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Biomedical subjects

R B Paisey

Publications and source records attributed to R B Paisey.

At least 19 recordsLinked to original sources
PubMed2004

Hypertriglyceridaemia in Alström's syndrome: causes and associations in 37 cases.

OBJECTIVE: To document frequency of severe hypertriglyceridaemia in Alström's syndrome (AS) and its relationship to hepatic and renal function, glycaemia and insulin resistance. PATIENTS AND METHODS: Thirty-seven subjects with AS aged 5-35 years, 51% male, were assessed at multidisciplinary clinics in Canada, UK and Italy. Diagnostic criteria were: severe cone/rod dystrophy leading to severe visual impairment in early childhood, sensorineural deafness, moderate overall obesity and normal intelligence. Three patients were treated with thyroxine for primary hypothyroidism and one female patient for secondary amenorrhoea with 20 micro g ethinyloestradial combined oral contraceptive. Two male patients were receiving monthly intramuscular testosterone enanthate for secondary hypogonadism. Fasting bloods were taken for serum insulin, serum glucose, serum triglycerides, hepatic and renal function and glycosylated Hb. Triglyceride levels > 8 mmol/l and fasting serum insulin levels > 16 microunits/ml were considered to represent severe hypertriglyceridaemia and severe insulin resistance, respectively. All subjects with (23) hypertriglyceridaemia also had high insulin resistance, as measured by HOMA modelling. However, there was no significant correlation between log tyriglyceride and log serum insulin or HOMA in the whole group (P = 0.2 and 0.14, respectively). There was no clear relationship between serum triglyceride levels and age, body mass index (BMI), hepatic or renal impairment or glycaemia. CONCLUSION: The first overview of serum triglyceride levels in a significant number of reported cases of Alström Syndrome shows an overlap between severe hypertriglyceridaemia and severe hyperinsulinism, but not a direct correlation between the two nor with insulin resistance measured by HOMA. Triglyceride levels were not related to glycaemia, hepatic or renal dysfunction.

Adolescent↗
PubMed2002

Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes.

AIMS: To complete 5-year follow-up of an intensive weight loss programme in established type 2 diabetic subjects. METHODS: Forty-five obese type 2 diabetic subjects, Body mass index (BMI) > 30, expressed interest in an intensive weight loss programme. Group 1 comprised 15 who selected very low calorie diet (VLCD), Group 2, 15 selected intensive conventional diet and exercise (ICD), 15 failed to follow either programme. Group sessions of eight to 15 subjects continued weekly for 6 months, then monthly for 12 months with prospective recording at 3, 6 and 12 months and then annually of quality of life, BMI, waist/hip ratio, blood pressure, fasting blood glucose, serum fructosamine and serum lipids. RESULTS: Weight loss was slower in the intensive conventional diet group than in the VLCD group, but better maintained at 5 years: group 1, 4.8 +/- 6 kg; group 2, 8.9 +/- 4 kg. In the intensive conventional diet group, 5 year high-density lipoprotein cholesterol was increased 1.78 +/- 0.26 mmol L-1 vs. 1.10 +/- 0.32 mmol L-1 at baseline, and diastolic blood pressure reduced 74.5 +/- 13.3 vs. 85.5 +/- 13.3 at baseline, both P < 0.05. CONCLUSIONS: Out-patient VLCD treatment proved safe and effective in overweight diabetic subjects but those who chose conventional diet and exercise had a slower but more sustained weight loss. Diabetic patients willing to attempt VLCD may safely lose sufficient weight to allow major surgery, but weight regain is inevitable. Patients willing to undertake a long-term group programme of conventional diet can sustain significant weight loss for 5 years, but still require antidiabetic medication.

Adult↗
PubMed1998

An intensive weight loss programme in established type 2 diabetes and controls: effects on weight and atherosclerosis risk factors at 1 year.

