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Biomedical subjects

M Hanefeld

Publications and source records attributed to M Hanefeld.

At least 109 records · Page 6Linked to original sources
PubMed1994

[Behavior of lipids, other serum parameters and cardiovascular functions in ultraviolet therapy].

During a period of 3 years, four controlled clinical studies in 34 patients with hypercholesterolaemia and 40 healthy persons--in some cases with stratification of the basic cholesterol levels and matched pair formation--were performed to find out the effects of serial sun-like UV irradiation on various serum parameters and blood circulation functions. The following significant effects were observed. Patients with hypercholesterolaemia: increase of HDL cholesterol after termination of the serial UV irradiation, increase of serum 25(OH)D3 levels, decrease of serum triiodothyronine, decrease of serum lactate; healthy persons: decrease of resting pulse rate, decrease of recovery pulse rate, decrease of systolic blood pressure. All effects were induced by application of suberythematous UV doses, i.e. amounts of UV with a relatively low risk of side effects.

Adult↗
PubMed1994

Efficacy of alpha-glucosidase inhibitors on lipids in NIDDM subjects with moderate hyperlipidaemia.

This paper summarizes literature data concerning the action of acarbose, an alpha-glucosidase inhibitor, on the concentrations of plasma lipids. Clinical trials in which acarbose has been used in the treatment of non-insulin-dependent diabetics have sometimes shown that it reduces serum triglycerides while it has little or no effect on serum cholesterol levels. The results of a randomized double-blind placebo-controlled study lasting 24 weeks are discussed in more detail. Under the controlled conditions, the effects of acarbose treatment on fasting concentrations of cholesterol, HDL-cholesterol, and triglycerides did not reach statistical significance for the entire patient group. However, in the highest tertile of initial cholesterol concentrations acarbose treatment led to significant lowering of the cholesterol concentration and of the total-to-HDL-cholesterol ratio. The most important benefits of acarbose were observed after a test meal given on day 0 and on week 24 of treatment. The triglyceride increment 1 h postprandial was significantly lowered. This was associated by a significant decrease of the insulin increment. Reduction of hyperinsulinaemia appears to be the mechanism by which acarbose treatment can improve plasma lipid concentrations.

Acarbose↗
PubMed1994

Recovery of cholesterol and triacylglycerol in very-fast ultracentrifugation of human lipoproteins in a large range of concentrations.

Very-fast ultracentrifugation using a benchtop ultracentrifuge was applied to the analysis of lipoproteins in 0.5 ml of human plasma. VLDL, IDL and LDL were flotated at densities of 1.006, 1.019 and 1.063 kg/l in runs lasting 30, 100 and 100 minutes. Chylomicrons, if present, were flotated in a separate run. HDL were isolated by precipitation of the apolipoprotein B-containing lipoproteins from total plasma using polyethylene glycol. Three series of separations were routinely performed: 1. VLDL run alone (632 samples), 2. VLDL run + LDL run (122 samples), and 3. Chylomicron separation + VLDL run + IDL run (92 samples). The concentrations of cholesterol and triacylglycerol were obtained for plasma, chylomicrons, VLDL, IDL, LDL and HDL. Plasma values ranged from 1.8 to 37.1 mmol/l cholesterol and 0.26 to 50.2 mmol/l triacylglycerol. The plasma triacylglycerol concentrations were corrected for free glycerol by 3% (for triacylglycerols < 2.5 mmol/l) and by 2% (for triacylglycerols > or = 2.5 mmol/l). The recovery rate of lipids after ultracentrifugation was determined by comparing the concentrations in lipoproteins and in plasma. It was near to 100% and decreased for samples with extremely high lipid concentrations.

Cholesterol↗
PubMed1993

Work absenteeism in type 2 diabetes mellitus: results of the prospective Diabetes Intervention Study.

