Biomedical subjects

L Wibell

Publications and source records attributed to L Wibell.

At least 19 recordsLinked to original sources

PubMed1992

Male predominance of type 1 (insulin-dependent) diabetes mellitus in young adults: results from a 5-year prospective nationwide study of the 15-34-year age group in Sweden.

The incidence of diabetes mellitus in Sweden in the 15-34 year age group was prospectively studied on a nationwide basis, beginning 1 January 1983. A total of 1,214 male and 720 female cases of newly-diagnosed (excluding gestational) diabetes were reported over a 5-year period. This corresponds to an incidence of 20.5 per 100,000/year in male subjects and 12.7 per 100,000/year in female subjects. Most cases were classified as Type 1 (insulin-dependent) diabetes, with an incidence of 15.9 in males and 8.6 in females. The incidence of Type 1 diabetes decreased gradually with age, while the incidence of Type 2 (non-insulin-dependent) diabetes increased. A male predominance was found in all age groups, with a male-to-female ratio of 1.8:1 for Type 1 diabetes and 1.3:1 for Type 2 diabetes. Maximum blood glucose concentration at diagnosis was significantly higher in males than in females in both Type 1 and Type 2 diabetic subjects. In contrast, the percent desirable weight was significantly higher in females, both in Type 1 and Type 2 diabetic subjects. The difference in diabetes incidence therefore cannot be attributed to any methodological error. The present finding of a marked male predominance after puberty in Type 1 diabetes in an ethnically quite homogeneous population supports the hypothesis that environmental risk factors and life-style are important for the development of the disease.

Adolescent↗

PubMed1992

Risk of developing insulin-dependent diabetes mellitus (IDDM) before 35 years of age: indications of climatological determinants for age at onset.

This study analyses data from two nationwide prospective diabetes registries now covering about 3400 cases from 19 million person-years of follow-up in the age group 0-34 years. The risk of developing insulin-dependent diabetes mellitus (IDDM) per 100,000 individuals before 15 years was 386 (95% confidence intervals (CI): 362-410) for boys and 391 (95% CI: 367-415) for girls and by 35 years 701 (95% CI: 671-731) for men and 562 (95% CI: 534-690) for women. The incidence rate showed a maximum for both boys and girls in early puberty. After pubertal years a sharp increase in the male to female incidence ratio of IDDM was notable. At 10-14 years it was 0.94, at 15-19 years 1.59 and at 20-24 years 2.08. A Cox regression model was used to analyse the effects on age at onset of sex, population density and climatological factors as measured by north-south area of residence and season at onset. The effect of sex was confirmed (P less than 0.001). A significant effect (P = 0.004) of season was shown when the four seasons were classified according to a four stage scale related to mean temperature. When dividing Sweden into 11 regions according to north-south gradient (Latitude 55 degrees, 56 degrees, 57 degrees, ..., 65 degrees) a significant effect (P = 0.038) was also found. However, no effects of population density or living near the coast versus in the interior were found. It is concluded that a large proportion of the young are at risk of developing this chronic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Mortality of all incident cases of diabetes mellitus in Sweden diagnosed 1983-1987 at age 15-34 years. Diabetes Incidence Study in Sweden (DISS) Group.

From 1983 all incident cases of diabetes in the age group 15-34 years in Sweden have been recorded prospectively. The aim of the present study was to assess the mortality pattern of cases reported for 1983-87 and followed until the end of 1987. Eighteen deaths were identified by linkage to the national death register. When comparing the mortality in the cohort with Swedish males and females in general, an excess mortality was found in all the groups studied. It is, however, less pronounced if the analysis is restricted to those with Type 1 diabetes (standardized mortality ratio (SMR) and 95% confidence interval = 2.1; 0.8, 4.6), Type 2 diabetes (SMR = 4.8; 1.3, 12.3) or Type 1 + Type 2 (SMR = 2.7; 1.3, 5.0). Eight (44%) of the deaths were in patients with secondary diabetes, a diagnosis that applied to less than 3% of the cohort. Alcohol abuse was prevalent in six cases and suspected in another two. Hypoglycaemia was established as a cause of death in only one case but could not be excluded in a further six. Only one death was associated with ketoacidosis. No valid support for an increased risk of the 'dead in bed' syndrome was found. We suggest that diabetes was decisively important for the death in two cases and less important in 10. In the remaining six cases the existing documentation precludes a proper judgement.

