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Biomedical subjects

A D Harrower

Publications and source records attributed to A D Harrower.

At least 19 recordsLinked to original sources
PubMed1991

Efficacy of gliclazide in comparison with other sulphonylureas in the treatment of NIDDM.

Three studies were performed to assess the efficacy of various sulphonylureas in the management of diet-failed NIDDM patients. In the first study, 224 patients inadequately controlled by diet alone or with oral hypoglycaemics received gliclazide in addition to diet or in place of existing drugs for three months. The dosage was adjusted to obtain adequate control or up to the maximum recommended dosage. Good glycaemic control was achieved in 65% of patients. Conversion from other oral hypoglycaemics to gliclazide led to an improvement in control except in cases previously treated with glibenclamide. In the second study, diabetic control was compared in 112 NIDDM patients treated concurrently for one year with chlorpropamide, glipizide, gliquidone, glibenclamide or gliclazide. On the basis of HbA1 levels, the best results were obtained with glibenclamide and gliclazide, leading to normal HbA1 levels in 74% and 80% of patients, respectively. In the third study, secondary failure rates were assessed in 248 NIDDM patients treated for five years with gliclazide, glibenclamide or glipizide. Gliclazide had the lowest secondary failure rate (7%) and was significantly better than glipizide (25.6% failures in five years), but the difference relative to glibenclamide (17.9%) just failed to reach the threshold of significance. The results of these studies show that gliclazide is a potent hypoglycaemic agent which compares favourably with others of its type. It has a low incidence of side effects, few problems with hypoglycaemia, and retains its efficacy longer than other sulphonylureas. Gliclazide may therefore be considered a first choice for the therapy of diet-failed NIDDM patients.

Blood Glucose↗
PubMed1990

Comparison of secondary failure rate between three second generation sulphonylureas.

Sulphonylureas are effective hypoglycaemic agents but have been reported to have a high failure rate with time. The introduction of a second generation of sulphonylureas may have modified this effect, but little information is available. Two hundred and forty-eight non-insulin dependent diabetic patients were prospectively randomly treated with one of three second generation sulphonylureas--gliclazide (86), glibenclamide (84), and glipizide (78), and were followed for 5 yr to assess the secondary failure rate. Six out of 86 (7%) failed with gliclazide, 15 out of 84 (17.9%) failed with glibenclamide, and 20 out of 78 (25.6%) failed with glipizide. Gliclazide was significantly better than glipizide (p less than 0.005), but not other differences were significant. With all three drugs, in the patients who failed on treatment, body mass index (BMI) at diagnosis was significantly lower than in those who responded to treatment (p less than 0.001). There are differences in secondary failure rate between second generation sulphonylureas. Measurement of the BMI at diagnosis may be useful in predicting those patients most likely to fail to respond.

Blood Glucose↗
PubMed1988

Antihypertensive therapy in diabetic patients. The use of indapamide.

Abnormalities in glucose tolerance in nondiabetic patients and rapid alteration in non-insulin-dependent diabetics have been reported with antihypertensive drugs such as beta-blockers or thiazide diuretics. Such deleterious effects on a cardiovascular risk factor could limit the long-term benefit of an antihypertensive treatment. Indapamide is a nonthiazide antihypertensive agent that appears to respect the glucose tolerance in hypertensive patients. The present study was conducted to assess the effects of indapamide 2.5 mg in 10 hypertensive non-insulin-dependent diabetic patients treated for a one-year period. Glucose tolerance was evaluated using a 50-g oral glucose test, with measurements of plasma glucose and insulin before and after treatment. At the end of the one-year treatment, both systolic and diastolic blood pressure were significantly reduced, whereas there was no significant alteration in either plasma glucose or plasma insulin levels. Thus, indapamide appears as an effective antihypertensive agent in the diabetic patient, with no adverse effects on the glucose tolerance.

Blood Glucose↗
PubMed1987

Myocardial scintigraphy with I-123 heptadecanoic acid as a test for coronary heart disease.

We have evaluated 123I-heptadecanoic acid for myocardial scintigraphy in the diagnosis of coronary heart disease by comparing the results obtained with it in subject groups with high and low probabilities of disease. We conclude that although some patients in the former group can be identified, the test is neither sufficiently sensitive nor specific for routine clinical use.

Adult↗
PubMed1986

Variability of left ventricular function at diagnosis and after treatment in insulin-dependent diabetes.