Newly diagnosed mild Type 2 diabetic patients, aged 30-55 years, were included in the prospective, multi-centre Diabetes Intervention Study. They were randomly allotted to either an intervention group receiving intensified health education or to a control group on usual care. This paper reports the incidence, duration of and causes for absence from work due to any disease in the patients who were working during the first 5-year follow-up. Data from 817 patients could be taken into account. 14.5% of the intervention patients and 17.3% of the control patients had never been on the sick list. Those patients who had undergone intensified health education were listed sick less often. Women showed a higher work absenteeism in either group; they had higher blood pressure and higher body mass index at entry. Cardiovascular diseases and musculo-skeletal disorders were major reasons for absence from work. However, when compared to the general population, these Type 2-diabetic patients were approximately four times more often on the sick list. Thus, the health education programme of the Diabetes Intervention Study was shown to be effective with respect to work absenteeism. Teaching patients is recommended as an important part of the therapeutic regimen.

Absenteeism↗
PubMed1992

[Different effects of fibrates on the lipoprotein profile. Comparison of the effectiveness of gemfibrozil and bezafibrate in various types of hyperlipoproteinemia].

AIMS: To compare the efficacy and tolerability of Gemfibrozil and Bezafibrate in patients with hyperlipoproteinemia, types IIa, IIb and IV. METHOD: In an open, randomized parallel study, the tolerability and efficacy of Gemfibrozil (G) and Bezafibrate (B) were investigated over a period of 12 weeks in 178 hyperlipidemic (HLP) patients first submitted to an 8-week "wash-out" (diet only) phase. In HLP type IIa patients, LDL cholesterol was lowered (G: -13%, B: -10%). In HLP type IIb, a decrease in triglyceride (TG) levels (G: -41%, B: -31%), an increase in HDL-cholesterol (G: +19%, B: +5%), and a decrease in the total cholesterol/HDL cholesterol ratio (G: -32%, B: -9%) predominated. Patients with type IV HLP responded to both fibrates with an appreciable reduction in TG levels (G: -45%, B: -42%). The effects of the preparations differed significantly with respect to the elevation of HDL cholesterol and a decrease in the total cholesterol/HDL cholesterol ratio in HLP type IIb patients. The respective lipid baseline concentration appeared to be of importance for the sense and extent of the changes induced.

Adult↗
PubMed1992

[Coronary heart disease and insulin concentration in type II diabetic patients--results of a diabetes intervention study].

There is experimental, clinical and epidemiological evidence that elevated insulin levels are associated with development of atherosclerosis. Early results came from studies in non-diabetics, but the situation with respect to diabetes is more complex and not so clear. The Diabetes Intervention Study is a population-based follow-up study in newly detected type II diabetics (30- to 55-yr-old). After 5 years 431 men and 320 women received a complex check up with oral glucose tolerance tests and measurements of plasma insulin and glucose levels, fasting and 2h post-load. Regarding the metabolic parameters, the fasting and postprandial insulin levels were higher among the patients having coronary heart disease (15% of men, 36% of women), as compared to patients without this disease. In multivariate analysis sex, age, antihypertensive treatment, blood pressure, body mass index, and fasting insulin levels were independently associated with the prevalence of coronary heart disease in patients with non-insulin dependent diabetes mellitus (NIDDM) treated with diet and/or oral antidiabetics. Body mass index and triglycerides were the only variables that independently correlated to insulin: fasting insulin = 0.4 (body mass index) + 0.1 (triglycerides) - 4,2. In future prospective studies of diabetics relating insulin concentrations to the development of vascular disease are of particular interest and necessity. Because hyperinsulinemia may contribute to accelerated atherosclerosis in NIDDM-patients, the aim of the treatment of type II-diabetes should be to correct hyperglycemia without aggravating insulin levels and other cardiovascular risk factors.

Adult↗
PubMed1991

Diabetes Intervention Study. Multi-intervention trial in newly diagnosed NIDDM.

