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Biomedical subjects

B R Zimmerman

Publications and source records attributed to B R Zimmerman.

At least 19 recordsLinked to original sources
PubMed1992

Preventing long term complications. Implications for combination therapy with acarbose.

Long term complications continue to be the major source of morbidity and mortality in patients with diabetes. Acarbose could potentially help to reduce diabetic complications if it improved glucose control, reduced lipid levels and hyperinsulinaemia. Acarbose has been shown to effectively reduce postprandial hyperglycaemia and haemoglobin A1c. This effect might be helpful in patients with insulin-dependent diabetes mellitus, as insulin injections do not provide complete control of rises in postprandial glucose levels, and in patients with non-insulin-dependent diabetes mellitus, because it simplifies the treatment programme. If improved control is shown to reduce complications, acarbose may be helpful. Although acarbose does not reduce hyperinsulinaemia, it reduces lipid levels and thus could reduce the risk of atherosclerosis.

Acarbose↗
PubMed1992

Diagnosis, pathogenesis, and management of diabetes mellitus.

Proper care of the patient with diabetes mellitus poses a challenge for all health care professionals. The diagnosis is often established at the onset of symptoms. Early diagnosis through screening of patients at high risk allows prompt initiation of therapy and may help prevent long-term complications. The fasting plasma glucose determination is the most useful diagnostic test, but random plasma glucose and the oral glucose tolerance test are also used to diagnose diabetes, depending on the circumstances. Complex insulin programs and frequent self-monitoring of blood glucose are required to achieve acceptable glucose control in patients with insulin-dependent diabetes mellitus. Treatment of non-insulin-dependent diabetes mellitus requires a choice among diet, sulfonylureas, insulin, or a combination of these therapies. Achievement of treatment goals requires diet, monitoring, education, and continuing care in addition to medication. A general understanding of these goals may help the optometrist participate more effectively in the care of this challenging and important class of patients.

Diabetes Mellitus↗
PubMed1991

Portable blood glucose meters. Teaching patients how to correctly monitor diabetes.

Self-monitoring of blood glucose is an important component of treatment in patients with diabetes. Recent improvements in glucose meters have made patient self-testing more reliable and less dependent on user technique. However, success of the process depends on the training, reassessment, and support of the patient by the healthcare team.

Blood Glucose Self-Monitoring↗
PubMed1991

Progression of peripheral occlusive arterial disease in diabetes mellitus. What factors are predictive?

The clinical, biochemical, and vascular laboratory measurements potentially associated with the development and/or progression of peripheral occlusive arterial disease (POAD) were assessed during a 4-year period in 110 normal control subjects, 112 patients with POAD without diabetes mellitus, 240 patients with diabetes mellitus without POAD, and 100 patients with diabetes mellitus and POAD. Age, history of hypertension or coronary heart disease, history of cigarette smoking, presence of POAD, systolic blood pressure, and beta-thromboglobulin level were associated with progression of POAD. A multivariate logistic regression model indicated that the presence of diabetes mellitus or POAD or both at baseline, decreased postexercise ankle-brachial index, increased arm systolic blood pressure, and current smoking were independently associated with progression of POAD. This study suggests that cessation of smoking and control of hypertension are essential treatment modifications to decrease the risk of progression of peripheral vascular disease in diabetic patients.

Arterial Occlusive Diseases↗
PubMed1990

Pancreas transplantation at Mayo: I. Patient selection.

From October 1987 to December 1988, 59 patients underwent assessment for combined kidney and pancreas transplantation or pancreas transplantation after receiving a kidney allograft. We report our criteria for accepting candidates for transplantation, the results of the selection process, and the clinical and laboratory profile of those patients who underwent transplantation. Of the overall group, 22 patients (37%) were approved medically, 3 of whom were awaiting financial approval. Of the 59 patients, 15 (25%) were not approved for the transplantation program for medical reasons; in addition, 16 patients declined participation and 3 were not accepted because of lack of financial resources. Medical reasons for exclusion from pancreas transplantation were coronary artery disease in six patients, severe peripheral vascular disease in six patients, other medical problems in two patients, and noncompliance in one patient. Thus, many patients who underwent assessment for pancreas transplantation did not enter the program because of medical, financial, or personal preference reasons. In most cases, the medical reason for exclusion from pancreas transplantation was a cardiovascular disorder.

Adult↗
PubMed1990

Course of peripheral occlusive arterial disease in diabetes. Vascular laboratory assessment.

