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Biomedical subjects

I S Ross

Publications and source records attributed to I S Ross.

At least 19 recordsLinked to original sources
PubMed2006

Structured diabetes therapy and education improves the outcome of patients with insulin treated diabetes mellitus. The 10 year follow-up of a prospective, population-based survey on the quality of diabetes care (the JEVIN Trial).

AIMS/HYPOTHESIS: JEVIN (Jena's St. Vincent Trial) is a prospective, 10 year follow-up, population-based survey of all insulin treated patients with type 1 and type 2 diabetes mellitus aged 16 to 60 years and living in the city of Jena (100,000 inhabitants), Thuringia, Germany. It aims to show the effects of implementation of the St. Vincent Declaration and to evaluate the effect of recent changes in the health care system and new treatment strategies. PATIENTS AND METHODS: 190 patients (83% of the target population), 244 patients (90%) and 261 patients (90%) were studied in 1989/90, 1994/95 and 1999/2000, respectively. RESULTS: Up to 1994/95, the HbA1c of patients with type 1 diabetes mellitus increased (1994/95: 8.50+/-1.80% versus 1989/90: 7.83+/-1.60%, p=0.002). For patients with type 2 diabetes mellitus, it remained constant (9.01+/-2.06% versus 9.17+/-1.60%, n. s.). During the period from 1994/95 to 1999/2000, there was a substantial improvement in the relative HbA1c of both, patients with type 1 (7.62+/-1.55%, p<0.0001), and with type 2 diabetes (7.57+/-1.29%, p<0.0001). Up to 1999/2000, 87.7% of the patients with type 1 (1989/90: 0%, 1994/95: 73.2%) and 96.6% of the patients with type 2 diabetes (1989/90: 0%, 1994/95: 89.7%) participated in TTP's. The incidence of acute and the prevalence of long-term complications remained constant. CONCLUSIONS: Results of the population-based, prospective trial to optimise patients' quality of diabetic control suggest: For patients with insulin treated type 2 diabetes mellitus, excellent treatment can be available by primary care physicians interested, educated and highly engaged in diabetes therapy. Moreover, structured diabetes therapy consisting of treatment and teaching programmes, regular self-monitoring, patients' insulin dose adjustment and patients' empowerment, should be offered to all patients with diabetes mellitus.

Adolescent↗
PubMed2004

Improvement of the quality of diabetes control and decrease in the concentrations of AGE-products in patients with type 1 and insulin-treated type 2 diabetes mellitus: results from a 10 year-prospective, population-based survey on the quality of diabetes care in Germany (JEVIN).

