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Biomedical subjects

D M Nathan

Publications and source records attributed to D M Nathan.

At least 73 records · Page 4Linked to original sources
PubMed1988

Combined kidney and pancreas transplantation in diabetics.

Kidney and pancreaticoduodenal transplantation were simultaneously performed in 12 insulin-dependent diabetic patients. These patients had advanced secondary complications, including blindness, vascular disease, and disabling neuropathy. Average posttransplant hospitalization and charges were 17.7 days and $42,780 compared with 11.2 days and $29,000 for patients who received renal allografts alone. Following transplantation, blood glucose and glycosylated hemoglobin A levels promptly returned to normal in all patients. Two patients subsequently died, one after five months of a cytomegalovirus infection and one after seven months of a ruptured bladder. After a mean of 11.6 months of follow-up, ten patients (83%) remained independent of insulin and dialysis. The success of pancreas transplantation in diabetics with advanced complications now approaches that of other organ allografts. It therefore appears reasonable to recommend transplantation for diabetics with less severe secondary complications, since these candidates are most likely to realize the potential benefits of long-term normoglycemia.

Adult↗
PubMed1988

Modern management of insulin-dependent diabetes mellitus.

Currently available treatment methods, albeit improved, remain less than totally satisfactory. New developments such as improved viability of whole organ pancreatic transplants, islet cell transplantation, immunosuppression in the treatment of new-onset diabetes, development of reliable glucose sensors to provide continuous feedback for insulin delivery devices, and alternate routes for insulin administration may drastically change diabetes treatment in the future. For now, physicians must carefully consider the risks and benefits associated with available treatments when discussing therapeutic options with patients and their families. The wide range of therapies available provides the opportunity for patient and physician to select the most appropriate treatment regimen.

Blood Glucose↗
PubMed1988

Depression and diabetic neuropathy: a complex relationship.

In a group of 64 non-insulin-dependent diabetic females, a significant positive correlation between Zung self-rated depression scores and objective measurements of diabetic peripheral neuropathy was limited to those women with Zung scores greater than 50 (depressed group, n = 12). In the overall group, there was no significant linear or quadratic relationship between peripheral neuropathy and depression scores. The associations between depression, peripheral neuropathy, and diabetes are discussed.

Blood Glucose↗
PubMed1988

Glyburide or insulin for metabolic control in non-insulin-dependent diabetes mellitus. A randomized, double-blind study.

STUDY OBJECTIVE: To compare the relative efficacy, risks, and benefits of insulin with glyburide in achieving normoglycemia in non-insulin-dependent diabetes mellitus. DESIGN: Randomized, double-blind, placebo-controlled trial with a 9-month treatment period. SETTING: University hospital. PATIENTS: Thirty-one patients with non-insulin-dependent diabetes mellitus who did not have normal glucose control with diet alone. INTERVENTIONS: Once-per-day NPH insulin and placebo glyburide, or glyburide and once-per-day placebo insulin injection. Active drug and placebo adjusted in parallel to achieve fasting plasma glucose level less than 6.4 mmol/L (115 mg/dL) without hypoglycemia. MEASUREMENTS AND MAIN RESULTS: Insulin and glyburide produced similar improvement in fasting blood glucose levels and hemoglobin A1c concentrations, similar frequencies of mild symptomatic hypoglycemia, and similar weight gain despite dietary reinforcement. Triglyceride and cholesterol levels decreased and high-density lipoprotein cholesterol and ratios of high-density lipoprotein to total cholesterol increased in both groups, with a significantly greater improvement in high-density lipoprotein cholesterol and ratio of high-density lipoprotein total cholesterol in patients treated with insulin. CONCLUSIONS: Therapy with glyburide or once-per-day NPH insulin provides a similar degree of glucose control in patients with non-insulin-dependent diabetes mellitus. Insulin may have a relative advantage in that it is associated with higher levels of high-density lipoprotein cholesterol and a higher ratio of high-density lipoprotein to total cholesterol.

Blood Glucose↗
PubMed1987

Memory self-assessment and performance in aged diabetics and non-diabetics.

Non-insulin dependent diabetes in older adults is associated with elevated depression and a greater decline in certain aspects of cognitive functioning than is found with normal aging. This study sought to determine whether diabetics report more memory complaints in carrying out their daily activities, and if memory self-assessments are reflective of performance on laboratory tasks. Middle-aged (55-64 years) and old (65-74 years) diabetics and non-diabetic control subjects were studied. Results showed that both diabetes and increased age were associated with poorer performance on some cognitive tests as well as with more self-reported memory problems. When depression levels were statistically controlled, the diabetes variable was no longer a significant predictor of memory complaints. The usefulness of self-assessments as an adjunct to more objective cognitive test measures was discussed.

