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Biomedical subjects

H J Bodansky

Publications and source records attributed to H J Bodansky.

At least 19 recordsLinked to original sources
PubMed1992

Evidence for an environmental effect in the aetiology of insulin dependent diabetes in a transmigratory population.

OBJECTIVE: To examine whether children of families moving from an area of low incidence of childhood diabetes to one which is higher show a corresponding rise in disease incidence. DESIGN: Disease incidence study over 12 years. SETTING: Bradford District Metropolitan Council area. SUBJECTS: All subjects aged 0-16 years resident within the study area. MAIN OUTCOME MEASURES: The incidences of childhood diabetes in Asian and non-Asian families. RESULTS: The incidence of diabetes in Asian children increased from 3.1/100,000 per year in 1978-81 to 11.7/100,000 per year in 1988-90 (chi 2 for trend = 4.95, df = 1, p = 0.026) whereas that for other children remained constant at 10.5/100,000 per year. Over the entire study period rates were lower in Asian females (4.9/100,000 per year) than in Asian males (8.8/100,000 per year) whereas the reverse was true for other children (males 9.2/100,000 per year; females 12.0/100,000 per year) (test for common odds ratio: chi 2 = 3.81, df = 1, p = 0.052). CONCLUSIONS: Offspring of this transmigratory population had a rising incidence of childhood diabetes which was approaching that of the indigenous population. The data provide strong evidence for an environmental effect in the aetiology of insulin dependent diabetes.

Adolescent↗
PubMed1992

Prescribing and dispensing of insulin: margins for error?

To investigate recent anecdotal reports of incorrect insulin dispensing, we compared retail pharmacists' and doctors' understanding of commonly used insulin brands. Eighty pharmacists, 29 general practitioners (GPs), and 31 junior hospital doctors were interviewed and completed a questionnaire concerning the duration of action and formulation of 17 insulins. Views on dispensing of alternative insulins were sought from the pharmacists. Fifteen insulin pairs in two columns, 'insulin prescribed' and 'dispense instead', were presented and pharmacists and doctors asked if substitution was appropriate. Mixtard, Penmix and Actrapid were the best understood insulins, Insulatard, Humulin Zn and Protaphane the worst. Both GPs (p = 0.014) and hospital doctors (p < 0.001) scored better than pharmacists. No pharmacist stated that they would routinely dispense alternative insulin, 27 out of 80 not even in an emergency, though 37 were prepared to do so in such a situation after checking, usually with a doctor or in the relevant literature. Sixteen pharmacists, 24 GPs, and all 31 hospital doctors completed the section on insulin pairs but accuracy at identifying appropriate substitutions was poor. These findings coupled with confusing insulin nomenclature may lead to dangerous dispensing errors.

Dosage Forms↗
PubMed1992

The effect of a city-wide mass media campaign on the public awareness of diabetes.

The aim of this study was to determine whether a mass media campaign about diabetes would increase public awareness and knowledge of diabetes, leading to an increased rate of detection of previously undiagnosed cases. A telephone questionnaire was administered to two groups of randomly selected members of the public before and after a 1-week mass media campaign. Cases of newly diagnosed diabetes were monitored by general practitioners. The median knowledge score rose from 5 (range 0-10) before the campaign to 6 (0-10) afterwards, p < 0.001. The knowledge score for a control group, questioned post-campaign only, was also 6 (1-10). The increase in the median knowledge score was mainly as a result of more people being able to define diabetes and give two presenting symptoms. This increased awareness did not however result in an increase in detection of new cases.

Adolescent↗
PubMed1992

Prevalence of haemoglobin variants in a diabetic population and their effect on glycated haemoglobin measurement.

The measurement of glycated haemoglobin (glycated Hb) by automated high pressure liquid chromatography enabled the prevalence of haemoglobin variants (Hb variant) to be determined in a large diabetic population within Leeds, UK. There were 16 patients showing a Hb variant amongst a total of 5300 diabetics, the majority of the variants being HbA/S traits. There were also 13 patients showing a slightly raised HbF in the range of 2% to 5%. A multi-centre study was carried out by distributing blood specimens from some of the patients with Hb traits. Significant differences in the percentage of glycated Hb were observed relating to the methodology used. However, glycated Hb is used to monitor glycaemic control and laboratories must be aware of Hb variant interferences on their methods. Also, screening for Hb variants should be considered for the at risk groups of diabetic patients.