To determine comparative rates of development and progression of peripheral occlusive arterial disease, 110 healthy nondiabetic control subjects, 112 patients with peripheral occlusive arterial disease (POAD), 240 patients with diabetes mellitus (DM), and 100 patients with diabetes mellitus and peripheral occlusive arterial disease (DM + POAD) were studied over 4 yr with noninvasive techniques. The presence of peripheral occlusive arterial disease was determined by postexercise ankle-brachial index (ABI) values; progression of peripheral occlusive arterial disease was determined by the rate of change in postexercise ABI. Patients who underwent peripheral arterial reconstructive surgery or amputation were also classified as having progression of their peripheral occlusive arterial disease. On this basis, follow-up revealed that peripheral occlusive arterial disease developed and therefore progressed in 1 (1%) of the control group and 22 (9%) of the DM. Peripheral occlusive arterial disease progressed in 31 (28%) of the POAD and 26 (26%) of the DM + POAD. The presence of peripheral occlusive arterial disease predisposes to progression of disease, and peripheral occlusive arterial disease is more likely to develop in diabetic patients who do not have peripheral occlusive arterial disease than in nondiabetic control subjects. However, the presence of diabetes mellitus in patients with peripheral occlusive arterial disease does not seem to increase the risk of progression.

Amputation, Surgical↗
PubMed1989

Influence of the degree of control of diabetes on the prevention, postponement and amelioration of late complications.

The relationship between hyperglycaemia and the chronic complications of diabetes has been disputed for many years. Some physicians believe that the evidence that hyperglycaemia is the primary determinant of the chronic complications is convincing; others believe the question remains unsettled. Several types of study provide information. In vitro and in vivo studies demonstrate biochemical alterations induced by hyperglycaemia which could lead to structural changes and diabetic complications. Animal models demonstrate that the complications develop with induction of hyperglycaemia and are ameliorated when blood glucose is returned toward normal. Many uncontrolled clinical studies demonstrate an association between diabetes control and complications but cannot prove causality. Controlled clinical trials have sometimes, but not always, shown functional changes suggestive of amelioration of complications with control of hyperglycaemia. A definitive clinical trial has not yet been completed. Pancreas transplantation has the potential of completely normalising blood glucose, but studies to date have been limited by small numbers of patients, the advanced state of complications, and the lack of adequate controls. On balance, the evidence is highly suggestive that hyperglycaemia is a major determinant of the chronic complications of diabetes. Even if the relationship is established, the risk involved in treatment programmes to achieve near normoglycaemia must be better defined so that potential risk versus benefit can be evaluated in the individual patient when making treatment decisions.

Animals↗
PubMed1988

Nerve glucose, fructose, sorbitol, myo-inositol, and fiber degeneration and regeneration in diabetic neuropathy.

We measured the alcohol sugars in sural nerves from 11 controls, 21 conventionally treated patients with diabetes and neuropathy, and 4 diabetics without neuropathy. The results were related to metabolic control and to clinical, neuropathological, and morphometric abnormalities in the nerves. The mean endoneurial glucose, fructose, and sorbitol values were higher in diabetic patients than in controls. Linear regression analysis revealed that nerve sorbitol content in the diabetics was inversely related to the number of myelinated fibers (P = 0.003). Mean nerve levels of myo-inositol were not decreased in the diabetic patients, with or without neuropathy, and were not associated with any of the neuropathological end points of diabetes. Our results indicate that myo-inositol deficiency is not part of the pathogenesis of human diabetic neuropathy, as had been hypothesized. Other accumulated alcohol sugars, however, were increased in diabetes and were associated with the severity of neuropathy. On repeat biopsy, six diabetics, treated for a year with the aldose reductase inhibitor sorbinil, had decreased endoneurial levels of sorbitol (P less than 0.01) and fructose (0.05 less than P less than 0.1), but unchanged levels of myo-inositol.

Adolescent↗
PubMed1988

Management of noninsulin-dependent diabetes mellitus.

Management of the patient with NIDDM requires the skill and patience of the physician and the input of a health team, including the dietitian and nurse educator. With perseverance and careful follow up, most treatment goals can be achieved in these patients. The attitude of neglect and easy treatment goals that previously characterized the care of these patients are not justified.

Continuity of Patient Care↗
PubMed1987

Neurologic evaluation and treatment of the diabetic foot.

Neuropathy is a frequent complication of diabetes and is most commonly manifest as a sensory neuropathy involving the feet. Although biochemical and experimental animal studies suggest a direct link between the hyperglycemia of diabetes and the development of neuropathy, this link is unproven in humans. Evaluation for neuropathy can usually be accomplished clinically, but in selected cases electromyography is helpful. Other testing methods have a well-defined research note, but their clinical utility is less well established. Treatment of diabetic neuropathy is empirical. Better blood glucose control is attempted and a variety of medications are used to treat the symptoms. Promising treatment methods are being investigated, but none is of proven benefit.

