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Biomedical subjects

L Niskanen

Publications and source records attributed to L Niskanen.

At least 109 records · Page 6Linked to original sources
PubMed1993

Insulin resistance is related to albuminuria in patients with type II (non-insulin-dependent) diabetes mellitus.

To determine whether albuminuria is associated with insulin resistance in patients with type II (non-insulin-dependent) diabetes mellitus, we performed hyperinsulinemic (40 mU/m2/min) euglycemic clamp studies in patients with a urinary albumin excretion (UAE) rate greater than 30 mg/24 h and in patients with a UAE less than 30 mg/24 h. The UAE-positive group (n = 22) did not differ significantly from the UAE-negative group (n = 18) with respect to age, sex, treatment of diabetes, body mass index, fasting or postload blood glucose or plasma insulin levels, blood pressure, or known duration of diabetes. The mean glucose disposal rate (GDR) was significantly lower in the UAE-positive group than in the UAE-negative group (3.44 +/- 0.29 v 4.75 +/- 0.52 mg/kg/min, P < .05). When patients with hypertension were excluded, GDR was still markedly lower in the UAE-positive group than in the UAE-negative group (3.89 +/- 0.54 v 6.68 +/- 0.71 mg/kg/min, P = .01). The difference between groups persisted even after adjustment for body mass index, sex, and hypertension (ANCOVA; P < .05). These results indicate that the presence of microalbuminuria is associated with impaired insulin action in patients with type II diabetes mellitus.

Albuminuria↗
PubMed1993

Resting energy expenditure in relation to energy intake in patients with Alzheimer's disease, multi-infarct dementia and in control women.

Energy intake and resting energy expenditure in relation to body composition were studied in female patients with Alzheimer's disease, multi-infarct dementia and in home-living non-demented elderly women. Patients with Alzheimer's disease tended to have lower body weight and higher energy intake (p = NS) than control subjects or patients with multi-infarct dementia. Resting energy expenditure did not differ significantly between the groups (1089 +/- 129 kcal/day for patients with Alzheimer's disease, 1078 +/- 102 kcal/day for patients with multi-infarct dementia and 1188 +/- 143 kcal/day for control women; mean +/- SD). Energy expenditure did not differ between the groups when calculated in relation to body weight or lean body mass. In institutionalized female patients with long-standing Alzheimer's disease the resting energy expenditure was not increased, but they tended to have low body weight despite a high energy intake.

Aged↗
PubMed1993

A prospective study of clinical and metabolic associates of proteinuria in patients with type 2 diabetes mellitus.

Urinary protein excretion rate and clinical and metabolic associates were investigated in a group of 108 patients with Type 2 diabetes mellitus at the time of diagnosis and after 5 years, and also 121 control subjects. The presence of coronary heart disease, neuropathy and retinopathy, cardiovascular risk factors and 24-h urinary excretion rate of albumin, beta-2-microglobulin, and IgG were examined. At the 5-year examination, urinary excretion rate of albumin was higher in diabetic patients than in control subjects (39 +/- 75 vs 16 +/- 28 mg 24 h-1 for men, p < 0.05; 38 +/- 57 vs 22 +/- 42 mg 24(-1) h for women, p < 0.01). Furthermore, increased beta-2-microglobulin excretion rate, a marker of tubular impairment, was observed in diabetic men as compared to control men (0.17 +/- 0.15 vs 0.14 +/- 0.21 mg 24 h-1, p < 0.05). Diabetic patients with increased albumin excretion rate (> 30 mg 24 h-1) showed poorer metabolic control than those with normal albumin excretion rate, but no significant differences in body mass index or in the frequencies of smoking, hypertension, coronary heart disease or retinopathy and neuropathy were observed between the groups. Baseline hyperinsulinaemia was closely associated with increasing albuminuria at the 5-year examination.

Adult↗
PubMed1993

Unemployment and mental wellbeing: a factory closure study in Finland.

The mental wellbeing of the entire personnel (n = 211) of a wood-processing factory located in Hämeenlinna, Finland was studied by mailing a questionnaire to the subjects 6 months after the factory was closed down. The entire personnel (n = 305) of a similar wood-processing factory acted as a control group. Mental wellbeing was measured by means of the 12-item General Health Questionnaire (GHQ score), the 13-item Beck Depression Inventory (BDI score), and the 13-item questionnaire assessing psychosomatic symptoms. Seventy-nine per cent of the study group and 65% of the control group returned the questionnaire. The two groups were similar sociodemographically. Mental wellbeing was poorer in the men of the study group than in the controls. No such difference was detected in women. Mental wellbeing was poorer in all age groups in the study group, especially in married men, than in the controls. The impaired mental wellbeing in the men in the study group was associated with insufficient social support, subjectively poor health, low income and uncertainty about the future. Based on a discriminant analysis, the two groups differed most in terms of GHQ score, income, sex and BDI score.

