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Biomedical subjects

J Ostman

Publications and source records attributed to J Ostman.

At least 19 recordsLinked to original sources
PubMed1999

Islet cell and glutamic acid decarboxylase antibodies present at diagnosis of diabetes predict the need for insulin treatment. A cohort study in young adults whose disease was initially labeled as type 2 or unclassifiable diabetes.

OBJECTIVE: To clarify the predictive value of islet cell antibody (ICA) and GAD65 antibody (GADA) present at diagnosis with respect to the need for insulin treatment 6 years after diagnosis in young adults initially considered to have type 2 or unclassifiable diabetes. RESEARCH DESIGN AND METHODS: The patient material was representative of the entire Swedish population, consisting of patients who were 15-34 years old at diagnosis of diabetes in 1987-1988 but were not considered to have type 1 diabetes at onset. At follow-up, 6 years after the diagnosis, it was noted whether the patient was treated with insulin. The presence of ICA was determined by an immunofluorescence assay, and GADAs were measured by a radioligand assay. RESULTS: Six years after diagnosis, 70 of 97 patients were treated with insulin, and 27 of 97 patients were treated with oral drugs or diet alone. At diagnosis, ICAs and GADAs were present in 41 (59%) of 70 patients and 41 (60%) of 68 patients, respectively, of those now treated with insulin, compared with only 1 (4%) of 26 patients and 2 (7%) of 27 patients who were still not treated with insulin. For either ICA or GADA, the corresponding frequencies were 50 (74%) of 68 for patients who were later treated with insulin and 3 (12%) of 26 for those who were still not treated with insulin, respectively. The sensitivity for later insulin treatment was highest (74%) for the presence of ICA or GADA, and the specificity was highest (100%) for ICA and GADA. The positive predictive value was 100% for the combination of ICA and GADA, 98% for ICA alone, and approximately 95% for GADA alone. CONCLUSIONS: Determination of the presence of ICA and GADA at diagnosis of diabetes improves the classification of diabetes and predicts the future need of insulin in young adults.

Adult↗
PubMed1999

Appearance of islet cell autoantibodies after clinical diagnosis of diabetes mellitus.

Islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GAD65Ab) are often present at diagnosis of insulin dependent diabetes mellitus (type I diabetes) and are supposed to decline in level and frequency during the first years of disease. We have analysed ICA and GAD65Ab at onset and after one year in 395 population based randomly selected 15-34 year old patients newly diagnosed with diabetes mellitus, to study how these autoantibodies persist, disappear and appear and their relation to C-peptide levels. Of the 395 samples 212 (54%) were positive for ICA, 250 (63%) were positive for GAD65Ab and 170 (43%) were positive for both. At follow up after one year, 27/183 (15%) of the ICA negative patients and 25/145 (17%) of the GAD65Ab negative patients had converted to positivity. Among the 103 patients negative for both ICA and GAD65Ab, 16 turned positive for one or both antibodies after one year. Patients converting to positivity for one or the other antibody after one year, had lower C-peptide levels after one year than patients who initially were and remained negative, supporting the hypothesis that these patients have a genuine type I diabetes. In conclusion, newly diagnosed patients may be negative for autoantibodies at diagnosis but develop these antibodies later on during the disease.

Adolescent↗
PubMed1998

Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non-insulin-dependent diabetes mellitus patients with hypertension. Swedish Quinapril Group.

OBJECTIVE: To compare the long-term effects of the angiotensin-converting enzyme (ACE)-inhibitor quinapril and the cardioselective beta-adrenergic blocking agent metoprolol on glycaemic control, with glycosylated haemoglobin (HbA1c) as the principal variable, in non-insulin-dependent diabetes mellitus (NIDDM) patients with hypertension. DESIGN: A randomized, double-blind, double-dummy, multicentre study during 6 months preceded by a 4 week wash-out and a 3 week run-in placebo period. Quinapril (20 mg) and metoprolol (100 mg, conventional tablets) were given once daily. No change was made in the treatment of diabetes (diet and hypoglycaemic agents). SUBJECTS: Seventy-two patients fulfilling the criteria were randomized and entered the double-blind period. Twelve patients did not complete the study. Sixty patients, 26 on quinapril and 34 on metoprolol, were available for the final analysis. MAIN OUTCOME MEASURES: The effect was assessed by changes in HbA1c, the fasting serum glucose and the post-load serum glucose, C-peptide and insulin levels during the oral glucose tolerance test. RESULTS: In the quinapril group, the fasting serum glucose, oral glucose tolerance and the C-peptide and insulin responses, determined as the incremental area under the curves (AUC), showed no change, but the mean HbA1c level increased from 6.2 +/- 1.1% to 6.5 +/- 1.3% (P < 0.05). In the metoprolol group, the rise in the mean level of HbA1c, from 6.3 +/- 1.0% to 6.8 +/- 1.3% (P < 0.01), tended to be more marked than after quinapril, although there was no significant difference between the increments. The mean fasting serum glucose showed an increase from 9.1 +/- 1.9 mM to 10.1 +/- 2.8 mM (P < 0.01) which correlated significantly with the duration of diabetes (P < 0.01) and the increase in fasting serum triglycerides (P < 0.001). Moreover, in the metoprolol group we found significant decreases in the oral glucose tolerance as well as C-peptide and insulin responses to the glucose load. CONCLUSIONS: Treatment with quinapril for 6 months appears to have advantages over metoprolol in NIDDM patients with hypertension. Although treatment with quinapril or metoprolol over 6 months was concomitant with a rise in the HbA1c, increased fasting blood glucose, decreased oral glucose tolerance and decreased C-peptide and insulin responses to a glucose challenge were observed only in patients treated with metoprolol.

