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Biomedical subjects

L Blonde

Publications and source records attributed to L Blonde.

At least 19 recordsLinked to original sources
PubMed2006

Interim analysis of the effects of exenatide treatment on A1C, weight and cardiovascular risk factors over 82 weeks in 314 overweight patients with type 2 diabetes.

AIM: Exenatide, an incretin mimetic for the adjunct treatment of type 2 diabetes (DM2), reduced A1C and weight in 30-week placebo-controlled trials. This analysis examined the effects of exenatide on glycaemic control and weight over an 82-week period in patients with DM2 unable to achieve adequate glycaemic control with sulphonylurea (SU) and/or metformin (MET). METHODS: This interim analysis is of 314 patients who received exenatide in the 30-week placebo-controlled trials and subsequently in 52 weeks of open-label uncontrolled extension studies for 82 weeks of exenatide in total. Patients continued their SU and/or MET regimens throughout. RESULTS: Patients completed 82 weeks of exenatide treatment [n = 314, 63% M, age 56 +/- 10 years, weight 99 +/- 21 kg, body mass index 34 +/- 6 kg/m2, A1C 8.3 +/- 1.0% (mean +/- SD)]. Reduction in A1C from baseline to week 30 [-0.9 +/- 0.1% (mean +/- SE)] was sustained to week 82 (-1.1 +/- 0.1%), with 48% of patients achieving A1C < or = 7% at week 82. At week 30, exenatide reduced body weight (a secondary endpoint) from baseline (-2.1 +/- 0.2 kg), with progressive reduction at week 82 (-4.4 +/- 0.3 kg). Similar results were observed for the intent-to-treat population (n = 551), with reductions in A1C and weight at week 82 of -0.8 +/- 0.1% and -3.5 +/- 0.2 kg respectively. The 82-week completer cohort showed statistically significant improvement in some cardiovascular risk factors. The most frequent adverse events were generally mild-to-moderate nausea and hypoglycaemia. CONCLUSION: In summary, 82 weeks of adjunctive exenatide treatment in patients with DM2 treated with SU and/or MET resulted in sustained reduction in A1C and progressive reduction in weight, as well as improvement in some cardiovascular risk factors.

Adolescent↗
PubMed2004

Durable efficacy of metformin/glibenclamide combination tablets (Glucovance) during 52 weeks of open-label treatment in type 2 diabetic patients with hyperglycaemia despite previous sulphonylurea monotherapy.

Oral anti-diabetic combinations that address insulin resistance and beta-cell dysfunction (e.g. metformin and glibenclamide) represent a rational therapeutic option for patients uncontrolled on monotherapy. A 52-week, open-label extension to a double-blind study evaluated metformin-glibenclamide combination tablets (Glucovance) in 477 patients with hyperglycaemia despite sulphonylurea therapy. Reductions in HbA1C were maintained, with a mean reduction of -1.7% after 52 weeks, compared with the baseline value for the double-blind trial. Eighty-five patients receiving 4 x 500 mg/2.5 mg tablets daily displayed a marked improvement in HbA1c following up-titration to a regimen of 2 x 500 mg/2.5 mg + 3 x 500 mg/5 mg tablets. Lipid profiles improved significantly. The combination tablets were well tolerated: 11.1% of patients reported hypoglycaemic symptoms (all either mild or moderate severity). No patient withdrew or required pharmacologic intervention for hypoglycaemia. Metformin-glibenclamide combination tablets are an effective and well-tolerated therapeutic option for intensifying oral anti-diabetic therapy.

Administration, Oral↗
PubMed2003

Influence of initial hyperglycaemia, weight and age on the blood glucose lowering efficacy and incidence of hypoglycaemic symptoms with a single-tablet metformin-glibenclamide therapy (Glucovance) in type 2 diabetes.

