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Biomedical subjects

R F Fletcher

Publications and source records attributed to R F Fletcher.

At least 37 records · Page 2Linked to original sources
PubMed1984

Effect of a high fibre, high carbohydrate dietary regimen on serum lipids and lipoproteins in type II hypertensive diabetic patients.

Fifty Type II diabetic patients with mild hypertension were treated by a high cereal fibre, low fat and low sodium diet in a controlled trial for a 3-month period. The modified diet and control diet groups were well matched although the control group had significantly increased levels of HDL2-cholesterol (p less than 0.05). The modified diet group had a significant reduction of mean serum triglyceride (p less than 0.05) and elevation of HDL2 (p less than 0.05) levels. There was also a reduction of systolic (p less than 0.001) and diastolic blood pressure (p less than 0.001), weight (p less than 0.01) and glycosylated haemoglobin (p less than 0.001). No changes were observed in the control group. In those patients with added hyperlipidaemia, dietary therapy resulted in a significant decrease of mean serum cholesterol (p less than 0.02), triglyceride (p less than 0.01) and glycosylated haemoglobin levels (p less than 0.01). The control group had a significant reduction of HDL-cholesterol (p less than 0.02). We conclude that a high cereal fibre, low fat and low sodium dietary regimen is associated with improvement in cardiovascular risk over a 3-month period, especially in those with hyperlipidaemia. Contrary to previous reports, no deleterious effect on serum triglyceride, HDL- and HDL2-cholesterol levels were recorded in this study. These data add further support to the recent dietary recommendations of several Diabetic Associations.

Blood Pressure↗
PubMed1984

Comparison of the hypotensive and metabolic effects of metoprolol therapy with a high fibre, low sodium, low fat diet in hypertensive type 2 diabetic subjects.

The clinical and biochemical response over a 3 month trial period of 21 hypertensive diabetics who were given metoprolol, 200 mg twice daily, have been compared to an age, sex, blood pressure, known duration of diabetes and diabetic treatment matched group who were treated with a high cereal fibre, low sodium and low fat diet. Both treatment groups had a significant reduction of systolic (p less than 0.001 on the diet; p less than 0.02 on metoprolol) and diastolic blood pressure (p less than 0.001 respectively). On metoprolol the heart rate significantly decreased throughout the study (p less than 0.001). Only the modified diet was accompanied with a reduction of mean glycosylated haemoglobin (p less than 0.01) and weight (p less than 0.001). By the end of the study mean serum triglyceride level was lower in the diet treated group (p less than 0.05) compared to the metoprolol group. In hyperlipidaemic patients only dietary therapy significantly decreased mean serum triglyceride (p less than 0.02) and glycosylated haemoglobin (p less than 0.001). We conclude that although both treatments had a similar hypotensive response only the modified diet beneficially influenced other cardiovascular risk factors. These data suggest that this diet might be considered an alternative to metoprolol in hypertensive diabetic patients.

Blood Pressure↗
PubMed1983

Effect of metformin on insulin receptor binding and glycaemic control in type II diabetes.

To investigate the effect of metformin on insulin receptor binding and diabetic control, eight obese type II diabetic patients were studied before treatment, after one and four weeks of taking metformin (500 mg thrice daily), and four weeks after withdrawal of the drug. After one and four weeks of treatment the number of erythrocyte insulin receptors had increased by 116% and 184% respectively. This was due almost entirely to an increase in the number of low affinity binding sites. The number of receptors was still raised four weeks after metformin had been withdrawn. Diabetic control as assessed by urinary glucose, glycosylated haemoglobin (HbA1), and glucose tolerance values was significantly improved during metformin treatment, while plasma insulin concentrations were not altered. These results indicate that metformin produces a rapid and protracted increase in low affinity insulin receptors in type II diabetes, associated with greater insulin sensitivity and improved diabetic control.

Aged↗
PubMed1983

The ethnic prevalence of hypertension in a diabetic clinic.