Adult↗
PubMed1993

The impact of unemployment on psychosomatic symptoms and mental well-being.

The relationship between psychosomatic symptoms and mental well-being among unemployed (N = 132) and employed (N = 187) personnel of two similar wood-processing factories was studied. Mental well-being was measured by means of the 12-item General Health Questionnaire (GHQ-score) and the 13-item Beck Depression Inventory (BDI-score). The 13-item questionnaire assessing psychosomatic symptoms was used (PS-score). The 33 and 66 percentiles (tertiles) were formed on the basis of PS-score of the two groups separately. The highest PS-score percentile was compared with the combined first and second percentile. Higher PS-score implied impaired mental well-being especially in the unemployed but also in the control group. Insufficient social support and uncertainty about the future was associated with highest PS-score in the study group but not in the control group. High PS-score was associated with subjective mental problems in both groups. Impaired health and PS-score were associated in both groups. Our results suggest that unemployment is a powerful external stress factor and that psychosomatic symptoms were associated with impaired mental well-being.

Adaptation, Psychological↗
PubMed1993

The patient-doctor relationship and metabolic control in patients with type 1 (insulin-dependent) diabetes mellitus.

OBJECTIVE: Our hypothesis was that patient-doctor relationship experienced positively by the patient is associated with adequate compliance behavior and thus to the long-term metabolic control of diabetes. METHOD: Cross-sectional study of 100 consecutive adult patients with Type 1 diabetes treated in a diabetes out-patient department. From a questionnaire, four scores (direct estimate of physician, satisfaction with the place of treatment, self-esteem score, security with the patient-doctor relationship) determining the patient-doctor relationship were formed. In score 3 (self-esteem score) the impact of the patient-doctor relationship to the patients' self-esteem was indirectly estimated. The anonymous data taken from diabetes register including information about treatment of diabetes, metabolic control and end-organ complications were returned together with the questionnaire. On the basis of GHbA1c diabetic patients were divided into two groups: with adequate metabolic control (GHbA1c < or = 8.0%) or with poor/moderate control (GHbA1c > 8.0%). RESULTS: In univariate analyses the score 3 associated with metabolic control (p < 0.001). In logistic regression analyses the nephropathy (t = 2.80, p < 0.05) and score 3 (t = 3.98, p < 0.001) were associated with metabolic control. CONCLUSION: Patient's positively-experienced patient-doctor relationship was associated with good metabolic control of diabetes.

Adult↗
PubMed1992

Comparison of insulin regimens in patients with non-insulin-dependent diabetes mellitus.

BACKGROUND: Insulin is widely used to improve metabolic control in patients with non-insulin-dependent diabetes mellitus (NIDDM), but there is no consensus about the optimal regimen of insulin treatment. METHODS: We treated 153 patients with NIDDM for three months with five regimens: (1) oral hypoglycemic drug therapy plus NPH insulin given at 7 a.m. (the morning-NPH group), (2) oral hypoglycemic drug therapy plus NPH insulin given at 9 p.m. (the evening-NPH group), (3) NPH and regular insulin (ratio, 70 units to 30 units) given before breakfast and dinner (the two-insulin-injection group), (4) NPH insulin at 9 p.m. and regular insulin before meals (the multiple-insulin-injection group), and (5) continued oral hypoglycemic drug therapy (the control group). RESULTS: The mean (+/- SE) value for glycosylated hemoglobin decreased similarly in all four insulin-treatment groups (1.7 +/- 0.3, 1.9 +/- 0.2, 1.8 +/- 0.3, and 1.6 +/- 0.3 percent, respectively). The decrease was significantly greater in these four groups than in the control group (0.5 +/- 0.2 percent; P < 0.001 vs. all insulin-treated groups). Weight gain was significantly less (1.2 +/- 0.5 kg) in the evening-NPH group than in the other insulin-treatment groups (2.2 +/- 0.5 kg in the morning-NPH group, 1.8 +/- 0.5 kg in the two-insulin-injection group, and 2.9 +/- 0.5 kg in the multiple-injection group; P < 0.05). In addition, the increment in the mean diurnal serum free insulin concentration was 50 to 65 percent smaller in the evening-NPH group than in the other insulin-treatment groups. Subjective well-being improved significantly more in the insulin-treatment groups than in the control group (P < 0.001). CONCLUSIONS: In patients with NIDDM who are receiving oral hypoglycemic drug therapy, the addition of NPH insulin in the evening improves glycemic control in a manner similar to combination therapy with NPH insulin in the morning, a two-insulin-injection regimen, or a multiple-insulin-injection regimen, but induces less weight gain and hyperinsulinemia. The data thus suggest that patients with NIDDM do not benefit from multiple insulin injections and that nocturnal insulin administration appears preferable to daytime administration.

