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Biomedical subjects

U Adamson

Publications and source records attributed to U Adamson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study.

In order to implement the St Vincent Declaration programme, instruments for quality assurance of medical outcomes as well as measures of psychological outcomes of diabetes care had to be developed. This paper presents baseline values for three questionnaires measuring psychological Well-being, Treatment Satisfaction and General Health among a representative sample of adult people with diabetes in Sweden consisting of 423 individuals of which 153 were insulin treated and 270 were diet/tablet-treated. Cronbach's alpha indicated that each of the Well-being and Treatment Satisfaction subscales was internally reliable, alphas ranging from 0.66-0.88. Factor analysis resulted in identification of five subscales (depression, anxiety, positive well-being, treatment satisfaction and metabolic control). There was no relation between any of the quality of life subscales with HbA1c, BMI, duration of diabetes, frequency of blood glucose tests per day, insulin regimens or diabetic complications. Females reported a more negative impact of diabetes on daily life compared with males (p < 0.001). In conclusion, the Well-being and Treatment Satisfaction scales are reliable for quality assurance purposes in diabetes while the briefer general health instrument provides a useful assessment of the global impact of a chronic disease.

Adult↗
PubMed1995

Day-to-day variation of insulin sensitivity in patients with type 1 diabetes: role of gender and menstrual cycle.

The aim of the present study was to compare the day-to-day variations of the insulin sensitivity in male and female Type 1 diabetic patients and to assess the insulin sensitivity in the follicular and luteal phases of the menstrual cycle. Ten male and 20 female Type 1 diabetic patients participated in the study. The insulin sensitivity was assessed by the insulin (0.4 mU kg-1 min-1)-glucose/(4.5 mg kg-1 min-1)-infusion test (IGIT). In 5 of the female patients, a simultaneous i.v. influsion of somatostatin (100 micrograms h-1) was given (SIGIT). Each patient was studied twice, with 2 weeks separating the two tests. The day-to-day variations of the insulin sensitivity were almost identical in the male and female patients, the coefficients of variation being 13% in both groups. In 15 of the female patients, ovulation occurred. In these women, the mean blood-glucose levels between 120 and 240 min after the onset of the IGIT/SIGIT were 9.8 +/- 1.1 mmol l-1 in the follicular phase and 10.3 +/- 1.0 mmol l-1 in the luteal phase, n.s. (95% confidence interval for the difference (luteal-follicular) -0.8-1.9 mmol l-1). Although the present study cannot exclude minor changes of insulin sensitivity during the menstrual cycle, our results suggest that the changes of the metabolic control during the menstrual cycle, experienced by many women with Type 1 diabetes, are largely attributable to mechanisms other than variations of insulin sensitivity.

Adult↗
PubMed1995

Comparison of bedtime NPH or preprandial regular insulin combined with glibenclamide in secondary sulfonylurea failure.

OBJECTIVE: To compare the effect of bedtime NPH insulin or preprandial regular insulin combined with glibenclamide on metabolic control in non-insulin-dependent diabetes mellitus (NIDDM) patients with secondary failure to sulfonylurea therapy. RESEARCH DESIGN AND METHODS: Eighty NIDDM patients were randomized to treatment with either three preprandial doses of regular insulin (daytime group D) or a bedtime dose of NPH insulin (nocturnal insulinization, group N), both regimens being combined with 10.5 mg of glibenclamide. Metabolic profiles were obtained at 0, 6, 16 weeks. RESULTS: Glycemic control had improved significantly in both groups after 4 months. Fasting blood glucose was significantly lower compared with baseline in both groups. The mean change +/- SD in group D was -2.8 +/- 3.5 mmol/l and in group N -6.4 +/- 3.0 mmol/L, the reduction being more pronounced in group N compared with group D (P < 0.0001). HbA1c was lowered similarly, from 9.2 +/- 1.4 to 7.1 +/- 1.2% in group D (P < 0.0001) and from 9.1 to 1.1 to 7.5 +/- 1.5% in group N (P < 0.0001). The total daily insulin doses were similar, 29 +/- 11 U in group D and 26 +/- 9 U in group N, and the circulating insulin levels during daytime were higher in group D than in group N. Total serum cholesterol and triglycerides were similarly and significantly lowered compared with baseline in both groups. Weight gain was more pronounced in group D (3.4 +/- 0.3 kg) than in group N (1.9 +/- 1.9 kg; D vs. N, P < 0.002), and the change was inversely correlated with initial eight but not with the improvement in HbA1c. CONCLUSIONS: The two insulin regimens exert similar effect on glucose metabolism and serum lipids in NIDDM patients on combination therapy. Weight gain is more pronounced in patients given insulin during the daytime when preprandial doses of short-acting insulin are used.

