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Biomedical subjects

G Rayman

Publications and source records attributed to G Rayman.

At least 19 recordsLinked to original sources
PubMed2006

Psycho-educational interventions for children and young people with Type 1 diabetes.

BACKGROUND: A systematic review of the literature in 2000 revealed numerous methodological shortcomings in education research, but in recent years progress has been made in the quantity and quality of psycho-educational intervention studies. SUMMARY OF CONTENTS: This review focuses on diabetes education programmes developed for children, young people and their families in the past 5 years. A comprehensive review of the literature identified 27 articles describing the evaluation of 24 psycho-educational interventions. Data summary tables compare the key features of these, and comparisons are made between individual, group and family-based interventions. Effect sizes are calculated for nine of the randomized studies. Three research questions are posed: firstly has the recent literature addressed the problems highlighted in the previous review; secondly is there sufficient evidence to recommend adaptation of a particular programme; and, finally, what do we still need to do? CONCLUSIONS: Progress in the quality and quantity of educational research has not resulted in improved effectiveness of interventions. There is still insufficient evidence to recommend adaptation of a particular educational programme and no programme that has been proven effective in randomized studies for those with poor glycaemic control. To develop a range of effective educational interventions, further research involving larger sample sizes with multicentre collaboration is required.

Adolescent↗
PubMed2006

Foot infection.

Explore the source record for details and available documents.

Aged↗
PubMed2004

A double-blind study comparing 0.5% and 1% tropicamide for annual retinal screening in diabetic adolescents.

AIMS: To determine whether there is any difference between 0.5% and 1% tropicamide in ocular discomfort and mydriatic efficacy in adolescents with Type 1 diabetes. METHODS: In a double-blind study, one drop of 0.5% tropicamide was instilled in one eye and one drop of 1% instilled in the other eye of 30 subjects aged 12-18 years. Drop strengths were randomized. Pupil size was measured before instillation, at 10, 20 and 30 min. Discomfort was measured using a recognized pain scale. RESULTS: Irrespective of the concentration of tropicamide used, all pupils dilated to at least 6 mm at 30 min, sufficient for successful ophthalmoscopy. Pain was significantly less when the lower concentration of tropicamide was used; pain score for the 0.5% group [median (interquartile range)] 1.0 (0-2) and 2.0 (1-3) for the 1.0% group, P = 0.009 (Wilcoxon rank test). CONCLUSIONS: This minor change in practice significantly reduces the distress associated with drop instillation without compromising the clinical examination, and may thus be important in encouraging compliance at the yearly diabetic review.

Adolescent↗
PubMed2003

The anaesthetic management of a patient with a reninoma.

We report on the anaesthetic management of a 28-year-old woman presenting for excision of a reninoma. This is a very rare tumour of the juxtaglomerular cells of the kidney, which can be cured immediately by surgery. Previous reports have failed to record the presence or absence of peri-operative cardiovascular lability. We have shown that blood pressure, cardiac index (CI) and systemic vascular resistance (SVRI) were remarkably stable in our patient throughout surgery, even during manipulation of the tumour. Isolation of the tumour was associated with a 23% reduction in SVRI, and a similar decrease in blood pressure. The cardiovascular lability associated with the removal of catecholamine-secreting tumours was not seen in this case.

Adenocarcinoma↗
PubMed2001

Diabetic neuropathic cachexia and acute bilateral cataract formation following rapid glycaemic control in a newly diagnosed type 1 diabetic patient.

