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J Najarian

Publications and source records attributed to J Najarian.

26 records · Page 2Linked to original sources
PubMedDate not supplied

The Minnesota diabetes complications clinical trial. The first three years.

A prospective and randomized clinical trial of an inception cohort of diabetic kidney recipients to test the hypothesis that maximized metabolic control of diabetes prevents or delays diabetic nephropathy in the renal allografts was initiated approximately three years ago. Notwithstanding the fact that all our diabetic patients were on prednisone and therefore metabolically unstable, we achieved and maintained a clear difference between the standard control (group A) and the maximized control patients (group B). At 13 months of study, the mean fasting blood glucose mg% (A: 242 +/- 22, B: 130 +/- 9, p less than 0.001), nonfasting blood glucose (A: 276 +/- 40, B: 135 +/- 10, p less than 0.001), 24 hour urine glucose (A: 85 +/- 16, B: 5 +/- 1, p less than 0.001), and glycosylated hemoglobin % (A: 13 +/- 0.9, B: 10 +/- 0.8, p less than 0.01) were all clearly and statistically significantly higher for the group A patients. These results show the feasibility of such a trial using the tools available today to treat diabetes.

Aftercare↗
PubMedDate not supplied

Feasibility of blood glucose self-monitoring in unstable insulin-dependent diabetes.

We have studied the impact of home blood glucose measurements with the Ames Dextrostix/Eyetone system on the metabolic control of 17 insulin-dependent, ketosis-prone, unstable diabetic patients. Thirteen patients (69 patient-months) were enrolled in a comprehensive program designed to achieve excellent metabolic control and which included the daily use of the Eyetone meter. Eleven of these patients were diabetic kidney recipients on daily prednisone. The improvement of the metabolic control, as assessed by daily home blood glucose measurements, was highly significant (P < 0.001) in 11 patients (85%). The control was still inadequate, however, in at least seven patients. In four unstable diabetic patients who were given the meter for 4 mo but were not followed closely during this period, modest or no improvement in metabolic control was observed. The Eyetone meter proved highly precise and accurate in our patients' hands. Several patients achieved a coefficient of variation of less than 5 (in 10 consecutive determinations) and a correlation coefficient with the Beckman glucose analyzer of 0.96. We concluded that the metabolic control can be markedly improved in the most unstable diabetic patients with home blood glucose measurements, provided the patients receive adequate and frequent encouragement and diabetic teaching. Without the latter, at least in unstable diabetes, whether patients are compliant or not, the instrument may have little impact on control.

Adult↗
PubMedDate not supplied

Long-term, ambulatory, subcutaneous insulin infusion versus multiple daily injections in brittle diabetic patients.

We compared the blood glucose control of four intact and eight kidney recipient, metabolically unstable, ketosis-prone, insulin-dependent diabetic patients under two different regimens: (a) intensive conventional treatment with two to four insulin injections daily (48 patient-months) and (B) subcutaneous, portable insulin delivery system (IDS) (54 patient-months). Both regimens included frequent home blood glucose and 24-h urine glucose determinations and daily telephone follow-up to maximize compliance with treatment. Analyzed as a group the fasting blood glucose for intact patients (A: 172 +/- 13 mg/dl; B: 141 +/- 12, P less than 0.02) and the nonfasting blood glucose for kidney recipient patients (A: 165 +/- 10; B: 138 +/- 5, P less than 0.01) were significantly lower during treatment with the IDS than with multiple injections. Six out of 12 patients (2/4 intact and 4/8 kidney recipient patients) showed significant and consistent improvement of blood glucose concentrations. Four showed marginal and inconsistent improvement. Two patients (one intact and one kidney recipient) improved on the IDS but maintained the improvement when changed back to conventional treatment. The 24-h urine glucose, maximal glucose excursions, number of blood glucoses less than or equal to 40 mg/dl, and glycosylated hemoglobin decreased significantly in some patients on the pump. We conclude that subcutaneous, portable insulin delivery devices can significantly improve the metabolic control of some ambulatory, unstable diabetic patients during long-term treatment beyond that obtained with intensive, multiple-injection, conventional treatment. Normalization of the metabolic control, however, is not obtained. These infusion systems still pose several problems during ambulatory use, which could have serious consequences in patients less compliant and/or followed less closely than ours.

Adult↗