AIM: To evaluate the efficacy and incidence of hypoglycaemic symptoms associated with fixed combinations of metformin and glibenclamide (glyburide in the USA) formulated within a single tablet (tablet strengths 250 mg/1.25 mg, 500 mg/2.5 mg and 500 mg/5 mg), in comparison with metformin 500 mg and glibenclamide 2.5-5 mg monotherapy, in clinically important patient subgroups within the type 2 diabetic population. METHODS: A total of 1856 patients from three randomized, double-blind, multicentre, parallel-group clinical trials were stratified at baseline according to HbA1C (< 8% or > or = 8%), age (< 65 years or > or = 65 years) and body mass index (BMI; < 28 kg/m2 or > or = 28 kg/m2). The effects of study treatments on HbA1C and the incidence of hypoglycaemic symptoms were determined in each subgroup. RESULTS: The combination treatments were more effective than either monotherapy irrespective of baseline HbA1C, age or BMI in each trial. Antihyperglycaemic effects were greater in patients with HbA1C > or = 8% at baseline, especially with the combinations. The majority of hypoglycaemic symptoms with glibenclamide-containing treatments occurred in patients with HbA1C < 8% at baseline. Neither age nor BMI had a marked effect on the efficacy of the combination treatments, and there was no increase in hypoglycaemic symptoms in older patients. CONCLUSIONS: Single-tablet metformin-glibenclamide combination treatment is more effective than metformin or glibenclamide monotherapy, and is well tolerated in patients with hyperglycaemia inadequately controlled by diet and exercise or antidiabetic monotherapy, irrespective of their severity of hyperglycaemia at baseline, age or weight.

Age Factors↗
PubMed2003

Greater reductions in A1C in type 2 diabetic patients new to therapy with glyburide/metformin tablets as compared to glyburide co-administered with metformin.

BACKGROUND: A cohort of patients with type 2 diabetes, prescribed glyburide/metformin tablets, experienced significantly greater improvements in glycaemic control compared to patients receiving glyburide co-administered with metformin. AIM: To compare the change in A1C for type 2 diabetic patients new to combination therapy with fixed-dose glyburide/metformin tablets vs. glyburide co-administered with metformin in a usual-care setting. METHODS: This retrospective cohort study analysed medication usage via an administrative pharmacy claims database and the patients' corresponding laboratory results. Patients were new to antidiabetic combination therapy with glyburide/metformin tablets or glyburide co-administered with metformin between August 2000 and July 2001 and had A1C measurements at baseline and within 76-194 days of initiating combination therapy. The change from baseline in A1C was analysed using statistical regression to adjust for significant covariates (baseline A1C and dosage). Adherence with therapy was also compared. RESULTS: The cohort consisted of 950 patients who received glyburide/metformin tablets and 471 taking glyburide co-administered with metformin. Glyburide/metformin patients were younger (mean age = 56 vs. 60 years, p < 0.0001) and received lower doses of each drug than patients taking glyburide co-administered with metformin (glyburide mean final dose = 6 vs. 10 mg/day, p < 0.0001; metformin = 893 vs. 1297 mg/day, p < 0.0001). The mean decrease from baseline A1C, adjusted for baseline A1C and dosage, of 2.02% for glyburide/metformin tablets was significantly (p < 0.0001) greater than the decrease of 1.49% for glyburide co-administered with metformin. Glyburide/metformin patients with baseline A1C >/= 8 experienced a significantly (p < 0.0001) greater decrease in A1C of 2.93% compared to 1.92% for glyburide co-administered with metformin. For patients with baseline A1C < 8%, the difference between the A1C responses remained significant, even though the reductions in A1C were smaller for both glyburide/metformin tablets and glyburide co-administered with metformin (0.54% and 0.23%, p = 0.0017). Patients were more adherent with glyburide/metformin tablets (84% vs. 76%, p < 0.0001), though regression analysis indicated that adherence was not a significant predictor of change in A1C. CONCLUSIONS: The lower medication doses delivered by glyburide/metformin tablets provided a significantly greater reduction in A1C than did glyburide co-administered with metformin in patients with type 2 diabetes, especially when baseline A1C >/= 8%.

Adult↗
PubMed2002

Glyburide/metformin combination product is safe and efficacious in patients with type 2 diabetes failing sulphonylurea therapy.

AIM: To compare the efficacy, safety and tolerability of a fixed combination glyburide/metformin preparation with those of glyburide or metformin alone in patients with type 2 diabetes inadequately controlled by sulphonylurea, diet and exercise. METHODS: In this 16-week, randomized, double-blind, parallel group study, 639 patients with inadequate glycaemic control on at least half-maximal dose of sulphonylurea were randomly assigned to: glyburide 10 mg b.i.d. (n = 164); metformin 500 mg (n = 153); glyburide/metformin 2.5 mg/500 mg (n = 160); or glyburide/metformin 5 mg/500 mg (n = 162). Titration was allowed to maximum doses of 2000 mg for metformin or 10 mg/2000 mg and 20 mg/2000 mg for glyburide/metformin 2.5 mg/500 mg and 5 mg/500 mg respectively. The primary outcome measure was HbA1c level after 16 weeks; secondary end-points included fasting and 2-h post-prandial plasma glucose. Adverse events (AEs) were recorded and summarized by treatment group. RESULTS: Both strengths of glyburide/metformin equally reduced mean HbA1c by 1.7% more than did glyburide alone (p < 0.001), and by 1.9% more than did metformin alone (p < 0.001). Final mean fasting plasma glucose concentrations were also lower in both glyburide/metformin groups than in the glyburide (-2.8 mmol/l, -51.3 mg/dl; p < 0.001) and metformin groups (-3.6 mmol/l, -64.2 mg/dl; p < 0.001). Safety and tolerability were similar across all treatment groups, except for a higher incidence of gastrointestinal AEs in the metformin monotherapy group, and more patients reporting mild or moderate symptoms of hypoglycaemia while taking glyburide/metformin. CONCLUSIONS: Both glyburide/metformin tablet strengths produced, with equal efficacy, significantly better glycaemic control than monotherapy with either agent. These data also confirm that glycaemic efficacy does not require maximal sulphonylurea doses in combination with metformin.

