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Biomedical subjects

A Frøland

Publications and source records attributed to A Frøland.

At least 19 recordsLinked to original sources
PubMed1992

Eight to nine year mortality in known non-insulin dependent diabetics and controls.

Microalbuminuria is known to predict mortality in elderly, non-insulin dependent diabetic individuals. To test whether this is also so when studied prospectively and over a longer period, we followed 228 persons with known diabetes mellitus and an age and sex matched, non-diabetic cohort for eight to nine years. Both cohorts were found during a population screening in 1981-1982 of 5292 citizens aged 60 to 74 years. At ascertainment extensive clinical and biochemical examinations including determination of urinary albumin were carried out. At May 15, 1990 111 diabetic and 46 non-diabetics had died (P less than 0.0001). In the diabetic cohort the median value of urinary albumin excretion (UAE) was 17.40 micrograms/min. In the group with values at or above 17.40 micrograms/min 62 died, compared with 40 deaths in the group with values below (P = 0.003). In the non-diabetic cohort the median UAE value was 7.52 micrograms/min. In the upper group 26 died, in the lower 15 (P = 0.05). Cox regression analyses showed coefficients of regression for ln(UAE) of 0.333 (P less than 0.001) for the diabetic group and 0.236 (P = 0.048) for the non-diabetic group. In the Cox model for the diabetics, ischemic heart disease was also of independent significance to mortality. The final model for the non-diabetics included hypertension and sex as significant variables. It is concluded that in a prospective study of elderly diabetics urinary albumin excretion rate is the best prognostic factor for long-term mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Microalbuminuria in non-insulin-dependent diabetes.

According to international consensus, microalbuminuria is defined as an elevated urinary albumin excretion rate (UAER) of 20-200 micrograms/min, which is below the proteinuric range. Nephropathy is a major complication in IDDM, seen in about 30% of patients after many years of diabetes. Increasing microalbuminuria is an excellent marker of subsequent nephropathy in these patients. End-stage diabetic nephropathy is also important in NIDDM, but in most Western countries this serious complication eventually develops in only 5 to 10% of cases, whereas the majority of patients die before this from cardiovascular disease. In completely healthy individuals there is no clear correlation between age and UAER, at least up to about 70 years of age. The mean excretion rate is around 5 micrograms/min, with a considerable range, but excretion only rarely exceeds 15 micrograms/min. In population studies among middle-aged and elderly individuals, higher values are seen. In newly diagnosed NIDDM about 40% of patients show an excretion rate above 15-20 micrograms/min. There is a significant but not precise correlation between albumin excretion rate and glycemic control, and usually UAER is reduced by standard antidiabetic treatment. In a considerable number of patients, high values cannot be reduced. In the course of NIDDM about 20-30% of patients show microalbuminuria. In patients with known diabetes, microalbuminuria is related not only to subsequent diabetic proteinuria, but even more strongly to early death, mainly from cardiovascular disease. Even slight microalbuminuria (15-40 mg/l in early morning urines) is clearly associated with increased mortality. In subjects with newly detected elevated blood glucose (by screening) microalbuminuria also predicts early mortality. The mechanisms are not established, but several arteriosclerosis-related risk factors are seen more frequently in patients with microalbuminuria, e.g. lipid abnormalities, elevated systolic blood pressure (BP), hemostatic measures, as well other markers of cardiovascular disease. Usually there is a significant but not precise correlation between BP and UAER in groups of patients throughout the course of diabetes. New studies document that also in the elderly background population microalbuminuria is a significant risk factor for early death, maybe even stronger than the established risk markers, which thus may be confounded with the presence of microalbuminuria.

Adult↗
PubMed1990

Microalbuminuria as predictor of increased mortality in elderly people.

