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Biomedical subjects

R B Tattersall

Publications and source records attributed to R B Tattersall.

At least 109 records · Page 6Linked to original sources
PubMed1976

Can phenformin-induced lactic acidosis be prevented?

Although patients taking phenformin are more likely to develop lactic acidosis in the presence of renal, cardiovascular, or hepatic disease, criteria for safe use of the drug are not well established. Eight diabetics died of lactic acidosis in Nottingham in 1972-5 and all were taking phenformin in therapeutic doses. Six had attended the diabetic clinic within a month of their terminal illness. Two patients had appreciable renal impairment and should not have been given phenformin. Four had hypertension and minimal evidence of renal disease, while in two no predisposing factor was identified. There are so many contraindications to the use of phenformin that it is doubtful whether patients on the drug can be monitored adequately. We suggest that phenformin should be withdrawn from general use.

Acidosis↗
PubMed1976

The various faces of diabetes in the young: changing concepts.

Diabetes included several disorders associated with hyperglycemia. A difference in inheritance between the families of juvenile-onset- and maturity-onset-type diabetics, provides evidence for genetic heterogeneity. Heterogeneity of insulin responses to glucose was foung among nonobese patients with maturity-onset-type diabetes. Prospective studies in young patients have shown that glucose intolerance may not progress for as long as 22 years and that subnormal insulin responses to glucose have not decreased further, up to 12 years. However, patients who progressed to diabetes requiring insulin had insulin responses that were subnormal or below the control mean. None whose insulin responses exceeded this mean have decompensated. Thus, insulin response to glucose has prognostic implications. A tentative classification of diabetes in the young is proposed. There was a significant correlation between muscle capillary basement membrane width and known duration of carbohydrate intolerance.

Adolescent↗
PubMed1975

Hemoglobin components in diabetes mellitus: studies in identical twins.

The minor components of hemoglobin which are increased in subjects with diabetes mellitus, hemoglobin Ala-c, were measured in identical twins concordant and discordant for diabetes to determine whether the observed increases represent a genetically determined abnormality. The mean values for the proportion of hemoglobins Ala-c in discordant twins differed markedly in the two members of the pair: 10.4 +/- 0.74 per cent for the diabetic twins and 6.85 +/- 0.33 for the nondiabetic twins (t = 4.3811, P less than 0.005). In concordant twins with juvenile onset diabetes, the mean proportion of Hb Ala-c was 11.4 per cent, and no marked differences were observed between members of twin pairs. Four pairs of identical twins concordant for maturity onset diabetes showed lower mean values for Hb Ala-c but did not show marked intra-pair differences. Thus, the abnormal proportions of hemoglobins Ala-c found in the presence of overt diabetes mellitus appear to be a manifestation of a metabolic abnormality of diabetes.

Adolescent↗
PubMed1975

Glucagon secretion in unaffected monozygotic twins of juvenile diabetics.

Glucagon secretion during a 50-g oral glucose tolerance test has been investigated in 16 nondiabetic monozygotic twins of juvenile diabetics and compared with the results in 10 normal controls and 10 untreated, newly diagnosed, maturity-onset diabetics. Normal subjects showed a significant mean fall in glucagon at 15, 30, and 60 min, with a return to the baseline at 120 min. Maturity-onset diabetics showed a significant mean rise 15 min after oral glucose. The mean of the twin group was intermediate between normals and diabetics, although there was considerable individual variation with some showing suppression and others stimulation of glucagon release. When the twins were divided according to the length of discordance it was found that the mean response in the 8 twins who had been discordant for a mean of 19 years was indistinguishable from that of normal subjects, whereas the mean response of twins discordant for a mean of only 4.5 years was similar to that of the diabetic patients. It is possible, therefore, that hypersecretion of glucagon may occur in some subjects predisposed to develop diabetes mellitus, and the finding of lack of suppression of glucagon in the identical twin of a juvenile diabetic may be of prognostic significance. Identical twins who have been discordant for over 10 years are thought on other grounds to be unlikely to develop diabetes, and the finding of a normal glucagon response is further confirmation of their normal metabolic status and reinforces the suggestion that they are not prediabetic.

Adult↗
PubMed1975

A difference between the inheritance of classical juvenile-onset and maturity-onset type diabetes of young people.

A difference in the inheritance of diabetes has been shown between the families of twenty-six patients with maturity-onset type diabetes of young people (MODY) and families of thirty-five patients with classical juvenile-onset diabetes (JOD). In the families of MODY: 1) twenty-two of twenty-six (85 per cent) propositi had a diabetic parent; 2) 46 per cent of families showed direct vertical transmission of diabetes through three generations; 3) of forty-seven tested siblings twenty-five (53 per cent) had latent diabetes; 4) the diabetic phenotype in the families was consistent, most affected individuals having a noninsulin requiring type of disease. These findings are compatible with autosomal dominant inheritance of MODY, although they do not exclude multifactorial inheritance. In contrast, in the families of JOD: 1) only four (11 per cent) of propositi had a diabetic parent; 2) three generation inheritance was found in only two (6 per cent) of JOD families, and 3) of seventy-four tested siblings eight (11 per cent) were diabetic. This difference provides further evidence of genetic heterogeneity in diabetes mellitus and indicates that there is a need for careful definition of the phenotype of diabetes in populations in which the genetics of diabetes is to be analyzed. Diabetes 24:44-53, January, 1975.

Adolescent↗
PubMed1973

Diabetes in twins.

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Diabetes Mellitus↗
PubMedDate not supplied

Optic disc swelling in young diabetic patients: a diagnostic dilemma.

We describe four young diabetic patients presenting with swelling of one or both optica discs ('papiloedema'). Two were asymptomatic while the others complained of blurred vision. Spontaneous resolution occurred in all within 6 months although three had developed optic atrophy within 5 years. These four patients fit into a spectrum of acute involvement of the optic nerve in young diabetic patients, of which over 50 cases have now been reported. Most have florid ophthalmoscopic appearances which resolve within weeks or months and usually carry a good visual prognosis. The condition appears to be a variant of anterior ischaemic optic neuropathy though its possible pathophysiology in diabetes is uncertain. Knowledge of the condition by diabetologists and ophthalmologists is important as patients and doctors may be reassured after fairly simple investigation.

Adolescent↗