Diabetes Mellitus↗
PubMed1991

A survey of UK diabetic pregnancy management.

The provision of care and current management strategies for diabetic pregnancy in the United Kingdom were assessed by canvassing British diabetologists. Questionnaires were sent to 376 Consultant Physicians known to have an interest in diabetes, in 239 Health Districts. The response rate was 52% providing information from 182 (76%) Districts. In 66 (36%) Districts, there was an existing combined diabetes/obstetric clinic, with median annual caseloads of 13 (range 1-200) patients. Preconception counselling was offered in 22 clinics. In 153 (84%) of the clinics, the standard WHO diagnostic criteria for diabetes were applied to pregnant patients and 149 (97%) of the clinics using WHO criteria treated patients with 'Impaired Glucose Tolerance' as if they were overtly diabetic. Reflectance meters for home monitoring were employed in 119 (65%) clinics. Target pre-meal blood glucose values were less than or equal to 6.0 (range 3.0-12.0) mmol l-1 (n = 172) and post-meal less than or equal to 8.0 (5.0-10.5) mmol l-1 (n = 139). Insulin was introduced when blood glucose values exceeded 7.0 (5.0-12.0) mmol l-1 (n = 162) pre-meal or 9.0 (5.5-15.0) mmol l-1 (n = 129) post-meal. No unit used oral hypoglycaemic agents during pregnancy. Sixty percent of respondents were unable to provide accurate fetal loss/perinatal mortality rates, usually due to lack of recorded data. Where data were available, fetal loss was almost always intra-uterine. Only 78 (43%) centres allowed pregnancy to progress to term.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1991

Attitudes and intentions of UK general practitioners to diabetes care at the time of implementation of their new contract.

Prior to the introduction of their new contract, the intentions of general practitioners in Leeds (UK) towards diabetes care were assessed. All general practices in one Health District (n = 74) were contacted. Assessment was made of 46 (62%), while 28 expressed lack of interest. Of the 46 assessed, 2 (4%) were single-handed, and 44 (96%) were group practices, and list size was 700-15,500. Practice nurses were employed in 44 (96%) practices. There were 35 (76%) practices which expressed an interest in starting a diabetic clinic, while 6 (13%) had established a clinic. Practice facilities necessary to establish and run a clinic were surveyed. Those available were: register of diabetic patients in 12 (26%) (six of which were incomplete); blood sampling facilities in 45 (98%); blood glucose reagent strips in 45 (98%); glucose meters in 21 (46%) (but five with inappropriate test strips). All practices could check urine, blood pressure, and fundi (dark room available in 40 (87%) practices). Access to dietetic and chiropody services on the premises was available in 19 (41%) and 17 (37%) practices, respectively. Some expertise in diabetes was claimed by only 10 (22%) doctors. Staff at all practices desired further training in diabetes. In conclusion, despite the interest of most practices in starting a diabetic clinic, access to dietetic and chiropody services was inadequate. Expertise was generally lacking, but enthusiasm and desire for training were strong.

Attitude to Health↗
PubMed1990

Increased urinary excretion of transferrin in children with type 1 diabetes mellitus.