Adrenergic beta-Antagonists↗
PubMed1997

Malignant salivary gland tumours in Sweden 1960-1989--an epidemiological study.

Epidemiological data from the Swedish Cancer Registry of new cases of malignant major and accessory salivary gland tumors in Sweden between 1960 and 1989 are presented, including the total number and the age-standardised incidence rate per 1 million population, by site and sex, I(s). An analysis of the various histopathological types of malignant salivary gland tumours in the different sublocations is also given. A comparison is made between the three 10-year periods 1960-1969, 1970-1979 and 1980-1989 regarding total number and I(s). The total number of new malignant major salivary gland tumors was 2557, representing approximately 85 new cases per year and 0.3% of all new diagnosed cancers in Sweden. In addition, approximately 25 new cases per year of malignant accessory salivary gland tumors were reported. If all malignant salivary gland tumours were considered, the most common location was found in the parotid glands with a relative frequency of 57.5%, and the next most common site was malignant accessory salivary gland tumours with 22.6%. I(s) was 10.2 for the major and 3.0 for the accessory salivary glands. No major difference between the examined 10-year periods was found concerning the relative frequency, and no statistically significant difference in I(s) was found between the examined 10-year periods, except for a statistically significant decrease in the I(s) between the time periods 1960-1969 and 1980-1989 for the multiple or unspecified malignant salivary glands from 0.5 to 1.4. A difference in the distribution of various histopathological types of malignant salivary gland tumours was observed between the different time periods. This was particularly valid for the diagnoses adenoid cystic carcinomas and mucoepidermoid carcinomas which increased in number and the diagnosis malignant salivary gland tumours of mixed type, which decreased in number during the examined time periods.

Adenoma, Pleomorphic↗
PubMed1996

Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis.

All incident cases of diabetes mellitus in the age group 15 to 34 years have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease onset, we selected the cases registered in 1983 and two controls per case from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns during a 3-month period were collected via a mailed questionnaire, returned by 317 (72%) patients with diabetes and 586 (68%) controls. Seventy-four percent of the cases and 19% of the controls reported at least one visit to a hospital outpatient clinic, including accident and emergency departments. The odds ratio for one visit was 14 (95% CI 9.6-20), for two visits 11 (95% CI 7.0-18), and for three or more visits 8.9 (95% CI 5.6-14). Even when specialized diabetes clinics were excluded from the analysis, the cases had higher odds for visits to internal medicine clinics, to ophthalmology clinics, and to gynaecology clinics, but not for visits to surgical clinics or to accident and emergency departments. Of non-hospital outpatient services, only visits to nurse practitioners were reported by a higher percentage of diabetic responders. Twenty-seven percent of patients with diabetes, as compared to 9% of the controls, had visited both hospital and non-hospital outpatient offices. Females were overrepresented among diabetic high-consumers. The results indicate that most young to middle-aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerable overlap exists between hospital and non-hospital outpatient services. Further research is needed into the determinants of utilization patterns in diabetes, such as gender.

Adolescent↗
PubMed1996

Patient administrative system as a tool to validate the ascertainment in the diabetes incidence study in Sweden (DISS).

The aim of this study was to evaluate the degree of ascertainment in a nationwide prospective registration of incident cases of diabetes mellitus in the age group 15-34 years (The Diabetes Incidence Study in Sweden (DISS)). Incident cases of diabetes mellitus in DISS during a five year period were compared with inpatients, with the diagnosis of diabetes mellitus, registered in a routine computer-based administrative register. The Patient Administrative System-Inpatient Care (PAS-IC). To clarify this issue the two-sample capture-recapture phenomena was employed in the two southernmost counties in Sweden, Malmöhus and Kristianstad, covering 9.2% of the total of 2.3 million people aged 15-34 years in Sweden. The results showed that the ascertainment level in DISS was 0.86 for insulin dependent diabetes mellitus (IDDM). Hence, the DISS registry is a valid tool to monitor the incidence of IDDM in young (15-34 years) adult subjects.

