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  • 1
    ISSN: 1432-5233
    Keywords: Metabolic control ; Glycated haemoglobin ; Home blood glucose monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aims of the study were to compare glycohaemoglobin (HbA1c) values measured by DCA (a benchtop analyzer primarily designed for within-clinic rapid HbA1c determination) to a reference HbA1c method and home blood glucose monitoring, and to explore the possibility of an uniform expression of data. A total of 103 blood samples and the corresponding mean capillary glucose values (4.4±1.2 tests/day) of the preceding 2 months were collected from 34 insulin-dependent diabetic adults. We measured the correlations and agreements using the residual plots method and regression equations between HbA1c measured by DCA and high-pressure liquid chromatography (HPLC), and between DCA and capillary glucose values. A highly significant correlation (r 2=0.85,P〈0.001) and an acceptable agreement (97% of values within 2 SD of the mean difference of 0.9%±0.4%) was found between DCA and HPLC values. The regression equation calculated on the first half of the cases was: DCA (%)=0.72 HPLC (%)+1.38. Of DCA values expressed in HPLC terms using this equation 87% fell within a clinically acceptable confidence interval when compared with measured HPLC data. A significant correlation (r 2=0.40,P〈0.01) was found between DCA and capillary glucose values, and the regression equation was: DCA (%)=0.34 capillary glucose (mM)+4.44. Of glycaemic levels calculated from DCA values using this formula 82% fell within a clinically acceptable error range when compared with measured glycaemic values. We conclude that the three methods of assessment of diabetes control are well correlated and that it is possible, with a degree of precision acceptable for the clinical setting, to express all data in uniform units, e.g. mM of capillary glucose or percentage of HPLC-HbA1c, though a simple correspondence table based on our transfer equations may be clinically sufficient and more handy.
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  • 2
    ISSN: 1432-5233
    Keywords: Exercise ; Diabetes control ; type 1 diabetes mellitus ; type 2 diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the clinical setting, the impact of educational efforts on the amount of regular exercise and its effects on diabetes control are unclear. Fifty type 1 diabetic, 50 type 2 diabetic and 70 non-diabetic subjects were evaluated using a questionnaire for type, duration and intensity of exercise to assess weekly energy expenditure. Diabetic subjects did not exercise more than controls: 36% of the type 1, 46% of the type 2 and 46% of the control subjects admitted no physical activity, and those exercising regularly had similar energy expenditure: 1808±320, 2722±617, 2523±304 (mean±SEM) kcal/week respectively (P=NS). There was no correlation between the degree of activity and HbA1c levels, or hypoglycaemic events. HbA1c levels were less than 6,8% in 31% of non-active active patients versus 21% of active patients (P=NS). A negative correlation was found between physical activity and daily insulin usage (r=0.27,P〈0.05), but differences between patients averaged only 4 IU/1000 kcal energy expenditure/day. We conclude that patients' attitude towards exercise was not improved by our educational methods and that physical exercise was not necessarily associated with good blood glucose control.
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  • 3
    ISSN: 1432-5233
    Keywords: Key words Metabolic control ; Glycated haemoglobin ; Home blood glucose monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aims of the study were to compare glycohaemoglobin (HbA1c) values measured by DCA (a bench-top analyzer primarily designed for within-clinic rapid HbA1c determination) to a reference HbA1c method and home blood glucose monitoring, and to explore the possibility of an uniform expression of data. A total of 103 blood samples and the corresponding mean capillary glucose values (4.4±1.2 tests/day) of the preceding 2 months were collected from 34 insulin-dependent diabetic adults. We measured the correlations and agreements using the residual plots method and regression equations between HbA1c measured by DCA and high-pressure liquid chromatography (HPLC), and between DCA and capillary glucose values. A highly significant correlation (r 2=0.85, P〈0.001) and an acceptable agreement (97% of values within 2 SD of the mean difference of 0.9%±0.4%) was found between DCA and HPLC values. The regression equation calculated on the first half of the cases was: DCA (%)=0.72 HPLC (%)+1.38. Of DCA values expressed in HPLC terms using this equation 87% fell within a clinically acceptable confidence interval when compared with measured HPLC data. A significant correlation (r 2=0.40, P〈0.01) was found between DCA and capillary glucose values, and the regression equation was: DCA (%)=0.34 capillary glucose (mM)+4.44. Of glycaemic levels calculated from DCA values using this formula 82% fell within a clinically acceptable error range when compared with measured glycaemic values. We conclude that the three methods of assessment of diabetes control are well correlated and that it is possible, with a degree of precision acceptable for the clinical setting, to express all data in uniform units, e.g. mM of capillary glucose or percentage of HPLC-HbA1c, though a simple correspondence table based on our transfer equations may be clinically sufficient and more handy.
