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Biomedical subjects

A Teuscher

Publications and source records attributed to A Teuscher.

At least 37 records · Page 2Linked to original sources
PubMed1991

Influence of human insulin on symptoms and awareness of hypoglycaemia: a randomised double blind crossover trial.

OBJECTIVE: To investigate the apparent increased risk of severe hypoglycaemia associated with use of human insulin by comparing the pattern of symptoms of hypoglycaemia with human insulin and porcine insulin. DESIGN: Randomised controlled double blind crossover trial of treatment with human insulin and porcine insulin, with two treatment periods of six weeks. SETTING: Diabetes outpatient department of a university teaching hospital in Berne, Switzerland. PATIENTS: 44 patients (25 men, 19 women) aged 14 to 60 years, with insulin dependent diabetes mellitus. All patients met the following criteria: receiving treatment with fast acting soluble insulin and long acting protamine insulin; performing multiple daily fingerstick blood glucose self measurements; and had stable glycaemic control with about one mild hypoglycaemic episode a week during the preceding two months. INTERVENTION: Patients were randomised to receive either human or porcine insulin for six weeks and were then changed over to the other type of insulin for a further six weeks. MAIN OUTCOME MEASURE: Questionnaire recording "autonomic" and "neuroglycopenic" symptoms that occurred during hypoglycaemic episodes confirmed by a blood glucose concentration less than or equal to 2.8 mmol/l. RESULTS: Insulin doses and blood glucose, glycated haemoglobin A1c, and fructosamine concentrations were similar during the two treatment periods. 493 questionnaires on hypoglycaemia (234 during treatment with human insulin and 259 during treatment with porcine insulin) were analysed. With human insulin patients were more likely to report lack of concentration (52% v 35%, p = 0.0003) and restlessness (53% v 45%, p = 0.004) and less likely to report hunger (33% v 42%, p = 0.016) than during treatment with porcine insulin. The difference in the pattern of symptoms during the two treatments was similar to that between the 12 patients with a history of recurrent hypoglycaemic coma and the 32 patients without such a history. CONCLUSIONS: The pattern of symptoms associated with human insulin could impair patients' ability to take appropriate steps to avoid severe hypoglycaemia. Caution should be exercised when transferring patients from animal insulin to human insulin, and a large scale randomised trial of the two types of insulin may be justified.

Adolescent↗
PubMed1989

Diabetes and hypertension. Blood pressure in clinical diabetic patients and a control population.

Blood pressure was recorded in a group of 514 randomly selected Swiss diabetic patients (267 men and 247 women; 164 early-onset and 350 late-onset diabetics) aged from 35 to 54 years. These patients were compared with a control group from a population survey in Switzerland (877 men and 850 women). Mean systolic pressure (+/- SD) in the diabetic population was 139.3 +/- 21 mm Hg as compared with 125.5 +/- 17 mm Hg among controls. Mean diastolic pressure was 85.4 +/- 12 mm Hg in diabetic subjects as compared with 79.1 +/- 12 mm Hg in controls. The difference was reduced by about 25% after adjustment for body mass, age, and sex; 30.7% of diabetic subjects as compared with 8.2% among controls were hypertensive. Sixty-two percent of the hypertensive diabetic patients and 45% of the hypertensive controls were receiving antihypertensive treatment. In a multivariate analysis, presence of proteinuria and larger body mass had an important influence on systolic and diastolic blood pressures and the risk of hypertension. Diabetes duration had a significant influence only on systolic blood pressure. Efforts are needed in the clinical and research field to limit and clarify the harmful effects of elevated blood pressure in diabetes.

Adult↗
PubMed1988

[Switzerland changes from U-40 to U-100 insulin].

At present over 95% of the insulin used in Switzerland is sold in a concentration of 40 units per ml (U-40 insulin). Only recently a small but increasing amount of more concentrated insulin has been introduced through the use of "pen" injectors which are all designed for U-100 (= 100 units per ml) insulin. Experience in other countries has shown that when different insulin concentrations are available on the market the risk of dosage errors with potentially severe consequences is high. The Swiss Diabetes Association has therefore taken the initiative in standardizing the concentrations available in Switzerland. A change from U-40 and U-100 to exclusively U-100 insulin is planned for the period from October 1988 to March 1989. A survey among 82 Swiss doctors and 243 IDDM patients has shown that about 60% of doctors and patients are in favour of the change while the remaining 40% are either neutral or opposed to it. Advantages, disadvantages and logistic problems of the change to exclusive use of U-100 insulin, and the possibility of pharmacological differences between insulins of different concentrations, are discussed. It is stressed that the change to U-100 must be medically supervised in every patient. An intensive information campaign providing detailed advice for patients, doctors and pharmacists is essential for the prevention of accidents.

Diabetes Mellitus, Type 1↗
PubMed1988

Incidence of diabetic retinopathy and relationship to baseline plasma glucose and blood pressure.

A nationwide, stratified population sample of 534 diabetic Swiss men and women, aged 35-54 yr, participated in a study of vascular disease. The study was based on a common protocol, standardized examination procedures, and centralized laboratory methods. Patients were chosen from a pool of diabetic Swiss with diabetes greater than or equal to 1 yr. After selection, the participants were classified into groups according to age at diabetes onset (greater than 30 or less than 30 yr) and insulin treatment status. Several variables thought to be related to retinopathy incidence were analyzed at the initial examinations: onset of diabetes before age 30, duration of disease, fasting plasma glucose, blood pressure, and insulin therapy. Follow-up examination of 358 of 458 survivors, with a diabetes duration that averaged 20 yr, showed retinopathy significantly and independently associated with initial fasting plasma glucose, systolic blood pressure, and insulin use but not with diabetes duration. Lower rates of retinopathy development were observed during the follow-up period in diabetic patients on antihypertensive therapy at the baseline examination, suggesting that not only lower fasting plasma glucose and systolic blood pressure levels but also blood pressure therapy itself decreases the incidence of retinopathy.