Using the WHO criteria of hypertension, we have demonstrated that 40% of randomly selected diabetic clinic attenders under the age of 65 were hypertensive. Black diabetics had a significantly greater prevalence (P less than 0.001) of hypertension than either white or Asian diabetics. Hypertension was commoner in black and white females compared with males (P less than 0.001); in Asians this difference was not statistically significant. Systolic hypertension was the most common form in all ethnic groups. Only 38.7% of diabetics receiving antihypertensive therapy had normal blood pressure readings. Blood pressure measurement should therefore be routinely performed in all diabetic patients under the age of 65, particularly in females of all ethnic groups and in black males.

Adult↗
PubMed1983

The effects of a high fibre, low fat and low sodium dietary regime on diabetic hypertensive patients of different ethnic groups.

Fifty-three diabetic patients with mild hypertension were allocated to a treatment diet with a high fibre, low fat and low sodium dietary regime or a control diet. After a 1-month treatment period, the modified-diet treated group (n = 35) showed a highly significant reduction in mean diastolic blood pressure (P less than 0.001) accompanied by significant reduction in urinary sodium excretion (P less than 0.01). The mean values of diastolic pressure (P less than 0.05) and urinary sodium/potassium ratio (P less than 0.01) were also significantly reduced at 1 month compared to control. White (n = 16) and West Indian (n = 10) diabetic hypertensive patients demonstrated a similar significant hypotensive response (P less than 0.05 and less than 0.01 respectively) with reduction in urinary sodium excretion to the modified diet. In contrast, Asian patients demonstrated no significant changes. Treatment of hypertension in diabetic subjects with a high fibre, low fat and low sodium dietary regimen may have a hypotensive response after a period of 1 month and there is a similar response in both black and white ethnic groups. Further observation of these patients will determine long-term response and compliance.

Adult↗
PubMed1983

Methazolamide and acetazolamide in acute mountain sickness.

Methazolamide (150 mg/d) was as effective as acetazolamide (500 mg/d) in preventing the symptoms of acute mountain sickness in 20 subjects ascending to 4985 m. PaO2 and oxygen saturation levels were similar on the two drugs but the fall in PaCO2 was greater on acetazolamide. Paraesthesiae, a side-effect of carbonic anhydrase inhibitors, tended to be less at high altitude on methazolamide and was significantly less when taking 100 mg/d at low altitude. It is likely that paraesthesiae is similar on the two drugs when given in doses that affect blood gases equally.

Acetazolamide↗
PubMed1981

Left ventricular function in diabetes mellitus. II: Relation between clinical features and left ventricular function.

We have shown a close relation between clinical microvascular complications and abnormalities of left ventricular function in 185 established diabetics without clinical heart disease. In 50 insulin-dependent diabetics who presented at under 20 years of age there was a correlation between the duration of diabetes and the isovolumic relaxation time, minimal dimension to mitral valve opening, and ratio of pre-ejection period to left ventricular ejection time. Diabetics with mild microvascular complications were similar to diabetics with no complications except for minor prolongation of the diastolic time intervals. Those with severe complications were significantly different from diabetes with milder complications and normal controls in all variables of left ventricular function. A close relation between left ventricular function and the microvascular complications index (code 0 when no complications to code 7 when all present and severe) was found for the following variables: isovolumic relaxation time, the interval from minimal dimension to mitral valve opening, ratio of pre-ejection period to left ventricular ejection time, and pre-ejection period index. It is concluded that in diabetes abnormalities of left ventricular function are related to duration of disease and complications; and that a diabetic specific heart muscle disorder occurs frequently in patients with severe microvascular complications.

Adult↗
PubMed1977

The treatment of Cushing's disease by trans-sphenoidal hypophysectomy.

Thirteen patients aged 24 to 65 with Cushing's disease have been treated by transphenoidal hypophysectomy. There was one incident of meningitis and one late death from myocarditis. No radiotherapy was given. In 12 patients pituitary histology showed Crooke's changes and an adenoma was present in seven. On review of the 12 survivors two to 11 years later, 11 are in complete remission. One patient still showed some clinical features of Cushing's syndrome but steroid levels were normal. In five of the seven premenopausal women normal menstruation has returned and pregnancy has occurred in three. In four patients replacement hormone therapy is no longer required and a further four take only partial treatment. We conclude that transphenoidal hypophysectomy is an effective treatment for Cushing's disease.

Adrenal Cortex Function Tests↗