Aged↗
PubMed1986

Non-insulin-dependent diabetes in older patients. Complications and risk factors.

Non-insulin-dependent diabetes mellitus is predominantly a disease of aging, with more than 70 percent of non-insulin-dependent (type II) diabetic patients older than 55 years of age. The prevalence of macrovascular, microvascular, and neurologic complications in outpatients with type II diabetes between the ages of 55 and 74 was compared with that in a similarly aged nondiabetic group of patients. The association between duration of diabetes, hypertension, age, and other putative risk factors that are prevalent in this elderly diabetic population and the occurrence of complications was explored. This cross-sectional survey confirmed a significant increase in retinopathy, neuropathy, impotence, and macrovascular complications in patients with type II diabetes. Within the diabetic population, duration of disease was associated with the occurrence of retinopathy and neuropathy, but not associated with such macrovascular complications as coronary artery disease. Gender, type of therapy, and previously identified risk factors for vascular disease such as hypertension had little impact on the prevalence of complications in this population. The notion that type II diabetes in the elderly represents "mild" diabetes with regard to complications must be discarded. Further identification of risk factors within this diabetic population may suggest therapeutic approaches that will prevent or ameliorate the development of complications.

Age Factors↗
PubMed1986

Bedside capillary glucose measurement by staff nurses in a general hospital.

The accuracy of capillary blood glucose monitoring has been well demonstrated when applied by patients in the outpatient setting or by specially trained nurses on inpatient diabetes units. In order to determine the applicability of this technique in the more general hospital setting, a program was initiated for instructing general staff nurses in the use of Chemstrips bG strips and the Accu-Chek bG meter. As a pilot study, nurses on four general medical and surgical hospital floors performed capillary glucose determinations within 15 minutes of the drawing of venous blood samples for determination of plasma glucose in the hospital's Chemistry Laboratory. Two hundred ten paired measurements were made by 31 nurses. Linear regression analysis yielded a Pearson correlation coefficient of 0.96 between bedside and laboratory glucose measurements. The mean percent deviation between the two values was 7.9 percent. Acceptance by both nurses and patients was high. Properly supervised capillary glucose monitoring can provide a valuable adjunct to the care of hospitalized patients with diabetes.

Blood Glucose↗
PubMed1986

Purification of rat hepatic glucokinase.

We have developed a rapid, reliable procedure for the purification of rat hepatic glucokinase. The purification utilizes DEAE-cellulose, two affinity chromatography steps, and high-performance liquid chromatography. Glucokinase with a specific activity of 240 units/mg, a 42 K-fold purification, and a yield of 60% is obtained. The enzyme appears as a homogeneous band, with over 99% purity as assessed by polyacrylamide gel electrophoresis. The purification procedure can be completed in 5 days.

Animals↗
PubMed1986

Retinopathy in older type II diabetics. Association with glucose control.

Non-insulin-dependent (type II) diabetics over the age of 55 comprise most of the diabetic population and are at considerable risk for the development of both macrovascular and microvascular complications. We studied the prevalence of retinopathy and its association with putative risk factors for its development in an elderly (55- to 75-yr-old) population of type II diabetics. Our cross-sectional analysis revealed that duration of diabetes and hemoglobin A1c (HbA1c) concentration were the two major predictors of the presence of retinopathy. Duration effect was seen after 10 yr of diabetes, whereas HbA1c effect was linear over its entire range. Hypertension, which has been reported to be a risk factor for microvascular disease in younger diabetic patients, was not associated with retinopathy in the older type II population. Multiple logistic regression analysis revealed that both the duration of diabetes and HbA1c remained significant independent determinants of retinopathy even after taking age and blood pressure into account. Our results support an etiologic role for metabolic control in the development of retinopathy in the elderly type II population.

Aged↗
PubMed1985

Metabolic response to three years of continuous, basal rate intravenous insulin infusion in type II diabetic patients.

We studied two obese type II diabetic patients before, during, and after 3 yr of continuous iv insulin infusion, delivered by means of totally implanted insulin infusion pumps. Tolerance of the devices was excellent, and no side-effects or episodes of significant hypoglycemia occurred. Glycosuria was eliminated, and mean 24-h plasma glucose and hemoglobin A1c levels decreased in both patients and remained in or near the normal range for 3 yr. Improvements were also noted in serum triglyceride concentrations and vitreous fluorescein concentrations after iv fluorescein injection. Euglycemic insulin clamp studies showed that no significant change in glucose disposal rate occurred after 6 and 12 months of treatment. However, some improvement in insulin secretion during hyperglycemic insulin clamp studies occurred in both patients after 6 months of insulin infusion. Evaluation of the insulin-glycerol mixture used in the pump revealed that moderate degradation of insulin occurred in the pump during the 21-day flow cycle, resulting in 6-12% increases in fasting blood glucose levels; in addition, higher mol wt species of immunoreactive insulin were present in the patients' serum. We conclude that long term continuous iv infusion of insulin using a totally implantable infusion pump is practical in type II diabetic patients, is acceptable to patients, and is capable of providing near-normal glycemic control.

