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Biomedical subjects

I Mühlhauser

Publications and source records attributed to I Mühlhauser.

At least 91 records · Page 5Linked to original sources
PubMed1983

Bicentric evaluation of a teaching and treatment programme for type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months.

In two hospitals an identical diabetes teaching and treatment programme (in-patient, Monday to Friday, group teaching) was set up. Seventy-eight consecutive, conventionally treated Type 1 diabetic patients (duration of diabetes 10 +/- 6 years), referred during a certain period, were reinvestigated after 1 year, and again (for assessment of metabolic control only) 22 months after the teaching and treatment programme. Initially, mean glycosylated haemoglobin was 2.6%, after one year 1.0%, and after 22 months 1.5% above the upper limit of the normal range (p less than 0.001). Hospital admissions were reduced from a mean of 10 to a median of 1 day per patient per year (p less than 0.001). The long-term quality of diabetes care achieved by the diabetes teaching and treatment programme was unrelated to intelligence quotient, diabetes duration, or diabetes-related knowledge. Patients with normal levels of glycosylated haemoglobin on follow-up (33% of all patients) had particularly good compliance rates, and significantly lower initial values of glycosylated haemoglobin than patients with glycosylated haemoglobin levels greater than or equal to 10%. The data indicate that the diabetes teaching and treatment programme resulted in a substantial long-term improvement of metabolic control and a striking reduction of hospital admissions. The study substantiates the feasibility of applying this teaching and treatment programme on a large scale to other hospitals, so as to improve the quality of diabetes care and decrease health care costs.

Adolescent↗
PubMed1983

Apolipoproteins (A-I, A-II, B), Lp(a) lipoprotein and lecithin: cholesterol acyltransferase activity in diabetes mellitus.

Concentrations of HDL cholesterol, apolipoprotein (apo) A-I and apo A-II were found to be significantly decreased in patients with insulin-dependent diabetes (IDD) and non-insulin-dependent diabetes (NIDD) compared with carefully selected controls matched for sex, age and body weight. LDL cholesterol and apo B levels did not differ significantly between diabetics and controls. Concentrations of lipoprotein Lp(a), an independent risk factor for coronary artery disease in non-diabetics, were above 20 mg/dl in only 14% of diabetics and in 5% of controls. LCAT activity was normal in diabetics, irrespective of type of diabetes, sex and age of patients. No correlation between HbA1 and either HDL cholesterol or A-I and A-II was found in IDD and NIDD. A positive correlation between HbA1 and either triglyceride or VLDL triglyceride was noted in IDD and NIDD. There was also a positive correlation between insulin dosage in IDD and HDL cholesterol, apolipoprotein A-I and A-II.

Adolescent↗
PubMed1983

Exercise induces in vivo platelet activation in patients with coronary artery disease and in healthy individuals.

Recently, conflicting results have been published about a possible relationship between platelet activity and exercise-induced myocardial ischemia. The present study was performed to investigate platelet behavior during a graded symptom-limited bicycle ergometer test both in relation to the intensity of exercise and to exercise-induced myocardial ischemia. Plasma concentrations of platelet factor 4 (PF4) and beta-thromboglobulin (beta-TG) were measured by radioimmunoassays in 53 patients who had had acute myocardial infarction 10 weeks before the study and, for comparison, in 9 healthy individuals. In the whole group of the 53 patients there was no significant alteration in platelet-specific proteins during exercise, whereas physical activity induced a 2- to 3-fold increase in beta-TG and PF4 levels in the controls. However, on differentiation of the patients as to their individual exercise performance, significant exercise-associated platelet activation was demonstrable in those who reached more than 75% of their calculated maximal working capacity, whereas no correlation was found between platelet activity and exercise-induced myocardial ischemia. Thus, the results from this study indicate that in vivo platelet activation is a physiological phenomenon which occurs when a certain degree of physical intensity is exceeded, independent of the precipitation of myocardial ischemia.

Adult↗
PubMed1982

Effect of bezafibrate on plasma lipids, lipoproteins, apolipoproteins AI, AII and B and LCAT activity in hyperlipidemic, non-insulin-dependent diabetics.