Adolescent↗

PubMed1992

What causes impaired glucose tolerance to deteriorate or normalize?

Twenty-five middle-aged subjects with impaired glucose tolerance (IGT) were analysed 5 years later, showing normal glucose tolerance in 28% and persistent glucose deterioration in 72%. Body mass index (strongly) and 2-h glucose levels were clinically useful predictors, in the newly detected IGT-subjects, of persistent glucose deterioration (IGT or NIDDM) 5 years later. The frequency of hypertension was 36% in the newly-detected IGT subjects. Five years later this frequency increased to 54% in the persistently hyperglycaemic group, and decreased to none in the normalized group. Predictors of hypertension at the follow-up were baseline blood pressure and parts of the hyperinsulinaemic syndrome, such as serum triglyceride at baseline, BMI and 2-h glucose at the follow-up. Microalbuminuria (greater than 20 mg day-1) was not found at the 5-years follow-up, either if the subjects then had NIDDM, IGT or normal glucose tolerance. ECG abnormalities (ST segment and T wave changes) were two-fold more prevalent in the group with IGT or NIDDM than in the normalized group at the follow-up. Predictors were baseline BMI and incremental BMI. In conclusion, obesity and high 2-h glucose in newly-detected IGT-subjects seemed to predict the persistence of IGT 5 years later. Hypertension, but not microalbuminuria, was frequent when glucose deterioration persisted.

Albuminuria↗

PubMed1992

Prevalences of risk factors and angiopathy in diabetic patients in Uppsala.

The prevalences of risk factors and angiopathy were studied in 260 diabetic patients, 100 females and 160 males, 35-54 years old, in Uppsala. The prevalence, in females and males separately, of hypertension (WHO-criteria) was 46-34%, of hypercholesterolaemia (greater than or equal to 6.7 mmol.l-1) 32-29%, and of obesity (relative BMI greater than or equal to 120%) 25-20%. Those smoking greater than 15 cigarettes/day were 11-20%. Mean HbA1 was 10.6-10.5%. The prevalence of angina pectoris was 11-6%, of possible infarction 4-6%, and of major ECG abnormalities 6-4%. Large vessel (cardiovascular) disease was independently related to HbA1 (strongly), hypertension, cholesterol, age and familial NIDDM. The prevalence of severe retinopathy (blindness, new vessels or large hemorrhage) was 0% with 7-13 years of diabetes duration, and 26% with greater than or equal to 14 years of duration. The prevalence of severe proteinuria was 4% with 7-13 years of diabetes duration, and 15% with greater than or equal to 14 years of duration. Small vessel (retinopathy and nephropathy) disease was independently related to diabetes duration (strongly), HbA1 and hypertension. The data were discussed related to data from the London, Berlin and Tokyo centres of the WHO Multinational Study of Vascular Disease in Diabetics, using the same study protocol in the present study.

Adult↗

PubMed1992

Pulse pressure, mean blood pressure and impaired glucose tolerance--a study in middle-aged subjects.

In a study of 695 middle-aged subjects, without antihypertensive agents, and without more pronounced obesity, both pulse pressure (PP) and mean blood pressure (MBP) were strongly related to 2-h blood glucose in 75 g OGTTs (p < 0.001). All hypertensives (DBP > or = 90 mm Hg) were separated into 39 with higher PP (> or = 60 mm Hg) and 137 with lower PP (< 60 mm Hg). The high PP hypertensives, compared with the low PP hypertensives and all 519 normotensives, had higher frequency of impaired glucose tolerance (IGT; WHO-criteria), 33%, 6%, and 4%, respectively (p < 0.001), and also higher mean 2-h blood glucose, 5.9, 4.5, and 4.2 mmol.l-1, respectively (p < 0.001). These differences were independent of MBP levels. Similarly, all 54 hypertensives with higher MBP (> or = 110 mm Hg) had more IGT and higher 2-h glucose than the 122 hypertensives with lower MBP (< 110 mm Hg) or the normotensives, 30%, 5% and 4%, respectively (p < 0.001), and 5.8, 4.4, 4.2 mmol.l-1, respectively (p < 0.001), independently of PP. Thus, both high PP and high MBP were related to IGT, independently of each other.