Urinary transferrin excretion was measured by radioimmunoassay in 74 children with Type 1 diabetes mellitus and in 40 normal children, and compared with urinary excretion of albumin, alpha-1-microglobulin, and N-acetyl-beta-D-glucosaminidase. Urinary transferrin excretion was significantly elevated in diabetic (median (range) 186 (18-1671) mg mol-creatinine-1) compared with normal (85 (27-668) mg mol-creatinine-1) children (p less than 0.001). Seventeen diabetic children had transferrin excretion above the 95th centile for normal children. In contrast there was no significant increase in urinary albumin excretion in the diabetic children although 8 had urinary albumin excretion which exceeded the 95th centile for normal children (6 of these 8 patients having coexistent urinary hyperexcretion of transferrin). Urinary transferrin excretion correlated significantly with urinary albumin excretion in both normal (rs = 0.62, p less than 0.001) and diabetic (rs = 0.61, p less than 0.001) children. The indices of proximal renal tubular function (urinary excretion of alpha-1-microglobulin and N-acetyl-beta-D-glucosaminidase) correlated significantly with transferrin excretion in both diabetic (rs = 0.43 and rs = 0.41, p less than 0.001) and normal (rs = 0.40, p less than 0.02 and rs = 0.53, p less than 0.001) children, but not with albumin excretion (rs = 0.20, p greater than 0.05 and rs = 0.22, p greater than 0.05). In addition urinary transferrin excretion significantly correlated with urinary glucose concentration (rs = 0.34, p less than 0.007) in Type 1 diabetic children. The discrepancy in urinary excretion of transferrin and albumin may reflect impaired proximal renal tubular reabsorption of transferrin and/or altered glomerular basement membrane selectivity for the two proteins.

Acetylglucosaminidase↗
PubMed1990

Drug treatment of obesity in type 2 diabetes mellitus.

Obesity is a common problem in Type 2 diabetes mellitus, and reduction of weight in obese diabetic patients will lead to an improvement in glucose tolerance. Despite the importance of weight loss, obese diabetic patients often fail to lose weight with advice on dietary restriction. Frequent visits to see the dietician provide the best chance of successful weight loss, and should be an important part of the management of the overweight patient. If this line of treatment is unsuccessful, then drug therapy may be considered to assist the patient in adhering to the dietary restriction. Over the past decade, drug therapy for weight loss has fallen into disrepute in the wake of the abuse of amphetamines and thyroid hormones by both patients and doctors. For this reason, the only drug commonly used in the diabetic clinic to assist patients to lose weight is metformin because of its putative therapeutic effect on obesity. However, currently available anorectic agents have much less potential for abuse by patients than their predecessors, and new drugs are being developed in this field.

Appetite Depressants↗
PubMed1990

Does exposure to rubella virus generate endocrine autoimmunity?

Rubella virus is a possible environmental agent which may be involved in triggering autoimmunity to pancreatic islet cells, leading to Type 1 diabetes. Autoantibody responses were determined in 239 10-year-old girls who received live attenuated rubella vaccine, of whom 61 (26%) had no pre-existing rubella immunity. Islet cell antibodies (ICA greater than 5 Juvenile Diabetes Foundation (JDF) units) were present in seven (2.9%) girls before vaccination, and they appeared in three more 6 weeks after vaccination (4.2%). However, the ICA levels were low in all cases and of the three girls who developed ICA greater than 5 JDF units 6 weeks post-vaccination, none had detectable ICA 18 months later. IgG-insulin autoantibodies were present in 17 (7.1%) girls before vaccination, and their prevalence decreased after vaccination (5.4%). Thyroid antibodies (thyroglobulin and microsomal) were present in 2% and 1%, respectively, of the girls before vaccination and none appeared afterwards. Thus, rubella vaccination did not elicit widespread endocrine autoantibody production and viral triggering of endocrine autoimmunity in susceptible subjects remains an open question.

Antigens, Viral↗
PubMed1988

A strategy for selection of elderly type 2 diabetic patients for insulin therapy, and a comparison of two insulin preparations.

Sixty-six patients with secondary failure to oral hypoglycaemic therapy were assessed in hospital, and those whose fasting blood glucose concentration was greater than or equal to 10.0 mmol l-1 were treated with insulin once a day for 6 months. Only 22 patients fulfilled this criterion, and they were randomly allocated to a daily injection of either Humulin-Zn (12 patients) or Neulente insulin (10 patients). The remaining patients were considered to be noncompliant with therapy. At the end of 6 months' insulin therapy a significant (p less than 0.05) improvement occurred in HbA1c from a median (range) of 13.2(9.8-16.4)% and 13.1(10.5-16.2)% to 10.6(8-14.2)% and 11.2(8.7-13.5)% in patients given Humulin-Zn and Neulente, respectively. However, there were 46 episodes of hypoglycaemia reported by patients who received Humulin-Zn, 36 of which occurred between 0300 and 0600 h. Only four episodes were reported by the Neulente-treated group. In addition, six patients treated with Humulin-Zn (but only one patient on Neulente insulin) required the addition of short-acting insulin. The patients not treated with insulin showed a significant (p less than 0.05) improvement in blood glucose control 2 months after in-patient assessment but this improvement was not sustained to 6 months.

