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Biomedical subjects

A E Lambert

Publications and source records attributed to A E Lambert.

At least 37 records · Page 2Linked to original sources
PubMed1987

Comparison of blood glucose profile and glycemic control in type 1 diabetic patients treated with Actrapid-Monotard or Actrapid Protaphane (NPH) human insulins.

The aim of this study is to compare the blood glucose profile and the glycemic control in Type 1 diabetic patients under two conventional semi-synthetic human insulin regimens (2 daily injections) combining regular (Actrapid) and intermediate acting insulins (Monotard or Protaphane). Actrapid-Monotard (scheme A) and Actrapid-Protaphane (scheme B) were administered during 3 months each, in a randomized order, to 18 outpatients. The glycemic control was evaluated by home glucose monitoring, as well as by the monthly measurements of HbA1. The total daily dose of insulin was comparable during each treatment period: 0.68 +/- 0.06 (scheme A) and 0.71 +/- 0.06 U/kg body wt. (scheme B) (mean +/- SEM). However, the total percentage of regular insulin was higher with Monotard than with Protaphane: 58 +/- 3 vs 48 +/- 5% in the morning (p less than 0.005) and 51 +/- 2 vs 46 +/- 3% in the evening (p less than 0.05). In C-peptide positive patients, the blood glucose values were comparable at all times with either insulin scheme. In contrast, in C-peptide negative patients, the blood glucose levels were higher in the afternoon with scheme B: 11.8 +/- 1 vs 8.6 +/- 1 mmol/l at 3 pm (p less than 0.02) and 12.2 +/- 1.3 vs 9.7 +/- 1.6 mmol/l at 6 pm (p less than 0.01). A slight but not significative increase of HbA1 was observed during the B period. In conclusion, an Actrapid-Protaphane scheme requires the use of a lower proportion of regular insulin than an Actrapid-Monotard treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Effect of an in-patient education programme upon the knowledge, behaviour and glycaemic control of insulin dependent diabetic patients.

The aim of this study was to evaluate the efficiency of a diabetes education programme (5 days in hospital) in type I diabetic patients by comparing their diabetes-related knowledge, behaviour and the level of HbA1 before with that 6 months and 1 year after the teaching session. The patients were divided into 2 groups according to whether they answered a questionnaire after 6 months (group I; 41 "responder" patients) or not (group II; 38 "non-responder" patients). Their usual regime of insulin therapy (2 daily injections of a mixture of regular and intermediate-acting insulins) was not modified during their hospitalization for teaching; the total daily doses of insulin and the percentages of regular insulin were comparable before and after the teaching session. In group I, we observed an improvement in knowledge and behaviour indices (evaluated by a written questionnaire) from 69 +/- 3 and 67 +/- 4% (mean +/- SEM) before the teaching session to 86 +/- 2 and 85 +/- 2% 6 months after, respectively (p less than 0.001). HbA1 decreased from 12.1 +/- 0.3% to 11.2 +/- 0.3% (p less than 0.05) and to 10.7 +/- 0.4% (p less than 0.025) after 6 and 12 months respectively. This improvement was observed in patients with or without residual insulin secretion. In group II patients, the index of knowledge increased similarly from 67 +/- 4 to 85 +/- 2% (p less than 0.001). No significant decrease of HbA1 was observed in this group after 6 and 12 months, however whether the patients possessed residual insulin secretion or not.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Effect of glibenclamide in insulin-treated diabetic patients with a residual insulin secretion.

We have studied the effect of the combination of a sulfonylurea (Hb 420 or glibenclamide) with insulin in 22 type II diabetic patients, treated with insulin and with residual insulin secretion (fasting plasma C peptide level greater than 0.2 pmol/ml). After a 3 week run-in period, the patients received either glibenclamide (7 mg of Hb 420 before breakfast and 3.5 mg before supper) or placebo in double blind fashion. Clinical and biological parameters (body weight, number of hypoglycemic episodes, daily insulin dose, fasting and postprandial glucose and C peptide levels after a standard meal) were collected during the basal (run-in) period and after 8 and 16 weeks of treatment. In the glibenclamide group, a significant increase in the number of hypoglycemic episodes was observed in spite of a 8 to 10% reduction in insulin requirements. A 18% reduction of both fasting and postprandial plasma glucose levels was found after 8 and 16 weeks of glibenclamide therapy. Concomitantly, a 35% increase of fasting and postprandial plasma C peptide levels occurred. The data suggest that the use of combined sulfonylurea and insulin therapy may be beneficial to type II diabetic patients with residual insulin secretion and poor glycemic control under insulin therapy alone.