The effect of bezafibrate on plasma lipids, lipoproteins, apolipoproteins AI, AII and B, and LCAT activity was investigated in 16 hyperlipidemic, non-insulin-dependent diabetes, who were treated for 8 weeks with either placebo or bezafibrate in a double-blind cross-over design. Bezafibrate induced a significant decrease in plasma triglycerides (P less than 0.01), cholesterol (P less than 0.05), VLDL triglycerides (P less than 0.05) and VLDL cholesterol (P less than 0.01), and a significant increase in HDL cholesterol (P less than 0.01), whereas LDL cholesterol remained unchanged. The apolipoprotein AI/apolipoprotein B ratio increased significantly (P less than 0.05), although individual changes in these apolipoproteins were not significant. Apolipoprotein AII increased significantly (P less than 0.05), although individual changes in these apolipoproteins were not significant. Apolipoprotein AII increased significantly (P less than 0.0001) and the apolipoprotein AI/apolipoprotein AII ratio decreased (P less than 0.0001), indicating an increase in the HDL3 rather than the HDL2 fraction. No significant change in LCAT activity was observed.

Aged↗
PubMed1981

Plasma concentrations of plbatelet-specific proteins in coronary artery disease.

The plasma concentrations of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) were measured in 100 patients with documented coronary artery disease (CAD) and in 40 controls. 18 patients had had coronary artery bypass surgery (CABS), 25 patients were on therapy with beta-blocking agents and 19 were treated with oral anticoagulants. 38 patients with CAD received neither CABS nor beta-blocking or anticoagulating drugs. The highest plasma concentrations of beta-TG and PF4 were found in the patient group without medical or surgical treatment (patients versus controls: p less 0.01). Patients with CABS showed beta-TG and PF4 levels within the normal range. Patients with beta-blocking agents also had lower beta-TG and PF4 values than the patient group without therapy (p less than 0.05). By contrast, patients on oral anticoagulation therapy presented with similar plasma concentrations of beta-TG and PF4 as untreated patients. Our data indicate that surgical or medical treatment with beta-blocking agents, but not with oral anticoagulants, may have some influence on platelet function in patients with CAD. beta-TG and PF4 radioimmunoassay may be a simple method to study platelet involvement in various diseases and to evaluate possible influences of medical of surgical treatment on in vivo platelet function.

Adrenergic beta-Antagonists↗
PubMed1981

[Effects of muscular exercise on non-glucoregulatory hormones (T3, rT3, T4, TSH, prolactin, FSH, LH) in type I diabetics (author's transl)].

In the present investigation the influence of muscular exercise on non-glucoregulatory hormones (T3, rT3, T4, TSH, prolactin) was analyzed in non-ketotic, juvenile-onset type diabetics (JD) in relation of their metabolic control. The plasma hormonal concentrations were measured in 8 well-controlled JD, 8 moderately controlled JD and in 8 healthy subjects, before, during and after a 30 min. bicycle ergometer test of moderate work intensity. The exercise-induced rise in T4, and rT3 was similar in both groups of diabetics and did not significantly differ with that obtained in controls. A significant increase of T3-concentrations occurred only in the controls. Hormone levels of TSH, FSH and LH did not change significantly during exercise in all three groups, whereas prolactin showed a considerable increase (N. S.) in the well-controlled JD-patient group with low blood glucose concentrations. These findings demonstrate that muscular exercise leads to a similar effect on the behavior of T4, rT3, TSH, LH, and FSH concentrations, but not on T3 (no increase) and prolactin in non-ketotic, conventionally treated JD compared with healthy individuals.

Adult↗
PubMed1981

[Effect of muscular exercise and metabolic control on cortisol, growth hormone, plasma-epinephrine and plasma-norepinephrine in type-I diabetics [author's transl)].

In the present study we investigated the influence of muscular exercise on stress-hormones (cortisol, growth hormone, epinephrine, norepinephrine) in nonketotic, juvenile-type diabetics (JD) in relation to the degree of metabolic control. The plasma-hormone-concentrations were measured in 8 well controlled JD, 8 moderately controlled JD and in 8 healthy subjects, before, during and after a 30 min bicycle ergometer test of moderate work intensity. The exercise induced rise in cortisol, epinephrine and norepinephrine wa similar in both groups of diabetics and not significantly different compared with controls. In healthy subjects growth hormone levels rose significantly with the onset of exercise, whereas in both patient groups maximal growth hormone concentrations were found at the end of the ergometer test. In moderately controlled JD, however, growth hormone concentrations were significantly higher than in well controlled JD. The results demonstrate that muscular exercise shows a similar effect on cortisol, epinephrine and norepinephrine, but not on growth hormone concentrations in nonketotic, conventionally treated JD compared with controls.