OBJECTIVE: Correlation of the urinary albumin excretion rate and the risk of death among elderly subjects. DESIGN: 216 Subjects aged 60-74 whose urinary albumin excretion rate had been determined were followed up 62-83 months later. SETTING: Municipality of Fredericia, Denmark. SUBJECTS: 223 People who had been selected as control subjects for diabetics found during a systematic screening for diabetes of all people aged 60-74 living in the municipality of Fredericia, Denmark. Of these subjects, 216 had an extensive clinical and biochemical examination within a few weeks of selection. MAIN OUTCOME MEASURE: Death. RESULTS: The median urinary albumin excretion rate was 7.52 micrograms/min. Eight of those with a rate below the median died compared with 23 with a rate equal to or greater than the median (p = 0.0078). The median albumin excretion rate in the 31 who died was 15.00 micrograms/min. Cardiovascular disease was the most common cause of death in both groups. A multivariate regression analysis of survival data was performed using the proportional hazards model. Besides albumin excretion rate, male sex, serum creatinine concentration, and hypertension were found to be of prognostic value. CONCLUSIONS: The association between the albumin excretion rate and mortality that has been described in recent years in patients with diabetes mellitus may be present in elderly people in general, even when other known risk factors are taken into account.

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PubMed1990

Predischarge maximal exercise test identifies risk for cardiac death in patients with acute myocardial infarction.

A maximal exercise test was performed in 54 patients with acute myocardial infarction (AMI) before discharge and in 49 age-matched control subjects. The long-term prognosis was assessed after an average follow-up of 7.6 years in AMI patients and 5.8 years in control subjects. The maximal work capacity and systolic blood pressure increase in AMI patients was 59% that of control subjects (p less than 0.001). Seventeen AMI patients had significant ST-segment shifts, 13 with ST depression and 4 with ST elevation. In AMI patients experiencing a cardiac death during follow-up the maximal work capacity and systolic blood pressure increase were significantly lower than in survivors and those who died from noncardiac reasons (p less than 0.01; p less than 0.05), with no difference between these groups in the number of patients with ST-segment shifts. The average maximal work capacity of control subjects was 143 watts. A maximal work capacity half this (less than or equal to 72 watts) predicted long-term mortality in AMI patients (p less than 0.001). In addition a low increase in systolic blood pressure (less than 30 mm Hg) also predicted long-term mortality (p less than 0.005), whereas ST shifts were of no significant value. In this study maximal work capacity turned out to be the best single exercise variable for identifying groups of AMI patients with very low and relative high risk of cardiac death. When all 3 exercise variables were combined, the predischarge maximal exercise test was of great value in identifying AMI patients at low risk for cardiac death (predictive value of a negative test: 95%).

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PubMed1990

Concentration-response relationship in imipramine treatment of diabetic neuropathy symptoms.

A single-blind imipramine dose titration study was conducted in 15 diabetic patients with neuropathy symptoms. The effect of treatment was evaluated by use of visual analog scales. Imipramine doses were individually adjusted until doses yielded plasma concentrations of imipramine plus desipramine that were well above 400 nmol/L or until all neuropathy symptoms had vanished. In all except one patient, there was marked relief of symptoms. In the responding patients (n = 14), much of the effect occurred at plasma levels of imipramine plus desipramine below 100 nmol/L, but a considerable interindividual variation was observed. Concentrations above 400 to 500 nmol/L were required to ensure maximal effect in all patients, and we did not find any indication of a decreased effect at high drug levels. The dose-dependent kinetics of imipramine was confirmed, and dose increments should therefore be carried out in small steps and preferably with monitoring of drug levels.

Adult↗
PubMed1989

[Self-monitoring of blood glucose and understanding of the disease in patients with insulin-treated diabetes. Correlation with metabolic regulation].

A questionnaire investigation was undertaken to register the extent to which 212 insulin-treated diabetic patients undertook home measurements of blood glucose and the consequences which they drew from these measurements. This was compared with the metabolic regulation estimated by HbA1c. The average HbA1c-value was 8.0%. Only 13% had HbA1c-values within the reference range for non-diabetic persons. 85% of the patients undertook self-monitoring of blood glucose. In 47.6% insulin was administered once or twice daily, 42.5% were treated with multiple injections and 9.9% employed insulin pumps. Regardless or the form of treatment, good metabolic control was associated with numerous daily measurements of blood glucose whereas no independent connection was found between the form of treatment and the level of regulation. The best regulated patients altered the dosage of insulin with low blood glucose values and planned reduced activity. No connection was observed between the form of treatment, level of regulation or whether the patients undertook self-monitoring and the number of hospital contacts on account of hypoglycaemia or hyperglycaemia. Metabolic regulation was not satisfactory despite self monitoring of blood glucose and good understanding of the disease.

