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Biomedical subjects

E van Ballegooie

Publications and source records attributed to E van Ballegooie.

At least 19 recordsLinked to original sources
PubMed1993

Long term use of captopril or nifedipine in normotensive microalbuminuric patients with insulin-dependent diabetes mellitus.

Several studies have suggested that ACE-inhibition may be effective in postponing the onset of nephropathy in insulin-dependent diabetic subjects. In contrast, other drugs might have opposing effects. To study the long term effects of either captopril or nifedipine in normotensive, microalbuminuric patients with insulin-dependent diabetes mellitus, eighteen subjects received either placebo (n = 5, P), 20 mg nifedipine daily (n = 7, N) or 50 mg captopril daily (n = 6, C) for one year. Baseline clinical and laboratory variables were comparable in the three groups. Glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and blood pressure did not differ between groups before and after one years medication. UAER did not change in the captopril and the placebo group (C: -12.6% (-58.1 to 51.8%)' P: -17.3 (-55.9 to 99.3%), medians and ranges. In contrast, in the patients that received nifedipine, UAER rose by 43.1% (-8.5 to 261.8%), (p < 0.05 Baseline vs one year, and one year nifedipine vs captopril and placebo). We therefore conclude, that long-term use of nifedipine increases UAER in normotensive microalbuminuric insulin-dependent subjects, in contrast to captopril or placebo. Whether this enhancement of microalbuminuria exerts an adverse effect on renal function in the long-term is yet unknown, but caution seems warranted.

Adult↗
PubMed1991

Impact of late complications in type 2 diabetes in a Dutch population.

The prevalence of late complications was determined in four general practices in a representative group of 137 patients with Type 2 diabetes and a control group of 128 non-diabetic individuals. Retinopathy was found in 35% of all diabetic patients, with the same prevalence below and above the age of 70 years. Microalbuminuria was found in 42% of diabetic patients and in 22% of the control group (p less than 0.001). Above 70 years of age microalbuminuria was found with increasing frequency in the control group and was not significantly higher in the diabetes group. Serum creatinine was the same in the diabetic patients and the control group. Peripheral neuropathy was found frequently in the diabetes group, but was not uncommon in the control group (abnormal temperature sensation 63 vs 49% (p less than 0.05), abnormal vibration perception 53 vs 33% (p less than 0.001), absent tendon reflex 62 vs 21% (p less than 0.001]. Above age 70 years there was again a reduction in the difference in prevalence of neuropathy between the diabetes and control groups. Ischaemic heart disease was found more frequently in the diabetes group, but only below 70 years of age (32% of diabetic patients and 14% of the control group with ischaemic changes on ECG (p less than 0.01]. Above that age 46% of the diabetes group and 45% of the control group had ECG signs of ischaemic heart disease.

Aged↗
PubMed1991

Renal function and renal function reserve in insulin-dependent diabetic patients during (near) normoglycaemia.

Twenty-three normoalbuminuric (N) and 7 microalbuminuric (M) insulin-dependent diabetes mellitus (IDDM) patients were studied under (near) normoglycaemic conditions. They were reasonably well controlled during the period preceding the renal function test (HbA1: N = 7.6 +/- 1.3%, N = 8.0 +/- 2.2%; normal less than 6.0%). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured using the clearances of 125I-thalamate and 131I-hippuran, respectively. The renal reserve filtration capacity (RRFC) was tested by using a combination of a liquid mixed meal and an amino acid infusion. Blood glucose levels were kept as constant as possible throughout the testing procedure, both under baseline (BL) conditions and after stimulation (S). Under such (near) normoglycaemic conditions, no BL GFR values exceeding 150 ml/min/1.73 m2 could be established. Furthermore, a RRFC could be established in all patients. Both groups showed a comparatively larger increase in GFR (N 13.0 +/- 3.8%, M 10.8 +/- 3.6%) than in ERPF (N 4.8 +/- 7.0%, M 2.2 +/- 5.8%; % delta GFR vs. % delta ERPF p less than 0.01), resulting in a higher filtration fraction (FF) during stimulation (N: BL FF 0.25 +/- 0.03 vs. S FF 0.27 +/- 0.03, p less than 0.01; M: BL FF 0.25 +/- 0.01 vs. S FF 0.27 +/- 0.01, p less than 0.05). This suggests afferent vasodilation during stimulation in these (near) normoglycaemic, reasonably well-controlled IDDM patients, a situation comparable to that in non-diabetic subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[The prevalence of late complications of type II diabetes mellitus].