BACKGROUND: Advanced glycation end (AGE)-products are a complex group of compounds that have been implicated in diabetes related long-term complications. Up to the present only few data exist about serum levels of the AGE-proteins N-epsilon-Carboxymethyllysine (CML) and pentosidine in patients with diabetes mellitus. PATIENTS AND METHODS: In the present 10-year, population-based trial of a selection-free cohort of patients with insulin-treated diabetes mellitus, serum CML and pentosidine levels were examined in correlation to the patients' quality of diabetes control and the prevalence of diabetes related long-term complications. RESULTS: Following the reunification of Germany in 1989 the health care system was decentralised. Up to 1994/95 the relative HbA1c (HbA1c/mean normal) of patients with type 1 diabetes increased (1.65 +/- 0.35 versus 1.52 +/- 0.31, p = 0.002). For patients with type 2 diabetes it remained constant (1.75 +/- 0.4 versus 1.78 +/- 0.31, p = 0.669). During the following period (from 1994/95 to 1999/2000) specialised diabetes care, structured treatment and teaching programmes (TTP), intensified insulin therapy and blood glucose self-monitoring for all patients were broadly implemented. This was accompanied by a substantial improvement in the relative HbA1c of both, patients with type 1 (1.48 +/- 0.3, p<0.0001), and insulin-treated type 2 diabetes mellitus (1.47 +/- 0.25, p<0.0001). During the same period the mean concentration of the AGE-product CML in the sera of patients with type 1 and insulin-treated type 2 diabetes decreased (type 1: 1994/95: 1158.1 +/- 410.0 ng/ml versus 1999/2000: 938.5 +/- 422.4 ng/ml, p<0.0001, type 2: 1994/94: 1244.7 +/- 1231.3 ng/ml versus 1999/2000: 970.9 +/- 458.6 ng/ml, p = 0.007). For pentosidine the same tendency was found for patients with type 1 diabetes (1994/95: 253.6 +/- 280.7 pmol/ml versus 1999/2000: 148.2 +/- 91.4 pmol/ml, p<0.0001). For patients with type 1 diabetes there was a positive correlation between the relative HbA1c-value calculated over the total follow-up period of 10 years and the CML-concentration in 1999/2000 (r = 0.405, p = 0.017). In 1999/2000 a reduced creatinine clearance (</=80 ml/min) was found in 7.8% of patients with type 1 and 14.9% of patients with insulin-treated type 2 diabetes. In comparison to patients with a normal creatinine clearance, patients with a reduced creatinine clearance had not only higher creatinine-concentrations in the sera and higher values of albuminuria but also significantly higher pentosidine levels. CONCLUSIONS: Comparing the data of 1999/2000 with those from 1994/95, there was not only a substantial improvement in patients' quality of diabetes control but also a decrease in the concentration of AGE-products. In patients with diabetes mellitus the AGE-products seem to be mainly influenced by the quality of diabetes control. The decline in renal function leads to increased serum pentosidine levels in patients with insulin-treated diabetes mellitus. Thus it seems that in patients with reduced renal function, higher levels may either play a causal role in the development and progression of nephropathy or they are an epi-phenomenon caused by the decrease in urinary excretion.

Adolescent↗
PubMed2001

The clinical application of a urine albumin:creatinine ratio point-of-care device.

INTRODUCTION: Microalbuminuria is an accepted predictive marker for the early detection of renal disease and the identification of patients at high risk of developing complications of diabetes and hypertension. The Bayer Clinitek 50 is a urine chemistry point-of-care analyser for the semi-quantitative measurement of albumin and creatinine and calculation of albumin:creatinine ratio (ACR). METHOD: Urine samples were obtained from 252 consecutive patients attending a city center diabetic clinic, and from 40 patients on admission to the ICU. Albumin and creatinine measurements were carried out using the Clinitek 50 and by the central laboratory. RESULTS: The Clinitek 50 results agreed with the central laboratory results in 89% of the diabetic patient samples and 80% of the ICU patient samples. Excluding samples defined as normal by the Clinitek 50 (ACR<3.4 mg/mmol) would have resulted in an 80% reduction in samples sent to the lab for further quantification. The average length of stay in the group of ICU patients with normal ACR was significantly less than for those patients with an abnormal ACR (p<0.005). CONCLUSIONS: The Clinitek 50 provides useful, immediate clinical information regarding the microalbuminuria status for use in the diabetic clinic setting or as a potential immediate risk management tool in intensive care.

Albuminuria↗
PubMed1997

The JEVIN trial: a population-based survey on the quality of diabetes care in Germany: 1994/1995 compared to 1989/1990.