OBJECTIVE: In a randomized 5-yr multi-intervention trial, we tested the efficacy of intensified health education (IHE) in improving metabolic control and reducing the level of coronary risk factors and incidence of ischemic heart disease (IHD). RESEARCH DESIGN AND METHODS: Within the intervention group, the benefit of clofibric acid was evaluated in a double-blind study. One thousand one hundred thirty-nine newly diagnosed middle-aged (30- to 55-yr-old) patients with non-insulin-dependent diabetes mellitus (NIDDM) entered the study. They were classified as diet controlled after a 6-wk screening phase with conventional dietary treatment. During the follow-up, the control group (n = 378) was cared for at different diabetes outpatient clinics with a standardized surveillance. The intervention group (n = 761) had a structured IHE that included dietary advice, antismoking and antialcohol education, and ways to enhance physical activity. RESULTS: Randomly, 379 of the IHE patients received 1.6 g clofibric acid/day, and the others received placebo. IHE resulted in improved glucose control (adjusted fasting blood glucose) levels after 5 yr (control subjects 9.27 mM, IHE group 8.71 mM, and IHE plus clofibric acid group 8.60 mM, P less than 0.01). The better glycemic control was achieved with fewer antidiabetic drugs. After 5 yr, antidiabetic drugs were prescribed to 47% of the control subjects, 28% of the IHE group, and 34% of the IHE plus clofibric acid group (cutoff limit for drug application was postprandial blood glucose of greater than or equal to 13.87 mM). The ratio of polyunsaturated to saturated fatty acids (0.26 vs. 0.40, P less than 0.01) and physical activity (174 vs. 327 scores, P less than 0.01) were increased, and blood pressure, tobacco, and alcohol consumption were significantly reduced by IHE. However, IHE had no effect on calorie intake, percentage of fat in the diet (45%), and body weight. The most important finding was the significant increase of blood cholesterol in all three groups (+0.47, +0.36, and +0.34 mM, respectively). Clofibric acid only prevented the increase of triglyceride levels (+0.56, +0.24, and +0.05 mM, respectively). The incidence rate per 1000 for myocardial infarction was 30.3 for control subjects, 53.6 for the IHE group, and 55.6 for the IHE plus clofibric acid group. The corresponding rates for IHD incidence were 90.9, 97.8, and 98.8, respectively. Men suffered more frequently from myocardial infarction, whereas women developed ECG criteria for IHD more frequently. Among the 35 cases of death, besides cardiovascular diseases, liver cirrhosis and neoplasia were the predominant causes. The death rate per 1000 in control subjects was 46.2, 30.6 in the IHE group, and 27 among patients with IHE plus clofibric acid. CONCLUSIONS: IHE was of substantial benefit for the control of glycemia, significantly diminished the need for antidiabetic drugs, and reduced a cluster of risk factors but had no effect on the control of blood lipids. This could be one major reason for the failure of IHE, effective lowering of blood pressure, and clofibric acid to prevent cardiovascular complications. Clofibric acid was only effective in reducing triglycerides.

Adult↗
PubMed1991

Therapeutic potentials of acarbose as first-line drug in NIDDM insufficiently treated with diet alone.

OBJECTIVE: Acarbose inhibits alpha-glucosidases of the small intestine and thus delays glucose release from complex carbohydrates. Therefore, its efficacy and acceptability as a first-line drug in non-insulin-dependent diabetes mellitus (NIDDM) insufficiently treated with diet alone was tested in a randomized double-blind placebo-controlled study. RESEARCH DESIGN AND METHODS: Ninety-four NIDDM subjects, aged 43-70 yr with average body mass index of 28 kg/m2 and undergoing a pretreatment period of at least 3 mo with diet alone, were treated with 100 mg acarbose three times daily or placebo for 24 wk. The patients were recruited after a 4-wk screening period of dietary reinforcement. The inclusion limits for patients termed diet not satisfactory were fasting blood glucose (FBG) greater than or equal to 7.8 mM and/or postprandial blood glucose (BG) greater than or equal to 10 mM. RESULTS: FBG was lowered in the acarbose group from 9.8 to 8.4 mM and in the placebo group from 10.2 to 9.6 mM after 24 wk (P = 0.007 vs. placebo). The most impressive therapeutic effect was a highly significant reduction of postprandial hyperglycemia for at least 5 h after the test meal (1-h postprandial BG with acarbose 10.4 mM and placebo 13.5 mM at 24 wk, P less than 0.001) accompanied by a significant decrease in HbA1 (acarbose 8.65%, placebo 9.32%, P = 0.003). Whereas C-peptide and fasting serum insulin were not significantly affected by acarbose, postprandial insulin increment was approximately 30% lower after 24 wk compared with placebo. Furthermore, acarbose significantly reduced 1-h postprandial triglyceride levels. After an initial phase of greater than 4 wk (when 76.6% in the acarbose group vs. 28% on placebo complained about flatulence, P less than 0.001), the drug was well accepted. At the end of the study, only 32% showed mild or moderate gastrointestinal sensations. CONCLUSIONS: Extrapolation shows that acarbose is an efficient and acceptable drug for the treatment of NIDDM with poor metabolic control by diet alone. It has beneficial effects on postprandial hyperinsulinemia and postprandial hypertriglyceridemia.