Adult↗
PubMed2001

Classification of diabetes mellitus.

Diabetes mellitus affects almost 16 million Americans. It has become a major public health problem and the number one cause of adult blindness, end-stage renal disease, and nontraumatic amputations in the United States. It also markedly increases the risk for cardiovascular, cerebrovascular, and peripheral artery disease. The resultant increased morbidity and mortality results in a cost from diabetes of almost $100 billion annually in the United States. Studies like the UK Prospective Diabetes Study have noted that a substantial percentage of patients with newly diagnosed diabetes already have evidence of microvascular and macrovascular complications of the disease. This indicates that diabetes began in these individuals many years before it was diagnosed. By reducing the diagnostic glycemic threshold for diabetes and recommending regular screening of individuals at increased risk, the ADA hopes that patients will have diabetes diagnosed earlier, before the occurrence of complications and at a time when appropriate treatment can reduce the long-term complications, adverse clinical outcomes, and impaired quality of life that today afflict so many diabetic individuals.

Diabetes Mellitus, Type 1↗
PubMed2000

Long-term cholesterol-lowering effects of psyllium as an adjunct to diet therapy in the treatment of hypercholesterolemia.

BACKGROUND: Hypercholesterolemia is a major risk factor for coronary heart disease and nutrition management is the initial therapeutic approach. OBJECTIVE: This multicenter study evaluated the long-term effectiveness of psyllium husk fiber as an adjunct to diet in the treatment of persons with primary hypercholesterolemia. DESIGN: Men and women with hypercholesterolemia were recruited. After following an American Heart Association Step I diet for 8 wk (dietary adaptation phase), eligible subjects with serum LDL-cholesterol concentrations between 3.36 and 4.91 mmol/L were randomly assigned to receive either 5.1 g psyllium or a cellulose placebo twice daily for 26 wk while continuing diet therapy. RESULTS: Serum total and LDL-cholesterol concentrations were 4.7% and 6.7% lower in the psyllium group than in the placebo group after 24-26 wk (P < 0.001). Other outcome measures did not differ significantly between groups. CONCLUSIONS: Treatment with 5.1 g psyllium twice daily produces significant net reductions in serum total and LDL-cholesterol concentrations in men and women with primary hypercholesterolemia. Psyllium therapy is an effective adjunct to diet therapy and may provide an alternative to drug therapy for some patients.

Adult↗
PubMed2000

Management of type 2 diabetes: update on new pharmacological options.

The value of intensive control of blood glucose levels has been clearly established. Data from the UKPDS demonstrated that improving glycemic control will reduce the risk of microvascular complications of type 2 diabetes, such as diabetic retinopathy, nephropathy, and peripheral neuropathy. Further, the metformin study in overweight patients and the epidemiological analysis of the study both demonstrated a reduction in macrovascular complications and mortality related to improved glycemic control. These findings should enhance awareness among both patients and physicians of the dangers of uncontrolled hyperglycemia and the need for early diagnosis and aggressive treatment for patients with type 2 diabetes. Optimal management of type 2 diabetes most often requires a combination of glucose-lowering medications to achieve glycemic control. Current guidelines for combination therapy advise the use of agents with differing and complementary mechanisms of action in order to maximize therapeutic activity and reduce toxicity. Earlier introduction of combination therapy is increasingly being recommended. The new glyburide/metformin combination medication may facilitate earlier, more appropriate and more effective treatment for patients with type 2 diabetes.

Blood Glucose↗
PubMed2000

Disease management approaches to type 2 diabetes.

