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Biomedical subjects

S Colagiuri

Publications and source records attributed to S Colagiuri.

At least 19 recordsLinked to original sources
PubMed2000

Insulin sensitivity predicts glycemia after a protein load.

Protein ingestion results in small but distinct changes in plasma glucose and insulin. We hypothesized that the glycemic and/or insulin response to protein might be related to the degree of insulin sensitivity. Our aim was to determine the relationships between insulin sensitivity (assessed by euglycemic-hyperinsulinemic clamp) and postprandial glucose, insulin, C-peptide, and glucagon responses to a 75-g protein meal and a 75-g glucose load. Sixteen lean healthy Caucasian subjects (mean +/- SD age, 25 +/- 6 years; body mass index [BMI], 23.1 +/- 1.7 kg/m2) participated in the study. After the protein meal, the mean plasma glucose declined gradually below fasting levels to a nadir of -0.36 +/- 0.46 mmol/L from 60 to 120 minutes, showing wide intraindividual variation. Insulin sensitivity (M value) was 1.1 to 3.9 mmol/L/m2 min in the subjects and correlated inversely with the plasma glucose response to the protein meal (r = -.58, P = .03), ie, the most insulin-sensitive subjects showed the greatest decline in plasma glucose. In contrast, there was no correlation between insulin sensitivity and the insulin or glucagon response to the protein load, or between the M value and the metabolic responses (glucose, insulin, C-peptide, and glucagon) to the glucose load. Our study suggests that the net effect of insulin and glucagon secretion on postprandial glucose levels after a protein meal might depend on the individual's degree of insulin sensitivity. Gluconeogenesis in the liver may be less susceptible to inhibition by insulin in the more highly resistant subjects, thereby counteracting a decline in plasma glucose.

Adult↗
PubMed1999

Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.

OBJECTIVE: To compare the effect of repaglinide in combination with metformin with monotherapy of each drug on glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 83 patients with type 2 diabetes who had inadequate glycemic control (HbA1c > 7.1%) when receiving the antidiabetic agent metformin were enrolled in this multicenter, double-blind trial. Subjects were randomized to continue with their prestudy dose of metformin (n = 27), to continue with their prestudy dose of metformin with the addition of repaglinide (n = 27), or to receive repaglinide alone (n = 29). For patients receiving repaglinide, the optimal dose was determined during a 4- to 8-week titration and continued for a 3-month maintenance period. RESULTS: In subjects receiving combined therapy, HbA1c was reduced by 1.4 +/- 0.2%, from 8.3 to 6.9% (P = 0.0016) and fasting plasma glucose by 2.2 mmol/l (P = 0.0003). No significant changes were observed in subjects treated with either repaglinide or metformin monotherapy in HbA1c (0.4 and 0.3% decrease, respectively) or fasting plasma glucose (0.5 mmol/l increase and 0.3 mmol/l decrease respectively). Subjects receiving repaglinide either alone or in combination with metformin, had an increase in fasting levels of insulin between baseline and the end of the trial of 4.04 +/- 1.56 and 4.23 +/- 1.50 mU/l, respectively (P < 0.02). Gastrointestinal adverse events were common in the metformin group. An increase in body weight occurred in the repaglinide and combined therapy groups (2.4 +/- 0.5 and 3.0 +/- 0.5 kg, respectively; P < 0.05). CONCLUSIONS: Combined metformin and repaglinide therapy resulted in superior glycemic control compared with repaglinide or metformin monotherapy in patients with type 2 diabetes whose glycemia had not been well controlled on metformin alone. Repaglinide monotherapy was as effective as metformin monotherapy.

Australia↗
PubMed1997

The extent of undiagnosed gestational diabetes mellitus in New South Wales.