Adolescent↗
PubMed1989

Fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and urinary C-peptide in relation to clinical type of diabetes.

Many patients with Type 2 (non-insulin-dependent) diabetes mellitus are treated with insulin in order to control hyperglycaemia. We studied fasting plasma C-peptide, glucagon stimulated plasma C-peptide, and 24 h urinary C-peptide in relation to clinical type of diabetes in 132 insulin treated diabetic subjects. Patients were classified clinically as Type 1 (insulin-dependent) diabetic subjects in the presence of at least two of the following criteria: 1) significant ketonuria, 2) insulin treatment started within one year after diagnosis, 3) age of diagnosis less than or equal to 40 years, and 4) weight below 110% of ideal weight of the same age and sex. Eighty patients were classified as Type 1 and 52 as Type 2 diabetic subjects. A second classification of patients into 6 C-peptide classes was then performed. Class I consisted of patients without islet B-cell function. Class II-VI had preserved islet B-cell function and were separated according to the 20%, 40%, 60% and 80% C-peptide percentiles. The two classifications of patients were compared by calculating the prevalence of clinical Type 1 and Type 2 diabetes in each of the C-peptide classes. This analysis showed that patients with a fasting plasma C-peptide value less than 0.20 nmol/l, a glucagon stimulated plasma C-peptide value less than 0.32 nmol/l, and a urinary C-peptide value less than 3.1 nmol/l, or less than 0.54 nmol/mmol creatinine/24 h, or less than 5.4 nmol/24 h mainly were Type 1 diabetic patients; while patients with C-peptide levels above these values mainly were Type 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Imipramine treatment in diabetic neuropathy: relief of subjective symptoms without changes in peripheral and autonomic nerve function.

The effect of imipramine on symptomatic peripheral diabetic neuropathy in 9 patients was examined in a double-blind cross-over study against placebo. The dose of imipramine was adjusted to yield optimal plasma levels of imipramine plus desipramine of 300-750 nM. Imipramine had a clear beneificial effect on the symptoms of the neuropathy, whereas no changes in a range of neurophysiological measurement was detected. Despite some adverse effects, especially of an anticholinergic nature, the patients generally preferred imipramine to placebo.

Adult↗
PubMed1989

Peripheral nerve function during hyperglycemic clamping in insulin-dependent diabetic patients.

The influence of hyperglycemia on peripheral nerve function was studied in 9 patients with long-term insulin-dependent diabetes. Blood glucose concentration was raised 13.5 +/- 0.5 mmol/l (mean +/- SEM) within 15 min and kept approximately 15 mmol/l over basal level for 120 min by intravenous glucose infusion. Hyperglycemia was accompanied by increased plasma osmolality. Sensory and motor nerve conduction and distal motor latency in the ulnar nerve were determined before, immediately after induction of hyperglycemia, and again after 120 min hyperglycemia. Distal (5th finger - wrist) and proximal (wrist - elbow) sensory nerve conduction showed an insignificant increase as hyperglycemia was induced. During hyperglycemia mean distal sensory conduction decreased from 53.1 m/s to 50.4 m/s (P less than 0.05) and mean proximal sensory conduction decreased from 56.0 m/s to 54.2 m/s (P less than 0.01). A mean of distal and proximal sensory conduction increased (53.5 m/s vs 54.6 m/s) (P less than 0.05) as hyperglycemia was induced and decreased (54.6 m/s vs 52.3 m/s) (P less than 0.01) during clamping. Motor nerve conduction decreased insignificantly throughout the study. Mean distal motor latency decreased from 3.1 ms to 2.8 ms (P less than 0.005) immediately after induction of hyperglycemia. During hyperglycemia it increased from 2.8 ms to 3.1 ms (P less than 0.001). We conclude that acute induction of hyperglycemia in long-term diabetics seems to increase sensory conduction and decrease distal motor latency, while 120 min hyperglycemia seems to decrease sensory conduction and increase distal motor latency.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Metabolic effect of islet B-cell function in insulin-treated diabetes.