The efficacy, safety, and effect on cardiovascular risk factors of two intensive weight loss programmes in overweight Type 2 diabetic subjects were studied. The patients were recruited from hospital diabetic clinics and control obese subjects from the community. Obese (BMI >30) patients with Type 2 diabetes mellitus and controls were offered intensive conventional diabetic advice or a very low calorie diet. Weekly 2 h sessions were conducted in two day-room areas of adjacent medical wards of Torbay Hospital. Non-diabetic and diabetic very low calorie diet groups reduced BMI by 6 and 5 kg m(-2), respectively, at 1 year. Waist-hip ratios (-0.06 and -0.05) were also reduced (p = 0.04 and p = 0.01), while HDL/total cholesterol ratios increased (+0.04 and +0.06, p = <0.01). Transient changes in blood pressure and antioxidant vitamin status occurred in the intensive conventional diet group. Fourteen of diabetic very low calorie diet subjects discontinued insulin and oral hypoglycaemic agents for the whole year, and psychological well-being transiently improved. Substantial weight loss and improvement in cardiovascular risk factors could be maintained for 1 year in Type 2 diabetic patients by the use of a very low calorie diet.

Adult↗
PubMed1986

Effects of cyproterone acetate and a long-acting LHRH analogue on serum lipoproteins in patients with carcinoma of the prostate.

Fasting serum lipoproteins were measured in 10 untreated patients with carcinoma of the prostate (Group I), 17 patients with non-malignant urological disorders (Group II), and 12 patients on cyproterone acetate (Group III) and 5 on a long-acting luteinizing hormone-releasing hormone (LHRH) analogue (Group IV) for at least 2 months for carcinoma of the prostate. Total high-density lipoprotein (HDL) cholesterol levels were significantly lower in patients in Group III than all the other groups. Very low-density lipoprotein (VLDL) triglyceride levels were significantly higher in patients in Group III than those in Groups II and IV. These results suggest a potentially adverse effect of cyproterone acetate, but not of the long-acting LHRH analogue, on serum lipids, which is likely to be of relevance only in younger patients.

Buserelin↗
PubMed1985

Glycosylation of maternal hair and cord skin during pregnancy in diabetic and non-diabetic women.

A study of 15 insulin-dependent diabetics (IDD), 4 gestational diabetics (GDM), and 21 non-diabetic women was undertaken to assess non-enzymatic glycosylation in maternal hair, cord skin, and cord blood. Glycosylation of maternal hair was stable from tip to root in controls. In the IDD group, levels were highest at the tip, but were significantly lower in the middle and scalp segment (p less than 0.01), both tip and middle segments were higher than control values (p less than 0.01). In contrast, only the scalp segment of hair from the GDM group had a higher than normal level of glycosylation (p less than 0.01). Cord skin and cord blood glycosylation were significantly increased in the IDD group compared with normal (0.100 +/- 0.002 vs 0.074 +/- 0.008 mumol fructosamine/100 mg, p less than 0.01, and 0.160 +/- 0.002 vs 0.14 +/- 0.008, p less than 0.05, mean +/- S.E.M.), respectively. Only cord skin glycosylation was increased in the GDM group (0.116 +/- 0.003, p less than 0.01). Thus near normal glycaemic control of maternal insulin-dependent diabetes during pregnancy was associated with small but significant increases in cord skin glycosylation and a fall towards normal in maternal hair glycosylation which may provide a useful retrospective index of diabetic control.

Adult↗
PubMed1985

Long-term high fibre, low fat diet in gestational diabetes.

A 30-year-old Caucasian who developed gestational diabetes in her first pregnancy requiring 58 U insulin daily and who subsequently adopted a high fibre, low fat diet and who was able to maintain normal glucose tolerance throughout a second pregnancy is reported.

Adult↗
PubMed1984

Persistent fetal haemoglobin and falsely high glycosylated haemoglobin levels.

Some of the routine methods of measuring glycosylated haemoglobin depend on its difference in charge from haemoglobin A and do not distinguish between glycosylated haemoglobin and fetal haemoglobin. Two insulin dependent diabetics showed persistent discrepancies between their capillary blood glucose values and their glycosylated haemoglobin values measured by agar gel electrophoresis: the blood values were normal but the glycosylated haemoglobin values were raised. In one patient increases in insulin dose in response to the glycosylated haemoglobin results repeatedly produced hypoglycaemia. Both patients were found to have higher than normal concentrations of fetal haemoglobin; and when measured by the thiobarbituric acid reaction their glycosylated haemoglobin levels were almost normal. This problem may be avoided by using a method that distinguishes between fetal and glycosylated haemoglobin or by testing glycosylation of hair or serum albumin if discrepancies arise. This is particularly important during pregnancy, when some women have an increase in fetal haemoglobin.

