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Biomedical subjects

Sandra N Nowak

Publications and source records attributed to Sandra N Nowak.

6 recordsLinked to original sources
PubMed2003

Aspirin dose for prevention of cardiovascular disease in diabetics.

OBJECTIVE: To determine whether a specific dose of aspirin can be recommended for prevention of cardiovascular disease in patients with diabetes. DATA SOURCE: Biomedical literature was accessed through MEDLINE (1990-February 2002). Key terms included diabetes, cardiovascular protection, and aspirin. DATA SYNTHESIS: Pharmacologic and clinical studies focusing on the dose-response relationship of aspirin therapy were reviewed. Evidence supports the benefit of low-dose aspirin therapy in reducing vascular events in secondary and primary prevention trials in various patient populations; however, some studies suggest larger doses of aspirin may be needed in certain patients. CONCLUSIONS: Review of the evidence does not support a particular dose of aspirin for cardiovascular protection in diabetic patients. Clinical guidelines recommend aspirin therapy in the range of 81-325 mg/d. However, due to an increased prevalence of cardiovascular morbidity and disturbances in coagulation in diabetic patients, the dose of aspirin for prevention of cardiovascular disease in these individuals may be different from that in other populations and requires further evaluation.

Aspirin↗
PubMed2003

Epidemiology of diabetes among Arab Americans.

OBJECTIVE: To examine the prevalence of diabetes and glucose intolerance by age and sex in the Arab-American community of Dearborn, Michigan. RESEARCH DESIGN AND METHODS: Participants were randomly selected adult Arab Americans, 20-75 years of age, from randomly selected households in Dearborn, Michigan. Demographic and anthropometric data were recorded. Glucose tolerance was assessed with 2-h 75-g oral glucose tolerance tests and classified according to 1997 American Diabetes Association and 1998 World Health Organization criteria. RESULTS: A total of 626 eligible adults were selected, and 542 participated (87% response rate). Because prevalence increases with age and the overall response rate for women (328/352; 93%) was higher than that for men (214/274; 78%), prevalence rates were adjusted for age and sex. The overall prevalence of diabetes was 15.5% (95% CI 12.2-18.7%) in women and 20.1% (15.0-25.2%) in men (P = 0.13). The prevalence of previously diagnosed diabetes was similar to that of undiagnosed diabetes. Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) were present in 16.8% (12.8-20.8%) of women and 29.7% (23.4-35.9%) of men (P = 0.0007). The combined rates of glucose intolerance (diabetes, IGT, and IFG) were 32.3% (27.8-36.7%) for women and 49.8% (43.1-56.4%) for men (P < 0.0001). Among younger adults, the prevalence in men was higher than that in women. As expected, subjects with diabetes or IGT/IFG were older and had greater BMI and waist-to-hip ratios than subjects with normal glucose tolerance. CONCLUSIONS: The prevalence of diabetes and glucose intolerance is extremely high among adult Arab Americans in Michigan and represents a major clinical and public health problem. Community-based intervention programs to prevent and treat diabetes are urgently needed.

Adult↗
PubMed2002

Insulin-metformin combination therapy in obese patients with type 2 diabetes.

The aim of the study was to evaluate the effects of insulin-metformin combination therapy compared to insulin monotherapyin obese, insulin-requiring patients with type 2 diabetes mellitus. Eighteen patients uncontrolled on > or = 70 U/day of insulin monotherapy were investigated in this prospective, open-label study. Patients continued their previous insulin and dietary regimens for 4 weeks, after which metformin was added with doses titrated to achieve a fasting plasma glucose (FPG) < 7.8 mmol/l or until the maximum daily dose was reached. Insulin-metformin combination therapy was continued for an additional 8 weeks. Insulin-metformin combination therapy resulted in a significant decrease in glycated hemoglobin values with a final mean reduction of 1.5% +/- 1.2% (p = 0.001). FPG decreased significantly (p < 0.005) by week 4 of insulin-metformin therapy, but the change was not statistically significant by week 12, and daily insulin requirements were significantly reduced during combination therapy (p < 0.05). These results suggest that in obese patients with type 2 diabetes mellitus receiving > or = 70 U of daily insulin, the addition of metformin leads to improved glycemic control with lower daily doses of insulin and without adverse effects.

Adult↗
PubMed2002

Pioglitazone: effect on CYP3A4 activity.

Clinical studies demonstrate CYP3A4 enzyme induction with troglitazone, a thiazolidinedione derivative structurally related to pioglitazone. The objective of this prospective, open-label study conducted in healthy volunteers was to evaluate the influence of multiple-dose pioglitazone therapy on the urinary excretion ratio of 6-beta-hydroxycortisol to cortisol, an endogenous marker of CYP3A4 activity. Twelve subjects were given pioglitazone hydrochloride 45 mg daily for 14 days. Urine was collected over a 24-hour period before pioglitazone and after administration of the last tablet. Baseline and posttreatment CYP3A4 activity was assessed with the urinary 6-beta-hydroxycortisol/cortisol ratio. The mean +/- SD 6-beta-hydroxycortisol/cortisol ratios before and after treatment were 8.3 +/- 4.4 and 9.4 +/- 4.0, respectively (p = 0.29). The mean change from baseline was a nonsignificant 20.2%. Nine subjects had a small increase and 3 subjects had a reduction in the ratio. Using the ratio as a marker of CYP3A4 activity, the data support a lack of inductive effect on CYP3A4 by multiple-dose pioglitazone therapy. Thus, administration of pioglitazone should not result in clinically significant effects on the pharmacokinetics of other CYP3A4 substrates.

Adult↗
PubMed2002

Correlation between activated clotting time and activated partial thromboplastin times.

OBJECTIVE: To evaluate the correlation between clotting time tests and heparin concentration, the correlation between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) results, and to compare the clinical decisions based on ACT results with those based on aPTT results. METHODS: Retrospective evaluation of a large database containing heparin concentrations, ACT results (1 device), and aPTT results (3 different instruments: 2 bedside, 1 laboratory-based). Correlations between heparin concentrations and clotting time tests and between ACT results and aPTT results were determined. Clinical decisions regarding heparin dosage adjustments based on ACT results were compared with those based on aPTT results. RESULTS: Correlations between clotting time tests and heparin concentrations were r = 0.72 for ACT and r = 0.74-0.86 for the aPTT instruments. The laboratory-based aPTT had the highest correlation to heparin concentrations. The correlation between ACT and aPTT results ranged from r = 0.64-0.67. Heparin dosage adjustment decisions based on ACT results agreed with decisions based on aPTT results 59-63% of the time. CONCLUSIONS: The laboratory-based aPTT has a stronger correlation to heparin concentration than the bedside-based aPTT and ACT. The correlation between ACT and aPTT was similar among 3 different aPTT instruments. Decisions to adjust heparin therapy based on ACT results differed from decisions based on aPTT results more than one-third of the time.

Anticoagulants↗