Analysis of Variance↗

PubMed1991

The effects of fish oil on triglycerides, cholesterol, fibrinogen and malondialdehyde in humans supplemented with vitamin E.

The effects of fish oils supplemented with 0.3 IU/g and 1.5 IU/g of vitamin E were compared in a double-blind, cross-over study. Twelve healthy volunteers were given 30 mL/day of either oil for 3 wk. Intake of the vitamin E-rich fish oil resulted in a marked decrease in serum triglycerides (48%) and in fibrinogen (11%). After administration of the low vitamin E-containing oil there was a considerably smaller reduction of serum triglycerides and no significant reduction of fibrinogen. Both oils caused an increase in high density lipoprotein cholesterol and a decrease in the atherogenic index, but neither oil altered the total cholesterol level. Serum vitamin E was decreased by 9% and plasma malondialdehyde was increased by 122% after intake of the low vitamin E-containing oil, but both remained normal after intake of the other oil. The effect of vitamin E may be due to inhibition of fatty acid peroxidation with less formation of malondialdehyde and a larger amount of active (n-3) fatty acids in their sites of action in the liver, resulting in a greater decrease in the synthesis of triglycerides and fibrinogen.

Adult↗

PubMed1991

Insulin resistance in the oral glucose tolerance test--a link with hypertension.

Insulin resistance was evaluated in 807 middle-aged subjects at a health survey, with use of an index measured in 75 g oral glucose tolerance tests. The mean value of insulin resistance was higher in a hypertensive group than among the normotensives, independent of body mass index, physical activity, smoking sex, age, and thiazide treatment. One-third of the hypertensives had a high resistance value. Another third of the hypertensives, and also about one-third of the normotensives, had a slightly increased resistance. The remaining third of the hypertensives had a normal-low resistance. A high resistance was also independently related to obesity, low physical leisure time activity, and a family history of NIDDM, but not to a family history of hypertension. The statistical analysis implied a sequence of events: low physical activity might cause high resistance, which in turn might cause high blood pressure.

Age Factors↗

PubMed1991

Metabolic control, residual insulin secretion and self-care behaviours in a defined group of patients with type 1 diabetes.

A population of 185 type 1 diabetes patients (insulin-dependent, IDDM), 25-45 years old, was studied retro- and prospectively over a 9-year period with the aim of analysing background factors of importance for the ability to perform adequate self-care. Expressed as mean HbA1c, the metabolic control was slightly improved at the end of the study, when the insulin schedule had been changed in 60% of the patients to multidose treatment. The degree of metabolic control remained constant over the years. The impact of residual insulin secretion, measured as 24-hour urinary C peptide, was low. Patients with less good metabolic control often had a poor educational background and made less use of self-monitoring of blood glucose (SMBG); they also experienced difficulties with SMBG. The applied knowledge of diabetes also differed between groups with good and poor control. Subjectively, most patients considered their metabolic control to be good, irrespective of the HbA1c values. When asked about their own diabetes complications, their answers were often discrepant from the medical records. Patients with particularly "good" or "poor" metabolic control were on the whole less satisfied with the education and information received than those with intermediate blood glucose regulation. Development of strategies for individually adjusted education seems important.

Adult↗

PubMed1991

Influences of familial and environmental factors on hypertension.

A group of 293 middle-aged subjects with a parental history of hypertension was compared with 210 middle-aged subjects without this history. The adjusted odds ratio for hypertension (WHO-criteria) was 2.0 with parental hypertension - independent of obesity, physical leisure time activity, age and sex. Comparatively in all 503 participants, the independent odds ratio for hypertension was 3.3 with obesity. Analysis of variance in all participants disclosed that blood pressure was independently related to three predictors, parental hypertension (p less than 0.05), body mass index (p less than 0.001), and 2-h blood glucose (p less than 0.001). Additional analysis of variance in all subjects, to estimate if these three predictors were interrelated, disclosed that parental hypertension was not related to either 2-h glucose or body mass index. A clear association was seen between 2-h glucose and body mass index (p less than 0.001). This was underlined in a separate analysis of the 88 hypertensives, among which 25% had impaired glucose tolerance (WHO-criteria). In conclusion, own obesity (environment) had about 1.5 times stronger influence on hypertension than parental hypertension (heredity). Parental hypertension seemed to have a separate influence on the blood pressure. Body mass index and 2-h glucose seemed to have partly separate, and partly interrelated, influences on the blood pressure.