Adult↗
PubMed1994

Acute mental stress impairs insulin sensitivity in IDDM patients.

The effect of acute mental stress on insulin sensitivity was evaluated in ten IDDM patients, studied on two occasions (test day and control day) in random order and separated by a period of 1-3 weeks. Mental stress was evoked by a modified filmed version of Stroop's CWT for 20 min. On the control day, the patients were resting quietly during the corresponding period. Insulin sensitivity was estimated by an insulin (0.4 mU.kg-1 x min-1)-glucose (4.5 mg.kg-1 x min-1)-infusion test (IGIT) for 6.5 h. Mental stress evoked significant responses for adrenaline, cortisol and GH, their respective peak values being 0.27 +/- 0.05 nmol/l, 426 +/- 27 nmol/l and 7.6 +/- 1.8 micrograms/l, as well as increases in systolic and diastolic blood pressure and pulse rate The steady-state blood glucose levels, i.e. the mean blood glucose levels 3-6.5 h after the start of the IGIT, were significantly higher after stress, compared with those on the control day, 10.6 +/- 1.5 vs 8.7 +/- 1.4 mmol/l, p = 0.01, demonstrating impairment of the insulin sensitivity by mental stress. It is concluded that acute mental stress induces a state of insulin resistance in IDDM patients, which can be demonstrated by an IGIT to appear 1 h after maximal stress and to last more than 5 h.

Acute Disease↗
PubMed1993

How accurate are home blood-glucose meters with special respect to the low glycemic range?

Comparisons were made between four blood-glucose meters (Diascan, Glucometer II, Reflolux II and ExacTech) and a reference method (YSI) for the full, clinical, blood-glucose range and for the subranges < 4.4 mmol/l, 4.4-10.0 mmol/l and > 10.0 mmol/l, respectively. In the low-glucose range, the error-grid analysis was also applied. All the meters showed acceptable agreement with the reference method when the whole glucose range was considered, yielding r-values between 0.96 and 0.99. However, when the results were separated in the different subranges, the outcome was different, in that the Diascan meter displayed systematically high glucose levels and the ExacTech meter showed a great spread of the values within the low-glucose range, whereas the Glucometer II and the Reflolux II meter were less accurate within the high-glucose range. By applying the error-grid analysis, several errors of clinical importance within the low glycemic range were revealed, while other significant errors, which might lead to inadequate therapeutic decisions, were classified as 'clinically accurate'.

Blood Glucose↗
PubMed1993

Factors influencing the clinical outcome of continuous subcutaneous insulin infusion in routine practice.

Possible factors that might influence the outcome of continuous subcutaneous insulin infusion (CSII) treatment were investigated in forty-nine, type 1, diabetic patients with median treatment of 3.25 years in routine diabetes care. In nine patients pump treatment was discontinued largely within the first 6 months. Patients characterized as blue-collar workers discontinued pump treatment at a significantly higher rate. Of the remaining forty patients those with the longest treatment experience were of attracted interest. Among twenty patients who had used CSII three years or more improvement of metabolic control was most evident in patients with high haemoglobin A1c (HbA1c) values before CSII (R-square 0.673, P = 0.0001) and in subjects with low insulin requirements on injection therapy (R-square 0.334, P = 0.0076). This improvement was not explained by more frequent monitoring of blood glucose only. It was found that those who had the lowest body mass index (BMI) before pump treatment had the more pronounced increase of BMI, while those in the upper normal range had an unchanged or reduced body mass (R-square 0.271, P = 0.0115). We conclude that high HbA1c values, low insulin requirements and low body mass in conventional injection therapy are the most important factors when trying to achieve and maintain metabolic improvement in CSII treated type 1 diabetic patients.