Diabetes is a serious and costly disorder. The economic impact on the health care delivery system in the United States is extremely large, and the cost to individual affected patients in terms of health status, productivity, and quality of life is immeasurable. Population-based DM initiatives are undergoing extensive testing and application. These strategies have been demonstrated to enhance the care delivered to diabetic patients, improve clinical outcomes and quality of life, and reduce the financial toll of managing the disease. These gains are very valuable to the MCO, which is concerned with providing optimal cost-effective patient care in a systematic fashion.

Algorithms↗
PubMed1999

Defining and measuring quality of diabetes care.

The literature on diabetes mellitus has increasingly focused on the quality of diabetes care and its measurement. Serious and widespread quality problems exist throughout American medicine. Current efforts to improve will not succeed unless we undertake a major, systematic effort to overhaul how we deliver health care services, educate and train clinicians, and assess and improve quality. This article defines the components of quality of diabetes care provision and discusses approaches to their measurement individually and globally.

Clinical Competence↗
PubMed1999

Internet use by endocrinologists.

Endocrinologists, like other physicians, are information managers. They manage both disease-specific and patient-specific information and must integrate both types of information to provide the best possible care for their patients. New technologies offer abundant new approaches to medical information management tasks. Many will focus on computer hardware and software applications; others will seek solutions from video, telecommunications, the marriage of computer and consumer electronics, and other evolving technologies popularly referred to as multimedia and virtual reality. Few innovations in history have had the potential to so profoundly change our lives as the Internet. The incredible growth of the Internet to a vast system of interconnected networks serving more than 75 million users in the United States alone largely has been driven by the growth of newsgroups and e-mail, providing a means of communication among Internet users and particularly the World Wide Web (WWW). Information on web pages can be "linked" so that users can click on a link and navigate to other information on the same page, on other pages of the same document, on other files on the same computer, or on other computers linked to the Internet anywhere in the world. Moreover, the navigation requires no knowledge of arcane, difficult-to-remember commands. Hypertext links have the great utility of allowing users to navigate through information according to their own interests and information needs, as opposed to those of an author. The WWW also allows authors to link to other sources of information, rather than having to recreate it themselves. Increasingly easy access to the WWW has dramatically reduced the barriers to publication of information, since it is much easier and much less expensive to place information on the WWW than it is to publish and distribute it in hard copy form. This ease of publication has led to an incredible proliferation of information on the WWW. Much WWW information is of value to health professionals, including endocrinologists. This chapter reviews a variety of potential uses of the Internet by endocrinologists in their clinical, research, and educator roles and provides a number of examples of each. Approaches to finding useful information on the Internet are addressed. Finally, we include some speculation about the role of the Internet in the future practice of endocrinology.

Decision Making, Computer-Assisted↗
PubMed1995

American College of Physicians (ACP) medical informatics and telemedicine.

The American College of Physicians (ACP) is the largest speciality society in the United States with over 83,000 Internal Medicine physician members. ACP seeks to be the foremost comprehensive education and information resource for all internists in support of its mission "to enhance the quality and effectiveness of health care." Medical Informatics and telemedicine is an integral part of the American College of Physicians' strategy to achieve its goals. ACP Medical Informatics Subcommittee and staff develop ACP policies and programs to improve clinical care and medical education through the use of Information Systems and new technologies for managing and integrating medical information and knowledge. This paper describes present and planned ACP informatics and telemedicine programs and projects focussing particularly on strategies to meet physicians' information needs incident to their patient care activities.

Forecasting↗
PubMed1990

High-density lipoprotein cholesterol. Recommendations for routine testing and treatment.

Evidence from epidemiologic, lipid intervention, and coronary angiographic studies demonstrates the importance of high-density lipoprotein cholesterol (HDL-C) in coronary artery disease (CAD) risk. Data from these studies strongly support the measurement of HDL-C in all patients screened for CAD. Patients with low levels should be treated using nonpharmacologic measures. High-risk patients deserve consideration for specific drug treatment.

Cholesterol, HDL↗
PubMed1978

Subacute thyroiditis with increased serum alkaline phosphatase.

Three patients had subacute thyroiditis and elevated serum alkaline phosphatase, presumably related to the thyroiditis. Concomitant elevation of the serum gamma-glutamyl transferase suggested that the alkaline phosphatase was of hepatic origin. The elevation of the serum alkaline phosphatase could not be definitely related to the degree or duration of elevation of the serum thyroxine. The combination of elevated serum alkaline phosphatase with the systemic symptoms of subacute thyroiditis may obscure the diagnosis, especially if patients have little or no neck pain.

Adult↗