Prevalence of late complications determined in a representative group of 137 patients with type II diabetes mellitus and a control group of 128 persons without diabetes from the same population. Retinopathy was not rare in type II diabetes mellitus (prevalence 35%), but only 50% of diabetic patients had proper ophthalmological care. Microalbuminuria was found in 42% of the patients with diabetes mellitus, although serious renal dysfunction was seldom found. The ratio of serious diabetic foot problems was 5%. Neuropathy and macrovascular problems occurred more frequently in the diabetic group, but above 70 years of age there was a remarkable reduction in difference between diabetics and non-diabetics with regard to these complications. In microalbuminuria the same tendency was observed. The cause of this reduction in difference at an older age is discussed.

Aged↗
PubMed1990

[Outpatient adjustment to insulin in patients with diabetes mellitus].

Starting insulin treatment of patients with diabetes mellitus commonly takes place during hospital admission. Home blood glucose monitoring and specially trained nurses, however, enable the physician to start insulin treatment on an outpatient basis. Consistent application of this procedure starting 1-10-1986 resulted in a fall of hospital admissions from 98.3% to 13% in this category of patients. Severe hypo- or hyperglycaemic episodes did not occur. Starting insulin treatment as an outpatient is a safe and cost-saving procedure.

Adolescent↗
PubMed1987

Renal reserve filtration capacity in patients with type 1 (insulin-dependent) diabetes mellitus.

Glomerular hyperfiltration is one of the factors held responsible for the development of diabetic nephropathy. A supranormal glomerular filtration rate (GFR) can be found in diabetic patients even when they are well controlled. Infusion of low-dose dopamine demonstrates that glomerular hyperfiltration in well-controlled insulin-dependent diabetic patients is not based on a predominant vasodilatation of the efferent arteriole. In the present study this is confirmed, since the dopamine-induced rise in GFR of control subjects (13.5% +/- 2.2) did not differ from that of patients with insulin-dependent diabetes mellitus (10.8% +/- 2.1). In animal studies it has been demonstrated that the increased GFR in diabetes mellitus is caused by a predominant decrease in resistance of the afferent arteriole. Protein loading and infusion of amino acids also increase GFR by dilatation of the afferent arteriole. Thus, protein loading or amino acid infusion may be used to test the existence of afferent vasodilatation. The present study investigates the effect of amino acid infusion on GFR of control subjects and insulin-dependent diabetic subjects. The amino acid-induced rise in GFR tended to be lower in the diabetic patients (6.9% +/- 2.8) compared with controls (13.2% +/- 2.7). Percentage amino acid-induced change in GFR appeared to decline with increasing baseline GFR in the diabetic subjects (r = -0.83; P less than 0.001). In controls, no such relationship was established (r = -0.22; n.s.). Our results suggest the existence of afferent vasodilatation in diabetic patients with a high GFR. The cause of this vasodilatation warrants further study.

Adult↗
PubMed1986

The effect of low-dose dopamine on renal haemodynamics in patients with type 1 (insulin-dependent) diabetes does not differ from normal individuals.

It is well known that patients with Type 1 (insulin-dependent) diabetes exhibit both increased glomerular filtration rate and effective renal plasma flow, which can be found even when these patients are well controlled. Usually this is attributed to a decrease in renal vascular resistance and/or to enlarged kidney size and glomerular volume. Among the factors which govern glomerular filtration rate, renal plasma flow is most important. Renal plasma flow increases if renal vascular resistance decreases. The latter might exist in insulin-dependent diabetes mellitus because of either a predominantly afferent or a predominantly efferent vasodilatation. Dopamine is an agent which causes predominantly efferent vasodilatation. Therefore, the effects of infusing a low dose of dopamine on glomerular filtration rate and effective renal plasma flow in 12 well-controlled patients with Type 1 (insulin-dependent) diabetes and 28 healthy volunteers were compared to investigate whether the increased glomerular filtration rate in Type 1 diabetes is caused by an efferent vasodilatation. The median increase in glomerular filtration rate during dopamine infusion amounted to 13.0% in diabetic patients and 12.5% in healthy control subjects (n.s.). It is concluded that the elevated glomerular filtration rate in well-controlled Type 1 diabetes is not caused by a predominantly efferent vasodilatation.

