Altered responsiveness to cortisol, epinephrine, and glucagon in insulin-infused juvenile-onset diabetics. A mechanism for diabetic instability.
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Adolescent↗
Biomedical subjects
H Shamoon
Publications and source records attributed to H Shamoon.
Effects of estrogen on glucose uptake by rat muscle.
The isolated rat diaphragm was used to study the effects of 17β-estradiol on basal and insulin-mediated glucose uptake. Rats were injected with estradiol for 2 wk in daily doses of 10 μg/100 g of body weight and were compared to untreated control animals. Estrogen treatment resulted in a 16% decrease in basal glucose uptake by diaphragm muscle as compared to controls. In contrast, in the presence of insulin, glucose uptake by muscle increased 103% above basal in estradiol-treated animals as compared to a 38% rise in the control group. The absolute rate of glucose uptake induced by insulin in the estradiol treated animals (5.8 mg/g/hr) was 22% higher than in controls. These findings were not accompanied by changes in weight gain, plasma glucose and plasma immunoreactive insulin concentrations in the treated animals. In vitro incubation of diaphragm muscle with estradiol did not have an effect on basal or insulin-mediated glucose uptake.The data indicate that treatment with naturally occurring estrogens increases muscle sensitivity to insulin-stimulated glucose uptake. These findings suggest that the carbohydrate intolerance associated with the administration of oral contraceptives may be related to the use of synthetic rather than natural estrogens and/or progestins in such preparations.
Animals↗
Ophthalmic referral rates for patients with diabetes in primary-care clinics located in disadvantaged urban communities.
The level of adherence with recommended standards for ophthalmic examinations was assessed in a purposive sample of diabetic patient charts (n = 350) from four clinics in medically underserved areas. All of the clinics referred patients with diabetes to off-site services for comprehensive eye examinations (dilation, visual acuity, and intraocular pressure); adherence with the standard of care was defined as a chart note indicating a referral for an ophthalmic examination. Overall, 86% of the patients were from high-risk minority groups (black or Hispanic) for diabetes and its complications. Mean age and duration of diabetes were 57.7 and 8.8 years, respectively. Referrals for ophthalmic exams were noted in 18% of the charts during the year preceding the review and in 28.6% of the charts during the 2 preceding years. Annual referrals in the preceding 2 years were noted in 3.1% of the charts. Eye disease was noted as a diagnosis in 22%. Patients who had a diagnosis of eye disease noted in their charts had a 7.5-fold increase in the odds of having a referral noted. The increased likelihood of being referred in patients with known eye disease may be due to follow-up of current eye problems.
Black or African American↗
Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects.
Quantitative sensory testing (QST) is commonly used in the assessment of diabetic neuropathy. However, little data are available on the reliability of tactile and thermal testing devices. Reproducibility of QST measures between centers has not been previously reported. This study was designed to validate QST testing procedures and determine if these devices are suitable for large scale multicenter clinical trials. Finger and toe vibratory (Vf, Vt) and thermal (Tf, Tt) thresholds were determined for ten normal individuals by a two-alternative forced-choice procedure using the Optacon Tactile Tester (OTT) and Thermal Sensitivity Tester (TST). Threshold measurements were reproducible between technologists and had a day-to-day coefficient of variation of Vf 20%, Vt 23%, Tf 41%, and Tt 95%. Thresholds were determined for 140 normal individuals at six centers. Mean threshold values between centers were not significantly different. Center-to-center coefficients of variation (CV) were Vf 44%, Vt 45%, Tf 47%, and Tt 87%. There was no significant difference in threshold measures with regard to sex, side studied, presence of calluses, or skin temperature. Vf thresholds significantly correlated with age (p < 0.01). There was no correlation between either vibratory or thermal thresholds in normal individuals, and nerve conduction velocities (NCV). Thermal and vibratory thresholds were determined for 98 diabetic patients. Diabetic subjects without clinical evidence of neuropathy were not significantly different from normal individuals, but diabetic patients with neuropathy had increased thresholds compared to normals (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Incentives and barriers to retinopathy screening among African-Americans with diabetes.
Diabetes-related ophthalmic complications are the leading cause of newly diagnosed blindness among adults. These eye complications are often asymptomatic in the early stages, yet the majority of diabetes patients are not screened yearly. To develop a health promotion intervention to increase the rate of screening for diabetic retinopathy by dilated fundus exam (DFE), we assessed the knowledge and health beliefs related to preventing diabetic eye complications among a sample of African-Americans with diabetes. The study design was cross-sectional, using a telephone interview to collect data. From a random sample of 104 African-Americans with diabetes, 67 (64%) were completed: 54 women; mean age of 58 years. The telephone interview schedule contained items grouped into subscales for Perceived Incentives, Perceived Barriers to getting a DFE, Causes of Eye Problems, Risk of Eye Problems, and Effective Treatments for Eye Problems. Descriptive statistics were used to analyze the quantitative data. Transcribed qualitative responses to the open-ended questions were analyzed for themes. The incentives "having eye problems" and "doctor said it was important to go" each had 91% responding it was an incentive to go for a DFE. Only about one-third agreed that any particular item was a barrier to receiving a DFE (e.g., economic factors). In the subscale for Risk of Eye Problems, "retinopathy" had the lowest level of perceived risk (30%). Only 21% of the sample reported there were effective treatments for retinopathy. Eighty-seven percent reported the faulty belief that "diabetic eye problems have symptoms." Only 36% of the sample said they had heard of retinopathy and of those, only 8% could describe it correctly. Among general response themes were: fear, spirituality (faith and hope), priorities, economic or logistical factors, and external/internal motivation. Perceived incentives for receiving a DFE were acknowledged at far greater rates than perceived barriers. Having a yearly DFE in the absence of symptoms must be emphasized in health promotion materials. There are effective, early treatments for diabetic eye problems, and this information should be used to counter the fear of a dreaded diagnosis with the hope of treatment and cure. Ways of coping with fear of having the exam should be included in health education. DFEs must become a routine yearly exam and not just a reaction to recognized problems. Health education must address the specific needs of high-risk minority populations.