Adult↗
PubMed1980

Platelet proteins (beta-TG and PF4) in atherosclerosis and related diseases.

The mean plasma concentrations of beta-TG and PF4 were significantly elevated in patients with diabetes mellitus, peripheral vascular disease and coronary artery disease reflecting enhanced in vivo platelet activity in some of these patients. No correlations could be observed between state of metabolic control and concentrations of platelet specific proteins in diabetic subjects. High mean beta-TG levels were noticed in diabetic patients with increasing severity of retinopathy. Raised beta-TG values decreased significantly after two weeks of treatment with dipyridamole in 10 type-I diabetics. In patients with peripheral vascular disease the WU-test, but not the ADP- or collagen induced platelet aggregation was significantly different between patients and controls, but there were no correlations between the mentioned platelet function tests.

Arteriosclerosis↗
PubMed1980

[The clinical importance of glycohaemoglobin (HbA1) (author's transl)].

Glycosylated haemoglobin provides an integrative measure of long-term glycaemic levels and complements conventional glucose monitoring in the management of diabetes. The present study was determined to review nomenclature, biochemistry and the analytic methods available for measurement of HbA1. Clinical studies are reported that relate HbA1 concentrations to various parameters of glucose control, diabetes type and diabetes therapy. Moreover, this review considers nondiabetic disorders that are associated with falsely abnormal HbA1 levels and in addition, the value of HbA1 in predicting complications of diabetes and in the diagnosis of subclinical diabetes is discussed.

Blood Glucose↗
PubMed1979

[Hypotrypsinemia in diabetes mellitus].

Plasma concentrations of immune-reactive trypsin (IRT) were determined in 212 patients with juvenile-onset, insulin-dependent diabetes (Type I) and in 158 patients with maturity onset diabetes (Type II) in comparison to 121 healthy individuals. Significantly increased IRT levels were obtained in the type I diabetics, whereas IRT concentrations were normal or increased in the type II diabetic patients. Hypotrypsinemia occurred predominantly in type I diabetics with high IgG-insulin antibodies or islet-cell antibodies. No correlation was noted between the IRT-levels and the beta-cell residual capacity in the type-I diabetics.

Diabetes Mellitus↗
PubMed1979

[Clinical significance of the radioimmunological determination of beta-thromboglobulin and platelet factor 4].

Recently new radioimmunoassay methods have been established to measure plasma concentrations of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4), platelet release products which are set free when platelets aggregate. Plasma concentrations of beta-TG and PF4 were investigated in disorders with increased thromboembolic risk. Extremely high concentrations of these platelet proteins were found in patients with venous thrombosis, pulmonary embolism, polycythemia vera, and chronic renal failure. Moderately increased beta-TG and PF4 levels were observed in patients with peripheral vascular disease, coronary artery disease, chronic rheumatoid arthritis, multiple myeloma, and diabetes mellitus. These data indicate, that plasma concentrations of beta-TG and PF4 are useful parameters for the evaluation of the "in vivo" platelet activity. By using these new methods for clinical applications special blood sampling conditions have been taken into account; moreover one has to consider that the plasma levels of the platelet "release products" are dependent from renal function.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Near-normotension and near-normoglycemia in blind type I diabetic patients with overt diabetic nephropathy.

In patients with diabetic nephropathy, near-normalization of blood pressure (BP) and blood sugar may have a beneficial impact on changes in kidney function, but visually impaired patients may face difficulties when striving for optimal control of hypertension and hyperglycemia. In a prospective feasibility study, we followed a group of nine blind Type I (insulin-dependent) diabetic patients (mean age 30 +/- 4 years) with overt diabetic nephropathy and uncontrolled hypertension. All patients received intensified insulin therapy after a structured diabetes treatment and teaching program, and adapted their antihypertensive drug treatment to self-monitored BP values. At recruitment, HbA1c values were 5.8 +/- 0.6%, and remained stable at 6.3 +/- 1.7% after a mean observation period of 27 months. BP pressure decreased from 150 +/- 14/99 +/- 14 mmHg to 130 +/- 17/86 +/- 10 mmHg after 1 year, and to 140 +/- 14/92 +/- 9 mmHg at the last examination, (p less than 0.05). Serum creatinine and creatinine clearance remained stable over the observation period at 165 +/- 56 mumol/L and 0.8 +/- 0.4 ml/s/1.72m2 at recruitment, and 152 +/- 47 mumol/L and 1.0 +/- 0.5 ml/s/1.72m2 at the final examination. Proteinuria decreased from 3.2 to 1.4 g/24 h (p less than 0.05). No patient needed renal replacement therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Effects of intensification of antihypertensive care in diabetic nephropathy.

