PubMed · 3635291
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E Mugnier. 1986. [Hypoglycemia].. https://pubmed.ncbi.nlm.nih.gov/3635291/
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HYPOTHESIS: Liver transplantation results in hepatic denervation. This may produce alterations of liver energy and substrate metabolism, which may contribute to weight gain after liver transplantation. DESIGN: Prospective clinical study. SETTING: Liver transplantation clinics in a university hospital. PATIENTS: Seven nondiabetic patients with cirrhosis were recruited while on a waiting list for liver transplantation. Seven healthy subjects were recruited as controls. INTERVENTION: Orthotopic liver transplantation. MAIN OUTCOME MEASURES: Evaluation of energy and substrate metabolism after ingestion of a glucose load with indirect calorimetry was performed before, 2 to 6 weeks after, and 5 to 19 months after transplantation. Whole-body glucose oxidation and storage and glucose-induced thermogenesis were calculated. RESULTS: Patients with cirrhosis had modestly elevated resting energy expenditure and normal glucose-induced thermogenesis and postprandial glucose oxidation and storage. These measures remained unchanged after liver transplantation despite a significant increase in postprandial glycemia. Patients, however, gained an average of 3 kg of body weight after 5 to 19 months compared with their weight before transplantation. CONCLUSION: Liver denervation secondary to transplantation does not lead to alterations of energy metabolism after ingestion of a glucose load.
Aim of this study was to investigate whether octreotide, a synthetic somatostatin analogue that inhibits growth hormone, insulin and glucagon secretion and improves glycaemic control in insulin dependent diabetic patients was able to exert similar effects in insulin treated type 2 diabetic patients with chronic renal failure who have high plasma glucagon levels. For this purpose saline or octreotide was randomly administered by continuous subcutaneous infusion (100 mcg/daily) in addition to usual insulin treatment for 5 days to six type 2 insulin treated diabetic patients with chronic renal failure and to six type 2 patients with normal renal function, as a control group. At day 3 of insulin plus saline or insulin plus octreotide treatment, total glucose uptake and hepatic glucose production (HGP) were investigated during an euglycemic clamp; at day 5 GH, glucagon and C-peptide plasma levels were evaluated. Octreotide treatment lowered endogenous insulin secretion (evaluated by C-Peptide levels assay), GH and glucagon in all patients, but caused a significant reduction of daily insulin requirement (32 +/- 14 I.U. vs 41 +/- 19 I.U., P<0.02) only in patients with renal failure. HGP was significantly (P<0.05) lowered in patients with renal failure but glucose uptake remained unchanged. The lowering effect of octreotide on insulin requirement in diabetic patients with renal failure in spite of the contemporaneous inhibition on insulin secretion could be explained on the basis of the greater reduction of glucagon levels which are very elevated in these patients as compared to patients with normal renal function. The lowering of glucagon could decrease HGP and, consequently, insulin requirement.
UNLABELLED: The aim of the study was to analyse psychometric properties of the WHOQOL-100, a multidimensionally conceptualised, generic, 100-item quality of life (QoL) instrument in a pilot sample of 63 type 2 diabetic patients (age 60.4 (10.1) years), 55% women, disease duration 10.2 (6.2) years, education 10 (5.2) years, 78% married. While covering the subjective perception and evaluation of the overall QoL and general health, as well as four broad domains (physical health, psychological state, social relationships and environment), the instrument may be useful in integrating the individual perception of the QoL. The properties tested referred to reliability, validity in discriminating patients with different disease characteristics, and responsiveness to change. METHODS: Reliability was determined by Cronbach's alpha coefficients of internal consistency. Discriminant validity was determined by comparing the groups of patients with poor and satisfactory glycaemic control, the first group being switched to insulin therapy (intervention group) and the second (comparison group) remaining on oral therapy (35 and 28 patients respectively). Responsiveness to change was determined by comparing the two groups after a 2-month follow-up period. RESULTS: The obtained alpha coefficients were 0.95 for the physical domain, 0.89 for the psychological domain, 0.76 for the social relationships domain, and 0.92 for the domain referring to environment. The interventional and comparison groups rated their QoL differently, primarily in the physical and psychological domains (P<0.01; P<0.05). After a 2-month follow-up period, the intervention group was improved in some QoL determinants (psychological domain), while no differences were found in the control group. CONCLUSION: Relying on the data obtained from the groups of diabetic patients in Croatia, the WHOQOL-100 can be considered as acceptably reliable and valid instrument for the QoL assessment in this particular population of health care users.