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Biomedical subjects

J C Konen

Publications and source records attributed to J C Konen.

At least 37 records · Page 2Linked to original sources
PubMed1993

Microalbuminuria and diabetes mellitus.

Small concentrations of albumin detected in the urine predict renal dysfunction and reflect vascular abnormalities such as atherosclerosis, retinopathy and, probably, neuropathy. Although microalbuminuria is not specific for diabetic complications, it has been most extensively studied in diabetics. The rate of urinary albumin excretion can also be used to determine therapeutic response to pharmacologic and lifestyle interventions such as diet, smoking cessation and physical activity. The pathophysiology of microalbuminuria and its clinical significance in diabetes is presented, along with a discussion of measurement issues and implications for clinical management. An algorithm for the evaluation of diabetic patients is included.

Albuminuria↗
PubMed1993

Prevalence and predictors of problem drinking among primary care diabetic patients.

BACKGROUND: Alcohol abuse among patients with diabetes mellitus is dangerous and complicates therapy, but its prevalence and the factors that predict it are unknown. This study examined the prevalence of problem drinking among a large number of primary care diabetic patients, exploring its relation to age, race, sex, psychological factors, and other health behaviors. METHODS: Volunteers with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were surveyed at three primary care practice sites. Patients completed a health risk appraisal designed to elicit alcohol use and other health practices, and two psychometric instruments: the Brief Encounter Psychosocial Instrument and the Affect Balance Scale. Fasting blood glucose and hemoglobin A1C levels were also determined. RESULTS: Of 395 diabetic patients, 32 (8.1%) had a drinking problem as defined by answering yes to the question "Have you ever had a drinking problem?" or reporting their last drink to be within 24 hours, or both. Patients with a drinking problem coped less well with psychological stress and had a more highly negative affect than those without a drinking problem. Depression, black race, and male sex were significantly associated with problem drinking (odds ratios = 8.42, 2.70, and 3.80, respectively). Problem drinking did not predict glycemic control but was associated with smoking and less frequent glucose monitoring. CONCLUSIONS: The prevalence of problem drinking among patients with diabetes mellitus appears lower than among other medical outpatient populations and is in keeping with the prevalence found in community surveys. While the lack of association between problem drinking and glycemic control in diabetic patients may be surprising, these data help define the characteristics of this subgroup of diabetic patients and highlight the need for family physicians to intensify alcohol screening efforts in this population.

Adolescent↗
PubMed1992

Racial differences in lipid and lipoprotein levels in diabetes.

Racial differences in plasma lipid and lipoprotein levels were investigated in 145 patients with non-insulin-dependent diabetes mellitus (NIDDM). Black men had higher high-density lipoprotein (HDL) cholesterol levels, lower triglyceride levels, and an improved atherogenic index compared with white men. Premenopausal black women were also found to have higher HDL cholesterol levels, lower triglyceride levels, and a lower atherogenic index than their white counterparts. Adjustment for age, waist to hip ratio (WHR), hemoglobin A1c (HbA1c), and physical activity did not eliminate the significant differences found. There were no racial differences found regarding total and low-density lipoprotein (LDL) cholesterol. Metabolic control as measured by HbA1c was significantly correlated with the triglyceride level in black women. These data confirm that racial differences exist in plasma lipid levels among patients with NIDDM.

Adult↗
PubMed1992

Evaluations by three graduating classes of a required community health project.

The authors analyzed seniors' evaluations of the first three years of an intensive community health project at the Bowman Gray School of Medicine of Wake Forest University in 1988-89, 1989-90, and 1990-91. The project was designed to provide a public health perspective by having the students select, study, and propose solutions to a community health problem. Of 285 seniors, 240 (84%) completed evaluation questionnaires, using a five-point scale. The students' perceptions of the value of the project became steadily more favorable with each subsequent class; the classes of 1990 and 1991 rated the value of the project as being greater than that of most other experiences in their medical education. The project was more positively evaluated by the 106 responding students (44%) who planned to enter primary care specialties. The students who invested more time in the project also perceived its value to be greater.

Attitude↗
PubMed1992

Race-related differences in metabolic control among adults with diabetes.

The effect of race on differences in metabolic control was examined in patients with non-insulin-dependent (NIDDM) and insulin-dependent (IDDM) diabetes mellitus. Data were collected on HbA1c, age, duration of diabetes, age at onset, family function, stress, body mass index, waist/hip ratio, total cholesterol, insulin dose, diet, and physical activity. Among those with NIDDM, black patients had significantly higher HbA1c levels than their white counterparts. This difference persisted after adjustment for covariates. Among patients with IDDM, black subjects were found to have higher HbA1c levels, body mass index, and total cholesterol levels than their white counterparts. After correction for diabetes duration, relative insulin dose, physical activity, body mass index, and cholesterol, black women had significantly higher HbA1c levels than black men, white men, or white women. We conclude that race and sex differences do affect the metabolic control of patients with diabetes mellitus.