Adult↗
PubMed1993

Estimation of blood-glucose variability in patients with insulin-dependent diabetes mellitus.

The aim of the study described here was to evaluate the standard deviation (SD) as a measure of blood-glucose variability in IDDM patients under 'normal life' conditions. One hundred IDDM patients performed self-monitoring of blood glucose (SMBG) five times every 2 days for 4 weeks. From these records the following measurements were calculated for each patient: the standard deviation of all blood-glucose values (SDBG), the M-value, the percentage of values < 3 and > 15 mmol l-1 (PE), and the mean, absolute difference of consecutive blood-glucose values (MAD), a novel measure of blood-glucose variability, also taking into consideration the succession of the values. Before the study the patients as well as their physicians were asked to estimate the blood-glucose stability of the patient, using a five-category scale of statements. The patients recorded an average of 64 (range: 32-70) SMBG values. The SDBG was normally distributed with a mean of 3.9 +/- 1.0 mmol l-1. There was a highly significant correlation between the SDBG and the other measures of blood-glucose variability (p = 0.0001, r > 0.8). It appeared that the variation of the SMBG values recorded before dinner contributed to the total glucose variability to a great extent. There was a poor agreement between the subjective estimations of the blood-glucose stability made by the patients and the physicians and the objective measures of the blood-glucose variability. It is concluded that the SD provides an accurate and easily available estimate of blood-glucose variability in IDDM patients practising home blood-glucose monitoring.

Adult↗
PubMed1993

An analysis of the glucagon response to hypoglycaemia in patients with type 1 diabetes and in healthy subjects.

The study aimed to analyse the glucagon response during hypoglycaemia in relation to gender, level of hypoglycaemia, and hyperinsulinaemia as well as its relation to other counterregulatory hormones in patients with Type 1 diabetes and in nondiabetic subjects. Mild hypoglycaemia was induced by an i.v. insulin infusion (244 pmol kg-1h-1) for 180 min in 43 Type 1 diabetic patients and 22 nondiabetic subjects. Venous blood glucose, plasma free insulin, glucagon, adrenaline, noradrenaline, growth hormone, and cortisol were measured every 15-30 min. The hormonal responses during hypoglycaemia were evaluated from the incremental areas under their respective curves. There was a linear correlation between the glucagon response and the decremental area of blood glucose (p < 0.005), but the slope of the regression line in the diabetic group was less steep than in the controls (p < 0.5), and, in spite of the deeper hypoglycaemia in the diabetic groups, their glucagon response was diminished (p < 0.05). Plasma, adrenaline, growth hormone and cortisol all increased during hypoglycaemia. The glucagon response correlated with the responses of growth hormone and cortisol in both groups, while it was positively correlated with the adrenaline response (p < 0.001) and inversely with the plasma insulin (p < 0.001) only in the diabetic patients. Although the insulin infusion rate was identical, the female diabetic patients had a lower metabolic clearance rate of insulin as compared with the males (p < 0.05). There was no statistical difference in the counterregulatory hormone responses between males and females in neither of the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Arterial, arterialized venous, venous and capillary blood glucose measurements in normal man during hyperinsulinaemic euglycaemia and hypoglycaemia.