Adult↗
PubMed1987

Hypoglycaemia unawareness in diabetics transferred from beef/porcine insulin to human insulin.

The case-histories of 3 patients with insulin-dependent diabetes mellitus (IDDM) suggested that, after a switch from beef/porcine to human insulin, a given level of hypoglycaemia may cause less pronounced sympathoadrenal symptoms (tremor, sweating, &c), so that there is less warning of impending unconsciousness. This possibility was investigated by questioning of 176 IDDM patients who had switched from beef/porcine to human insulin with negligible change in dosage 1-48 months earlier. 66 (36%) said that their symptoms of hypoglycaemia had changed from those of sympathoadrenal activation to those of neuroglycopenia. This disadvantage of human insulin is an argument for continued availability of beef/porcine insulin.

Adolescent↗
PubMed1987

Absence of diabetes in a rural West African population with a high carbohydrate/cassava diet.

1028 (99%) of the 1038 inhabitants of the West African village of Agbave and a random sample of 353 (12.4%) of the population of 2850 in Kati, another West African village, were screened for diabetes. Also recorded were their anthropometric data, dietary habits, possession of antibodies to malaria, and serum IgG concentrations. About 85% of the study population consumed cassava root at least once a day. The mean (SD) capillary random blood glucose concentration was 5.1 (1.1) mmol/l in men and 5.1 (0.6) in women. The mean (SD) body mass index was 20.2 (1.8) in men and 20.7 (2.3) in women. The mean blood glucose was similar whether cassava was consumed once daily, more than once daily, or less than once daily. None of the 1381 subjects examined had diabetes. This finding suggests that a high carbohydrate/cassava intake (84% of a mean daily supply of 1916 calories) combined with a low protein consumption (8% of caloric supply) does not cause diabetes. This does not support the World Health Organisation hypothesis that malnutrition-related diabetes exists, at least not in this West African rural population.

Adolescent↗
PubMed1986

[Carbohydrates and dietary fiber in the diabetic diet].

Dietary fibre has a blood-glucose reducing effect, as is manifested by a diminished glycemic index. In 1980 the consumption of dietary fibre in Switzerland is 22 g/day in comparison to 27 g in 1956. Thirty-five patients with diabetes (15 with insulin and 20 without) were treated with a high carbohydrate-high fibre diet (55% of total calories) for a period of 12 months. There were no changes in postprandial blood glucose values, HbA1, cholesterol or bodyweight (in insulin-treated patients the weight decreased p less than 0.05) despite a high carbohydrate diet.

Blood Glucose↗
PubMed1983

[Vascular diseases in 534 Swiss diabetics within the scope of a multinational study].

In Switzerland 278 diabetic men and 256 women in the age group 35 to 54 were examined for the presence of angiopathic lesions, according to a standardized protocol of a multinational study comprising 6,695 diabetics from 14 countries. The diabetics were distributed according to sex, age, and duration of the disease into groups of equal size. Macro-angiopathy, as the sum of coronary heart disease, stroke, and vascular disease of the legs was found in 28% of men and in 29% of women in the Swiss group. The prevalence of myocardial infarction alone was 6.8% in men and 5.5% in women. These rates did not differ from those found in the other national groups. Micro-angiopathy was found in the form of retinopathy in 35% and as nephropathy in 32% of the Swiss diabetics. These rates were not different from those of all groups. Severe retinopathy was found more frequently in Swiss diabetics than in the whole study. Micro-angiopathy was strongly related to duration, hypertension, and type of treatment in all centres. Japanese diabetics showed a higher frequency of micro-angiopathy, although macrovascular disease was found at a low rate. Systolic blood pressure (BP) in the Swiss diabetics did not differ from the results of the whole group. In 14% of the Swiss diabetic men and in 18% of the women, systolic BP was over 160 mmHg. These rates were remarkably higher than in an age- and sex-matched sample of a randomly selected sample of a Swiss population (3.2% in men, 2.4% in women). Cholesterol was high in the Swiss diabetic groups, whereas body mass index was in the intermediate range. Of the Swiss diabetic men 38% smoked regularly. The frequency of coronary heart disease in Swiss men and women was similar. This is different from the lower rate usually found in non-diabetic women. Age, and not duration of the disease was the most important factor relating to macro-angiopathy. The different rates of macro- and microvascular complications in various populations, selected according to the same protocol, suggests that the risk factors for macrovascular disease differ from those of microvascular complications. Race, nutrition, treatment, exercise, and hypertension may further influence the prevalence of angiopathy in diabetics of same sex, age, and duration of the disease.

Adult↗
PubMed1982

Interrelationships of microangiopathy, plasma glucose and other risk factors in 3583 diabetic patients: a multinational study.

In a multinational study, fasting plasma glucose values in 3583 diabetic patients, aged 34-56 years, were related to the characteristics of these subjects and to the presence and severity of microangiopathy as ascertained by standardised methods. The patients were from nine different populations and ranged in number from 193 to 686 per population (London, Warsaw, Berlin (FRG), New Delhi, Tokyo, Havana, Oklahoma Indians, Arizona Pima Indians, and a national sample in Switzerland). In the total group, mean fasting plasma glucose was 8.1 mmol/l for those on diet alone, 9.7 mmol/l for those on oral agents, and 12.7 mmol/l for insulin-treated patients, of whom 25% had values exceeding 16.5 mmol/l. Since many variables were measured in each patient, it was possible to take into account many confounding factors in evaluating the relationship of plasma glucose levels to retinopathy and nephropathy.

Adult↗