Adolescent↗
PubMed1995

Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study.

In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Well-being, Treatment Satisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated. Cronbach's alpha indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66-0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p < 0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.

Adult↗
PubMed1995

Malignant oral tumours in Sweden 1960-1989--an epidemiological study.

Epidemiological data from the Swedish Cancer Registry of new cases of malignant oral tumours in Sweden 1960-1989 are presented, including the total number and the age-standardised incidence rate per 1 million population, by site and sex, (I(s)). An analysis of the various histopathological types of malignant oral tumours in the different sublocations is also given. A comparison is made between the three 10-year periods 1960-1969, 1970-1979 and 1980-1989 regarding total number and I(s). The total number of cases, 17,158, represented 1.8% of all newly diagnosed cancers in Sweden. The following relative frequencies were noted for the respective sites: intra-oral region 0.7%, lip 0.6% and pharynx 0.5%. The results indicated an increase in total number and a statistically significant increase of I(s) for malignant lip tumours in females over the whole period. A corresponding increase in total number during the periods 1960-1969 and 1980-1989 and a decrease in I(s) during the periods 1970-1979 and 1980-1989 in lip tumours for males was observed. For males there was an increase in total number and a statistically significant increase in I(s) for malignant tongue tumours, while the corresponding figures for females remained constant. For malignant floor of the mouth tumours there was an increase in total number and a statistically significant increase in I(s) for both men and women. In the intra-oral region, including the sublocations oral cavity-other sites, tongue and floor of the mouth, the male:female ratio was 1.8:1 and I(s) changed from 22.8 (1960-1969) to 29.6 (1980-1989).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Transplantation of porcine fetal pancreas to diabetic patients.

Transplantation of fetal porcine islet-like cell clusters (ICC) reverses diabetes in experimental animals. We have now transplanted porcine ICC to ten insulin-dependent diabetic kidney-transplant patients. All patients received standard immunosuppression and, at ICC transplantation, antithymocyte globulin or 15-deoxyspergualin. ICC were injected intraportally or placed under the kidney capsule of the renal graft. Four patients excreted small amounts of porcine C-peptide in urine for 200-400 days. In one renal-graft biopsy specimen, morphologically intact epithelial cells stained positively for insulin and glucagon in the subcapsular space. We conclude that porcine pancreatic endocrine tissue can survive in the human body.

Adult↗
PubMed1994

[Pancreas transplantation in diabetes mellitus].

In the course of 20-25 years' duration of disease, a large proportion of patients with type 1 (insulin-dependent) diabetes mellitus develop micro- and macro-angiopathy and morphological organ changes. The development of late complications in diabetes is significantly correlated to the level of blood sugar regulation, and can be prevented or delayed by the establishment of stable normoglycaemia. A successful pancreas transplantation is today the sole means available for inducing stable normoglycaemia in patients with insulin deficiency. More than 5,000 pancreas transplantations have already been performed throughout the world, in most cases concomitantly with renal transplantation in patients with late stage diabetes.

Diabetes Mellitus, Type 1↗
PubMed1992

Male predominance of type 1 (insulin-dependent) diabetes mellitus in young adults: results from a 5-year prospective nationwide study of the 15-34-year age group in Sweden.

The incidence of diabetes mellitus in Sweden in the 15-34 year age group was prospectively studied on a nationwide basis, beginning 1 January 1983. A total of 1,214 male and 720 female cases of newly-diagnosed (excluding gestational) diabetes were reported over a 5-year period. This corresponds to an incidence of 20.5 per 100,000/year in male subjects and 12.7 per 100,000/year in female subjects. Most cases were classified as Type 1 (insulin-dependent) diabetes, with an incidence of 15.9 in males and 8.6 in females. The incidence of Type 1 diabetes decreased gradually with age, while the incidence of Type 2 (non-insulin-dependent) diabetes increased. A male predominance was found in all age groups, with a male-to-female ratio of 1.8:1 for Type 1 diabetes and 1.3:1 for Type 2 diabetes. Maximum blood glucose concentration at diagnosis was significantly higher in males than in females in both Type 1 and Type 2 diabetic subjects. In contrast, the percent desirable weight was significantly higher in females, both in Type 1 and Type 2 diabetic subjects. The difference in diabetes incidence therefore cannot be attributed to any methodological error. The present finding of a marked male predominance after puberty in Type 1 diabetes in an ethnically quite homogeneous population supports the hypothesis that environmental risk factors and life-style are important for the development of the disease.

Adolescent↗