The purpose of this study was to evaluate the effectiveness of the warm-air box method on the arterialization of venous blood during euglycaemia and hypoglycaemia. Six healthy male volunteers were studied using an i.v. infusion of insulin (144 mU.kg-1.h-1). Arterial blood glucose was clamped at the baseline level for the first 30 min and subsequently reduced to 3.2 and to 2.5 mmol/lf or 20 min. At each stage, including prior to insulin infusion, arterial, arterialized venous (heating the hand in a warm-air box set to 55-60 degrees C), venous and capillary blood samples were taken simultaneously for analyses of blood glucose and oxygen saturation (not for capillary blood). The oxygen saturations in arterialized blood were approximately 3% below the arterial values. The arterial-arterialized difference of blood glucose was about 0.1 mmol/l (the 95% confidence interval: from -0.19 to 0.41 mmol/l), which tended to correlate with the difference in oxygen saturations between the arterial and arterialized blood samples (r = 0.25, p = 0.08). During the test the forearm venous blood oxygen saturation increased by 9% and the arteriovenous difference in blood glucose ranged from 0.2 to 0.5 mmol/l which correlated significantly with the difference in oxygen saturations (r = 0.48, p less than 0.001). Capillary glucose was similar to the arterialized value. Rectal temperature was stable during the experiment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Stressful life events and Graves' disease.

The role of stressful life events in the onset of Graves' disease (toxic diffuse goitre) is controversial. However, the numerous early clinical reports that supported such an association were not adequately controlled and specificity of the diagnosis could be questioned. Later studies have not shown a causal relation, but these studies were small, did not have proper controls, or epidemiological methods were inappropriate. To assess possible associations between life events, heredity, social support, and Graves' disease, we have done a population-based case-control study in a defined area with about 1 million inhabitants. Over 2 years, 208 (95%) of 219 eligible patients with newly-diagnosed Graves' disease and 372 (80%) of all selected matched controls answered an identical mailed questionnaire about marital status, occupation, drinking and smoking habits, physical activity, familial occurrence of thyroid disease, life events, social support, and personality. Compared with controls, patients claimed to have had more negative life events in the 12 months preceding the diagnosis, and negative life-event scores were also significantly higher (odds ratio 6.3, 95% confidence interval 2.7-14.7, for the category with the highest negative score). Individuals who had relatives with thyroid disease (especially first-degree and second-degree relatives) were more likely to have Graves' disease (3.6, 2.2-5.9). Slightly more patients than controls were divorced (1.8, 1.0-3.3) and reported a less frequent intake of alcohol (0.4, 0.2-0.8). When results were adjusted for possible confounding factors in multivariate analyses, risk estimates were almost unchanged. These findings indicate that negative life events and hereditary factors may be risk factors for Graves' disease.

Adult↗
PubMed1991

Insulin absorption is faster when keeping the infusion site in use for three days during continuous subcutaneous insulin infusion.

To evaluate the possible influence of regular infusion site changes on insulin absorption, fifteen type 1 diabetic patients using continuous subcutaneous insulin infusion (CSII) were studied on four occasions: the first day after an infusion site was settled, again the first day after a new infusion site was utilized and the two fourth days after the two infusion sites had been used for three days. A bolus of insulin (1 U/10 kg of body weight) was infused by the pump in the lower para-umbilical region. Plasma free insulin and blood glucose levels were determined before and during 240 min of the study at 30-min intervals. It was found that the peak times extracted from the individual insulin curves were shorter in 17 out of 23 curves when the fourth day was compared with the first day and the mean value of peak time of the fourth day was significantly shorter than that of the first day (56 +/- 11 vs 110 +/- 15 min, P less than 0.01). The mean area under the insulin curves during the first hour of the study tended to increase on the fourth day compared to that of the first day (25 +/- 2.2 vs 21 +/- 2.1 mU.l-1.min, P = 0.12). The decremental area of blood glucose on the fourth day was larger than on the first day (405 +/- 111 vs 82 +/- 160 mmol.l-1.min, P less than 0.05). We conclude that during CSII, the absorption rate of the injected insulin bolus is faster when the infusion site has been in use continuously for three days.

Absorption↗
PubMed1991

Insulin clearance during hypoglycemia in patients with insulin-dependent diabetes mellitus.

Eight male patients with insulin-dependent diabetes mellitus (IDDM) without residual beta-cell function were studied on two occasions in random order. In one experiment hypoglycemia was induced by a constant rate iv infusion of insulin (0.034 U/kg/h) during 150 minutes. At the other occasion an identical infusion of insulin was given, but this time euglycemia was maintained by a variable iv infusion of glucose. Plasma levels of free insulin were almost identical during the two experiments indicating that insulin clearance is not influenced by hypoglycemia in patients with IDDM.

