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Biomedical subjects

H C Gerstein

Publications and source records attributed to H C Gerstein.

At least 55 records · Page 3Linked to original sources
PubMed1998

1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association.

OBJECTIVE: To revise and expand the 1992 edition of the clinical practice guidelines for the management of diabetes in Canada incorporating recent advances in diagnosis and outpatient management of diabetes mellitus and to identify and assess the evidence supporting these recommendations. OPTIONS: All aspects of ambulatory diabetes care, including organization, responsibilities, classification, diagnosis, management of metabolic disorders, and methods for screening, prevention and treatment of complications in all forms of diabetes were reviewed, revised as required and expressed as a set of recommendations. OUTCOMES: Reclassification of types of diabetes based on pathogenesis; increased sensitivity of diagnostic criteria; recommendations for screening for diabetes; improved delivery of care; recommendations for tighter metabolic control; and optimal methods for screening, prevention and treatment of complications of diabetes. EVIDENCE: All recommendations were developed using a justifiable and reproducible process involving an explicit method for the citation and evaluation of the supporting evidence. VALUES: All recommendations were reviewed by an expert committee that included people with diabetes, family physicians, dietitians, nurses, diabetologists, as well as other subspecialists and methodologists from across Canada. BENEFITS, HARM AND COSTS: More aggressive screening strategies and more sensitive testing and diagnostic procedures will allow earlier detection and management of diabetes. Cost-effectiveness analyses suggest that this will lead to savings in health care costs relating to diabetes care by reducing the incidence of complications of diabetes. Similarly, tighter metabolic control in most people with diabetes, through intensive diabetes management, seeks to reduce the incidence of complications and, hence, their associated social and economic burdens. RECOMMENDATIONS: This document contains numerous detailed recommendations pertaining to all aspects of ambulatory diabetes care, ranging from service delivery to prevention and treatment of diabetes-related complications. The terms "insulin-dependent diabetes mellitus" and "non-insulin-dependent diabetes mellitus" should be replaced by the terms "type 1" and "type 2" diabetes. Testing for diabetes using fasting plasma glucose (FPG) level should be performed every 3 years in those over 45 years of age. More frequent or earlier testing should be considered for people with additional specific risk factors for diabetes. The FPG level at which diabetes is diagnosed should be reduced from 7.8 to 7.0 mmol/L to improve the sensitivity of the main diagnostic criterion and reduce the number of missed diagnoses. Depending on the type of diabetes and the therapy required to achieve euglycemia, people with diabetes should generally strive for close metabolic control to achieve optimal glucose levels. This entails receiving appropriate diabetes education through a diabetes health care team, diligent self-monitoring of blood glucose, attention to lifestyle and adjustments in diet and physical activity, and the appropriate and stepwise use of oral agents and insulin therapies needed to maintain glycemic control. Also highlighted is the need for appropriate surveillance programs for complications and management options. VALIDATION: All recommendations were graded according to the strength of the evidence and consensus of all relevant stakeholders. Collateral efforts of the American Diabetes Association and the World Health Organization and the input of international experts were also considered throughout the revision process.

Canada↗
PubMed1998

The Study of Health Assessment and Risk in Ethnic groups (SHARE): rationale and design. The SHARE Investigators.

The Study of Health Assessment and Risk in Ethnic groups (SHARE) is a study to determine the risk factors for atherosclerosis among three ethnic populations in Canada. Three hundred and thirty South Asian Canadian, 320 Chinese Canadian and 320 European Canadian men and women between 35 and 75 years of age are being randomly sampled from communities in Hamilton and Toronto, Ontario and Edmonton, Alberta for assessment of conventional (i.e., smoking, dyslipidemia, diabetes and hypertension) and emerging (i.e., candidate genes for atherosclerosis, homocysteine, fibrinolytic parameters, neurohormones, glucose intolerance, markers of infection, socioeconomic status, psychosocial status and diet) cardiovascular disease risk factors. Subclinical atherosclerosis is measured by quantitative B-mode ultrasonography of the carotid arteries, and other objective measures of vascular disease are a 12-lead electrocardiogram, a two-dimensional echocardiogram, ankle to arm blood pressure ratio and urine microalbumin concentration. The relationship between the conventional and emerging risk factors, and atherosclerosis, vascular disease and markers of end-organ damage will be evaluated between and within ethnic groups.