Blood Glucose↗

PubMed1991

Familial influence on type 1 (insulin-dependent) diabetes mellitus by relatives with either insulin-treated or type 2 (non-insulin-dependent) diabetes mellitus.

In 161 patients with Type 1 (insulin-dependent) diabetes mellitus, the familial influences by first-degree relatives with insulin-treated diabetes mellitus (ITDM), and by first-degree relatives with Type 2 (non-insulin-dependent) diabetes mellitus were investigated. A control group consisted of 730 subjects with normal glucose tolerance. Independent odds ratios (adjusted for covariates) for Type 1 diabetes in offspring were 7.0 (p < 0.001) with first-degree ITDM relatives, and 2.5 (p < 0.01) with first-degree Type 2 diabetic relatives. When relatives were separated into parents and siblings, odds ratios for Type 1 diabetes in offspring were higher due to paternal ITDM and paternal Type 2 diabetes, than in cases of maternal diabetes. Siblings with ITDM, but not siblings with Type 2 diabetes, also showed increased odds ratios. Thus, both familial ITDM and familial Type 2 diabetes showed influences in separate ways on the presence of Type 1 diabetes in offspring, indicating separate genetic mechanisms.

Analysis of Variance↗

PubMed1990

Insulin release and peripheral sensitivity at the oral glucose tolerance test.

With the use of a 75 g oral glucose tolerance test, both insulin release (IRG) and the degree of peripheral sensitivity (SI) were evaluated simultaneously in groups with normal (NGT) and impaired (IGT) glucose tolerance as well as NIDDM. IRG was expressed as the ratio of the area under the insulin curve to that of the glucose curve above fasting levels. The peripheral glucose uptake rate (M) during the OGTT was measured as the difference between the glucose load and the increase in the amount of glucose in the glucose space during the oral glucose tolerance test (OGTT). SI was expressed as the ratio of the metabolic clearance rate (M/mean blood glucose) to log mean serum insulin. In the non-obese groups, both mean IRG and mean SI values were decreased with an increasing degree of hyperglycemia from NGT to NIDDM. Decreased mean SI values were also found in obese subjects. IGT-subjects given 3 months of diet and exercise achieved improved SI values. A non-obese NIDDM-group had higher mean IRG and mean SI values after 6 months of treatment with glipizide. The results were comparable to data obtained with more complicated techniques, such as the insulin clamp and suppression tests, and should be easy to apply on a large scale in epidemiological studies.

Aged↗

PubMed1990

Impaired glucose tolerance after autologous bone marrow transplantation.

In this study we investigated glucose tolerance in relation to autologous bone marrow transplantation (ABMT). In 13 adult patients with acute myeloblastic (AML) or lymphoblastic (ALL) leukaemia in complete remission (CR), intravenous glucose tolerance test (IVGTT) was performed 1 month before and 6 months after ABMT. Patients with AML in CR received, as myeloablative therapy, cyclophosphamide combined with busulphan or total body irradiation (TBI). ALL patients received total body irradiation in combination with vincristine, daunorubicin, Ara-C, cyclophosphamide and prednisone. Before ABMT all patients, in spite of the intensive chemotherapy given for remission induction and consolidation, had a normal glucose tolerance. However, 6 months after the transplantation the k-value (rate of glucose elimination) for this group of patients had decreased (p less than 0.01). The trend towards impaired glucose tolerance was correlated with lower peak insulin values during IVGTT (p less than 0.05). Thus, the myeloablative therapy in connection with ABMT caused an impairment of pancreatic beta-cell function. No patient has hitherto developed clinical diabetes mellitus.

Adult↗

PubMed1989

Placental hormones and maternal glucose metabolism. A study of fetal growth in normal pregnancy.