In patients with Type 1 diabetes mellitus (DM), the development of complications within the first few years of diagnosis is very unusual and the development of complications within weeks of commencement of insulin therapy is exceptional. Diabetic neuropathic cachexia, unlike the other more common neuropathies associated with diabetes, is a rare form of peripheral neuropathy characterized by profound weight loss, painful dysaesthesias over the limbs and trunk with spontaneous resolution usually occurring within a year. The morphologically distinct diabetic or metabolic cataract in patients with newly diagnosed Type 1 DM is also a rare complication. We describe the first case of a young man with newly diagnosed Type 1 DM who developed these two rare complications within 3 months of diagnosis and insulin therapy commencement. Rapid development of complications in this patient raises two possibilities, i.e. a probable link between the pathophysiology of these two complications following rapid glycaemic control, and a subset of patients with unusual susceptibility to complications. We re-emphasize the need for vigilant monitoring of complications in young diabetic patients, even in the first few years of their disease. In particular, young patients with visual impairment should be evaluated carefully for evidence of treatable eye complications.

Adult↗
PubMed2001

Exploring the use of an alginate dressing for diabetic foot ulcers.

Few studies have investigated the use of dressings on patients with diabetic foot ulceration. This paper reports the results of a non-comparative, two-centre study investigating the performance characteristics of SeaSorb dressing in patients with this condition. This was an exploratory study to determine the potential use of this dressing, and not a large randomised control trial. All patients had diabetic foot ulceration of 1 cm or more in diameter, classified as Wagner grade I or II, with an ankle brachial pressure index of > 0.4. The investigators carried out objective assessments including photography and ulcer tracing as well as subjective assessments of exudate levels, wound bed condition, peri-ulcer skin condition, ease of application and removal of the dressing, dressing conformability, discomfort during dressing application and removal, and clinical signs of infection. Investigators recruited 41 patients in two sites (31 in site one and 10 in site two). Of these, the findings relating to 39 patients could be evaluated. The patients were treated for a maximum of six weeks or until the ulcer healed. The study found that 28.2% (11/39) of the ulcers healed within the six-week period. Overall, there was a significant reduction in mean ulcer area from 2.8 cm 2 to 1.02 cm 2 from week 0 to week six. The relative ulcer area showed a significant decrease from 100% to 33%. For patients who experienced ulcer pain (11 patients), its intensity decreased over the six weeks. Severe maceration was not reported for any patient throughout the study. Six patients required treatment for infection. A total of 12 adverse events were reported: seven mild to moderate and five severe. None were directly attributed to the study dressing.

Adult↗
PubMed2000

Blindness following a diabetic foot infection: a variant to the 'eye-foot syndrome'?

AIMS: The 'eye-foot syndrome' was initially described by Walsh et al. to highlight the important association of foot lesions in patients with diabetic retinopathy. We present a case of a 58-year-old patient with Type 2 diabetes mellitus who developed blindness following endogenous staphylococcal endophthalmitis from an infected foot ulcer. RESULTS: Our case describes the link between the eye and the foot but is somewhat different to the association as described by Walsh et al. Endogenous endophthalmitis is rare with diabetic patients being especially at risk, and we report the first case of endogenous staphylococcal endophthalmitis related to a diabetic foot lesion. CONCLUSIONS: Our case illustrates several important issues in the management of diabetic patients admitted to hospital with infection; the need to thoroughly examine the feet to ascertain any foot lesions and any underlying peripheral vascular disease or peripheral neuropathy, to treat aggressively any infected foot lesions to prevent serious complications of septicaemia and to consider rare conditions like endogenous endophthalmitis in any diabetic patient presenting with acute visual impairment and septicaemia.

Blindness↗
PubMed1995

Microvascular response to tissue injury and capillary ultrastructure in the foot skin of type I diabetic patients.

1. Microvascular blood flow responses to injury and capillary ultrastructure were assessed by laser Doppler flowmetry and detailed light and electron microscopy respectively in skin biopsied from 28 patients with insulin-dependent diabetes and 17 control subjects. 2. The hyperaemic response induced by biopsy (P < 0.001) and heating to 44 degrees C (P < 0.001) was significantly lower in the diabetic patients and showed progressive impairment with the severity of complications (P < 0.001). 3. Skin capillary basement membrane thickness was significantly increased in the diabetic patients (P < 0.001) and also increased with the severity of complications (P < 0.002). Both the luminal area (P < 0.001) and the endothelial cell outer perimeter (P < 0.002), measures of luminal and capillary size, respectively, were significantly reduced in all diabetic patients. 4. Basement membrane thickness was related significantly to the impaired hyperaemic response to both biopsy (P < 0.01) and thermal injury (P < 0.01). 5. Our findings support the hypothesis that structural abnormalities, which are characterized by an early reduction in capillary size and later thickening of basement membrane, form an important mechanism for the impaired hyperaemic response in diabetic patients.