We studied the relationship between endogenous insulin secretion and fasting levels of plasma free fatty acids (FFA), plasma acetoacetate plus plasma 3-hydroxybutyrate (total ketone bodies), blood glucose, and HbA1 in 132 diabetic outpatients treated with conventional insulin regimens. Patients were divided into four groups according to plasma C-peptide concentration after intravenous stimulation with glucagon: one group with C-peptide stimulation less than 0.06 nmol/l, one group with C-peptide stimulation 0.06- less than 0.32 nmol/l, one group with C-peptide stimulation 0.32- less than 0.60 nmol/l, and one group with C-peptide stimulation greater than 0.60 nmol/l. According to clinical criteria the prevalence of insulin-dependent diabetes mellitus was approximately 90% in patients with C-peptide stimulation less than 0.32 nmol/l, approximately 25% in patients with C-peptide stimulation from 0.32- less than 0.60 nmol/l, and approximately 10% in patients with C-peptide stimulation greater than 0.60 nmol/l. All metabolic variables were significantly higher in patients without detectable C-peptide in plasma when compared to values found in patients with C-peptide stimulation from 0.06- less than 0.32 nmol/l. These two patient groups also had similar peripheral plasma free insulin levels and were comparable according to age, sex, and body mass index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Community care for elderly diabetics: the Fredericia Survey of diabetic and fasting hyperglycaemic subjects aged 60-74 years.

A study was undertaken of the use of community care services by 228 known diabetics and 87 subjects with one fasting blood glucose greater than or equal to 7 mmol/l (fasting hyperglycaemics) found during population screening of a geographically well-defined population aged 60-74 years. The two groups were compared with non-diabetic control groups with the same sex and age distribution as the study groups. The group of known diabetics comprised 52 insulin treated, 101 treated with oral hypoglycaemic agents + diet, 66 diet treated, and nine untreated. Information on community care services (pensions, home help, home nursing care, sick benefit, rent allowance, and technical aids) during the 12 months before ascertainment was obtained from the municipality office. Fasting hyperglycaemics did not receive more community care services than controls other than with regard to home help. More known diabetics received community care services than non-diabetics. Insulin treated diabetics received disability pension, aids, and home nursing care more often than the non-insulin treated. The mean number of hours of home help per person per year was 3-4 times higher for known diabetics in all antidiabetic treatment groups than for controls. The mean number of visits by home nurses/person/year for insulin treated diabetics was 83, for the non-insulin treated 6-7, and for controls 1-2 visits. Insulin injections and treatment of ulcers were the main reasons for the visits.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1989

[Clinical chemical parameters for metabolic control of patients with diabetes mellitus].

Fructosamine and various measures of blood glucose were compared to glycosylated hemoglobin as indices of glycaemic control in 148 patients with insulin treated diabetes. Fructosamine correlated fairly well with glycosylated hemoglobin (r = 0.67), but around 40 per cent of the patients with glycosylated hemoglobin below upper reference limit had a fructosamine value over upper reference limit and vice versa. The possibility to predict the level of glycosylated hemoglobin from fasting blood glucose, postprandial blood glucose, and self-measured blood glucose was poor. The difference in self-measured blood glucose from patients with high versus low levels of glycosylated hemoglobin was very modest (0.5-2.0 mmol/l). It is concluded that it is reasonable to measure both glycosylated hemoglobin and fructosamine to evaluate glycaemic control in insulin treated diabetic patients. Fasting blood glucose, postprandial blood glucose, and self-measured blood glucose only seem to reflect glycaemic control to a minor degree.

Adult↗
PubMed1988

Peripheral nerve function during hyperglycemic clamping in healthy subjects.