Measurements of left ventricular ejection fraction (LVEF) were made using nuclear angiography in 9 newly-diagnosed insulin-dependent diabetic patients at diagnosis and after a period of stable control. Similar measurements were made in a control group of 10 insulin-dependent patients whose control was stable. While mean LVEF did not change significantly in either group, 5 of the newly-diagnosed patients had a significant change in LVEF (both positive and negative). None of the stable diabetic patients had any significant change in LVEF. Analysis of variance of the changes in LVEF in both groups showed a significant difference (p less than 0.002). Abnormal left ventricular function in diabetic patients may be transient, reversible and related to change in diabetic control and need not indicate structural myocardial disease such as cardiomyopathy.

Adolescent↗
PubMed1985

Adverse effect of smoking on the hyperaemic response in diabetic patients and control subjects.

In order to determine whether smoking had an adverse effect on the hyperaemic response, as measured by transcutaneous oximetry, matched groups of insulin-dependent diabetic smokers and non-smokers were compared both with each other and with similar matched groups of non-diabetic control subjects. The hyperaemic response was also measured immediately, 1 hour and 24 hours after smoking a cigarette in five control subjects who smoked. The hyperaemic response was significantly lower in the diabetic smokers compared with the diabetic non-smokers (p = 0.008) and in the control smokers compared with the control non-smokers (p = 0.011). No other significant differences were found. In the five subjects studied at intervals after smoking the responses were variable and inconsistent. Smoking modifies the hyperaemic response and this must be taken into account in any investigation using such measurements.

Adult↗
PubMed1985

Poliomyelitis in an adult male.

Paralytic poliomyelitis is now unusual in developed countries following the success of vaccination programmes. This paper reports a case of poliomyelitis in a patient with incomplete vaccination where the source of infection is unclear.

Adult↗
PubMed1978

Hypothalmic-pituitary adrenal responsiveness to dexamethasone-insulin tolerance test in acromegalic patients before and during treatment with bromocriptine.

Insulin tolerance tests were carried out in 10 acromegalic patients after 1 mg dexamethasone had been given the previous evening (DEX-ITT). Nine patients showed a rise in plasma 11-OHCS and four patients showed a rise in plasma growth hormone (GH) levels. These responses were unaltered after treatment with bromocriptine 10 mg daily for two months. Basal plasma GH levels fell in 6 of the patients and the mean plasma GH levels of the 10 patients during an oral glucose tolerance test (OGTT) fell from 63.2 +/- 25.5 ng/ml before treatment to 53.0 +/- 27.1 ng/ml (mean +/- sem; p less than 0.05). These data fail to confirm a previous report of abnormal hypothalmic-pituitary-adrenal suppressibility during a DEX-ITT in acromegalic patients. They also indicate that bromcriptine does not alter the responses of plasma 11-OHCS and plasma GH to the DEX-ITT despite lowering plasma GH levels.

11-Hydroxycorticosteroids↗
PubMed1978

'On-the-spot' blood glucose requirement at a peripheral diabetic clinic.

In 100 consecutive diabetics attending a peripheral clinic subsequent blood glucose analyses indicated the need for some change in treatment in 24 patients. As it can be difficult to predict which patients should have their blood glucose levels checked provision of some form of comprehensive and reliable 'on-the-spot' analysis is essential for the best management of diabetics attending such clinics.

Adolescent↗
PubMed1977

Growth hormone, insulin, and prolactin secretion in anorexia nervosa and obesity during bromocriptine treatment.

We studied secretion of growth hormone (GH), insulin, and prolactin in eight women with anorexia nervosa and nine women with refractory obesity before and during treatment with bromocriptine, 10 mg/day. In the anorexic patients the raised plasma GH concentrations occurring during an oral glucose tolerance test fell significantly while on bromocriptine treatment, but there was no change in plasma insulin or blood glucose concentrations. In the obese patients, however, plasma GH concentrations remained low during the oral glucose tolerance test, and were not modified by bromocriptine. Blood glucose and plasma insulin concentrations were also unchanged. Plasma GH and plasma 11-hydroxycorticosteroid responses to insulin-induced hypoglycaemia were unaffected. Serum prolactin concentrations which were raised in five anorexic patients and marginally raised in two obese subjects, fell significantly in both groups during treatment. We observed no consistent weight changes in either groups.

Adolescent↗