Adult↗
PubMed1984

Glycosylation of hair: possible measure of chronic hyperglycaemia.

To determine whether hair is excessively glycosylated in diabetes mellitus 4 cm hair samples were taken proximally from behind the ear in 50 white non-diabetics and 46 diabetics. Hair glycosylation was assayed by a modification of the thiobarbituric acid reaction. Blood was taken from the diabetics at the same time for measurement of glycosylated haemoglobin concentration. The mean (1 SD) concentration of fructosamine (mumol/100 mg hair) was 0.054 (0.011) for normal hair. Glycosylation was not related to sex, age, or hair colour. The diabetics' hair was more heavily glycosylated (0.097 (0.045] than normal (p less than 0.01) and there was a correlation between hair glycosylation and the concentration of glycosylated haemoglobin in the diabetics (r = 0.71; p less than 0.01). Hair from non-diabetics showed a stable time related increase in glycosylation when incubated with glucose. Glycosylation of hair might provide a stable long term measure of tissue glycosylation, useful in the investigation of microvascular complications of diabetes mellitus.

Adolescent↗
PubMed1980

Home blood glucose concentrations in maturity-onset diabetes.

Blood glucose concentrations during normal daily activities were measured in 106 patients with maturity-onset diabetes from capillary blood samples collected on to filter paper. Samples were taken before and two hours after main meals, before going to bed, and, in 51 cases, during the night. Fasting and mid-morning values were closely correlated with the mean values over 24 hours irrespective of the type of anti-diabetic treatment being given. Postprandial blood glucose concentrations remained below 11.5 mmol/l (207 mg/100 ml) when the fasting blood glucose value was 7.0 mmol/l (126 mg/100 ml) or less, and repeated fasting blood glucose values exceeding 7.0 mmol/l were associated with raised blood glycosylated haemoglobin concentrations. Diabetic control in maturity-onset diabetes may be satisfactorily monitored by regular measurement of fasting or mid-morning blood glucose values.

Adult↗
PubMed1980

The relationship between blood glycosylated haemoglobin and home capillary blood glucose levels in diabetics.

Serial capillary blood glucose levels from insulin treated patients were recorded over 24 hour periods at fortnightly intervals for three months. Total glycosylated haemoglobin as % of HbA was measured at the end of this period by the Flückiger method, and % HbA1 by column chromatography. There were highly significant correlations between mean blood glucose levels over the three months and % HbA1 (r = 0.93, 95% confidence limits 0.84-0.98), and with total glycosylated haemoglobin (r = 0.88, 95% confidence limits 0.75-0.94). There was also a good correlation between results obtained by the two methods (r = 0.81, p less than 0.0001). There were less strong correlations between % HbA1 and blood glucose levels during each of the three months before the estimation, with percentage of glucose levels greater than 10 mmol/l and with mean fasting blood glucose. These data support the hypothesis that % HbA1 and total glycosylated haemoglobin are satisfactory measurements of short term diabetic control.

Adult↗
PubMed1980

The effect of improvement in diabetic control on plasma and whole blood viscosity.

Rheological studies were made on the blood of 12 diabetic patients after a period of poor diabetic control (HbA1 12.6 +/- 0.7% (mean +/- SD); mean home capillary blood glucose level 11.7 +/- 1.2 mmol/l), and after at least three months of improved control (HbA1 9.1 +/- 0.4%, p < 0.01; mean home capillary blood glucose level 9.2 +/- 0.6 mmol/l). There were significant decreases in plasma fibrinogen levels (4.1 +/- 0.6 to 3.7 +/- 0.6 g/l, p < 0.01), plasma viscosity (1.31 +/- 0.1 to 1.25 +/- 0.04, p < 0.001), and whole blood viscosity at low (22.8 +/- 2.7 to 20.2 +/- 2.9, p < 0.01) and high shear rates (3.4 +/- 0.2 to 3.1 +/- 0.2, p < 0.01). Ten diabetics with clinically evident complications were matched with diabetics of similar age, sex, duration and current control of diabetes. There were no significant differences in plasma or whole blood viscosities between the two groups. Hyperviscosity in diabetes seems strongly related to hyperglycaemia and to be influenced by the quality of diabetic control.

Adolescent↗