Adult↗
PubMed1994

A study of factors governing fluid filtration in the diabetic foot.

The effect of lowering the foot on the factors governing fluid filtration in the foot were studied in 12 male insulin-dependent diabetic subjects and 10 controls. Toe skin blood flow, measured by laser Doppler flowmetry, was significantly higher during dependency in the diabetic group. In the control subjects, the colloid osmotic pressure of venous blood sampled from the foot rose to 47.7 mmHg (range 45.1-53.8) after 50 min of foot dependency. In the diabetic group, colloid osmotic pressure failed to rise to the same extent (median 36.7 mmHg; range 28.6-43.0; P < 0.001). Capillary pressure, measured directly by the Landis microinjection technique, was significantly higher in the diabetic group (85.3 +/- 1.7 (n = 6) vs. 92.2 +/- 4.6 cm H2O (n = 6); P < 0.007), as was foot swelling rate determined by mercury strain gauge plethysmography (0.069 +/- 0.022 vs. 0.099 +/- 0.025 ml min-1 100 ml-1; P < 0.02). These results suggest an impairment of the oedema-preventing mechanisms in diabetic subjects which may contribute to the risks of ulceration in the diabetic foot.

Adult↗
PubMed1994

A novel capillary collection method for obtaining current glycosylated haemoglobin levels in diabetic children.

A simple method for collecting capillary blood for measurement of glycosylated haemoglobin (HbA1c) was developed that allows samples to be obtained at home and then mailed to the laboratory 2 weeks before a hospital visit. A single drop of blood is collected into a 2 ml plastic tube and sent for HbA1c assay on the Diamat HPLC system which has inter- and intra-assay coefficients of variation < 2.6 and < 1.2%, respectively. Results of simultaneously obtained venous and capillary samples in 32 diabetic children agreed well with each other. A separate study of 25 patients was performed to determine whether transport conditions affected the samples. Posted samples were compared with venous samples; again the values were in good agreement. This method is now used routinely in the diabetic clinic. Its value was determined by questionnaire in 40 children with age range 4-17 years. No family experienced difficulty collecting samples and all samples received were suitable for analysis. Children preferred this method to blood collection in the clinic as they felt it was less traumatic and more convenient. Seventy-nine percent of them understood its value in the long-term control of diabetes. In 40.5% of visits changes to management were made at the clinic due to the availability of the results.

Adolescent↗
PubMed1994

Loss of the first phase insulin response to intravenous glucose in subjects with persistent impaired glucose tolerance.

Loss of the first phase insulin response to intravenous glucose is one of the earliest detectable defects of beta cell dysfunction in Type 2 diabetes mellitus. Impaired glucose tolerance (IGT) is considered a prediabetic condition, therefore loss of first phase insulin secretion in subjects with IGT would suggest beta cell dysfunction as an early lesion in the development of Type 2 diabetes. Three groups of subjects were studied, 7 subjects with persistent IGT (classified as having IGT at two 75 g oral glucose tolerance tests (OGTT) done 6 months apart), 6 subjects with transient IGT (IGT at the first OGTT, but normal glucose tolerance at a repeat OGTT 6 months later), and 7 normal controls. First phase insulin secretion was studied using an intravenous glucose tolerance test with arterialized blood sampling. Fasting, 3, 4 and 5 min samples were assayed for glucose and insulin (specific two-site immunoradiometric assay). The fasting insulin was similar in all three groups, however the 3 min insulin response was significantly lower in those with persistent impaired glucose tolerance (p < 0.02). Thus subjects with persistent impaired glucose tolerance demonstrated loss of the first phase insulin response as an early indicator of beta cell dysfunction while subjects with transient IGT had a normal insulin response to intravenous glucose. During the OGTT, the 30 min glucose was not significantly different (p = 0.1) but the 30 min insulin to glucose ratio was significantly lower in subjects with persistent IGT (p < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Insulin deficiency and increased plasma concentration of intact and 32/33 split proinsulin in subjects with impaired glucose tolerance.