Adult↗
PubMed1998

Patients with type 2 diabetes have a high frequency of the C282Y mutation of the hemochromatosis gene.

OBJECTIVE: To determine whether a specific mutation (C282Y) associated with primary hemochromatosis (PHC) is more common in patients with type 2 diabetes than in a control group of patients with type 1 diabetes. Patients with type 2 diabetes have a two- to threefold higher rate of PHC than the general population. Recent identification of a genetic mutation in patients with PHC raises the possibility that the mutation is related to type 2 diabetes. DESIGN: Cross-sectional study. SUBJECTS: One hundred and five patients with type 2 diabetes and 103 control patients with type 1 diabetes, who attended the same tertiary care diabetes clinic, who were of European origin, and in whom there was no clinical suspicion of hemochromatosis. INTERVENTIONS: Patients completed a brief clinical assessment and provided a blood sample. Iron studies were measured in serum, and DNA was assayed for the presence of the C282Y and H63D mutations of the HFE gene. RESULTS: Twenty-three of 105 patients (21.9%, 95% confidence interval [CI] 14.0, 29.8) with type 2 diabetes (1 homozygote) and 12 of 103 patients (11.7%; 95% CI 5.5, 17.9) with type 1 diabetes (all heterozygotes) had at least 1 copy of the C282Y mutation (odds ratio [OR] = 2.1; 95% CI 1.0, 4.5; p = 0.048). Neither serum ferritin nor transferrin saturation level identified patients with a C282Y mutation. CONCLUSION: The C282Y gene mutation is a potential genetic marker for type 2 diabetes. It, or a closely linked gene, may be associated with greater than 20% of cases of type 2 diabetes.

Adolescent↗
PubMed1997

The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus. A systematic overview of the literature.

OBJECTIVES: To critically analyze the literature linking microalbuminuria with total and cardiovascular mortality and cardiovascular morbidity in non-insulin-dependent diabetes mellitus (NIDDM) and to quantify the risk. METHODS: A combination of retrieval techniques (MEDLINE, SCISEARCH, and handsearching published bibliographies) was used to find all relevant articles based on title and abstract and "Methods" sections. Unpublished data on albumin excretion rate were sought from large NIDDM cohort studies. RESULTS: A total of 264 citations were retrieved, of which 11 cohort studies were selected for inclusion in the overview, representing a total of 2138 patients followed up for a mean of 6.4 years. Patient age was similar across cohorts. Duration of NIDDM ranged from newly diagnosed to 13 years. The prevalence of microalbuminuria ranged from 20% to 36% in the 8 cohorts that excluded patients with clinical proteinuria. All studies reported either a trend or a significant association between microalbuminuria and total mortality or cardiovascular morbidity or mortality; the overall odds ratio for death was 2.4 (95% confidence interval, 1.8-3.1) and for cardiovascular morbidity or mortality, 2.0 (95% confidence interval, 1.4-2.7). We found no evidence of reporting bias. CONCLUSION: Microalbuminuria is a strong predictor of total and cardiovascular mortality and cardiovascular morbidity in patients with NIDDM.

Albuminuria↗
PubMed1997

Glucose: a continuous risk factor for cardiovascular disease.

The glucose level that defines diabetes mellitus is that level above which patients have a high risk of eye, kidney, and neuronal disease. The risk of these complications rises as glucose levels increase, and decreases as therapy brings the glucose level down. Thus, in patients with diabetes, glucose is a continuous, modifiable risk factor for eye, kidney and peripheral nerve disease. Plasma glucose concentrations in the diabetic range are also a continuous risk factor for cardiovascular disease (CVD). Moreover, epidemiological evidence shows that the relationship between plasma glucose concentration and CVD extends well below the glucose level defined for diabetes and even impaired glucose tolerance. This continuous relationship between glucose and CVD exists in all people, not just in those with a defined metabolic disease, and is therefore similar to the relationship between cholesterol or blood pressure and CVD. It may be secondary to either a direct effect of elevated glucose or to some underlying metabolic abnormality that raises both glucose and cardiovascular risk. Whether interventions that lower glucose will also lower the risk of CVD is still unknown; the results of clinical trials are awaited.

