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F Holleman

Publications and source records attributed to F Holleman.

15 recordsLinked to original sources
PubMed2004

Metformin and lactic acidosis: cause or coincidence? A review of case reports.

OBJECTIVE: Metformin has been associated with the serious side-effect lactic acidosis. However, it remains unclear whether the use of metformin was a cause or a coincidence in lactic acidosis. DESIGN: A literature search of the Index Medicus (1959-66) and of the databases Embase, Medline, Medline Express (1966-99) was performed using the keywords metformin, biguanides and lactic acidosis. All articles of cases with metformin-induced lactic acidosis (MILA) were cross-referenced. SUBJECTS: Cases were included for analysis if they met the following criteria: serum pH < or =7.35, lactate concentration > or =5 mmol L(-1). INTERVENTION: A forum of six experts in intensive care medicine independently categorized the cases in MILA unlikely (score 0), possible MILA (score 1) or probable MILA (score 2). MAIN OUTCOME MEASURES: Statistical analysis included the paired interobserver agreement (kappa) and multivariate regression analysis. RESULTS: Of 80 reported cases, 33 were excluded because of insufficient quality. The forum scores of the remaining 47 cases were distributed normally with a mean score of 7 (range 2-10). The kappa-value was 0.041 (SD = 0.24, range -0.514, 0.427). Neither lactate concentration nor mortality correlated with serum metformin concentrations. CONCLUSIONS: Given the low interobserver agreement and the lack of any relationship between metformin levels and outcome parameters, the concept that there is a simple, causal relationship between metformin use and lactic acidosis in diabetic patients has to be reconsidered.

Acidosis, Lactic↗
PubMed2002

[The last breath. The decision to ventilate patients with severe chronic obstructive pulmonary disease or not].

Three patients, a 74-year-old man and 2 women aged 40 and 58 years, were admitted to the hospital on a number of occasions due to respiratory insufficiency as a result of progressive debilitating COPD. Weaning from mechanical ventilation became increasingly difficult. Therefore, in two patients it was eventually decided not to apply mechanical ventilation again; they died after the next COPD exacerbation. The 40-year-old woman was eligible for a lung transplant and was placed on the waiting list for this procedure. The decision to mechanically ventilate patients with severe COPD and respiratory insufficiency is fraught with therapeutical, emotional and ethical dilemma. Objective criteria indicating a poor outcome in mechanically ventilated patients with severe COPD are: a forced expiratory volume in one second lower than 700 ml, being housebound, advanced age, cardiac comorbidity, and a low serum albumin concentration prior to mechanical ventilation. Since subjective criteria such as the patient's own wishes should also be considered, a policy is advocated in which the consultant pulmonologist regularly evaluates the available data and communicates the feasibility of mechanical ventilation.

Adult↗
PubMed2000

[Metformin efficacious in poorly controlled diabetes mellitus type 2].

Three patients, 1 man and 2 women, aged 60, 55 and 72 years, had an insufficient glucose regulation with insulin therapy or with sulfonylurea derivatives. They started metformin therapy, after which HbA1c decreased by 0.8-1.8%. One patient had to discontinue metformin therapy due to excessive diarrhoea. Many studies have shown the beneficial effect of metformin on glucose control. The recent UK Prospective Diabetes Study has proven the effectiveness of metformin for any diabetes related endpoint. Frequent side effects of metformin are nausea, abdominal discomfort and diarrhoea. Most side effects disappear after decreasing the dosage, although in 5% of patients diarrhoea only disappears after discontinuation of metformin. Lactic acidosis is a rare, serious adverse effect of metformin, which can be prevented by carefully observing the contra-indications.

Abdominal Pain↗
PubMed2000

Effect of metformin on glycaemic control in type 2 diabetes in daily practice: a retrospective study.

INTRODUCTION: Recently the UKPDS study revealed the potency of metformin therapy in obese type 2 diabetic patients. A retrospective study was performed to assess the efficacy of metformin therapy in improving metabolic control in everyday practice. PATIENTS AND METHODS: Type 2 diabetic patients were included if they met the following criteria: metformin had been added when the previous treatment failed to optimise glycaemic control expressed in HbA1c level; duration of metformin therapy had to be at least six months. Efficacy of metformin therapy, expressed as a decrease in HbA1c, was measured with a median follow-up of 32 (range 6-60) months. Variables were analysed using a paired t-test. RESULTS: One hundred and sixty-three patients were treated with metformin. 98 patients were excluded, because of absence of an HbA1c value prior to treatment with metformin mainly (n = 78). The mean HbA1c of included patients had decreased 1.4% (p < 0.001) after 6 months (n = 65), 1.6% (p < 0.001) after 24 months (n = 45) and 1.5 (p < 0.001) after 36 months (n = 28). During follow-up there was no significant weight gain or loss. CONCLUSION: Metformin can be considered an effective treatment to improve glycaemic control in obese type 2 diabetic patients.

Case-Control Studies↗
PubMed1998

[The Montignac method: scientific foundation debatable].