Adult↗
PubMed1986

Fetal behaviour in type-1 diabetic women.

Real-time ultrasound observation of fetal movement patterns can be used to assess the development of the motor component of the nervous system. Data are presented on the emergence of fetal movements in the first trimester of pregnancy, and on the development of fetal behavioural states in the third trimester, in women with type-1 (insulin dependent) diabetes. In the first trimester there is a delay in emergence of movement patterns. This delay is, however, not specific but parallels that of growth. In the third trimester there is a delay in emergence of fetal behavioural states. It is concluded that a tight metabolic control, achieved with continuous insulin infusion, does not prevent these disturbances in development.

Diabetes Mellitus, Type 1↗
PubMed1985

Delayed emergence of fetal behaviour in type-1 diabetic women.

In pregnancies complicated by maternal type-1 diabetes early fetal growth delay is common and it is suggested that there might be a common mechanism behind this growth delay and the induction of abnormal embryogenesis. As some of the most frequent congenital malformations involve the nervous system, the following study was performed in order to determine whether there is a specific delay in development of neural activity in these embryos and fetuses. In ten women with type-1 diabetes the emergence of specific fetal movement patterns, which are an expression of the functional motor development of the nervous system, was studied weekly by 1 h real-time ultrasound observations, starting at or before 8 weeks of gestation. Data were compared with those obtained in uncomplicated pregnancies. In all women a tight metabolic control was achieved with continuous subcutaneous insulin infusion. In six patients this treatment was started before conception. In all but one of the movement patterns emerging in the first 12 weeks of gestation a delay of 1-2 weeks was found in their first appearance. Only breathing movements were observed for the first time at the same gestational age as in the control group. Plotted according to crown-rump length the emergence of fetal movement patterns occurred, however, almost at the same time as in the control group. It is concluded, that in well controlled diabetic pregnancy there is a delay in functional motor development of the embryonic and fetal nervous system; this delay is not very specific but mostly parallels that of growth; breathing movements emerge relatively early as compared to growth.

Adult↗
PubMed1985

The effect of continuous subcutaneous insulin infusion on renal function in type I diabetic patients with and without proteinuria.

The effect of continuous subcutaneous insulin infusion on renal function was studied in 12 patients with insulin-dependent diabetes mellitus. Serum creatinine was less than 110 mumol/L in all patients. Total urinary protein excretion was less than 250 mg/24 hr in seven patients (group I) and exceeded 0.5 g/24 hr in five (group II). Initial glomerular filtration rate was higher in group I compared with group II: 136.0 +/- 8.5 ml/min versus 103.2 +/- 4.6 ml/min (mean +/- SEM; p less than 0.02). After one to three months pump therapy glomerular filtration rate decreased in both groups. It remained stable during 32-36 months in group I (126.3 +/- 6.1, and 127.9 +/- 7.7 ml/min, respectively) but deteriorated in group II (98.6 +/- 4.4, and 60.0 +/- 6.8 ml/min, respectively; p less than 0.01 compared with group I). These results indicate that strict blood glucose control with continuous subcutaneous insulin infusion does not prevent deterioration of renal function in type I diabetic patients with clinical proteinuria. This suggests that other factors than metabolic control are involved in the course of diabetic nephropathy.

Adult↗
PubMed1984

The plasma and erythrocyte fatty acid composition of poorly controlled, insulin-dependent (type I) diabetic patients and the effect of improved metabolic control.

Analysis of the plasma and erythrocyte fatty acid composition of poorly controlled, insulin-dependent (type I) diabetic patients revealed a low level of 18:3c, omega 6, 20:3c, omega 6, 22:6c, omega 3 and total polyunsaturated fatty acids, and a high level of 18:0 and total saturated fatty acids. Improvement of diabetic control, achieved by treatment with continuous subcutaneous insulin infusion coincided with an increase of arachidonic acid and a normalization of total polyunsaturated fatty acids, with a concomitant decrease of total saturated fatty acids and total monounsaturated fatty acids, especially 18:1c, omega 9. The results of this study can be important for the dietary advice to poorly controlled, diabetic patients.

Adult↗