In order to determine insulin status and beta cell function during the oral glucose tolerance test (OGTT), in impaired glucose tolerance (IGT), 51 such subjects and matched controls, identified during a population survey for diabetes, underwent a 75 g OGTT. Fasting, 30 min and 2 h insulin and intact proinsulin, and fasting and 2 h 32/33 split proinsulin, were measured by specific two-site immunoradiometric assays. The subjects with IGT had higher fasting (geometric mean +/- SD, 5.0 +/- 4.0 pmol-1 vs 2.9 +/- 1.7, p < 0.02) and 2 h intact proinsulin (23 +/- 14 vs 14 +/- 12, p < 0.0001), and fasting (3.2 +/- 3 pmol-1 vs 1.8 +/- 1.8, p < 0.0007) and 2 h 32/33 split proinsulin (18.3 +/- 19 pmol-1 vs 6.6 +/- 15, p < 0.0001). Despite higher plasma glucose concentrations, the IGT group had similar fasting insulin, lower 30 min insulin (216 +/- 124 pmol-1 vs 278 +/- 130, p < 0.02), and a lower 30 min insulin/glucose ratio (23.7 +/- 2.1 vs 34.8 +/- 2.3, p < 0.002). The percentage of fasting proinsulin-like to total insulin-like molecules was higher in those with IGT (15.3 +/- 8% vs 11.6 +/- 8, p < 0.04). After 6 months, at repeat OGTT, the same subjects with IGT were classified as 'persisters' or 'reverters'. The persister (24/51 47.1%), at initial OGTT, had a higher 2 h glucose level, a greater BMI and higher systolic blood pressure, but other parameters were similar to the reverters.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1992

Skin epidermal thickness and vascular density in type 1 diabetes.

Epidermal skin thickness and vascular density were assessed in skin biopsies obtained from the dorsum of the foot in 28 Type 1 diabetic patients and 17 normal control subjects, matched for age. Epidermal skin thickness did not differ significantly between control subjects (74 +/- 4 (+/- SE) microns) and diabetic patients (78 +/- 4 microns). It was not related to the duration of diabetes and presence of complications. Neither small (capillary) nor large (arteriole/venule) vessel densities differed significantly between control subjects (59 +/- 6 mm-2 and 19 +/- 2 mm-2) and diabetic patients (65 +/- 4 mm-2 and 22 +/- 3 mm-2). Vessel densities were unrelated to the duration of diabetes and presence of complications.

Adult↗
PubMed1990

The first phase insulin response to intravenous glucose is highly reproducible.

To determine the reproducibility of the first phase insulin response to intravenous glucose, ten normal subjects underwent two intravenous glucose tolerance tests separated by at least two weeks. Intravenous dextrose (0.3 g/kg) was administered over 2 min by continuous infusion and arterialised-venous samples were taken from a retrogradely cannulated hand vein in the opposite arm. Within subjects, median coefficient of variation for the 3 min insulin was 4.0% (range 1.2-24.3%) and median coefficient of variation for the 0-10 min area was 6.7% (range 1.7-18.8%). These coefficients of variation are close to those of the assay itself (less than 10%). Despite this, between subject responses varied by greater than sixfold. In conclusion, contrary to previous reports the intravenous glucose tolerance test is highly reproducible. This makes it a very valuable tool for further studies of the pathogenesis of diabetes.

Adult↗