Adult↗
Delivery of diabetes care to low--income patients: assessment of a federally funded program.
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Adult↗
Diabetes care needs of Hispanic patients treated at inner-city neighborhood clinics in New York City.
The charts of 254 Hispanic patients were selected from a sample of 321 patients with diabetes in four urban clinics that received federal funding to provide medical care in underserved communities. A standardized chart-audit protocol was used to assess the process of healthcare delivery and the presence of diabetes-associated comorbidities and complications in patients. Inconsistent recognition of obesity (11% identified vs 59% present), hyperlipidemia (17% identified vs 69% present), and renal dysfunction (3.5% identified vs 16% present) was evident on chart review. We also found inadequate compliance with current recommendations for diabetes care with respect to routine health screenings for diabetes-related complications, recognition of comorbid diagnoses, and referral of patients for recommended specialty consultations. Issues specific to the varied Hispanic populations may need to be considered to improve the delivery of diabetes care for the growing Hispanic population with diabetes.
Community Health Centers↗
Effect of propranolol on delayed glucose recovery after insulin-induced hypoglycemia in normal and diabetic subjects.
In order to evaluate the influence of beta-adrenergic blockade on recovery from insulin-induced hypoglycemia, we compared the effect of saline or propranolol infusion during concomitant hypoglycemia in normal and type I diabetic persons. The diabetic subjects were initially rendered euglycemic with a basal insulin infusion. Glucose turnover was measured using [3-3H]glucose tracer. Propranolol caused a small but significant delay in glucose recovery in normal subjects, with plasma glucose only 80% of the values seen during saline infusion 1 h after hypoglycemia (P less than 0.005). This delay was caused by a 70% reduction in the rebound glucose output, which was responsible for posthypoglycemic recovery. In the diabetic subjects, glucose recovery was significantly delayed as compared with that in normal persons, even in the absence of propranolol, and associated with reduced secretion of epinephrine and glucagon. Moreover, the addition of propranolol caused a further 50% reduction in glucose recovery such that plasma glucose remained below 50 mg/dl for 3 h. In contrast to normals, propranolol did not inhibit the already blunted rebound in glucose output. However, propranolol prevented the decline in glucose utilization that occurred when saline alone was infused. During saline infusion, glucose uptake was at basal rates by 60 min whereas, during propranolol administration, glucose uptake remained above baseline until 180 min (P less than 0.01). Thus, propranolol may interfere with glucose recovery after insulin-induced hypoglycemia in diabetic patients by blocking epinephrine's inhibition of glucose utilization whereas, in normals, propranolol's effect is largely accounted for by blockade of epinephrine-induced hepatic glucose production.
Blood Glucose↗
Psychological and social correlates of glycemic control.
Eighty-four persons with insulin-dependent diabetes participated in this study to determine whether glycemic control was related to personality, anxiety, depression, and/or quality of life. The subjects were placed on either a conventional treatment regimen consisting of one to two injections of mixed short- and intermediate-acting insulin, with urine testing or an intensive treatment regimen consisting of two or more injections of mixed insulins, with self-monitoring of blood glucose. Personality was found to have no relationship to level of glycemic control either at the beginning of the study or at any point during the study. In contrast, anxiety, depression, and quality of life showed a significant relationship to metabolic control at entry and throughout the study period. Lower anxiety and depression scores and better quality of life scores were recorded for those subjects in good control (HbA1 less than 8.9%) when compared with those in average control (HbA1 9.0-11.9%) and those in poor control (HbA1 greater than 11.9%) at entry (P = 0.01). At each point during the study the difference between those in good control and those in poor control in terms of anxiety, depression, and quality of life was significant (P = 0.02). Change in glycemic control was found to account for up to 20% of the between-patient variability for these psychosocial parameters.
Adaptation, Psychological↗
Self-monitoring of capillary blood glucose: changing the performance of individuals with diabetes.
Standard reflectance meters were modified by the addition of memory chips capable of storing 440 glucose determinations with corresponding time and date. These modified reflectance meters (MR) were given to 20 individuals with type I diabetes in an effort to determine the level of reliability and accuracy they could achieve on a self-monitoring regimen. During a 6-wk period these subjects measured their capillary blood glucose and recorded the results in a logbook (LB). At 2-wk intervals they visited the clinic. Data from the MR was offloaded onto an Apple IIe microcomputer (Apple Computer, Inc., Cupertino, California) and presented to the subjects in a graphic format, depicting the level of metabolic control over the previous 2 wk. The performance of subjects for the 6-wk period showed that they averaged 7 omissions from the LB for every 100 MR recordings; 1 added value in the LB for every 200 MR recordings; and 1 error in accurately copying the test value for every 100 determinations. In comparison with subjects who participated in an earlier study in which they were unaware of the memory function of the reflectance meter, performance during the current study improved in all categories. It was also observed that consistency in reliable and accurate record keeping did not diminish throughout the study period. Despite these positive changes in performance, no alteration in glycemic control was found.
Adolescent↗