Acarbose↗
PubMed1991

Beneficial effects on serum lipids in noninsulin dependent diabetics by acarbose treatment.

Acarbose (Bay g 5421, Glucobay; CAS 56180-94-0) inhibits alpha-glucosidases of the small intestine and thus delays glucose release from complex carbohydrates. It is therefore efficient as a first-line drug in the treatment of noninsulin-dependent diabetics (NIDDM) insufficiently treated with diet alone. Information is scarce whether under acarbose treatment the lipid metabolism can also be improved. Therefore the changes of triglycerides, cholesterol and HDL-cholesterol were analyzed in a randomized double-blind placebo-controlled trial. In brief, 94 NIDDM aged 43 to 70, after a pretreatment period of at least 3 months, were treated with 100 mg acarbose t.i.d. or placebo for 24 weeks. The patients were recruited after a 4-week screening phase with reinforcement of diet. The most impressive results of acarbose treatment were lowering of blood glucose and insulin, especially in the postprandial state, and of HbA1 (glycosylated hemoglobin). Results on lipids: The initial serum cholesterol levels showed a broad spectrum. Low concentrations remained unchanged under acarbose, while high concentrations (the upper tercile) decreased from 273 to 251 mg/dl. This effect was statistically significant compared to placebo. HDL-cholesterol levels increased continuously under acarbose and placebo as well thus indicating some study effect. Similarly, fasting triglycerides leveled down under acarbose and placebo. However, drastic differences appeared in postprandial triglycerides which were checked 1 and 5 h after a test meal given at entry and at finish of the study. The lowering by acarbose compared to placebo was highly significant for the 1 h postprandial concentrations. It is concluded that acarbose treatment can reduce elevated cholesterol concentrations and postprandial triglyceride concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Acarbose↗
PubMed1990

[Guidelines for the treatment of hypercholesterolemia].

The prevalence of mild and moderate hypercholesterolemia among the middle-aged population of the G.D.R. is about 30%. Thus, this is the most important risk factor for coronary heart diseases. Primary therapeutic techniques are elimination of overweight, low-fat diet, rich in monoenic and polyenic acids, and increase of physical activity. When by these measures a decrease of cholesterol to 5.2-5.5 mmol/l is not achieved the introduction of lipid drugs is to be considered in dependence on the individual risk (associated risk factors like smoking, hypertension, diabetes, low HDL-cholesterol). In case of mild to moderate polygenic hypercholesterolemia cholestyramine, nicotinic acid and modern fibrates have the priority. Familial hypercholesterolemia demands as a rule the introduction of statins (e.g. lovastatin) or combinations of the above mentioned lipid drugs or the combination of cholestyramine and lovastatin, resp. In this way the prognosis even of patients with severe familial hypercholesterolemia can be improved decisively. Considering the fact that this would be a life-accompanying therapy a thorough consideration of the risk/benefit ratio and an adequate medical supervision are necessary.

Cholesterol, Dietary↗
PubMed1990

Efficacy of a combined bezafibrate retard-colestyramine treatment in patients with hypercholesterolemia.

In a placebo-controlled randomized study the effect of combined bezafibrate-colestyramine therapy in comparison with monotherapy with both drugs was investigated. 47 patients with primary hypercholesterolemia received 400 mg bezafibrate (Cedur) retard/d, subsequently bezafibrate retard plus colestyramine (24 g/d) or colestyramine plus placebo in a double-blind fashion. The combination therapy was most effective (LDL decrease 36%, HDL-C increase 31%, apoprotein B decrease 28%), bezafibrate and colestyramine were equally effective with regard to LDL-C and apoprotein B, but only bezafibrate decreased triglycerides (-37%) and increased HDL-C (+24%). Bezafibrate was well-tolerated, but gastro-intestinal side-effects were frequent during therapy with colestyramine, and 16 patients tolerated only a reduced dosage of this drug. From the results presented it can be concluded that combined therapy with bezafibrate retard plus colestyramine is highly effective in the treatment of severe hypercholesterolemia.