Blood Glucose↗
PubMed1997

Dysglycemia, not just diabetes, is a continuous risk factor for cardiovascular disease.

Dysglycemia is a continuous cardiovascular risk factor. Whether or not interventions that lower glucose levels will also lower cardiovascular risk remains to be determined. A number of ongoing studies may provide answers to this question. Recognition that these non-diabetic glucose levels confer an increased cardiovascular risk may suggest new ways for preventing CVD.

Editorial↗
PubMed1997

Psychiatric symptoms, bone density and non-specific symptoms in patients with mild hypercalcemia due to primary hyperparathyroidism: a systematic overview of the literature.

To determine (1) the relationship between primary hyperparathyroidism with mild hypercalcemia and psychiatric disturbances, bone density, or non-specific symptoms, and (2) the effect of parathyroidectomy on these outcomes, a systematic and critical review of the literature was conducted. Relevant citations were identified using MEDLINE (1966 to August, 1995) and PsycINFO (1967 to August, 1995). Studies were included for the overview if they described patients with mild hypercalcemia (< 12 mg/dl), and if they dealt with at least one of the following outcomes: psychiatric disturbances, bone density, joint pain, constipation, polyuria/nocturia or weight loss. Either a calculated effect size or Z score was used to estimate the effect of the disease or parathyroidectomy on these outcomes. Seven studies met the inclusion criteria for this overview. Two out of three case-control studies on psychiatric symptoms found a significant association between primary hyperparathyroidism with mild hypercalcemia and psychiatric disturbances (effect sizes; 0.17, 1.2 and 1.6). One of the three studies also examined the effect of parathyroidectomy on psychiatric symptoms, and found an effect size of 1.5. All four cross-sectional studies that measured bone mass showed significantly reduced bone density in the forearm and the lumbar spine. The bone loss ranged from 0.9 to 1.4 standard deviation below the age- and sex-adjusted mean value in the forearm, and was 0.5 in the spine. There was no relevant study regarding non-specific symptoms. Among the seven studies, five did not explicitly indicate whether the patients had classical symptoms of either osteitis fibrosa cystica or renal stones. Primary hyperparathyroidism with mild hypercalcemia is associated with psychiatric disturbances and reduced bone density. Nevertheless, further research is needed to determine the symptoms, particularly for a group of patients without either classical bone disease or renal stones. The effects of parathyroidectomy on these outcomes also remain to be determined.

Bone Density↗
PubMed1996

The relationship between cow's milk exposure and type 1 diabetes.

Environmental factors are important for the development of Type 1 diabetes mellitus. They likely account for changes in the incidence of this disease over time, as well as the well-documented differences in incidence in ethnically and genetically similar people living in different parts of the world. There is a relationship between early cow's milk exposure and the development of Type 1 diabetes in humans, and between early cow's milk exposure and the development of autoimmune diabetes in rodent models of Type 1 diabetes. Moreover, some immunological studies have suggested a possible mechanism whereby exposure to cow's milk protein could result in beta-cell directed autoimmunity and subsequent Type 1 diabetes. Although provocative, the existence of alternative explanations for these epidemiological and biological observations, suggest that the data are insufficient to conclude that the observed associations represent causal relationships or to mandate changes in recommendations for infant feeding. The question of whether or not avoidance of cow's milk protein in infancy will prevent Type 1 diabetes can, however, be tested in an international randomized clinical trial of infant diets, which is currently under review.

Animals↗
PubMed1996

Rationale and design of a large study to evaluate the renal and cardiovascular effects of an ACE inhibitor and vitamin E in high-risk patients with diabetes. The MICRO-HOPE Study. Microalbuminuria, cardiovascular, and renal outcomes. Heart Outcomes Prevention Evaluation.