Blood Glucose↗
PubMed1985

Diagnostic evaluation of measurements of carboxyl-terminal flanking peptide (PDN-21) of the human calcitonin gene in human serum.

Calcitonin and its carboxyl-terminal flanking peptide (PDN-21), also encoded by the calcitonin gene, were measured by RIA in unextracted serum of normal subjects and patients with primary hyperparathyroidism and surgically verified and suspected medullary thyroid carcinoma. Serum PDN-21 was detectable (greater than 0.005 ngeq/ml) in the large majority of normal subjects (92%), and the values increased significantly more in men than women (4.8- and 2.0-fold, respectively; P less than 0.01) in response to 1-min iv calcium injections. Calcitonin was detectable (greater than 0.025 ngeq/ml) in only 25% of normal subjects before iv calcium and became measurable after iv calcium in 88% of men and 41% of women. In patients with chronic hypercalcemia due to primary hyperparathyroidism, PDN-21 and calcitonin were within normal limits. In normal subjects, iv pentagastrin (0.5 microgram/kg BW) did not increase PDN-21, and calcitonin remained undetectable. In 41 medullary thyroid carcinoma patients, basal PDN-21 and calcitonin levels were increased similarly, and they were stimulated in response to iv calcium or iv pentagastrin. In 5 siblings of medullary thyroid carcinoma patients, PDN-21 and calcitonin were increased in response to iv pentagastrin, and we suspect C-cell hyperplasia or medullary thyroid carcinoma. In conclusion, a diagnostically useful RIA for the measurement of PDN-21 in unextracted serum which complements calcitonin measurements has been developed.

Adolescent↗
PubMed1985

Gastric acid and pancreatic polypeptide responses to sham feeding are impaired in diabetic subjects with autonomic neuropathy.

To assess the relationship between cardiac and extra-cardiac dysfunction in diabetic autonomic neuropathy, the gastric acid output and the pancreatic polypeptide (hPP) secretion in response to sham feeding were evaluated in diabetic patients with (group 1) and without (group 2) cardiac autonomic neuropathy (CAN), and in normal subjects (group 3). All patients assigned to the group with CAN exhibited an impaired beat-to-beat heart rate variation during deep breathing. The basal gastric acid output was comparable in the three groups (1.3 +/- 0.5, 2.8 +/- 1.5, and 3.9 +/- 1.5 mmol/h, respectively). In contrast, the gastric acid output stimulated by sham feeding was significantly lower in patients with CAN (5.3 +/- 1.3 mmol/h) than in diabetic subjects without CAN (14.0 +/- 3.5 mmol/h; P less than 0.01) and in controls (10.9 +/- 3.1; P less than 0.05). The maximal gastric acid secretion capacity, determined after pentagastrin injection, was similar in all patients. Mean basal hPP concentrations were comparable in the three groups (185 +/- 53 pg/ml, 131 +/- 29 pg/ml, and 116 +/- 19 pg/ml). In the controls and diabetic subjects without CAN, a significant mean 60% increase of the hPP levels above basal values was observed during sham feeding. In contrast, no significant hPP response occurred in the group with CAN. These data suggest that diabetic CAN is associated with dysfunctions of the vagal pathways controlling the gastric acid output and the hPP secretion. Moreover, the results demonstrate a strong association between cardiac autonomic neuropathy and gastric vagal neuropathy (P less than 0.001).

Adult↗
PubMed1981

Continuous subcutaneous insulin infusion in the treatment of juvenile-onset diabetes.

Control of glycemia by means of continuous subcutaneous insulin infusion (CSII) was examined in two groups of diabetic patients. In the first group of five totally insulin-dependent diabetics, the glycemic profile was compared in hospital during optimized conventional insulin therapy and CSII. A second group of five recently diagnosed diabetic patients was treated for periods up to 70 days with CSII. Two insulin infusion systems were used: (1) a commercially available infusion pump and (2) a specially developed device, permitting a more flexible infusion rate and including an audible warning of malfunction. In the first group the mean plasma glucose levels decreased significantly under CSII (202 +/- 18 mg/dl vs 151 +/- 18 mg/dl; p less than 0.05; mean +/- SEM) although the M value and the MAGE index were similar during CSII and the optimized conventional therapy. In the second group of subjects, improved diabetic control, as assessed by the mean blood glucose level (135 +/- 18 mg/dl), and M value and the MAGE index, was rapidly achieved by CSII in all patients. Insulin requirements fell to zero in two of the three patients who maintained CSII at home for 60 and 70 days. It is concluded that CSII permits blood glucose control at least as good as optimized conventional treatment in totally insulin-dependent diabetics in hospital as well as in newly diagnosed diabetics.

Adult↗