Adolescent↗
PubMed1992

Changes in personal health behaviors of medical students.

Physicians, including medical students, seem to lead healthier lives than the general public. Whether their favorable health behavior is learned through medical education is not known. This study uses a standardized health risk assessment to compare the personal health behaviors of a single class of medical students before and after completing their clinical rotations. Our findings confirm that medical students exhibit healthier lifestyle behaviors than that of the general population, and that changes in health behaviors may evolve with training.

Adult↗
PubMed1992

Microalbuminuria: frequency and clinical significance in hospital patients.

We investigated the frequency and the clinical significance of microalbuminuria (UA) in 312 hospital patients suspected of renal disorders, but with normal or borderline levels of urinary total protein (UTP). Approximately one-third of the patients with urinary total protein < 300 mg/g creatinine had microalbuminuria, above the reference interval (< 32 mg/g creatinine). In contrast, only 10% of the patients with elevated total urinary protein above the reference interval (> 200 mg/g creatinine) did not have microalbuminuria. About half of the patients with elevated UA had diabetes mellitus, hypertension, an immune-related disorder, or had undergone a recent renal transplant. About half of the patients with borderline elevated UTP (100 to 300 mg/g creatinine) did not have any obvious renal problem. These data demonstrate that: 1) microalbuminuria occurs very commonly in hospital patients, 2) it is a more sensitive and specific assay for the early detection of many renal disorders compared to urinary total protein, especially when the latter test is normal or borderline elevated; and 3) a thorough patient history is required for interpretation of microalbuminuria in diabetes to eliminate other complicating factors.

Aged↗
PubMed1991

Albuminuria vs urinary total protein for detecting chronic renal disorders.

A literature review and our own data are presented to demonstrate that urinary albumin (UA) excretion increases in many renal disorders and that it offers a far more sensitive indicator than the commonly used urinary total protein (UTP) for the early detection of renal involvement in many chronic diseases such as diabetes mellitus, hypertension, and systemic lupus erythematosus. In many individuals with these disorders, UA increases severalfold, even while UTP remains within the reference interval. UA is also more suited than UTP for following therapeutic responses in these slowly progressive renal disorders. Increases in UA are associated with increased mortality. UTP measurements are plagued with many analytical problems, whereas UA is much easier to standardize. We recommend that both UA and UTP be measured when quantitative urine protein assays are ordered, especially when the UTP is less than 300 mg/g of creatinine.

Albuminuria↗
PubMed1990

Plasma fibrinogen levels in type II diabetics.

Plasma fibrinogen levels measured by an immunoassay method on 170 type II diabetic patients exhibited a bimodal distribution with one small population demonstrating levels greater than those of the normal reference range. The mean plasma level of fibrinogen in the type II diabetics was higher than that of the normal population. Spearman's correlations demonstrated statistically significant positive relationships in type II diabetic patients between fibrinogen levels and fasting glucose levels, serum cholesterol, glycosylated hemoglobin and urinary albumin excretion rate. These relationships suggest that increased plasma fibrinogen may be another marker for coronary heart disease complications encountered by diabetics.

Albuminuria↗
PubMed1990

Screening diabetic patients for microalbuminuria.

Abnormal rates of urinary albumin excretion have been shown to predict the development of nephropathy and may signal atherosclerotic disease in diabetic patients. This study demonstrated the feasibility of measuring microalbuminuria in diabetic patients from a large family practice population. Although only one half of the 473 diabetic patients offered free screening took advantage of the testing, those participating did not differ in terms of sex, race, type of diabetes, mean age, systolic blood pressure, and fasting blood glucose levels from those not electing to participate. Over 40% of those screened had abnormally elevated albumin excretion rates as defined as greater than 0.02 g of albumin per gram of creatinine. Those participating in the screening perceived the process as useful and were able to comply with directions for overnight urine collection. Results show that screening for microalbuminuria in diabetic patients cared for by family physicians is feasible, simple, and inexpensive. Interventions to slow or reverse the progression of abnormal microalbuminuria and future risk for nephropathy in those with diabetes are underway.

Adult↗
PubMed1990

Microtransferrinuria and microalbuminuria. I. In the diabetic human.

We studied albumin, transferrin and total protein excretion in the urine of 110 diabetics visiting a family practice department. Of these patients 18.2% had an elevated total urinary protein above the reference range (greater than 200 mg/g creatinine). Of the remaining patients (normoproteinuria), 25.5% have elevated transferrin (greater than 0.9 mg/g creatinine) while 18.8% have elevated albumin (greater than 32 mg/g creatinine). The correlation coefficient between transferrin and albumin in urine when total urinary protein is normal was 0.77. Moderate exercise increased urinary transferrin in normal subjects 950%, while for albumin the increase was 440%. These data demonstrate the usefulness of microtransferrinuria, a potentially more sensitive indicator than microalbuminuria for diabetic nephropathy.

