Type 2 diabetes is increasing in prevalence and is predominantly managed in general practice. This series contains case histories which deal with some of the metabolic problems that may be encountered in the management of these patients and indicates some of the many issues, other than glycaemic control, that need to be considered.

Diabetes Mellitus, Type 2↗

PubMed1997

Monitoring glucose control.

Type 2 diabetes is increasing in prevalence and is predominantly managed in general practice. This series contains case histories raising some of the metabolic problems which may be encountered in the management of these patients and indicates some of the many issues, other than glycaemic control, that need to be considered.

Blood Glucose Self-Monitoring↗

PubMed1997

A cautionary tale.

Aged↗

PubMed1997

The diabetic with renal impairment.

Explore the source record for details and available documents.

Aged↗

PubMed1995

Case studies in lipid management.

Seven cases are described that highlight practical aspects of lipid management in Australian general practice. The major issues are strategies for obtaining reliable lipid values, interpreting the lipids in the context of overall cardiovascular risk, and appropriate use of pharmacotherapy in high risk patients.

Adult↗

PubMed1993

Hypertension and diabetes in older people.

Explore the source record for details and available documents.

Aged↗

PubMed1991

A randomised study of outcomes in a defined group of acutely ill elderly patients managed in a geriatric assessment unit or a general medical unit.

The aim of this study was to identify differences in the medical management and clinical outcome in a group of elderly patients admitted to a designated geriatric assessment unit (GAU) or to two general medical units (GMUs). A prospective randomised controlled trial was undertaken in 267 patients aged 70 years and over (mean age = 78.3 years). Following discharge from hospital, patients were followed up at three monthly intervals for a total of 12 months. At the time of discharge, no significant differences were found in inpatient management, length of stay, mortality rates, discharge rates to institutional care or utilisation of community services in patients admitted to the GAU and the GMUs. Similarly, no significant differences were found at three, six, nine, and 12 month follow up in case fatality, activities of daily living indices, mental health status, rates of institutional referral and the level of community service support in patients admitted to the GAU and the GMUs studied. These findings do not show any advantage for the unselected 70+ acutely ill elderly patient who is admitted to a designated geriatric assessment unit rather than to a general medical unit. Therefore, an admission policy to GAU, based solely on age 70+ is medically inappropriate and cost-inefficient. Evidence from other sources suggests that an age cohort of acutely admitted patients beyond 80 years may well have returned more optimistic findings for the GAU. In future, GAUs will require a more selective admission policy to maximise the benefits of their rehabilitative and interdisciplinary approach.

Acute Disease↗

PubMed1987

The influence of age on steroidogenic enzyme activities of the rat adrenal gland: enhanced expression of cholesterol side-chain cleavage activity.

The ability of isolated adrenocortical cells to secrete corticosterone in response to ACTH challenge declines as rats age, but the site or mechanism(s) of this impairment is still unknown. To test the functionality of steroidogenic capacity per se, we measured the key enzyme activities involved in corticosterone biosynthesis. We also measured the mitochondrial cytochrome P-450 content and nonsteroidogenic enzymes specific for subcellular fractions. Mitochondria and microsomal fractions were isolated from the adrenals of 2-, 12-, and 18-month-old animals and used for various enzyme measurements. Mitochondrial side-chain cleavage enzyme activity (nanomoles per min mg protein-1) increased from a mean of 0.43 +/- 0.06 in 2-month-old rats to 1.26 +/- 0.11 and 1.51 +/- 0.06 in 12- and 18-month old rats, respectively. After incubation with 5-cholesten-3 beta,25-diol (25-hydroxycholesterol; 25 micrograms/ml) side-chain cleave activity rose to 5.0 +/- 0.6, 12.4 +/- 1.2, and 16 +/- 1.4 nmol min-1 mg protein-1 in adrenal mitochondrial fractions from 2-, 12-, and 18-month-old rats, respectively. In contrast, mitochondrial cytochrome P-450 content did not vary with advancing age. Microsomal delta 5-3 beta-hydroxysteroid dehydrogenase-delta 5-delta 4-isomerase activities were similar in 2- and 12-month-old rats, but 21-hydroxylase (nanomoles per min mg protein-1) activity was significantly increased in 12-month-old rats (2-month-old, 5.2 +/- 0.2; 12-month-old, 7.7 +/- 0.5). Finally, mitochondrial 11 beta-hydroxylase was comparable in both age groups. In addition, activities of mitochondrial nonsteroidogenic enzymes, such as monoamine oxidase, amytal insensitive NADH cytochrome c reductase, cytochrome c oxidase, succinate dehydrogenase, and malate dehydrogenase, did not change with age. It appears from the evidence presented that the activities of the steroidogenic enzymes are not responsible for the diminished capacity in corticosterone production seen with aging in the rat.

Adrenal Glands↗

PubMed1987

Effects of aging on cholesterol content and cholesterol-metabolizing enzymes in the rat adrenal gland.