Adult↗
PubMed1991

Experience of long-term intraperitoneal insulin treatment using a new percutaneous access device.

A pilot study was conducted to determine the efficacy of a new percutaneous device, designed to help to deliver insulin from an external, multiprogrammable pump to the abdominal cavity in patients with Type 1 (insulin-dependent) diabetes. Six patients received intraperitoneal insulin therapy for 15-24 months, a total experience of 9.4 patient-years. Glycosylated haemoglobin stabilized at 7.6 +/- 0.7% with no change in insulin dose. Four patients had to submit to reimplantation after 30 to 60 weeks. One patient met with inconvenient location of the device and three had blockage of the system. In four patients treatment had to be interrupted due to blockage of the intraperitoneal catheter by omental-tissue encapsulation. In two of those patients this blockage was combined with deeper infections. In another patient treatment had to be interrupted due to chronic, local, subcutaneous infection.

Adult↗
PubMed1991

A high concentration of circulating insulin suppresses the glucagon response to hypoglycemia in normal man.

In an attempt to clarify whether circulating insulin per se exerts an inhibitory effect on the hormonal responses to hypoglycemia, with special emphasis on glucagon secretion, nine healthy volunteers were exposed to low dose (244 pmol/kg.h) and high dose (1034 pmol/kg.h) iv insulin infusions for 3 h on two separate occasions. A close to identical arterial hypoglycemia of about 3.4 mmo/L was obtained in both tests by glucose clamping during the high dose test. The corresponding glucose concentration in the venous blood was significantly lower in the high dose test (2.5 +/- 0.1 vs. 3.0 +/- 0.1 mmol/L; P less than 0.01), while the plasma free insulin level was 4 times higher in the high dose test (897 +/- 50 vs. 208 +/- 14 pmol/L). Plasma glucagon was elevated in both experiments, but its rise was reduced during the high dose test after 1 h, yielding an incremental area under the glucagon curve that was significantly smaller than that obtained during the low dose test (213 +/- 70 vs. 348 +/- 81 ng/L.h; P less than 0.05). The plasma adrenaline, noradrenaline, GH, C-peptide, pancreatic polypeptide, and somatostatin profiles were similar in the two tests. We conclude that an inhibitory effect of circulating insulin on the glucagon response to hypoglycemia can be demonstrated in normal man during an infusion of insulin yielding a plasma concentration of about 900 pmol/L. The responses of other hormones studied are not significantly influenced by the circulating insulin level.

Adult↗
PubMed1990

Permanent neuropsychological impairment after recurrent episodes of severe hypoglycaemia in man.

Seventeen Type 1 (insulin-dependent) diabetic patients with a history of recurrent and severe hypoglycaemia and Type 1 diabetic patients with no severe hypoglycaemia were compared as regarded performances in tests of neuropsychological functioning. To test the hypothesis that recurrent severe hypoglycaemia gives rise to permanent cognitive impairment, the study group was selected among those patients who had met with repeated attacks over the last three years or more as identified by a questionnaire among almost 600 insulin-treated diabetic patients. The comparison group without known severe reactions were comparable to the study group with respect to type of diabetes, sex, age, age at onset, duration of diabetes, socio-economic parameters, and prevalence of neuropathy and retinopathy. The results indicate that Type 1 diabetic patients with recurrent severe hypoglycaemia scored lower than those without severe hypoglycaemia in tests of motor ability, short-term and associative memory and visuospatial tasks assessing ability in general problem-solving. Type 1 diabetic patients with severe hypoglycaemia also displayed a higher frequency of perspective reversals suggesting frontal-lobe involvement. These data can be interpreted in two ways. One interpretation implies that the cognitive impairment of Type 1 diabetic patients with severe hypoglycaemia reflects a selection factor, the other that recurrent episodes of severe hypoglycaemia result in permanent cognitive impairment.

Cognition↗