The overall quality of antihypertensive care in diabetic patients in Germany is poor. Only a minority of unselected hypertensive patients reach permanent normotensive blood pressure control. Previously, we have shown in a prospective randomized 3-year follow-up study in essential hypertension that implementation of a hypertension teaching and treatment program into routine care results in a significant improvement of blood pressure control. Subsequently, we have performed a prospective, controlled 5-year follow-up trial in hypertensive type I diabetic patients with nephropathy. One-half of a sequential sample of about 100 hypertensive patients with overt nephropathy participated in the program based on blood pressure self-monitoring with the goal of normalization of blood pressure values below 140/90 mm Hg (intensified care, IC). The remaining patients followed routine antihypertensive therapy and formed the control group (routine care, RC). During 5 years of follow-up in IC group patients, blood pressure control was significantly improved. The occurrence of primary study end points (need for dialysis and death) was significantly lower in the IC group patients. In conclusion, in patients with diabetic nephropathy, participation in a hypertension teaching treatment program results in a long-term improvement of blood pressure control and a decrease in mortality and morbidity.

Antihypertensive Agents↗
PubMedDate not supplied

Pharmacokinetics and bioavailability of injected glucagon: differences between intramuscular, subcutaneous, and intravenous administration.

Pharmacokinetics and bioavailability of 1 mg glucagon injected intramuscularly (i.m.), subcutaneously (s.c.), or intravenously (i.v.) were studied in 6 nondiabetic men rendered hypoglycemic by s.c. injection of 10 U regular insulin. At 90 min after the insulin injection, when blood glucose levels had fallen to a mean of 49 mg/dl, glucagon was administered. Ten minutes later plasma glucagon levels had risen from a mean of 246 to 3233 pg/ml (s.c. experiment) and from 250 to 2638 pg/ml (i.m. experiment). Accordingly, there was no difference in blood glucose behavior whether glucagon was injected s.c. or i.m. In the i.v. experiment, plasma glucagon levels were significantly higher during the first 15 min after the glucagon injection when compared with the other experiments. The initially high levels of plasma glucagon after i.v. administration were associated with a steeper rise of glycemia during the first 5 min after glucagon injection; the maximal increase of blood glucose was, however, not different when compared with the s.c. or i.m. route of glucagon administration. Thus, in case of severe hypoglycemia, therapeutically administered glucagon will be most efficient when injected i.v., but there is no difference between the i.m. and s.c. routes of administration with regard to the efficacy to increase blood glucose levels.

Adult↗
PubMedDate not supplied

Incidence and management of severe hypoglycemia in 434 adults with insulin-dependent diabetes mellitus.

The risk of severe hypoglycemia associated with the particular therapeutic approach of two University hospitals was assessed in 96% of all patients with insulin-dependent diabetes mellitus (IDDM) who had been admitted during a period of almost 3 yr to the diabetic wards of two hospitals and who participated in a structured teaching and treatment program. During a mean follow-up period of 18 mo, 10% of the conventionally treated patients (N = 384; age 30 +/- 13 yr; duration of diabetes 12 +/- 9 yr) and 9% of the CSII-treated patients (N = 50, age 28 +/- 7 yr, duration of diabetes 13 +/- 7 yr, total follow-up period 1093 patient-mo) experienced at least one severe hypoglycemic episode per year, and a total of 123 severe hypoglycemic episodes occurred. In a subgroup of 169 conventionally treated patients, mean glycosylated hemoglobin values decreased from 10.5 +/- 1.9% before participation in the program to 9.2 +/- 2.0% (P less than 0.001) 18 +/- 4 mo thereafter. For the CSII-treated patients, glycosylated hemoglobin values were 9.7 +/- 1.9% before initiation of pump therapy and remained at the upper normal range from 3 mo thereafter throughout the study. There was no relationship between glycosylated hemoglobin levels and the occurrence of severe hypoglycemic episodes. Fifty-three severe hypoglycemic episodes were treated with glucagon injections by the patients' relatives (all but one effectively), 30 were managed by assisting physicians, and 44 led to hospitalization. Thus, successful attempts to improve glycosylated hemoglobin values in an unselected group of patients with IDDM were not associated with an unduly high risk of severe hypoglycemia when compared with the scarce data from the literature.

Adolescent↗