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Biomedical subjects

G R Spollett

Publications and source records attributed to G R Spollett.

9 recordsLinked to original sources
PubMed1998

Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus.

BACKGROUND: Combination therapy is logical for patients with non-insulin-dependent (type 2) diabetes mellitus, because they often have poor responses to single-drug therapy. We studied the efficacy and physiologic effects of metformin and troglitazone alone and in combination in patients with type 2 diabetes. METHODS: We randomly assigned 29 patients to receive either metformin or troglitazone for three months, after which they were given both drugs for another three months. Plasma glucose concentrations during fasting and postprandially and glycosylated hemoglobin values were measured periodically during both treatments. Endogenous glucose production and peripheral glucose disposal were measured at base line and after three and six months. RESULTS: During metformin therapy, fasting and postprandial plasma glucose concentrations decreased by 20 percent (58 mg per deciliter [3.2 mmol per liter], P<0.001) and 25 percent (87 mg per deciliter [4.8 mmol per liter], P<0.001), respectively. The corresponding decreases during troglitazone therapy were 20 percent (54 mg per deciliter [2.9 mmol per liter], P=0.01) and 25 percent (83 mg per deciliter [4.6 mmol per liter], P<0.001). Endogenous glucose production decreased during metformin therapy by a mean of 19 percent (P=0.001), whereas it was unchanged by troglitazone therapy (P=0.04 for the comparison between groups). The mean rate of glucose disposal increased by 54 percent during troglitazone therapy (P=0.006) and 13 percent during metformin therapy (P= 0.03 for the comparison within the group and between groups). In combination, metformin and troglitazone further lowered fasting and postprandial plasma glucose concentrations by 18 percent (41 mg per deciliter [2.3 mmol per liter], P=0.001) and 21 percent (54 mg per deciliter [3.0 mmol per liter], P<0.001), respectively, and the mean glycosylated hemoglobin value decreased 1.2 percentage points. CONCLUSIONS: Metformin and troglitazone have equal and additive beneficial effects on glycemic control in patients with type 2 diabetes. Metformin acts primarily by decreasing endogenous glucose production, and troglitazone by increasing the rate of peripheral glucose disposal.

Administration, Oral↗
PubMed1998

Preventing amputations in the diabetic population.

More than 50% of all lower extremity amputations occur in patients with diabetes. This phenomenon is largely preventable through risk factor reduction and proper foot care education. In cases where lower extremity injury or infection are present prompt and aggressive care can preserve the limb. New techniques for revascularization to ulcerated areas of the foot are promoting wound healing and improving long term outcomes.

Amputation, Surgical↗
PubMed1994

Nutritional management of common gastrointestinal problems.

Nutritional management plays a vital role in many gastrointestinal problems commonly seen in primary care. Irritable bowel syndrome, lactose intolerance, and celiac sprue are three problems that are best managed by dietary changes. To achieve positive outcomes, NPs must know the latest nutritional interventions and provide their patients with counseling and education to support these dietary changes. Elements of high fiber, lactose-free, and gluten-free diets are discussed in this article.

Gastrointestinal Diseases↗
PubMed1993

Intensive insulin therapy in insulin dependent diabetes and combination therapy.

Intensive insulin therapy (IIT) and combination therapy using sulfonylurea and insulin are two insulin regimens being used more frequently to improve glycemic control. For those patients with insulin-dependent diabetes, IIT or multiple daily injection therapy mimics normal pancreatic function by its timing of insulin delivery. The improvement in glycemic control carries with it the risk of a two- to threefold increase in episodes of hypoglycemia. For those with non-insulin-dependent diabetes, combination therapy attempts to provide a bridge between maximal dose oral hypoglycemic agents and aggressive insulin therapy. Although this therapy remains controversial, it has proved useful in select patient groups. This article discusses the rationale for IIT, and its implementation. Variables that affect IIT are discussed. The combination therapy section provides guidelines for patient selection and insulin protocols for evening insulin administration. The health care provider is familiarized with these alternative therapies and their successful applications.

Blood Glucose↗
PubMed1989

Irritable bowel syndrome: diagnosis and treatment.

Irritable bowel syndrome (IBS) affects 8 to 14 percent of the population on any given day, and is the most common of all gastrointestinal ailments. Although IBS has been the focus of many investigational studies, little definitive information is available concerning etiology, diagnosis and treatment. In making this diagnosis of exclusion, an extensive list of gastrointestinal illnesses must be ruled out. Therefore, the diagnosis depends on a thorough history and physical examination. The nature of IBS requires a holistic treatment program, including nutrition, exercise, medication, behavior modification and emotional support. Since IBS is a recurring disease, the client should be helped to set realistic goals for treatment. The caring and supportive relationship between the health care practitioner and the client with IBS is essential to the success of treatment.

Clinical Protocols↗
PubMedDate not supplied

Health-promotion practices of young black women at risk for diabetes.

PURPOSE: The purpose of this study was to assess the health-promoting practices of young black women at risk for type 2 diabetes. METHODS: The sample consisted of 30 black women from an urban area who had a history of gestational diabetes and/or a first-degree relative with diabetes. Participants completed the Health-Promoting Lifestyle Profile II Survey and an interview. Both were used to categorize health-promoting practices, exercise, diet, knowledge of diabetes prevention, and general health. RESULTS: Demographic information and interview revealed a propensity towards obesity, despite education and income levels. The results for the Lifestyle II Survey showed a higher average total score for healthy nutrition than physical activity, which were inconsistent with the qualitative data obtained by interview. Fifty percent stated that they exercised as a general health-promoting behavior. Self-reported daily caloric, fiber, and fat intake was high to moderate; 60% reported initiating diet modifications secondary to a desire to lose weight or for medical problems; and 26% reported receiving information on diabetes prevention from a healthcare provider. CONCLUSIONS: A systematic approach of planning and actively incorporating health-promoting activities into one's lifestyle as a young adult may protect or delay the onset of diabetes and prevent complications.

Adult↗
PubMedDate not supplied

Assessment and management of erectile dysfunction in men with diabetes.

PURPOSE: Erectile dysfunction occurs earlier in men with diabetes than in the general population, affecting over 50% of male patients by age 60. This article summarizes the etiologies and presents methods of patient assessment and treatment options for erectile dysfunction. METHODS: Assessments of neurologic and vascular complications related to diabetes should be included in a sexual function history. The assessment must be holistic and focus on organic as well as psychogenic causes. Diabetes educators must be prepared to discuss the various pharmacologic treatment options. RESULTS: Sildenafil currently is the only oral medication available for erectile dysfunction. Injectable treatments have proven successful but with limited long-term use and poor patient acceptance. Implantable devices carry surgical risk and increased rates of infection. CONCLUSIONS: All men with diabetes should be screened for erectile dysfunction. The availability of a new oral medication provides a patient-acceptable treatment option.

Adult↗