Previous studies from this laboratory have documented a progressive decline in basal and ACTH-stimulated corticosterone production in isolated adrenocortical cells as rats age. In the current study we examined the possibility that the aging process exerts this effect by interfering with the mechanism(s) by which cholesterol is processed and/or synthesized by the adrenal gland. Freshly excised adrenals from 2-, 5-, 12-, and 18-month-old rats were used for the measurement of cholesteryl ester, free cholesterol, cholesteryl esterases, and acyl co-enzyme A (CoA)-cholesterol acyltransferase activities as well as key enzymes involved in cholesterol biosynthesis. The results showed that cholesteryl ester content increased in a linear manner with advancing age, while neutral cholesteryl esterase activity decreased steadily until at 18 months of age it reached 40% that of 2-month-old control rats. In contrast, lysosomal acid cholesteryl esterase did not change with age, and acyl CoA: Cholesterol acyltransferase showed only a 33% decrease at 12 months of age. The activity of 3-hydroxy-3-methylglutaryl CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis, decreased steadily with advancing age, and at 18 months of age, activity was only half of that in 2-month-old control rats. In contrast, the activities of other enzymes involved in the de novo synthesis of cholesterol, namely acetoacetyl CoA thiolase and HMG CoA synthase, were similar in 2- and 12-month-old rats, while mevalonate kinase activity was significantly lower in the 12-month-old rats. After depletion of plasma lipoprotein cholesterol by 4-aminopyrazolo-[3,4-d]pyrimidine, the intraadrenal cholesteryl ester content in young and aged animals fell significantly. Furthermore, such treatment enhanced the activities of all of the cholesterol de novo synthetic enzymes examined. In addition, HMG CoA synthase and HMG CoA reductase activities rose to much greater levels in both young and old rats compared to acetoacetyl CoA thiolase and mevalonate kinase. Finally, markedly higher activities of HMG CoA reductase were observed in 12- and 18-month-old rats after 4-aminopyrazolo-[3,4-d]pyrimidine treatment. Similar results were seen using 17 alpha-ethinyl estradiol to deplete cholesterol and adrenal sterol ester stores. The metabolism of endogenous cholesterol and exogenous hydroxysterols (which bypass the cAMP-dependent transport of endogenous cholesterol to mitochondrial side-chain cleavage enzyme complex) to corticosterone by collagenase-dispersed adrenocortical cells isolated from rats of various ages were also studied.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenal Glands↗

PubMed1986

Differential effects of aging on adrenocorticotropin receptors, adenosine 3'5'-monophosphate response, and corticosterone secretion in adrenocortical cells from Sprague-Dawley rats.

This study examined the effect of aging on adrenal cell function in Sprague-Dawley rats, as judged by the binding of iodinated Phe2, Nle4-ACTH-(1-38) to the adrenal cells, and the ability of the cells to respond to ACTH stimulation by the production of cAMP and corticosterone in vitro. Collagenase-dispersed adrenal cells obtained from 2-, 12-, and 18-month-old-rats were used. The maximum corticosterone concentration after incubation with ACTH was significantly lower (P less than 0.001) in the 12-month-old (40 +/- 7 ng/micrograms DNA) and 18-month-old rats (28 +/- 3 ng/micrograms DNA) compared to that in 2-month-old controls (102 +/- 9 ng/micrograms DNA). The ED50 values of ACTH-induced corticosterone production measured in the cell suspension were similar in 2- and 12-month-old groups (30 pg/ml), and the diminished production of corticosterone in the 12-and 18-month-old rats persisted after incubation with N6,O2-dibutyryl cAMP. Neither the number nor the binding affinity of adrenal receptors for [125I]I-Tyr23,Phe2,Nle4-ACTH-(1-38) changed from 2-12 months of age. Furthermore, increases in concentrations of intra- and extracellular cAMP after ACTH stimulation were not significantly different in the 2-, 12-, and 18-month-old groups. Similarly, adrenal hydrolysis of cAMP by low and high Km phosphodiesterases did not change significantly with advancing age. These results provide strong evidence that there is a diminished capacity for corticosterone production with aging in the rat, and that the site of the defect lies distal to binding of trophic hormone to its receptor and to the production of its secondary messenger. Finally, an age-related decline in adrenal steroidogenic capacity could be viewed as a counterregulatory mechanism invoked in old rats to compensate, at least partially, for elevated plasma ACTH and corticosterone concentrations.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed1984

Peer review of utilisation of medical beds at Flinders Medical Centre.

A clinical audit of all medical inpatients was undertaken and the appropriateness of admissions and of length of stay was assessed from a clinical viewpoint on 4 separate days within an 11 day period. In addition, the mode of entry of hospital, length of stay of patients, occupancy rate, and the vacancy interval were analysed for all medical patients during the preceding three months. The mean length of stay of medical patients in hospital during this 3 months period was 5.6 days, with an occupancy rate of 93% and a vacancy interval of 0.43 days. Seventy-four percent of all medical inpatients were admitted through the Accident and Emergency Department (A&E). The short length of stay, high occupancy rate and low vacancy interval indicated that bed usage in the medical wards was efficient. A total of 493 reviews was carried out on 294 individual patients. In 87% of cases, both admission to hospital and length of stay were appropriate on clinical grounds alone. The number of patients whose admission to hospital (11), or length of stay (27) was not justified on medical grounds alone was 38 (13% of total patients). These patients were elderly, or had complex social and psychological problems contributing to their illness. It was concluded that stricter control of admissions or length of stay was unlikely to make a significant numbers of beds available for other admissions.

Australia↗

PubMed1984

A review of early medical readmissions at the Flinders Medical Centre.

Explore the source record for details and available documents.

Australia↗