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Biomedical subjects

R Jelfs

Publications and source records attributed to R Jelfs.

10 recordsLinked to original sources
PubMed1986

Sucrose in the diet of diabetic patients--just another carbohydrate?

The effects of regularly eating sucrose were studied in 23 diabetic patients, 12 Type 1 (insulin-dependent) and 11 Type 2 (non-insulin-dependent), with differing degrees of glycaemic control. Two diets, each lasting 6 weeks, were compared in a randomised cross-over study. Both diets were high in fibre and low in fat. In one diet 45 g of complex carbohydrate was replaced by 45 g of sucrose taken at mealtimes. There were no significant biochemical differences between the two diets in either Type 1 or Type 2 patients. In Type 1 patients the mean (+/- SEM) fasting plasma glucose was 10.5 (1.8)mmol/l on the control diet and 10.3 (1.5) mmol/l on sucrose. In Type 2 patients the levels were 9.1 (0.8) mmol/l and 8.9 (0.8) mmol/l respectively. Glycosylated haemoglobin for the Type 1 patients was 9.9% on control and 10.3% on sucrose; for Type 2 patients the figures were 9.3% and 9.0% respectively. There were no differences in mean daily plasma glucose levels or diurnal glucose profiles. Cholesterol (total and in lipoprotein fractions) was unchanged, as were diurnal triglyceride profiles and plasma insulin profiles in the Type 2 patients. There were no changes in medication or body weight. We conclude that a moderate amount of sucrose taken daily at mealtimes does not cause deterioration in metabolic control in diabetic patients following a high fibre/low fat diet.

Adult↗
PubMed1986

Platelet aggregation in non-insulin-dependent diabetes is associated with platelet fatty acids.

Platelet aggregation was measured in 15 patients having non-insulin-dependent diabetes mellitus (NIDDM) at the time of diagnosis and after three months of dietary treatment. Mean fasting plasma glucose fell from 13.0 to 8.8 mmol/l (p less than 0.0002), glycosylated haemoglobin fell from a mean of 11.3% to 9.0% (p less than 0.005) and insulin levels fell from a mean of 17.5 to 13.8 mU/l (p less than 0.005). Platelet aggregation showed a variable response and did not correlate with plasma glucose, glycosylated haemoglobin or plasma insulin. Multiple linear regression analysis was carried out on the aggregation values against the biochemical variables and platelet phospholipid fatty acid levels following logarithm transformation. Platelet linolenic acid and eicosapentaenoic acid levels were significantly inversely associated with aggregation but the difference between the relationship at diagnosis and after three months was not statistically significant. The association between platelet omega 3 fatty acids and platelet aggregation suggest that dietary change aimed at increasing the proportions of these fatty acids might favourably influence vascular disease in NIDDM via an effect on platelet function.

Adult↗
PubMed1986

Glycosylated haemoglobin: comparison of five different methods, including measurement on capillary blood samples.

Glycosylated haemoglobin was measured in venous blood samples and in blood collected in 'Unistep' bottles by isoelectric focusing (IEF), as the reference method, and by electroendosmosis (EEO), the thiobarbituric acid method (TBA), ion-exchange chromatography (IEC) and affinity chromatography (AC). Isoelectric focusing, electroendosmosis and thiobarbituric acid gave similar results. Affinity chromatography gave lower results than isoelectric focusing for normal values but similar results for diabetics. Ion-exchange chromatography gave 24% lower results than isoelectric focusing across the range. Using Unistep collected blood samples and comparing multiple samples from the same patient, electroendosmosis gave the best results (coefficient of variation 4%) and thiobarbituric acid gave slightly less good precision that other methods. Re-use of affinity chromatography columns gave less good precision. Collection of blood samples into a Unistep bottle gave similar results to venous sample results. Storage of venous capillary blood samples in Unistep bottles over 1 week at 21 degrees C gave similar results to immediate assay. Electroendosmosis of blood samples in Unistep bottles gave stable results over 2 weeks. Home collection by a patient of a capillary blood sample into a Unistep bottle allows glycosylated haemoglobin results to be available when seen in the clinic.

Capillaries↗
PubMed1985

Polyunsaturated fatty acids and diabetic retinopathy.

One hundred and forty nine diabetic patients were ophthalmologically assessed seven years after randomisation to a low carbohydrate or modified fat diet (rich in linoleic acid). Glycaemic control, regardless of the type of diet, was a major determinant of the development of retinopathy. Poorly controlled patients (haemoglobin A1c greater than 8%) with low levels of linoleic acid in cholesterol ester had a significantly greater frequency of retinopathy than well controlled patients or patients with similarly unsatisfactory control but higher levels of linoleic acid. The findings support an earlier suggestion that linoleic acid might protect against diabetic retinopathy.