Bezafibrate↗
PubMed1989

[Coronary heart diseases and associated risk factors in newly manifested type II diabetic patients over the course of 5 years].

Using the baseline data of the diabetes intervention study (DIS) from 1126 newly manifested type II-diabetics our analysis demonstrates higher mean-values of some components of the so-called metabolic syndrome in patients with ECG-abnormalities indicating coronary heart disease (CHD) in diagnosis of diabetes compared with subjects without ECG-findings. The impact of general risk factors for the prevalence of CHD in diagnosis and after a 5-year follow-up is obviously different in both sexes. In multivariate analysis only systolic blood pressure was persistently a significant predictor in both sex groups. With increasing age life-duration gets as time-related factor importance for the development of CHD. The mathematically demonstrated association of triglyceride levels to the presence of ECG-abnormalities agrees with the results of WHO multinational study of vascular disease in diabetes mellitus. In the interventions as well as in the control-groups diabetic subjects with CHD after 5 year follow-up showed in comparison to diabetics without CHD higher levels of investigated risk factors which develop their pathogenetic effect probably by their clustering impact, because the differences of their mean-values are only in some cases significant. The common lower level of the most risk factors at the intervention group compared with the conventionally treated group is the result of the intervention measures.

Adult↗
PubMed1989

Pathogenetic role of adipose tissue lipase deficit for development of hypertriglyceridaemia.

In 87 patients (74 males, 13 females; age 43 +/- 9.2 years) covering a wide range of triglyceride (TG) concentrations (8.8 to 80.7 mmol/l) the turnover of total serum TG has been measured using the technique of labelling endogenously synthesized TG with 3H-glycerol. In parallel, lipoprotein lipase activity in adipose tissue and the adipose-tissue lipase activity in post-heparin plasma have been assessed following an oral 50 g glucose load. Despite the well-recognized function of this enzyme for intravascular lipolysis no direct relationship between lipase activities and fractional catabolic rates (FCR), reflecting TG removal processes, was found. On the other hand, relative enzyme activities (per TG moles) are positively correlated with the FCR. However, a detailed analysis of this relationship revealed that only in HTG patients whose FCR are below 0.210 h-1 a rate-limiting influence of a relative lipase deficit can be shown. In these patients, a statistically significant elevation of concentrations of free fatty acids is supposed to contribute to the impairment of the TG removal.

Adipose Tissue↗
PubMed1989

Very low calorie diet therapy in obese non-insulin dependent diabetes patients.

VLCD is an effective and safe measure to reduce overweight in NIDDM. It substantially improves glucose control and corrects associated coronary risk factors, in particular dyslipoproteinaemia and hypertension. Both insulin secretion and insulin resistance were ameliorated by perfect glucose control with VLCD. Reliable data on long term efficacy and factors determining weight loss and success in permanent glucose control are urgently needed.

Blood Glucose↗
PubMed1988

[Intensive basic therapy decreases the need for drug treatment and improves glucose control: an important result of the diabetes intervention study].

In a period of five years in the diabetes intervention study (DIS), 1,139 diabetics aged 30-55 years, who in a 6-week screening phase had been classified as dietetically manageable, were treated in a controlled randomized study with intensified non-medicamentous basic therapy and--in a double blind trial--with 1,6 g clofibric acid. The essential components of the basic therapy were a fat-modified diet (so-called prudent diet) and recommendations for endurance training. Thus in comparison to the control group we succeeded in performing a ca. 40% decrease of the application of oral antidiabetic drugs. The fasting blood values were, nevertheless, with 155 mg% significantly lower than in the control group (169 mg%). Clofibric acid had no influence neither on the necessity to use insulin or oral antidiabetic drugs nor to the control of glycaemia.

Clinical Trials as Topic↗