Administration, Oral↗
PubMed1992

Morning or bed-time insulin with or without glibenclamide in elderly type 2 diabetic patients unresponsive to oral antidiabetic agents.

We studied in a group of elderly (mean age 77 yr) non-obese Type 2 diabetic patients (n = 9) in a randomised, placebo-controlled prospective cross-over study of 8 months duration, the effects of substituting maximal sulfonylurea medication with a single injection of human zinc insulin taken either at bedtime (BTI) or morning (MI). All patients were poorly controlled with oral antidiabetic agents. After a 2-month regimen with either BTI or MI, a glibenclamide (GL, 3.5 mg/day) was given for an additional 2 months. Both insulin regimens decreased mean diurnal blood glucose and glycosylated HbA1c values to a similar extent (2.6-2.7%; p < 0.01-0.05), but with a lower daily insulin dose with BTI (0.30 +/- 0.03 IU/kg) as compared with MI (0.39 +/- 0.05 IU/kg; p < 0.01). A further improvement in metabolic control was observed in both groups after the introduction of GL; the mean reduction in glycosylated HbA1c was 1.4% for BTI and 0.7% for MI (p < 0.01 and 0.05, respectively), In conclusion, a subgroup of poorly controlled elderly Type 2 diabetic patients showed an improvement in metabolic control after a single injection of insulin despite discontinuation of maximal doses of oral antidiabetic agents. After 2 months of insulin treatment, a further improvement was achieved by a low dose of sulfonylurea in these patients who were formerly considered unresponsive to oral antidiabetic agents.

Aged↗
PubMed1992

Hyperglycaemic symptoms before diagnosis of non-insulin-dependent (type 2) diabetes mellitus in relation to 5-year outcome.

A group of newly diagnosed patients with non-insulin-dependent (type 2) diabetes mellitus (n = 133) were divided into two groups according to the symptoms of diabetes mellitus at diagnosis; a group (26 men and 17 women) with hyperglycaemic symptoms (polydipsia, polyuria, weight loss and tiredness) and a group (44 men and 46 women) without such symptoms. At the time of diagnosis, symptomatic patients tended to be leaner (P = NS), and they were more hyperglycaemic (P less than 0.001-0.06) and had lower insulin responses to an oral glucose load (P less than 0.01-0.05) than asymptomatic patients, but after 5 years no difference in these respects was found. No significant differences in the frequency of islet-cell antibodies or cardiovascular diseases were found between the two diabetic groups. At the 5-year examination, the initially symptomatic patients were receiving pharmacological treatment for hyperglycaemia more often than asymptomatic patients. No consistent differences in clinical characteristics and 5-year outcome were observed between those diabetic patients who were diagnosed on the basis of hyperglycaemic symptoms and those who were diagnosed for other reasons. In conclusion, in middle-aged patients with newly diagnosed diabetes mellitus classified as non-insulin-dependent, diabetic symptoms at diagnosis did not predict the 5-year outcome of the patients in terms of metabolic control or cardiovascular events.

Diabetes Mellitus, Type 2↗
PubMed1991

Five-year follow-up of islet cell antibodies in type 2 (non-insulin-dependent) diabetes mellitus.