Diabetic Neuropathies↗
PubMed1986

Comparison of distal sympathetic with vagal function in diabetic neuropathy.

We measured distal sympathetic and vagal function in 73 consecutive patients with diabetic neuropathy seen at the Mayo Autonomic Reflex Laboratory. Postganglionic sympathetic failure measured proximally within the foot occurred as commonly as vagal failure (58% and 55%, respectively) and occurred much more frequently than did orthostatic hypotension (26%). Either vagal or distal sympathetic abnormalities occurred in isolation in about one in six patients with diabetic neuropathy. We conclude that distal sympathetic failure and vagal failure occur with equal frequency when sensitive and quantitative recording methods are used and that it is advantageous to test both systems, as only one may be involved in some patients.

Adult↗
PubMed1986

Practical aspects of intensive insulin therapy.

Application of the principles of intensive insulin therapy in an attempt to achieve near-normal glycemia necessitates making many practical decisions for each patient. Often these decisions must be based on experience and opinion because the questions have not been studied adequately enough to be answered definitively. One approach to selection of patients, initiation of therapy, insulin management, blood glucose monitoring, and patient follow-up is reviewed.

Blood Glucose↗
PubMed1986

Sterol excretion and cholesterol absorption in diabetics and nondiabetics with and without hyperlipidemia.

Fecal neutral and acidic sterols and cholesterol absorption were measured in 12 normal control subjects, 40 diabetic subjects with and without hyperlipidemia, and 27 subjects with hyperlipidemia but without diabetes mellitus. All subjects were on a low-cholesterol diet (less than 300 mg cholesterol/day). Fecal excretion of neutral and acidic sterols was increased in patients with hypertriglyceridemia and was more marked in diabetic patients with hypertriglyceridemia. Cholesterol absorption was decreased in diabetic patients with hypertriglyceridemia. Otherwise, there were no significant differences in sterol excretion or cholesterol absorption in diabetic and nondiabetic subjects compared with control groups with similar lipid levels. The best predictors of fecal neutral- and acidic-sterol excretion and of estimated cholesterol synthesis were very low [corrected]-density lipoprotein triglycerides and high-density lipoprotein cholesterol. Correction of hyperlipidemia may be beneficial in decreasing cholesterol synthesis and, thereby, in decreasing the risk of atherogenesis.

Adult↗
PubMed1985

Reproducibility of noninvasive tests of peripheral occlusive arterial disease.

We studied the reproducibility of four tests of peripheral occlusive arterial disease in 54 subjects, 32 of whom had this disease. We found that the reproducibility of systolic blood pressures obtained at rest from the thighs, calves, and ankles approximated that of arm systolic and diastolic blood pressures, as did the ankle-to-arm systolic blood pressure ratios. The average of the tenth and ninetieth percentile ranges of the resting systolic blood pressure ankle-to-arm ratios was +/- 0.10. Systolic blood pressures from the fingers were somewhat less reproducible, and those from the toes were even more variable. Systolic blood pressure ankle-to-arm ratios measured after the patient had exercised were less reproducible than resting ratios. The average of the tenth and ninetieth percentile ranges of the 1-, 3-, 5-, and 10-minute ratios after exercise was -0.13 to +0.16. Skin temperatures from the fingers and toes were approximately as reproducible as systolic blood pressures from the arms and legs and as the resting ankle-to-arm blood pressure ratios. Pulse-volume recordings from the thighs, calves, ankles, feet, toes, and fingers were very poorly reproducible. We conclude that information on the reproducibility of these measurements is essential in the evaluation of noninvasive arterial tests that are used to determine the course of peripheral occlusive arterial disease.

Arm↗
PubMed1977

Prolonged follow-up in diabetic retinopathy treated by sectioning the pituitary stalk.

Because no complete long-term follow-up of visual status after pituitary ablation has been reported, records were reviewed on all 40 patients undergoing sectioning of the pituitary stalk for diabetic retinopathy at the Mayo Clinic from 1961 through 1968. One patient died and another was blind immediately postoperatively. One patient was lost to follow-up after 125 months. Twenty-seven patients have died after a follow-up interval of 7 to 120 months (mean, 63 months). The last available evaluation of these patients indicated stable or improved visual acuity in 20 patients. Eleven patients remain alive. Seven of these have stable or improved visual acuity and retinopathy. We conclude that although late post-operative mortality is high, in carefully selected patients with florid retinopathy but no fibrosis, pituitary ablation is an effective method for maintaining visual acuity.

Adolescent↗