OBJECTIVE: To describe the rationale and design of a large international study (microalbuminuria, cardiovascular, and renal outcomes [MICRO] in the HOPE [Heart Outcomes Prevention Evaluation] study) of an ACE inhibitor and vitamin E for the prevention of diabetic nephropathy (DN) and cardiovascular disease (CVD) in patients with diabetes and microalbuminuria (MA). RESEARCH DESIGN AND METHODS: A total of 3,657 diabetic subjects, including 1,129 with MA, are randomly allocated to receive the ACE inhibitor ramipril (or placebo) and vitamin E (or placebo) for 4 years in a two-by-two factorial design. Diabetic subjects are a subset of the 9,541 subjects enrolled in the HOPE study. RESULTS: The development of DN in microalbuminuric diabetic subjects and the development of MA in normoalbuminuric subjects, as well as cardiovascular death, myocardial infarction, and storke, are the main outcomes. The correlation of changes in albuminuria with changes in carotid atherosclerosis documented in a subset of subjects will also be analyzed. CONCLUSIONS: The effect of both an ACE inhibitor and vitamin E on the progression of renal and CVD in patients with diabetes is being assessed in the MICRO-HOPE study.

Albuminuria↗
PubMed1995

Feasibility and acceptability of a proposed infant feeding intervention trial for the prevention of type I diabetes.

OBJECTIVE: To determine the feasibility of a randomized double-blind controlled trial of an infant formula without intact cow's-milk protein for preventing type I diabetes in high-risk children. RESEARCH DESIGN AND METHODS: We surveyed 83 people who either were parents of a child with type I diabetes or were pregnant women with type I diabetes in the ambulatory diabetes and obstetrics clinics in a university hospital. After a written and verbal description of the cow's milk-diabetes hypothesis, participants were asked to sign a sham consent form. A questionnaire designed to explore factors affecting their decision to either sign or not sign the consent form, as well as infant-feeding patterns, was subsequently administered. RESULTS: Overall, 69.9% (95% confidence interval, 60.0-79.8%) consented to participation in the proposed randomized trial. The decision to consent was not affected by the degree of belief in the cow's milk-diabetes hypothesis, the child's risk of diabetes, the respondent's demographic data, or infant feeding habits. CONCLUSIONS: A randomized feeding intervention study is an acceptable and feasible way to determine whether avoidance of cow's-milk protein during the first 6 months of life prevents type I diabetes in North American children.

Animals↗
PubMed1994

Spectrum of quality of life impairment in hypothyroidism.

The aim of this study is to evaluate the frequency and relative importance of different aspects of health related quality of life (HRQOL) impairment in patients with hypothyroidism. A survey of 200 patients with treated hypothyroidism was undertaken. Patients were identified and questionnaires distributed through family physicians, endocrinologists, and regional branches of the Thyroid Foundation of Canada. Frequency of importance of patients' symptoms attributed to hypothyroidism and resolved or improved with treatment were measured. Establishing the wide variety of patient-specific complaints associated with hypothyroidism provides guidance for clinicians dealing with hypothyroid patients, and investigators interested in HRQOL impairment in these patients.

Humans↗
PubMed1994

Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature.

OBJECTIVE: To critically review and summarize the clinical evidence relating a short duration of breast-feeding or early cow's milk exposure to insulin-dependent (type I) diabetes. RESEARCH DESIGN AND METHODS: All relevant citations retrieved through comprehensive searching of the medical literature were critically reviewed and analyzed. Those case-control studies that minimized the possibility of bias were meta-analyzed to determine overall odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Ecological and time-series studies consistently showed a relationship between type I diabetes and either cow's milk exposure or diminished breast-feeding. In the case-control studies, patients with type I diabetes were more likely to have been breast-fed for < 3 months (overall OR 1.43; 95% CI 1.15-1.77) and to have been exposed to cow's milk before 4 months (overall OR 1.63; 95% CI 1.22-2.17). Slightly lower ORs were obtained when all of the case-control studies were meta-analyzed in a sensitivity analysis. CONCLUSIONS: Early cow's milk exposure may be an important determinant of subsequent type I diabetes and may increase the risk approximately 1.5 times.

Animals↗
PubMed1993

Incidence of postpartum thyroid dysfunction in patients with type I diabetes mellitus.