Since 1990 in most Eastern European countries health care systems have been decentralized or are undergoing the processes of decentralization. Increasingly, diabetic patients are no longer treated by diabetologists but by non-specialized physicians. During the same period structured treatment and teaching programmes have been introduced and health care is increasingly influenced by the St. Vincent declaration. To show the effect of these changes on the quality of diabetes care 90% (n = 244) of all insulin-treated diabetic patients aged 16 to 60 years and living in the city of Jena (100247 inhabitants) were studied in 1994/1995. The results were compared with the baseline examination of 1989/1990 (n = 190). HbA1c (HbA1c/mean normal) in IDDM patients under specialized care was similar in 1994/1995 (1.54 +/- 0.27, n = 47) to 1989/1990 (1.52 +/- 0.31, n = 131, p = 0.0018), but higher under non-specialized care (1.71 +/- 0.38, n = 80, p = 0.0087). In the total group of NIDDM patients there was no significant change in HbA1c (1994/1995: 1.75 +/- 0.4, n = 117, vs 1989/1990: 1.78 +/- 0.4, n = 59, p = 0.67), but with a tendency to higher HbA1c under non-specialized (1.81 +/- 0.4, n = 79) compared to specialized care (1.66 +/- 0.39, n = 38, p = 0.06). Incidence of severe hypoglycaemia (IDDM 0.13; NIDDM 0.04), ketoacidosis (0.02; 0.01) and the prevalence of nephropathy (21%; 35%) and neuropathy (24%; 38%) remained unchanged in comparison to 1989/1990, whereas there was an increase in the prevalence of diabetic retinopathy. Specialized care is mandatory for patients with IDDM.

Adult↗
PubMed1997

Approach to maintaining comparability of biochemical data during long-term clinical trials.

Our objective was to design a structured approach to maintaining comparability of biochemical data during a long clinical trial. Maintaining the comparability of clinical and biochemical data obtained in long-term studies is essential, even though analytical methods in the laboratory may be changed, conventions on specimen handling and storage revised, calibration procedures updated, quality-control systems replaced, and secular changes may occur. The United Kingdom Prospective Diabetes Study (UKPDS), a large randomized control trial investigating therapy for type 2 diabetes, was the setting for the study. Data were collected from 5102 subjects randomized since 1977. Our techniques included quality control, external quality assurance, direct comparison of laboratory methods when updating assays and statistical techniques for the detection of unsuspected changes in assay bias, laboratory comparisons of new with old assay methodologies, the realigning of data to current methods, the use of a suitable reference population for long-term monitoring, and rules to aid decision-making about clinical vs statistical significance. Procedures by which comparability of data is assured should be specified for all long-term trials and, where possible, comparison with reference methods should be detailed to allow results from different laboratories to be compared.

Diabetes Mellitus, Type 2↗
PubMed1995

Role of metabolic acidosis on cardiac mechanical performance during severe acute hypoxia and reoxygenation is small and transient.

OBJECTIVE: The aim was to determine whether the metabolic acidosis that develops during severe acute myocardial hypoxia improves or impairs the recovery of cardiac mechanical function during reoxygenation. METHODS: Isolated rat hearts performed external work against a model of the rat systemic vascular impedance. Four groups of 10 hearts were used for mechanical studies. In these experiments, the hearts were subjected to normoxic ventilation for 15 min, hypoxic ventilation for 20 min, and reoxygenation for 60 min. The perfusate pH was either allowed to drift downward due to metabolic acidosis, or it was corrected to 7.4 as hypoxia or reoxygenation began. Mechanical performance was assessed by measuring heart rate and model "aortic" pressure and flow and by computing left ventricular mean, pulsatile, and total hydraulic power output and stroke work. A further four groups of 10 hearts were used for biochemical studies. In these experiments, myocardial high energy phosphates and calcium content were measured at the end of the period of hypoxia. RESULTS: When no attempt was made to regulate the perfusate pH, it drifted downward from 7.40(SEM 0.01) to 7.33(0.01) during hypoxia and then to 7.25(0.02) during reoxygenation. All mechanical variables measured and computed were severely depressed by hypoxia, whether the pH was regulated or not. Left ventricular total hydraulic hydraulic power output decreased to less than 10% of the control value in all experiment groups and recovered to 86.7-91.2% of the control value after 60 min of reoxygenation. Mechanical recovery was most rapid when the correction of acidosis was delayed until reoxygenation was begun. After 5 min of reoxygenation, it had recovered to 65.5% of the control value compared with a 37.0% recovery when the pH was allowed to drift and 34.9% when the pH was corrected to 7.4 during hypoxia. However, the differences in power output became non-significant after 10 min of reoxygenation. Myocardial creatine phosphate and adenosine triphosphate concentrations were decreased by hypoxia whether the pH was corrected (63.0% and 26.9% relative to the control), or not (68.9% and 35.0% relative to the control) (not statistically significant), but total cell calcium was not affected. CONCLUSIONS: In the isolated rat heart, correction of the moderate metabolic acidosis that developed during severe acute myocardial hypoxia improved the rate of mechanical recovery, but the effect was small and not sustained.