The influence of hyperglycemia with physiological hyperinsulinemia on peripheral nerve function was studied in 10 non-diabetic subjects. Blood glucose concentration was raised from 3.8 +/- 0.2 mmol/l (mean +/- SEM) to 17.1 +/- 1.4 mmol/l (mean +/- SEM) within 15 min and kept at this level for 120 min by intravenous glucose infusion. Sensory and motor nerve conduction velocity, and distal motor latency in the ulnar nerve were determined before, immediately after induction of hyperglycemia, and again after 120 min of hyperglycemia. Mean sensory nerve conduction velocity increased from 57.7 m/s to 59.5 m/s (P less than 0.005) immediately after induction of hyperglycemia, and after 120 min of hyperglycemia mean sensory nerve conduction velocity was 59.6 m/s (P less than 0.05). An insignificant increase was seen in motor nerve conduction velocity during hyperglycemia. Mean distal motor latency decreased from 3.1 ms to 3.0 ms (P less than 0.025) immediately after induction of hyperglycemia, and after 120 min of hyperglycemia distal motor latency was 2.9 ms (P less than 0.05). We conclude that short term hyperglycemia with physiological hyperinsulinemia seems to increase sensory nerve conduction velocity and decrease motor latency.

Adult↗
PubMed1988

The beta-cell response to glucagon and mixed meal stimulation in non-insulin dependent diabetes.

The aim of this study was to evaluate the correlations of the C-peptide and insulin responses after stimulation with glucagon intravenously as well as the 24-h urinary excretion of C-peptide to the C-peptide response to a standard mixed meal in 30 patients with non-insulin dependent diabetes mellitus (NIDDM). Fasting plasma C-peptide as well as the C-peptide and insulin responses to glucagon, showed similar but only modest correlations with the C-peptide response to the meal. Urinary C-peptide showed no correlation with the C-peptide response to the meal, but correlated modestly with fasting plasma C-peptide (r = 0.55, p less than 0.01). The C-peptide and insulin responses after meal stimulation correlated modestly inversely with HbA1. In conclusion, measurement of C-peptide in fasting state, as well as measurements of C-peptide and insulin after glucagon stimulation, only modestly predict the C-peptide response to physiologic stimulation in NIDDM. Twenty-four-hour urinary C-peptide excretion does not predict this response. Patients with NIDDM seem to show a better metabolic control if they have a more pronounced beta-cell response to physiologic stimulation.

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PubMed1985

Glycosylated hemoglobin A1 used in quality-control of diabetes care: a cross-sectional study in an outpatient clinic.

HBA1 was used to evaluate the quality of treatment and regulation in 163 insulin treated diabetes patients. The mean of HBA1 in all patients was 11.2 +/- 2.4%. Only 24% of the patients had HBA1 values below the mean + 3 SD of non diabetics. Patients with high values of HBA1 were controlled and treated more intensively than those with lower or normal values. They were also seen more frequently at the outpatient clinic, their insulin doses were larger, and they took more frequent insulin injections. 63% of the patients practised home monitoring of blood glucose, but they were not better controlled than those, who did not. In some of the patients conspicuous discrepancies were found between high HBA1 percentages and low blood glucose values measured at the outpatient clinic. It is concluded, that home monitoring of blood glucose, frequent visits to an outpatient clinic, and 2 daily insulin injections do not appreciably improve diabetes control, and that other approaches are needed, e.g., greater co-operation by the patients in frequent adjustments of treatment between clinic visits.

Adult↗
PubMed1979

Sexual function and pituitary axis in insulin treated diabetic men.

The prevalence of sexual dysfunction and the pituitary-gonadal function were studied in 72 consecutive diabetic male patients. Sexual dysfunction was found in 43% and in these patients peripheral neuropathy was significantly more frequent than in patients with normal sexual function. Sexual dysfunction was more frequent in patients at the age of 50--55 years than in young diabetics (age 25--30 years). No significant correlation between sexual dysfunction and the duration of the disease and no difference in the serum concentrations of luteinizing hormone, follicle stimulating hormone, prolactin, testosterone and oestradiol-17beta between patients with normal and reduced sexual function was found. It is concluded, that sexual dysfunction is not accompanied by altered serum concentrations of testosterone, oestradiol 17beta, gonadotrophins or prolactin. Sexual dysfunction correlates with peripheral neuropathy, but the high prevalence of dysfunction in males with short duration of diabetes without neuropathy makes other causes likely.

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