OBJECTIVES: To estimate the number of pregnant women in New South Wales who had not been tested for gestational diabetes mellitus (GDM) during the period 1991-1994. DESIGN: The number of women not tested for GDM was estimated from the recorded data available in the NSW Midwives Data Collection (MDC) annual reports and compared with three incidence surveys. MAIN OUTCOME MEASURE: The number of pregnant women not tested for GDM. RESULTS: Over the four-year period, the average annual recorded MDC incidence of GDM was 2.2%. This percentage was adjusted up to 3.3% after review of the MDC validation study and an incidence study. However, the expected incidence of GDM from three incidence surveys was 6.6%. Thus, half of the pregnant women in NSW do not appear to have been tested for GDM. CONCLUSION: For the four-year period 1991-1994, an-estimated 50% of women in NSW were probably not tested for GDM.

Bias↗
PubMed1997

The metabolic syndrome: from inherited survival trait to a health care problem.

A critical role is proposed for the quantity and quality of dietary carbohydrate in the pathogenesis of the insulin resistance and hyperinsulinaemia which characterise the Metabolic Syndrome. We propose that an insulin-resistant genotype evolved to provide survival and reproductive advantages for the cold-climate, large game hunters of the last Ice Age who consumed a low carbohydrate, high protein diet with periodic starvation. Insulin resistance would have minimised glucose utilisation by muscles thereby facilitating the preferential utilisation of glucose by the brain, foetus and mammary gland. But beginning about 10,000 years ago following the end of the last Ice Age and the development of agriculture, dietary carbohydrate increased and the selection pressure for insulin resistance decreased in some groups. Agriculture began in the Middle East and spread throughout Europe long before it was developed elsewhere. Hence the prevalence of the insulin-resistant genotype decreased in Europeans and other groups exposed to a high carbohydrate intake for sufficiently long. Some geographically isolated groups such as the Pima Indians and Nauruans experienced conditions which further diminished the gene pool diversity and resulted in particularly insulin resistant populations. Traditional carbohydrate foods have a low glycaemic index and produce only modest increases in plasma insulin. However, the constant supply of highly refined high glycaemic index carbohydrate in modern diets, results in postprandial hyperinsulinaemia. The insulin-resistant genotype is now disadvantageous and predisposes to the development of the Metabolic Syndrome.

Blood Glucose↗
PubMed1997

Oral hypoglycaemic agents. When, how and why.

Non insulin dependent diabetes mellitus (NIDDM) is often incorrectly viewed as a mild form of diabetes. Complications are as frequent as in insulin dependent diabetes and control of oral hypoglycaemic agents is integrated with other lifestyle changes in managing NIDDM.

Administration, Oral↗
PubMed1995

The use of orthotic devices to correct plantar callus in people with diabetes.

Foot problems are a major cause of morbidity in people with diabetes. Plantar callus is common and is a sign of abnormal foot pressures. Shear stresses at these areas of high foot pressures may ultimately result in ulcer formation. This study compared the effect on plantar callus of the use of rigid orthotic devices and conventional podiatric care. Twenty diabetic subjects participated in the study and were randomly allocated to conventional treatment (n = 11) or orthotic device treatment (n = 9). After 12 months the patients in the orthotic group showed a significant reduction in callus grade, whereas the conventionally treated group showed no significant change. There were no adverse effects from wearing the orthotic device. Rigid orthoses have a beneficial effect on plantar callus presumably through the lowering and redistribution of abnormal foot pressures.

Aged↗
PubMed1995

Can patients set their own educational priorities?

This study aimed to determine if patients can set their own educational priorities accurately and if the impact of diabetes education on knowledge differed between patients who did and did not set their own priorities. Forty patients referred for individual education were randomly assigned to one of two groups. Prior to education with a diabetes specialist nurse (DSN) patients ranked 10 diabetes care topics in order of perceived importance and relevance to their needs and completed a knowledge questionnaire. Group 1 set their own priorities and the DSN directed education according to the patients stated priorities. In Group 2 the DSN set the educational priorities without seeing the patients priority list. The priority ranking by the two groups of the 10 topics and their pre-education knowledge score were not significantly different. Post-education knowledge scores improved equally and significantly in both groups (Group 1 from 23 to 87%; Group 2 from 21 to 79%); P < 0.0001). In both groups, knowledge scores for the top three priorities were significantly higher than for the three lowest ranked topics. Knowledge is neither dependent on, nor a good discriminator of, patient-selected priorities. There may be reasons why it is important for patients to set their own priorities, but education directed solely at those priorities may leave knowledge deficits which could compromise diabetes care.