Acidosis↗
PubMed1995

Reduced uptake of nickel by a nickel resistant strain of Candida utilis.

A nickel resistant strain of the yeast Candida utilis was obtained by selection of spontaneous mutants on solid medium containing 3 mM Ni2+. In time-course experiments, non-growing suspensions of the mutant strain took up approximately 50% less nickel than the parent strain over 30 min incubation in MES buffer plus glucose at pH 5.5. Efflux of nickel from either strain was negligible. Uptake was reduced by omission of glucose from the uptake buffer in both strains but this was much more marked in the parent strain. Uptake of nickel in the presence of equimolar concentration of Mg2+ was reduced by 80% in both parent and mutant strains. It was concluded that resistance to nickel was due to an alteration in a transport system primarily responsible for uptake of magnesium.

Candida↗
PubMed1993

Quality of centralized diabetes care: a population-based study in the German Democratic Republic 1989-1990.

The efficacy of care in the centralized diabetes care system in the former German Democratic Republic was evaluated on the basis of the recommendations of the St. Vincent Declaration. Eighty-three per cent (n = 190, 46% women) of all insulin-treated diabetic patients aged 16-60 years who were registered in one district diabetes care unit were examined. Of these, 131 patients had type 1 (insulin-dependent) diabetes (69%) and 59 type 2 (non-insulin-dependent) diabetes (31%). All patients were on animal insulin and 96% (n = 187) had conventional therapy consisting of fixed insulin dose and a fixed diet. Levels of glycosylated haemoglobin (normal 4.15%, SD 0.54) were 6.3 +/- 1.3% in type 1 and 7.4 +/- 1.7% in type 2 diabetics. Retinopathy was found in 35% of type 1 (proliferative 3.8%) and 23% of type 2 patients (proliferative 3.4%). No patient was blind. Screening for nephropathy identified 29% of type 1 and 47% of type 2 diabetics as having albuminuria > 20 mg/l in early-morning urine. The prevalence of hypertension was 31% and 69% for type 1 and type 2 patients respectively. Foot ulcers were found in 2.1% and lower limb amputations in 2.1%. The incidence of severe hypoglycaemia (except in pregnancy) was 0.07 per patient per year. This study shows that the diabetes care system was effective and the winding up of this system with the reunification of Germany was not a medical necessity. However, the system failed to establish an integrated regime with regional general practitioners for the effective treatment of hypertension.

Absenteeism↗
PubMed1993

[Illness-specific knowledge, coping with illness and metabolic control in insulin-injecting diabetic patients in a random city population].

A knowledge test about diabetes using a standardized interview was assessed in 186 (81%) of 229 insulin treated patients below the age of 60 who are registered and treated in the diabetes care unit Jena. 90% of these patients were on conventional insulin therapy. The frequency of errors was positive correlated to glycosylated haemoglobin, age and body-mass-index, it was lower in type 1 than in type 2 diabetic patients and decreased with a better education level. Deficiencies of knowledge were detected in the following areas: hyperglycaemic coma, consequence of acetone and obesitas. Knowledge regarding late complications was on a high level. 20% of type 1 and 43% of type 2 diabetic patients did not know their daily carbohydrate units. But the metabolic control in these patients was not different from the patients who know their carbohydrates exactly. Most frequent missed subjects in the patient information were reported: modern therapy strategies, insulin pumps and nutrition. 77% of all patients did not feel ill because of their diabetes and 91% reported an unchanged relationship to their family after diabetes was diagnosed.