OBJECTIVE: To assess the incidence of postpartum thyroid dysfunction in women with type I diabetes. DESIGN: Cohort study of consecutive patients with clinical and biochemical assessments of thyroid dysfunction and glycemic control done during the first postpartum week and 3 and 6 months after delivery. SETTING: University medical center providing obstetric care for more than 90% of the pregnant women in the region with type I diabetes. PATIENTS: Fifty-one patients with type I diabetes who resided in the Hamilton, Ontario, catchment area and who delivered babies between May 1989 and June 1991, were not taking thyroid medication or thyroactive or immunosuppressive medications. Forty patients completed follow-up. MAIN OUTCOME MEASURES: Postpartum thyroid dysfunction was defined on the basis of thyroid function test results. RESULTS: Postpartum thyroid dysfunction occurred in 10 of 40 patients (25%; 95% CI, 12.7% to 41.2%); postpartum thyroiditis developed in 9 patients and postpartum Graves disease developed in 1 patient during the first 6 months after delivery. The incidence could have varied between 19.6% and 41.2% , depending on whether none or all of the 11 nonparticipating eligible patients developed thyroid dysfunction. Glycemic control was not affected by thyroid dysfunction. CONCLUSIONS: Women with type I diabetes are at a high risk for symptomatic postpartum thyroid dysfunction and therefore may benefit from routine thyroid function screening at postpartum visits.

Adult↗
PubMed1990

How common is postpartum thyroiditis? A methodologic overview of the literature.

The incidence of postpartum thyroiditis (PPT) in the general population has been reported to range from 1.9% to 16.7%, depending on the study. To determine whether bias may have played a role in the generation of these widely varying estimates, a set of methodologic criteria were applied to the published original research dealing with the epidemiology of PPT. The articles that passed these methodologic filters reported a narrow range of incidences of PPT, varying between 3.7% and 5.9%. Reanalysis of these articles confirmed that thyrotoxicosis occurred more frequently in the first 3 months post partum than did hypothyroidism, and that a positive antimicrosomal antibody titer was strongly associated with postpartum thyroid dysfunction (odds ratio, 86.6; 95% confidence interval, 45.9 to 163.2). This article suggests that PPT is a common condition that occurs in the postpartum period. The best estimate of the incidence of PPT in an unselected cohort of postpartum women is 4.9%.

Autoantibodies↗
PubMed1987

Immunomodulatory effect of the treatment of Graves' disease on antigen-specific monocyte procoagulant activity production.

The monocyte procoagulant activity (PCA) production assay has been shown to be a good parameter of cell-mediated immunity. We have studied antigen-specific PCA production in peripheral blood mononuclear cells from patients with Graves' disease to determine the effect of the treatment on the cell-mediated immune response. Peripheral blood mononuclear cells from patients with untreated or relapsed Graves' disease produced significantly greater PCA with thyroid antigen stimulation than those from normal subjects. Patients both on antithyroid drugs in the hyperthyroid state and within 3 months post-131I therapy also produced significantly larger amount of PCA than normal subjects. However, there was no significant difference in PCA production with thyroid antigen stimulation between normal subjects and patients on anti-thyroid drugs in the euthyroid state, or patients over 3 months post-131I therapy. The ratio of positive to negative PCA production in patients on anti-thyroid drugs in the euthyroid state or over 3 months post-131I therapy was significantly lower than in untreated or relapsed Graves' disease patients. Mononuclear cells from patients on propylthiouracil responded to propylthiouracil in vitro by production of PCA. Cells from normal subjects, untreated Graves' disease patients, or patients with Hashimoto's thyroiditis did not produce PCA with propylthiouracil stimulation. Mononuclear cells from patients who were on propylthiouracil for more than 3 months produced greater PCA than those on the drug for less than 3 months, suggesting sensitization of lymphocytes to propylthiouracil during the course of treatment. However, after 131I therapy, they gradually became unresponsive to propylthiouracil. This study has shown that the activity of the antigen-specific response assessed by PCA production in mononuclear cells from Graves' disease patients declined after treatment, suggesting that the treatment exerted immunomodulatory effects.

Adolescent↗