Aged↗
PubMed1988

Tubular dysfunction and microalbuminuria in insulin dependent diabetes.

The nature of microproteinuria in the early years of insulin-dependent diabetes was investigated in a cross sectional study of 80 children with insulin-dependent diabetes and 40 normal children. Urinary excretion of three low molecular weight proteins: alpha-1-microglobulin, beta-2-microglobulin and kappa light chains was used as an index of proximal renal tubular function. The first urine samples of the morning were collected and excretion of proteins measured was expressed as ratio of protein to creatinine. There was a strong correlation between excretion of alpha-1-microglobulin and chi light chains and their excretion was significantly higher in diabetic children indicating decreased proximal tubular reabsorbtion. The excretion of beta-2-microglobulin was found to be an unsatisfactory index of proximal tubular function. Urinary albumin excretion was not significantly raised in diabetic children and did not correlate with urinary alpha-1-microglobulin or chi light chain excretion. Glycaemic control might influence proximal tubular function as both urinary glucose concentration and glycosylated haemoglobin showed correlations with urinary alpha-1-microglobulin excretion and with urinary chi light chain excretion.

Adolescent↗
PubMed1987

Familial diabetes mellitus with variable B cell reserve; analysis of a pedigree.

Some patients do not fall neatly into the categories of Type 1 (insulin-dependent), Type 2 (non-insulin-dependent) or maturity onset diabetes of young people diabetes. The pedigree and characteristics of the family reported here illustrate this problem. Nine cases of diabetes are known in 4 out of 5 generations, with onset between 17-70 years. Treatment was with insulin in 5 (onset 17-29 years), tablets in 3 (onset 32-70 years), and in one diabetes occurred before the insulin era. Plasma C-peptide was 0.04-0.52 nmol/l (fasting) and 0.35-1.33 nmol/l (peak stimulation with glucagon). HLA typing, available in 7 diabetic patients showed DR2 or DR7 in all, DR4 in 2 and DR3 in none. Pancreatic islet cell antibodies were absent at diagnosis in the most recently diagnosed patient. Diabetic complications remain absent in two insulin-treated patients (duration 28 and 24 years), but have occurred extensively in the remainder. The form of diabetes in this family is therefore characterised by (a) strong family history (possible autosomal dominant with variable penetrance), (b) widely variable age of onset, (c) a variable degree of B cell reserve (d) no association with HLA DR3/4 and the presence of DR2 or DR7 and (e) no protection from complications.

Adult↗
PubMed1987

Insulin dependent diabetes in Asians.

Type 1 diabetes is said to be extremely rare in children in India, where diabetes treated with insulin may be due to chronic pancreatic disease or malnutrition. To see whether typical type 1 diabetes occurred in Asian children in the United Kingdom, all known Asian children with diabetes in industrial West Yorkshire were ascertained. A total of 17 such children were studied; of these, seven were from three multiplex families and two fathers from these families had diabetes. All children were ketosis prone and developed diabetes while resident in the UK. There were significant increases in HLA-B8 and HLA-DR3 and increases in HLA-DR4 and HLA-DR3/DR4, while HLA-B15 was absent. Islet cell antibodies, either IgG or complement fixing, were present in four of 18 subjects tested, all of whom had disease of short duration. The prevalence of type 1 diabetes in Asian children aged 15 years or less in West Yorkshire was 36/100,000, assuming complete ascertainment. It is concluded that typical type 1 diabetes may occur in Asian children and this condition may be more common in families who have migrated to the UK.

Adolescent↗