The aim was to study the frequency and appearance of cytoplasmic islet cell antibodies in relation to impairment of insulin secretory capacity and some clinical characteristics in a representative group of middle-aged (45-64 years) patients with Type 2 (non-insulin-dependent) diabetes mellitus (70 male, 63 female) at the time of diagnosis and at five-year follow-up. Non-diabetic control subjects (62 male, 82 female) were similarly examined at five-year intervals. At the baseline five out of 133 (3.8%) diabetic patients were positive for conventional and four (3.0%) for complement-fixing islet cell antibodies. Ten patients had become positive by the second screening for conventional antibodies and six for complement-fixing antibodies, but none showed negative conversion. Two non-diabetic subjects (1.5%) became antibody positive during the follow-up. Insulin treatment was started during the follow-up for four out of 15 (27%) conventional antibody positive and for one out of 121 (0.8%) antibody negative diabetic patients (p = 0.001). The sensitivity of the positive conventional and complement-fixing antibody for identifying patients who developed an impairment of insulin secretory capacity (post-glucagon C-peptide less than or equal to 0.60 nmol/l at 5-year) was 75%. The respective specificity was 90% and the positive predictive values were highest in the case of high positivity (50%). The negative predictive value of antibody positivity was close to 100%. In conclusion, islet cell antibody positivity in patients classified as Type 2 was persistent during the follow-up and predicted the future development of insulin deficiency especially in those patients with high or increasing antibody titres.

Autoantibodies↗
PubMed1991

Psychotherapy in patients with poorly controlled type 1 (insulin-dependent) diabetes.

We studied a group of 9 poorly controlled type 1 diabetic patients who were referred to the metabolic ward for a 10-day intensive patient education and treatment period and followed thereafter for 1 year. The psychodynamically and phase-specifically oriented intensive psychotherapy was prescribed. In terms of mental coping ability assessed by an index constituting the attitude towards diabetes, the family support and the expectations from the psychotherapy, the final outcome was classified as good or moderate in 7 of 9 patients. The complexities of different personality characteristics and their interaction with metabolic control are issues that require further exploration.

Adaptation, Psychological↗
PubMed1990

Microalbuminuria predicts the development of serum lipoprotein abnormalities favouring atherogenesis in newly diagnosed type 2 (non-insulin-dependent) diabetic patients.

We studied the relationship of slight albuminuria (microalbuminuria) to serum lipid and lipoproteins in a representative group of middle-aged Type 2 (non-insulin-dependent) diabetic patients. A random sample of non-diabetic control subjects was also examined. Diabetic patients had both at diagnosis and after five years higher total, LDL- and VLDL-triglyceride levels and higher VLDL-cholesterol, but lower HDL-cholesterol levels than non-diabetic subjects. No consistent difference was found in LDL-cholesterol levels between diabetic and non-diabetic subjects. The prevalence of microalbuminuria (greater than 35 mg/24h) remained about the same in diabetic patients at both examinations (19-20%). The diabetic patients with persistent microalbuminuria were slightly hyperglycaemic and they tended to have lower creatinine clearance at the 5-year examination than those without persistent microalbuminuria. There were no differences in the blood pressure levels or the occurrence of hypertension between the diabetic groups with and without microalbuminuria. At the baseline examination, no differences were seen in serum lipids and lipoproteins between diabetic patients with and without microalbuminuria. In patients with persistent microalbuminuria, a statistically significant increase in VLDL-cholesterol (p less than 0.05) and VLDL- and LDL-triglyceride levels (p less than 0.05) and a decrease in HDL-cholesterol level (p less than 0.05) was seen at the 5-year follow-up. These changes could not be explained by age, sex, body mass index or HbA1. In conclusion, persistent microalbuminuria predicts and aggravates abnormalities in lipoprotein composition and a decrease in HDL-cholesterol in patients with Type 2 diabetes mellitus.(ABSTRACT TRUNCATED AT 250 WORDS)

Albuminuria↗
PubMed1990

Eosinophilic fasciitis. Increased collagen production and type I procollagen messenger RNA levels in fibroblasts cultured from involved skin.

Two patients with eosinophilic fasciitis were studied to elucidate the activation of collagen production in this disorder. Histologic examination of biopsy specimens from the involved area of skin revealed the presence of inflammatory cell infiltrates and various degrees of collagen accumulation in the dermis, subcutis, fascia, and underlying muscle. Fibroblast cultures initiated from the involved skin exhibited 2.0- to 3.7-fold increased collagen production when compared with control fibroblast cultures established from the uninvolved skin of the same patients. Eosinophilic fasciitis fibroblasts also displayed 2.4- to 6.2-fold higher steady-state levels of type I procollagen messenger RNA than did the control cells, indicating pretranslational activation of type I procollagen gene expression. In addition, cellular fibronectin messenger RNA steady-state levels were elevated 1.9- to 3.3-fold in eosinophilic fasciitis fibroblasts. These results suggest that fibroblasts in the involved skin of patients with eosinophilic fasciitis exhibit an activated phenotype, similar to that of scleroderma fibroblasts, leading to accumulation of collagen in the skin and the underlying structures.

Adult↗