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Biomedical subjects

L J Duncan

Publications and source records attributed to L J Duncan.

At least 19 recordsLinked to original sources
PubMed1979

Glycosylated haemoglobin concentrations in newly diagnosed diabetics before and during treatment.

Concentrations of total glycosylated haemoglobins (Hb A1) were measured in 40 diabetics at diagnosis and at monthly intervals after treatment with chlorpropamide, insulin, or diet alone was begun. The mean Hb A1 concentration at presentation in 16 patients treated with chlorpropamide was significantly higher than that in 12 patients treated with insulin, and the duration of glycaemic symptoms was much longer in the chlorpropamide-treated group. In contrast, the mean plasma glucose concentration was similar in both groups. The mean concentrations of Hb A1 and plasma glucose at diagnosis in the 12 patients treated by diet alone were lower than those in the other two groups, and most of these patients were free of symptoms. Treatment quickly relieved symptoms and lowered plasma glucose in all patients. The Hb A1 concentration fell significantly with treatment such that after two months there was no significant difference between the three groups, although results remained above the normal range. These findings support the theory that the Hb A1 concentration reflects the blood glucose control over the previous one to two months and suggest that the duration of hyperglycaemia may be important in determining the Hb A1 concentration as well as the absolute blood glucose concentration.

Adult↗
PubMed1979

Seasonal onset of insulin dependent diabetes in relation to sex and age at onset.

All newly diagnosed insulin dependent diabetics presenting consecutively to the Diabetic Department of the Royal Infirmary from the City of Edinburgh or its environs, between the years 1964 and 1977, were analysed for sex (297 males, 205 females), age at diagnosis (range 10--75 years), month of diagnosis, duration of symptoms and month of symptomatic onset. Males aged 10--19 years showed a significant seasonal variation in diagnosis (p less than 0.025) with an increase in autumn and winter months which was not seen in females aged 10--19 years nor in patients of either sex aged more than 19 years at diagnosis. The duration of diabetic symptoms increased with increasing age at diagnosis in both males and females and was consistently greater in females than in males for each age group at diagnosis. When the month of symptomatic onset was considered in relation to sex and age at diagnosis, having excluded patients with duration of symptoms of more than three months, only males aged 10--19 years at diagnosis showed a significant seasonal variation in incidence (p less than 0.005).

Adolescent↗
PubMed1979

Diabetic mortality in Edinburgh.

A prospective study of mortality in 3,113 diabetics was carried out in Edinburgh over a period of eight years; 1,272 patients (41 %) died. Death rates for females equalled those for males and, in relation to the general population, there was a considerable excess mortality which was greater for females. Statistical analysis indicated that the important mortality risk-factors are age, duration of diabetes of greater than ten years and treatment. The risk of oral therapy or insulin were approximately equally greater than that of diet therapy and probably reflected severity of disease. Using international coding for diagnosis, 27 % of deaths were classified as directly due to diabetes and 49 % to vascular disease. Reclassifying the terminal cause of death left only 26 patients (2 %) recorded with diabetes as the direct cause of death. Three hundred and thirty five males (66 %) and 561 females (73 %) died of vascular disease. There was a predominance of myocardial infarction in males and cerebrovascular disease in females. These percentages were a little lower when post-mortem information was available. These results provide additional evidence that diabetes reduces life expectancy by inducing premature vascular disease and that the effect is greater in women than in men.

Adolescent↗
PubMed1979

The value of islet cell antibody in predicting secondary failure of oral hypoglycaemic agent therapy in Diabetes mellitus.

The sera of 160 diabetics who were well controlled by oral hypoglycaemic agents (OHA) for at least three months after diagnosis were tested for pancreatic islet cell antibodies (ICAb) either at diagnosis or within two years after diagnosis. 129 were non-obese at diagnosis and of these ICAb was detected in the sera in 20 (16%). 31 were obese at diagnosis and of these ICAb was detected in the sera in three (10%). All of the 160 diabetics were insulin independent at the time of testing the serum for ICAb. The presence of ICAb was associated with a high probability of becoming insulin dependent, calculated from actuarial statistics. 86% of ICAb positive patients initially controlled on OHA may be expected to be insulin dependent at five years from diagnosis as compared to 18% of ICAb negative patients. Obesity at diagnosis did not significantly affect the probability of becoming insulin dependent. ICAb positive diabetes controlled by OHA can be regarded as a less severe form of insulin-dependent (Type I) diabetes.

Administration, Oral↗
PubMed1978

Immune complexes in newly diagnosed insulin-dependent (type I) diabetics.

Soluble immune complexes (AgAb) and islet cell antibodies (ICAb) were studied in 110 insulin dependent diabetics (IDD) within a week of diagnosis and in about a third of the patients after 1, 3, 6 and 12 months. AgAb were studied by the solid phase Clq binding test in all the patients and also by the Raji cell radioimmunoassay in 52 sera at diagnosis. Diabetics at diagnosis showed a significantly higher incidence of AgAb in comparison with the control population. AgAb positivity declined with increasing time from diagnosis to reach the normal range within 3 months. Both the Clq and the Raji methods revealed a significant correlation at diagnosis between the occurrence at AgAb and the presence of ICAb. The possibility exists that AgAb, perhaps comprised of pancreatic antigen and ICAb, may be involved in the pathogenesis of type I diabetes.

