Biomedical subjects

J E Thurman

Publications and source records attributed to J E Thurman.

4 recordsLinked to original sources

PubMed1999

Drug therapy of postprandial hyperglycaemia.

It is widely accepted that the most challenging goal in the management of patients with diabetes mellitus is to achieve blood glucose levels as close to normal as possible. In general, normalising postprandial blood glucose levels is more difficult than normalising fasting hyperglycaemia. In addition, some epidemiological studies suggest that postprandial hyperglycaemia (PPHG) or hyperinsulinaemia are independent risk factors for the development of macrovascular complications of diabetes mellitus. Recently, several drugs with differing pharmacodynamic profiles have been developed which target PPHG. These include insulin lispro, amylin analogues, alpha-glucosidase inhibitors and meglitinide analogues. Insulin lispro has a more rapid onset of action and shorter duration of efficacy compared with regular human insulin. In clinical trials, the use of insulin lispro was associated with improved control of PPHG and a reduced incidence of hypoglycaemic episodes. Repaglinide, a meglitinide analogue, is a short-acting insulinotropic agent which. when given before meals, stimulates endogenous insulin secretions and lowers postprandial hyperglycaemic excursions. Both insulin lispro and repaglinide are associated with postprandial hyperinsulinaemia. In contrast, amylin analogues reduce PPHG by slowing gastric emptying and delivery of nutrients to the absorbing surface of the gut. Alpha-Glucosidase inhibitors such as acarbose, miglitol and voglibose also reduce PPHG primarily by interfering with the carbohydrate-digesting enzymes and delaying glucose absorption. With the availability of agents which preferentially reduce postprandial blood glucose excursions, it is now possible to achieve glycaemic goals in a larger proportion of individuals with diabetes mellitus.

1-Deoxynojirimycin↗

PubMed1999

Glucotoxicity: potential mechanisms.

Plasma concentration of glucose is found within a relatively narrow range of values for most animal species, yet it has little correlation with maximum lifespan; however, hyperglycemia in most animals is associated with premature death. This article presents evidence for hyperglycemia-induced tissue toxicity and discusses potential mechanisms of glucotoxicity and implications for the aging organism.

Age Factors↗

PubMed1997

Vitamin supplementation therapy in the elderly.

Vitamin supplementation in large dosages is increasingly common in the older population. Often, such supplementation is used in an attempt to improve an individual's health status. There have been claims that the effects of vitamins halt the normal aging process or prevent and cure disease. However, several recent studies have failed to demonstrate the efficacy of vitamin supplementation in preventing several types of cancer. In moderate dosages, supplementation with vitamin E (tocopherols) shows promise as a lipid antioxidant, and may reduce the risk of coronary heart disease. However, before vitamin E becomes an accepted medical therapy, further long term studies must be undertaken to examine the safety and efficacy of such therapy. An adequate intake of vitamins should be ensured by adherence to a well balanced diet. However, the elderly are prone to circumstances that may prevent them from eating a balanced diet. In addition, there are several age-related medical conditions that may predispose individuals to dietary and vitamin deficiencies. To prevent vitamin deficiency diseases and their associated morbidity, modest vitamin supplementation may be necessary. However, supplementation should be reserved for individuals with documented deficiency or who are at risk of developing such deficiencies, especially those who are homebound or institutionalised. Vitamins taken in large dosages should be considered as drugs. These medicines, which are obtainable over-the-counter, should be carefully regulated to prevent toxicity.

Adult↗

PubMedDate not supplied

Trends in approaches to night and shiftwork and new international standards.

While relatively few countries have changed their working time legislation in recent years, new working time patterns show some changes in approaches to night and shiftwork. Prominent trends include (i) the spread of irregular hours of work to different sectors, including services, often as a result of decoupling business hours from individual working hours; (ii) greater flexibility, often in return for shorter hours, in covering operating hours by different individuals; (iii) the appearance of complex combinations of different categories of working time arrangements, such as a combination of full-time semi-continuous shifts and part-time weekend shifts; and (iv) the adoption of a complex process for changes in schemes, incorporating group study and joint planning. Importantly, these trends reflect fundamental changes in the concept of night work (and that of nightworkers). The issues related to these recent trends were apparent in the two-year debate that led to new international labour standards, the Night Work Convention (No. 171) and Recommendation (No. 178), 1990, both of which apply to both sexes and to nearly all occupations. Also adopted was the Protocol of 1990 to the Night Work (Women) Convention (No. 89) of 1948, under which national laws or regulations may now permit night work of women in industry under strictly defined conditions. The new Convention and Recommendation define 'nightworker' to include workers performing a substantial amount of night work. They prescribe a variety of actions to improve the quality of working life of such workers, including measures related to working hours, rest periods, safety and health, transfer to day work, maternity protection, social services, and consultations. Strategies should be adopted that take into account the local situation, that are participatory, and that take due account of the diverse aspects of working life associated with the new concept of night work.

Circadian Rhythm↗