The interrelations between three placental hormones (oestradiol, progesterone and hPL), maternal glucose metabolism, maternal anthropometry and fetal growth were studied in a sample of 52 carefully selected pregnant women. A relation was found between infant birthweight and both fasting blood glucose and t1/2 of glucose of an intravenous glucose tolerance test at week 37 of pregnancy. The serum concentrations of the placental hormones were not significantly related to the glucose variables. The correlation between birthweight and the maternal levels of hPL in late pregnancy (r = 0.60) persisted when fasting blood glucose and t1/2 of glucose were taken into account. Maternal fat mass was found to explain more of the variation in basal insulin levels around week 37 than did the placental hormones.

Adipose Tissue↗

PubMed1988

Maternal glucose metabolism and infant birth weight: a study in healthy pregnant women.

An intravenous glucose tolerance test (IVGTT) with serum insulin determinations was performed at week 37 of pregnancy in 52 healthy primiparae, selected to provide an increased variation in infant birth weight. A significant relationship was found between infant birth weight and both fasting blood glucose and t1/2 of glucose. Infant skinfold thickness, however, was not correlated independently to any of the parameters of the IVGTT. There was a significant correlation between maternal lean body mass and glucose metabolism, but this could not fully explain the relation between lean body mass and infant birth weight. Maternal fat mass was not significantly correlated to infant birth weight, though it was correlated with serum insulin levels. In the investigated population, fasting blood glucose, t1/2 of glucose, and maternal lean body mass accounted for 27% of the variation in infant birth weight.

Adult↗

PubMed1986

Studies on microbial contamination of reused disposable plastic insulin syringes.

The microbial contamination of reused disposable insulin syringes and bottles was studied. Fourteen patients, aged 16-64 years, took part in the study. 50 syringes and 52 bottles were examined for sterility at different stages of use. Twelve (24%) syringes and 4 (8%) bottles were found to be contaminated by micro-organisms, although only in low numbers. The micro-organisms recovered belonged to the normal skin flora of man.

Adolescent↗

PubMed1986

Concentration-dependent blood pressure effects of guanfacine.

Central alpha 2-adrenoceptor stimulation decreases blood pressure, whereas stimulation of postjunctional peripheral adrenoceptors induces a pressor response. The net blood pressure response during multiple dosing is the sum of these effects and is dependent on drug kinetics, receptor affinity, and receptor occupancy. Guanfacine (2 to 6 mg/day), a selective alpha 2-adrenoceptor agonist, decreased blood pressure in patients with hypertension. At a dose greater than 6 mg/day the antihypertensive response deteriorated. Steady-state kinetics were linear but there was a tendency for a decrease in clearance after the highest dose. These results have practical implications for the therapeutic handling of the drug: Low doses for maximal therapeutic effect and longer dosage intervals at high-dosage schedules are indicated.

Adrenergic alpha-Agonists↗

PubMed1986

The relationship of blood pressure to blood glucose and physical leisure time activity. A study of hypertension in a survey of middle-aged subjects in Uppsala 1981-82.

Hypertension was detected in 56 of 436 women and 34 of 371 men in an urban population sample of 47-54-year-old individuals. The prevalence of glucose intolerance according to WHO criteria was 22.2% in the hypertensive group and 4.3% among the normotensives, with mean 2-hour blood glucose values of 5.8 and 4.4 mmol X 1(-1), respectively. The difference in mean 2-hour blood glucose was independent of body mass index, physical activity during leisure time or at work, age and smoking in covariance analysis. Subjects with high physical leisure time activity (n = 125) had a lower mean blood pressure and a lower prevalence of hypertension, 4.8%, than those with low activity (n = 682), 12.3%. The increase in diastolic blood pressure in the latter group and the male subgroup appeared to be independent of body mass index, physical job activity, age and smoking. Multiple regression analyses with blood pressure as dependent variable and six metabolic and clinical characteristics as predictors identified 2-hour blood glucose and body mass index as the most important predictors. Physical leisure time activity was associated with diastolic blood pressure, however only when 2-hour blood glucose was not included as predictor. Thus, physical activity may exert an influence on the blood pressure level mainly through changes in glucose tolerance and/or body weight, although alternative mechanisms cannot be excluded.

Age Factors↗