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  • 4
    ISSN: 1432-0428
    Keywords: Blood glucose ; plasma insulin ; meals ; diurnal patterns ; estrogens
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Significant sex differences were observed in 24 young lean men and women submitted to two mixed isocaloric meals (880 Kcal; protein 40 g; carbohydrate 90 g; fat 40 g;) at 8.15 AM and 12.45 PM. After an overnight fast venous blood glucose levels were lower in women than in men. Plasma insulin responses were lower after the afternoon meal than after the morning one in men but not in women. Thus women did not present the well known cycle of insulin secretion described in men. Estradiol benzoate, 10 mg per day given intra-muscularly for eight days in six men who served as their own control, lowered fasting venous blood glucose levels and enhanced post prandial plasma insulin levels after the morning and the afternoon meal as well. It is suggested that the sex related differences in venous blood glucose and plasma insulin patterns may be due in part to estrogens.
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  • 5
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; insulin ; artificial pancreas ; metformin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It has been suggested that biguanides should be used in Type 1 (insulin-dependent) diabetic patients in order to diminish insulin requirements and reduce the chances of insulin reactions. The efficacy of these compounds in such patients has been controversial. We have studied the effect of metformin (850mg) given at 08.00 h in diminishing insulin needs after a 60g carbohydrate mixed meal taken at 12.00 h, using an artificial pancreas and a sequential analysis of the results. The morning test dose of metformin or placebo was preceded by 48 h treatment with metformin (850mg twice daily) or placebo. After the eighth patient a 26% saving of insulin need was demonstrated in the metformin-treated group (p〈0.01). Metformin is thus effective in reducing post-prandial insulin needs in Type 1 diabetic patients, although its use in such circumstances requires consideration of several other issues.
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  • 6
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 7
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 8
    ISSN: 1432-0428
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 9
    ISSN: 1432-0428
    Keywords: Hypoglycaemia ; Type 1 diabetes ; diabetes management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this study was to discover the frequency, severity and causes of hypoglycaemic reactions in Type 1 (insulin-dependent) diabetes. One hundred and seventy-two outpatients answered a questionnaire which also inquired about their feelings, opinions and fears with respect to insulin reactions. Hypoglycaemic reactions were common: a mild episode occurred at least once a month in 58% of patients, and at least one severe reaction (defined by the need of assistance) during the past year was described by 26%. Both were positively related to the duration of the disease. However, the occurrence of mild and severe attacks was not related. In addition, patients prone to mild hypoglycaemia seem to be somewhat different from patients prone to severe attacks in their attitudes towards the disease. For example, mild reactions are more frequent in patients devoted to ‘perfect’ control, whereas severe episodes were observed more frequently in those who did not think that controlling diabetes is a difficult task. The social consequences of any reaction, even mild, were important in 30% of the patients. Twenty-one percent of the patients said that the short-term risks of a hypoglycaemic reaction, even if correctly treated, were high and 6% said that the fear of having a reaction was unbearable. In addition to rational explanations, emotional factors were given as a cause of hypoglycaemia (14%), but 11% of cases felt that attacks occured without any obvious reason in spite of correct management.
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  • 10
    ISSN: 1432-0428
    Keywords: Sucrose ; honey ; simple sugar ; diabetic diet ; Type 2 diabetes ; plasma glucose ; plasma insulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Exclusion of simple sugars from the diabetic diet is not always followed by patients and may not even be as crucial as was hitherto thought. We tested three types of mixed breakfasts (400 kcal, 50 g HCO) including an isoglucidic amount either of white bread (30 g), honey (20 g) or sucrose (15 g), at the critical morning period i.e. for breakfast, in a group of 21 Type 2 (non-insulin-dependent) diabetic patients (6 well- and 15 badly controlled). Mean plasma glucose and insulin levels were comparable on the three occasions: respectively with bread, sucrose and honey, peak glucose values were 18 mmol/l, 17.7 mmol/l and 17.5 mmol/l in the uncontrolled group versus 13.9 mmol/l, 12.8 mmol/l and 12.7 mmol/l in the well-controlled group. Peak insulin values were 33.6 mU/l,34.0 mU/l and 36.3 mU/l (p〉0.05) in uncontrolled patients against 57.5 mU/l, 54.8 mU/l and 52.5 mU/l in well-controlled subjects (p〉0.05). The mean increment in peak plasma glucose values for the three breakfasts was as follows: 6.9 mmol/l, 6.3 mmol/l and 6.2 mmol/l for the uncontrolled group against 7.2 mmol/l, 5.9 mmol/l and 6.2 mmol/l in well-controlled subjects; the mean increment in peak plasma insulin levels was 21.8 mU/l, 22.0 mU/l and 24.2 mU/l in the controlled group versus 38.2 mU/l, 32.0 mU/l and 34.7 mU/l in the well-controlled subjects, all values being non-significantly different (p〉0.05). We conclude that, in acute conditions, simple sugars have no additional hyperglycaemic effect over an isoglucidic amount of bread in well- and in badly controlled Type 2 diabetic patients, even at breakfast.
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