.1 +/- 0.3%; group C: -0.4 +/- 0.3%). However, the degree of compliance to blood glucose self-monitoring in group C appeared to relate to the outcome: a significant correlation was found between the number of blood glucose strips used and the decrease of HbA1c (r = .36, p less than .02). We conclude that regular self-monitoring has no definite advantage over the usual management for improving metabolic control in non-insulin-treated diabetic patients, though it may possibly help patients ready to comply with its use.

Aged↗

PubMedDate not supplied

Some keys factors in the clinical diagnosis of non insulin-dependent diabetes: a multinational comparison.

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Diabetes Mellitus, Type 1↗

PubMedDate not supplied

Telephone versus face to face interviewing as a means of collecting data relevant to the management of diabetes among general practitioners in France: a randomized design.

Successful patient education requires planed programs with specific target populations. As general practitioners see 85% of noninsulin-dependent diabetics in France, this study was designed to test the feasibility of the telephone as a method for data collection within the context of a random sample of general practitioners in the Paris region. In addition, data were collected assessing physician's perceptions of various barriers and facilitators to the management of this illness. The study demonstrated the feasibility of phone interviews among general practitioners, as no significant differences were found in response rates or for any single variable collected on the telephone versus "face-to-face". Treatment patterns were described and results indicated that 77% of general practitioners agreed to participate in a subsequent study and, of these 93% agreed to the participation of their noninsulin-dependent patients.

Data Collection↗

PubMedDate not supplied

[Epidemiological study of cutaneous and subcutaneous tuberous angiomas. Results of a prospective survey].

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Female↗