Adaptation, Psychological↗
PubMed1993

[In former East Germany were diabetic patients not only "well managed", but also well treated?].

The quality of diabetes care in the former GDR 1989/90 and in former West Germany 1990/91 was compared in a case control study. The study group consisted of 83% of the diabetic patients registered in the local diabetes care unit in Jena who were on insulin. The patients (86 women, 104 men; 131 Type-I and 59 Type-II, aged 16-60 years) were in the care of the local diabetes care unit. The control group consisted of randomly selected diabetic patients of the outpatient department of the university of Düsseldorf (matched pairs). Despite a different strategy of therapy the HbA1c (Jena/Düsseldorf) was the same: 154%/153% of the mean normal value in type-I and 178%/175% in type-II. The prevalence of retinopathy in type-I and type-II and proteinuria in type-I was not different, whereas the prevalence of proteinuria in type II- and of hypertension in both types of diabetes was higher in Jena.

Adolescent↗
PubMed1992

The ranges of insulin response and glucose tolerance in lean, normal, and obese women during pregnancy.

OBJECTIVE: We characterized insulin secretion and glucose disposal in a large unselected group of women, encompassing the full spectrum of glucose tolerance in pregnancy, and related the findings to maternal obesity. STUDY DESIGN: Intravenous glucose tolerance and first-phase insulin response were measured at about 32 weeks' gestation in 690 unselected pregnancies. The women were designated as "lean," "normal," or "obese" on weight-for-height criteria. RESULTS: The distribution of insulin response was bimodal, but there was no corresponding dichotomy in maternal glucose disposal rate. Insulin response was greatest and glucose disposal rate slowest in obese women. In general, "poor" glucose tolerance was associated with relatively low insulin output. It was not possible to identify any cluster of women, obese or otherwise, in whom poor glucose tolerance was specifically associated with an unusually high insulin response. CONCLUSION: The data indicate that the distribution of glucose tolerance in pregnancy is a continuum. Glucose intolerance represents one end of that spectrum and is attributable to insufficient insulin secretion. This relative insufficiency is most frequent with maternal obesity.

Blood Glucose↗
PubMed1991

A simple approach to screening for microalbuminuria in a type 1 (insulin-dependent) diabetic population.

The reproducibility of albumin concentration in first-morning samples of urine was assessed in 334 insulin-dependent diabetic patients aged 18-60 years. The albumin excretion rate was determined immunoturbidimetrically in three sterile, Albustix-negative, first-morning urine samples submitted over a week. An abnormally high mean value, greater than or equal to 2.5 mg albumin per mmol creatinine (Ua/Uc), was found in 33 patients (9.9%). These patients were older (mean 42 vs 34 years, P less than 0.01), had longer disease duration (18 vs 14 years, P less than 0.01) and higher HbA1c values (6.8 vs 6.3%, P less than 0.05) than those without microalbuminuria. Although triplicate samples were collected within 7 days, Ua/Uc showed considerable intraindividual variation, with a mean coefficient of variation of 49%. Despite this it was found that Ua/Uc values greater than 1 mg/mmol on the first specimen had a sensitivity of 97% and a specificity of 82% for detecting those with a three-sample mean value greater than 2.5 mg/mmol. Thus virtually all those with microalbuminuria (32/33) had a single first-morning result greater than 1 mg/mmol, and in those with a lower ratio microalbuminuria was excluded with more than 99% certainty.

Adolescent↗
PubMed1990

Uptake of manganese by Penicillium notatum.

Intact mycelium and protoplasts of Penicillium notatum were shown to take up manganese ions by an energy-dependent, high affinity uptake mechanism. Uptake was not inhibited by a range of divalent metal ions including Mg2+, indicating that manganese uptake by this process was specific.

Culture Media↗