Adult↗
PubMed1995

Effect of ambient temperature and humidity on performance of blood glucose meters.

The accuracy of four blood glucose meters (Accutrend, ExacTech Companion, Medisense Companion 2, and Glucometer III) was tested at temperatures ranging from 4 to 44 degrees C (control solutions) and 8 degrees C, 24 degrees C, and 36 degrees C (venous blood) and at humidities of 60% and 80%. Low and high temperatures resulted in a number of statistically significant changes in glucose readings with all meters. However, Accutrend, Medisense Companion 2, and Glucometer III were 100% clinically accurate at all temperatures. With the ExacTech Companion, only 70.8% of control solution and 55.6% of venous blood results were clinically accurate. The main errors were: (1) cold temperatures lowered the result so that euglycaemic levels erroneously read in the hypoglycaemic range and hyperglycaemic levels gave a better than actual result and (2) hot temperatures increased the result whereby hypoglycaemic levels falsely gave a euglycaemic result. Weather conditions at which blood glucose meters may be operated can affect results and potentially lead to errors in clinical decisions.

Blood Glucose↗
PubMed1994

The carnivore connection: dietary carbohydrate in the evolution of NIDDM.

We postulate a critical role for the quantity and quality of dietary carbohydrate in the pathogenesis of non-insulin-dependent diabetes mellitus (NIDDM). Our primate ancestors ate a high-carbohydrate diet and the brain and reproductive tissues evolved a specific requirement for glucose as a source of fuel. But the Ice Ages which dominated the last two million years of human evolution brought a low-carbohydrate, high-protein diet. Certain metabolic adaptations were therefore necessary to accommodate the low glucose intake. Studies in both humans and experimental animals indicate that the adaptive (phenotypic) response to low-carbohydrate intake is insulin resistance. This provides the clue that insulin resistance is the mechanism for coping with a shortage of dietary glucose. We propose that the low-carbohydrate carnivorous diet would have disadvantaged reproduction in insulin-sensitive individuals and positively selected for individuals with insulin resistance. Natural selection would therefore result in a high proportion of people with genetically-determined insulin resistance. Other factors, such as geographic isolation, have contributed to further increases in the prevalence of the genotype in some population groups. Europeans may have a low incidence of diabetes because they were among the first to adopt agriculture and their diet has been high in carbohydrate for 10,000 years. The selection pressure for insulin resistance (i.e., a low-carbohydrate diet) was therefore relaxed much sooner in Caucasians than in other populations. Hence the prevalence of genes producing insulin resistance should be lower in the European population and any other group exposed to high-carbohydrate intake for a sufficiently long period of time.

Agriculture↗
PubMed1994

The clinical usefulness of 3 alpha-androstanediol glucuronide in premenopausal women with hirsutism.

A biochemical parameter correlating with the clinical assessment of the severity of hirsutism and changing appropriately with the clinical response to treatment would be extremely useful. Preliminary reports of androstanediol glucuronide indicated that it was a peripherally-derived androgen and had a high correlation with clinical gradings of hirsutism. More recent reports have cast doubts on this association. This paper presents an evaluation of the clinical usefulness of androstanediol in 121 consecutive premenopausal patients with hirsutism. Androstanediol had a positive correlation with the clinical grading of hirsutism (p < 0.02) and the BMI (p < 0.01) but a negative correlation with age (p < 0.01). After adjustment for the effects of age and BMI there was no significant association between the degree of hirsutism and the level of androstanediol.

Adolescent↗