Blood Glucose↗
PubMed1985

Programming pre-exercise snacks to prevent post-exercise hypoglycemia in intensively treated insulin-dependent diabetics.

Five intensively treated, insulin-dependent diabetics exercised for 45 minutes after fasting while receiving basal insulin injections. Plasma glucose concentrations remained stable during exercise but then declined, resulting in clinical hypoglycemia 1 to 2 hours later. Efficacies of three pre-exercise snacks in preventing the hypoglycemia were compared in a randomized crossover design. Orange juice, whole milk, and skim milk, each containing 13 g of carbohydrate, all prevented postexercise hypoglycemia. However, the more rapidly absorbed snacks, orange juice and skim milk, caused a greater increase in plasma glucose concentrations and the area under the glucose curve during exercise. From the recognized glucose profiles that occur after consumption of different carbohydrates, snacks as well as exercise and insulin can now be programmed for intensively treated, insulin-dependent diabetics. Because plasma glucose levels remain stable during exercise done after fasting and only fall late after exercise, a "lente" carbohydrate snack, such as whole milk, is an appropriate pre-exercise snack.

Adult↗
PubMed1984

Ice cream in the diet of insulin-dependent diabetic patients.

We investigated the effect of ice cream ingestion on blood glucose control in conventionally treated and intensively treated insulin-dependent (type I) diabetic patients. After the ingestion of 100 g of ice cream, plasma glucose excursions as measured by the peak increment (90 +/- 30 mg/dL) and area under the curve (166 +/- 59 mg/dL X hour) were modest and not significantly different between the subgroups of intensively treated and conventionally treated diabetics. A small dose (3 to 5 units) of rapid-acting insulin given 30 minutes before ingestion of ice cream reduced the modest plasma glucose excursion. A modest amount of ice cream may be included in weight-maintaining diets of insulin-dependent diabetics. Small doses of rapid-acting insulin prevent any adverse effect of the ice cream on blood glucose control.

Adult↗
PubMed1984

The clinical information value of the glycosylated hemoglobin assay.

We evaluated the clinical information value of the glycosylated hemoglobin assay by comparing it with practitioners' estimates of glucose control over the preceding 10 weeks in 216 patients with diabetes. Twenty-four per cent of the practitioners' estimates, which were based on historical and laboratory data collected during a routine office visit, differed by more than +/- 75 mg per deciliter from the actual mean blood glucose levels calculated with the glycosylated hemoglobin assay. One third of the mean blood glucose concentration fell outside the confidence intervals physicians used to bound their estimates. When examined individually or in the aggregate, historical information, such as polyuria, nocturia, or home urine testing for glucose, and laboratory information, such as fasting or random blood glucose levels, were weak predictors of the actual mean concentration of blood glucose. We conclude that the glycosylated hemoglobin assay provides information about the degree of long-term glucose control that is not otherwise obtainable in the usual clinical setting.

Blood Glucose↗
PubMed1984

Decreased cognitive function in aging non-insulin-dependent diabetic patients.

A cross-sectional study was conducted to determine whether normal, age-related declines in cognitive function are accelerated in non-insulin-dependent (type II) diabetes mellitus. Study participants ranged in age from 55 to 74 years. Results indicate that cognitive function is inferior in the patients with type II diabetes compared with a comparably aged, nondiabetic control group. On the basis of a series of cognitive tests, it appears that the cognitive impairment is due to a deficiency in memory retrieval rather than to an attentional or encoding deficit. Cognitive performance is poorer in diabetic patients with peripheral neuropathy or elevated hemoglobin A1c levels. The apparent cognitive impairment in aging patients with type II diabetes may complicate adherence to medical regimens.

Aged↗
PubMed1983

Effect of aspirin on determinations of glycosylated hemoglobin.

We investigated the in vivo and in vitro effects of aspirin on several clinical assays of glycosylated hemoglobin. Acetylation of hemoglobin falsely increased the glycosylated hemoglobin fraction measured by "high-performance" liquid chromatography and electrophoresis, but isoelectric focusing and colorimetric techniques differentiated between acetylated and glycosylated fractions. Aspirin ingestion may result in an apparent increase in glycosylated hemoglobin measured with common clinical assays.

Acetylation↗