Cholesterol Esters↗
PubMed1985

Low-dose guar improves diabetic control.

Twenty diabetic outpatients (12 non-insulin-treated and 8 insulin-treated) were given guar granulate in a dose of 10 g daily for two months in order to study the effect on glycaemic control and lipid levels. Mean glycosylated haemoglobin levels (HbA1c%) fell from 11.1 +/- 2.0% pre-guar to 10.5 +/- 2.2% (P less than 0.001) after one month on guar and to 10.1 +/- 2.3% (P less than 0.0001) after two months. Following discontinuation of guar, HbA1c% rose to 11.1 +/- 2.5% (P less than 0.002). However, there were no significant changes in fasting blood glucose, 1 h postprandial blood glucose following a test meal, 24 h urinary glucose excretion or in lipid levels. Gastrointestinal side effects occurred in 4 patients during treatment with guar. Four patients reduced their dose of insulin and 2 patients reduced their dose of sulphonylurea therapy during this time because of symptoms suggestive of hypoglycaemia. We suggest that the low dose of guar used in this study may help improve glycaemic control in diabetic patients and that this may be achieved with a low incidence of gastrointestinal side effects.

Blood Glucose↗
PubMed1984

High carbohydrate-high fibre diets in poorly controlled diabetes.

Fifteen non-insulin-dependent diabetic patients with persistently elevated blood glucoses despite high doses of oral hypoglycaemic agents, were randomly allocated to a high carbohydrate-high fibre diet (HC) or a reinforced low carbohydrate diet (LC). After six weeks the diets were reversed for a similar period. Immediately preceding the study and at the end of each dietary period 24-h biochemical profiles were performed. In the 11 patients who completed the study, fasting and preprandial glucose, percentage glycosylated haemoglobin, VLDL cholesterol and mean 24-h triglycerides were significantly lower on HC than on LC or during the initial profile on their usual diet. There was no significant difference in any of the measurements on LC compared with the usual diet. Previous studies of high carbohydrate-high fibre diets in diabetes have been carried out in relatively well-controlled patients. These data show that poorly controlled non-insulin-dependent patients have an even more striking response.

Aged↗
PubMed1979

Lipid abnormalities in untreated maturity-onset diabetics and the effect of treatment.

Plasma cholesterol and serum triglyceride levels and frequency of lipoprotein abnormalities were investigated in 126 untreated maturity-onset diabetics and 126 age- and sex-matched control subjects. Serum triglyceride levels were higher (mean: 1.67 mmol/l) and type IV hyperlipoproteinaemia occurred more frequently (16.7%) in the diabetic group as compared with the controls (1.29 mmol/l and 4.8% respectively). These findings were not explained by an excessive frequency of renal disease, hypertension or drug treatment amongst the diabetics. Normal men showed higher serum triglyceride (mean: 1.36 mmol/l) and lower plasma cholesterol (mean: 5.6 mmol/l) levels than normal women (1.21 mmol/l and 6.4 mmol/l respectively). No sex difference was seen amongst the diabetics. Triglyceride levels fell after one month of dietary treatment but only remained lowered in diabetics who required sulphonylureas for glycaemic control. After treatment for one year the correlation between serum triglycerides and blood glucose rose from r = 0.15 (NS) before treatment to r = 0.43 (p less than 0.001). Similarly the correlation between serum triglycerides and ponderal index rose from r = 0.19 (NS) to r = 0.28 (p less than 0.02).

Body Weight↗
PubMedDate not supplied

Glycosylated haemoglobin measurement on blood samples taken by patients: an additional aid to assessing diabetic control.

200 patients attending a diabetic outpatient clinic were each asked to post to the hospital, prior to their three-monthly routine clinic visit, a finger-prick capillary blood sample for glycosylated haemoglobin assay (HbA1). Patients took their own blood into UNISTEP bottles, which automatically measure a 53 microliters aliquot and mix it with 150 microliters of diluent suitable for transport to the laboratory. During 1 year 883 (84%) of 1046 bottles sent out were returned of which 776 (87%) were suitable for analysis. The availability of the result at the time of the patients' clinic visit aided assessment of diabetic control and was associated with a mean reduction of the HbA1 by 0.8% (p less than 0.001) over a twelve-month period. This simple system facilitates remote monitoring of HbA1 levels, is suitable for both hospital and general practice use and may allow a reduction in the number of patient visits.

Diabetes Mellitus, Type 1↗