Antibodies↗
PubMed1977

Familial studies of type-I and type-II idiopathic diabetes mellitus.

A study of 296 diabetics demonstrated an association between the type of diabetes in the propositi and their first-degree relatives (aged 40 to 89 yr), the type of diabetes being defined as insulin-dependent (type I) or insulin-independent (type II). This association was significant at the 1% level and was still maintained when only the propositi in whom the diabetes was diagnosed at the age of 30 years or later were considered. The findings also suggest that there is a greater genetic independence between these two types than was previously supposed and that the disease should be subdivided into type according to the treatment needed rather than by the age of onset.

Administration, Oral↗
PubMed1977

Clinical and pathogenic significance of pancreatic-islet-cell antibodies in diabetics treated with oral hypoglycaemic agents.

20 out of 179 diabetics treated with oral hypoglycaemic agents (O.H.A.) within 3 mo of diagnosis had pancreatic-islet-cell antibodies (ICAb) in their sera at diagnosis or later. 13 of these 20, compared with only 14 of the remaining 159, subsequently required insulin at a mean follow-up of 2 yr 10 mo and 4 yr 11 mo, respectively (p less than 10(-7)). 5 of the 7 ICAb-positive diabetics still continuing on O.H.A. therapy after a mean follow-up of 4 yr 6 mo required maximum or near-maximum combined oral therapy, while only 34 of the 145 ICAb-negative diabetics continuing on O.H.A. did so at a mean follow-up of 5 yr 4 mo (p less than 0.02). In addition, 81 diabetics treated initially with diet for a mean time of 4 yr 7 mo before going on to O.H.A. therapy were studied. All were ICAb-negative when tested at a mean interval of 6 yr 10 mo from diagnosis. By the end of the mean follow-up period of 10 yr 3 mo, 27 were on combined oral therapy and 3 had been transferred to insulin treatment. ICAb-positive diabetics on O.H.A. had a high prevalence of a personal history of organ-specific autoimmune disease, thyrogastric antibodies, a family history of insulin-dependent diabetes and possibly of HLA-B8 comparable to that in insulin-dependent diabetes and higher than that expected in a control population or in diabetics controlled by diet alone. We believe that ICAb-positive diabetes controlled by O.H.A. is an earlier stage in the same disease process (type-I diabetes) that culminates in insulin-dependency.

Administration, Oral↗
PubMed1977

Pericarditis in diabetic ketoacidosis.

A 25-year-old insulin-dependent diabetic man who was admitted to hospital with severe diabetic ketoacidosis and dehydration showed sequential electrocardiographic abnormalities of acute pericarditis. Though the patient had retrosternal chest pain, no pericardial friction rub was heard. None of the usual causes of pericarditis was found and the electrocardiographic abnormality may have been attributable to subepicardial injury caused by dehydration associated with the ketoacidosis. The abnormalities on the electrocardiogram were transient, returning to normal after 5 days. Whatever the exact underlying nature of the pericarditis, it is important to recognise that such transient changes may occur as, in the absence of other obvious causes of pericarditis, the condition is benign.

Adult↗
PubMed1977

Plasma beta-thromboglobulin in diabetes mellitus.

The plasma beta-thromboglobulin (betaTG) content was measured in 56 diabetic patients with known complications of this disease, including neuropathy, retinopathy, and ischemic skin lesions. Although two patients were found to have elevated levels beyond the normal range, there was no significant difference between the diabetic group as a whole and the group of 35 controls. The significance of these findings with regard to the proposed contribution of small-vessel platelet sequestration in the pathogenesis of late complications of diabetes mellitus is discussed.

Beta-Globulins↗
PubMed1977

Pancreatic islet-cell antibodies in diabetes mellitus correlated with the duration and type of diabetes, coexistent autoimmune disease, and HLA type.

In a study of 972 patients with diabetes mellitus, humoral pancreatic islet-cell antibodies (I.C.Ab.) were detected in highest prevalence in insulin-treated diabetics with (38 per cent) and without (22 per cent) associated overt organ-specific autoimmune disease (A.I.D.) where consideration was not given to the duration of diabetes. They were also detected in 8 per cent of diabetics treated with oral hypoglycemic agents (O.H.A.), but not in diabetics requiring diet alone and in only 0.5 per cent of 434 control subjects. Six per cent of 522 patients with overt organ-specific A.I.D. but not diagnosed to be diabetic had I.C.Ab.s. I.C.Ab.s were present in the sera of 2 per cent of 157 first-degree relatives of I.C.Ab.-positive subjects. In insulin-treated diabetics and, to a lesser extent, in diabetics not requiring insulin, the prevalence of humoral I.C.Ab. was strongly dependent of the duration of the diabetes, being 60 per cent during the first year from diagnosis in the insulin-treated group and falling to 20 per cent at two to five years and to 5 per cent at 10-20 years. The prevalence of I.C.Ab. in insulin-treated diabetics showed no correlation with the patient's age at the time of testing when the duration of diabetes was taken into account. Diabetics who did not require insulin for treatment but who were I.C.Ab.-positive showed a significant tendency to subsequently require insulin and to have a higher prevalence of other autoantibodies than insulin-independent diabetics who were I.C.Ab.-negative. Persistence of I.C.Ab. for more than five years from diagnosis of diabetes was associated with coexistent overt organ-specific A.I.D. and with HLA-B8, A1, and A1 + B8.

Adult↗