Albuminuria↗
PubMed1990

Microtransferrinuria and microalbuminuria. II. In the rat.

We studied albumin and transferrin excretion in the normal and diabetic rat: (1) The rat secretes small concentrations of albumin and transferrin in the urine. (2) The secretion depends on the strain and was highest in the Kyoto spontaneously hypertensive rat. (3) The secretion of these two proteins in the rat is quite dependent on age and sex. The level increases dramatically with age. The secretion is much higher in the male compared to the female. This difference is observed after puberty. The changes in transferrin relative to those in albumin are much higher. (4) In streptozotocin-induced diabetes, the concentration of albumin and transferrin expressed as milligrams per liter decreases; however, the output/24 h or per gram creatinine is increased with a greater increase in transferrin output relative to that of albumin. The similarities and differences between excretion of these two proteins in the human and the rat as well as their importance are discussed.

Aging↗
PubMedDate not supplied

Hyperinsulinemia in hypertension: associations with race, abdominal obesity, and hyperlipidemia.

OBJECTIVE: To determine the relative contributions of race, sex, abdominal obesity, and hyperlipidemia to the development of hyperinsulinemia among patients with hypertension. DESIGN: Cross-sectional survey. SETTING: A large family practice ambulatory care unit in Winston-Salem, NC. PATIENTS: One hundred and forty adult patients with essential hypertension (systolic blood pressure > or = 160 mm Hg or diastolic blood pressure at or above 90 mm Hg on 2 or more occasions) or who were receiving antihypertensive treatment. MAIN OUTCOME MEASURES: Fasting insulin, lipid, and glucose levels; glycosylated hemoglobin; waist-hip ratio; and resting blood pressure. METHODS: Among 4 patient subgroups (hypertension alone; hypertension and abdominal obesity; hypertension and hyperlipidemia; and hypertension, abdominal obesity, and hyperlipidemia) logistic regression analysis was used to determine correlates of elevated fasting insulin levels. RESULTS: Controlling for age and blood pressure, black males had the highest fasting insulin levels (135 +/- 70 pmol/L [18.8 +/- 9.6 microU/mL] and 265 pmol/L [37.0 +/- 0.0 microU/mL] [mean +/- SD] for obese and nonobese black males, respectively); nonobese white males had the lowest fasting insulin levels (23 +/- 22 pmol/L [3.2 +/- 3.0 microU/mL]). Multivariate logistic regression indicated that the addition of abdominal obesity or hyperlipidemia to pure hypertension more than doubled the risk of hyperinsulinemia (adjusted odds ratio, 2.69; 95% confidence interval, 1.04-6.89; and adjusted odds ratio, 2.62; 95% confidence interval, 0.37-8.6, respectively). The combination of abdominal obesity and hyperlipidemia exerted additive effects among patients with hypertension for elevated insulin levels (adjusted odds ratio, 5.1; 95% CI, 1.59-16.4). CONCLUSIONS: Race, sex, abdominal obesity, and hyperlipidemia interact to produce increases in fasting insulin levels. This knowledge may help physicians prevent sequelae from hyperinsulinemia syndrome among their patients with hypertension.

Adult↗
PubMedDate not supplied

Prevalence and nature of orofacial and dental problems in family medicine.

OBJECTIVE: To determine the prevalence and nature of orofacial and dental problems in 2 family medicine practices. DESIGN: Prospective, cross-sectional analysis of consecutive patient visits. SETTING: Urban and rural family medicine practices. PATIENTS AND PARTICIPANTS: Four hundred seventy-two patients between age 10 and 86 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prevalence and nature of patient visits to family medicine practices that were either initiated by problems in the region of the oral cavity or that involved questions raised by the patient concerning oral or perioral sites. RESULTS: Twenty-one patients (4.5%) of 472 met the inclusion criteria, 16 (76%) of whom had an oral problem as the primary or secondary reason for their visit. Perioral pain and mucosal ulcerations were the most common problems, and gingival tissue was the most common location. Almost two thirds of these patients had bacterial, fungal, or viral infections. Regarding treatment, 13 (62%) of these patients received advice, 10 (48%) received prescriptions, and 3 (15%) were referred to a dentist or another medical specialist. CONCLUSIONS: Oral and perioral problems are common in the practice of family medicine, which suggests the desirability for specific oral medicine topics in the training and continuing education of primary care physicians. Arch Fam Med. 2000;9:1009-1012

Adolescent↗