Obesity is a major health issue in Western society. In the Netherlands every fifth person suffers from obesity and every third person is on a weight-reducing diet. The Montignac method is a very popular diet. The diet is claimed to be a nutritional science. The method is based on several hypotheses about the metabolism of carbohydrates and fatty acids: carbohydrates with a low glycaemic index are preferred, carbohydrates are not to be eaten in combination with fatty acids, fruit is propagated but must not be combined with other components. The scientific literature refutes the hypotheses of Montignac regarding the metabolic effects of carbohydrates and fatty acids. As a method to lose weight, the conventional recommendations of caloric restriction, less intake of saturated fatty acids and more physical activity should be preferred to the Montignac diet.

Diet, Reducing↗
PubMed1997

Insulin lispro.

Explore the source record for details and available documents.

Diabetes Mellitus↗
PubMed1997

Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients treated with insulin lispro. The Benelux-UK Insulin Lispro Study Group.

OBJECTIVE: Several studies have suggested that use of the short-acting insulin analog, insulin lispro, in multiple injection therapy may reduce the risk of hypoglycemia in comparison with regular insulin. This effect might be more pronounced in well-controlled patients, since intensive treatment of IDDM increases the rate of severe hypoglycemic events. This study evaluated the effects of insulin lispro on glycemic control and hypoglycemia rates in well-controlled IDDM patients. RESEARCH DESIGN AND METHODS: This was an open, randomized, 6-month crossover study of 199 IDDM patients. Glycemic control was evaluated by HbA1c, home blood glucose measurements, and rate and timing of hypoglycemic events. At the end of the study, patients completed an evaluation form regarding therapy-related quality of life. RESULTS: HbA1c remained constant at approximately 7.3% throughout the study. Meal-related glucose excursions were significantly lower with insulin lispro compared with regular insulin (mean -0.8 +/- 1.7 vs. 1.1 +/- 1.6 mmol/l, P < 0.001), as was the within-day variability (M value 27.7 +/- 19.7 vs. 30.2 +/- 23.1, P = 0.007). The incidence of severe hypoglycemic events (58 vs. 36, P = 0.037) including coma (16 vs. 3, P = 0.004) was significantly lower with insulin lispro than with regular insulin. Patients felt that insulin lispro increased flexibility and freedom of lifestyle. CONCLUSIONS: In well-controlled IDDM patients, insulin lispro is associated with a lower risk of severe hypoglycemia and coma.

Adult↗
PubMed1996

Comparison of LysB28, ProB29-human insulin analog and regular human insulin in the correction of incidental hyperglycemia.

OBJECTIVE: To obtain clinically applicable data on the effects of regular human insulin and the LysB28,ProB29-human insulin analogue (lispro) on the correction of incidental hyperglycemia. RESEARCH DESIGN AND METHODS: The insulins were compared in a non-clamped randomized crossover study of 27 male IDDM patients. Hyperglycemia was induced by the withdrawal of the normal evening dose of insulin; the next morning patients fasted and received a single dose of study insulin according to a dosing nomogram. Blood glucose concentration and GR (a measure of glucose corrected for differences in administered insulin dose: GR = glucose concentration X BMI X insulin dose-1) were followed for 4 h. RESULTS: The time courses of blood glucose concentration and GR were significantly different after regular insulin in comparison with lispro (multiple analysis of variance, P < 0.001). At t = 120 min, glucose concentrations had decreased 1.4 mmol/l more with lispro than with regular insulin (95% confidence interval [CI] 0.6-2.3, P = 0.002). Similarly, GR had decreased 4.4 mol.kg.IU-1.m-5 more with lispro than with regular insulin (95% CI 2.6-6.2, P < 0.001). The overall difference in glucose values was 0.87 mmol/l (lispro < regular insulin, P = 0.036), and the overall difference in GR values was 1.96 mol.kg.IU-1.m-5 (lispro < regular insulin, P = NS). Unexpectedly, the intrinsic variability of GR was higher for lispro than for regular insulin. CONCLUSIONS: The more rapid action of lispro is an advantage in the correction of hyperglycemia, even though actual differences in glucose concentrations are smaller than suggested by previous clamped studies.

Adult↗
PubMed1995

Evaluation of fine needle aspiration (FNA) cytology in the diagnosis of thyroid nodules.

FNA cytology of 112 patients with thyroid nodules seen in a 5-year period in a general hospital setting, and the histology obtained from the 53 operated patients, were retrospectively analysed. The inadequacy rate of FNA cytology was 11%, sensitivity was 84% (16/19), specificity was 52% (15/29), positive predictive value was 53% (16/30) and negative predictive value was 83% (15/18). Extrapolating these figures to the whole study group a negative predictive value of 95% is put forward as a more realistic figure. The results and the clinical pitfalls of the use of FNA cytology in diagnosing thyroid nodules are discussed. The authors conclude that FNA cytology is a reliable first diagnostic step in the diagnosis of thyroid nodules, even in a general hospital setting.

Biopsy, Needle↗