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T R Pieber

Publications and source records attributed to T R Pieber.

44 records · Page 3Linked to original sources
PubMed1995

Hemoglobin Sherwood Forest detected by high performance liquid chromatography for hemoglobin A1c.

Hb Sherwood Forest has been so far identified in only one patient in 1977. This study describes the second detection of this hemoglobin variant by routine high performance liquid chromatography (HPLC) in a diabetic patient and her healthy grand niece. In both, glycosylated hemoglobin (HbA1c) values were excessively elevated (52%), as determined by HPLC with a cation exchange column. The latex agglutination test showed values of HbA1c in the expected normal range. Citrate agar electrophoresis revealed a hemoglobin variant with a mobility similar to HbF. Amino acid analysis and DNA sequence analysis revealed an Arg-->Thr exchange at codon 104 of the beta-chain. This sequence has been described as Hb Sherwood Forest in 1977. The hemoglobin variant is clinically silent and might be confused with excessively high HbA1c in routine measurement of glycosylated hemoglobin.

Aged↗
PubMed1995

Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria.

The efficacy of a treatment and teaching programme for non-insulin-treated Type 2 diabetic patients in general practice was evaluated in a prospective, controlled study. In a rural area in southern Austria, 53 patients from seven general practices participated in a structured programme (intervention group) and 55 patients from seven general practices without the programme served as the control group. After 6 months the weight reduction in the intervention group was 2.6 kg (1.6-3.7 kg, p < 0.001) and the difference in HbA1c between the groups was 0.92% (0.23-1.61%, p < 0.01) at follow-up. Systolic (-16.6 mmHg) and diastolic (-11.1 mmHg) blood pressure, serum triglycerides (-0.63 mmol I-1), and serum cholesterol (-0.40 mmol I-1) were reduced significantly in the intervention group (p < 0.006). The number of patients with callus formation and poor nail care decreased significantly after participating in the teaching programme (p < 0.001). In the control group no reduction in body weight, metabolic control or in risk factors for diabetic foot complications were observed. Calculated health care costs per patient and year decreased in the intervention group (-33 pounds) and increased in the control group (+ 30 pounds) mainly due to changes in prescription of oral hypoglycaemic agents in both groups. This programme may be an efficient and helpful model to increase overall quality of diabetes care according to the St Vincent Declaration.

Austria↗
PubMed1995

Evaluation of a structured outpatient group education program for intensive insulin therapy.

OBJECTIVE: To determine the efficacy and safety of a structured diabetes teaching and treatment program (DTTP) in patients with insulin-dependent diabetes mellitus (IDDM) in an outpatient setting. RESEARCH DESIGN AND METHODS: All patients with IDDM who completed a structured 5-day outpatient DTTP were reevaluated after a mean follow-up of 3 years. A standardized interview was used to assess frequency of severe hypoglycemia, type of insulin treatment, self-monitoring, and other diabetes-related parameters. HbA1c was measured by high-performance liquid chromatography. RESULTS: Of 205 patients, 4 (2%) died during the observation period. HbA1c in the 201 surviving patients decreased significantly from 8.7 +/- 2.0 to 7.5 +/- 1.2% at follow-up (P < 0.001); frequency of severe hypoglycemia decreased from a mean of 0.46 to 0.13 per patient per year (P < 0.001). Hospital admission due to acute metabolic disturbances decreased from 4.5 +/- 11.1 to 1.4 +/- 6.7 days/patient-year (P < 0.001). At follow-up, intensive insulin therapy was carried out by 98% of the patients, and 80% of the patients reported three or more measurements of blood glucose per day. Diabetes-related knowledge had a positive (P < 0.01) and body mass index a negative (P < 0.02) influence on improving HbA1c assessed by multiple regression analysis. Severe hypoglycemia after DTTP was associated with a history of severe hypoglycemia before DTTP (P < 0.001) and the existence of overt diabetic nephropathy (P < 0.05). CONCLUSIONS: A structured outpatient DTTP as used in this study is able to improve overall metabolic control and decrease the frequency of severe hypoglycemia in patients with IDDM.

Adult↗
PubMed1995

[Management of diabetes in Austria 5 years after the St. Vincent Declaration].

In 1989 representatives of all European governments agreed on the "St. Vincent Declaration". In this statement of intent and recommendations all governments, including that of Austria, pledged to implement policies on preventive measures geared to reduce morbidity and mortality of all diabetic patients in Europe. Structured patient education has been shown to improve the overall quality of care in Type 1 diabetic patients. Reduction of acute metabolic disturbances after participation in the patient education programme reduces hospitalizations and allows significant savings in health care costs, which can help to make safe and effective therapy available to all patients with Type 1 diabetes without additional costs. A teaching and treatment programme for Type 2 diabetics by general practitioners has proven to be effective, feasible and inexpensive. Nationwide implementation of such an evaluated patient education programme shifts diabetes care to "primary health care" level, and increases long-term quality of diabetes care without generating new expenses. Patient education is considered not only the basis for successful management of diabetes, but also, as laid down in the St. Vincent Declaration, a basic human right of all patients, which still needs to be put into practice.

Austria↗
PubMed1995

[Erectile dysfunction in patients with type I diabetes mellitus].

To improve diabetes care according to the St. Vincent Declaration an interdisciplinary working group on erectile dysfunction in patients with diabetes was installed in the Departments of Internal Medicine, Urology and Psychiatry at the University of Graz. The screening and basic diagnostic procedures are performed in the diabetes clinic in the Department for Internal Medicine. To inform the patients about the options of treatment of diabetic erectile dysfunction and to determine prevalence data an anonymous questionnaire with a pre-stamped envelope was sent to 133 male patients with diabetes mellitus type I (IDDM). 59 (44%) of the questionnaires were returned and could be analyzed. Mean age and diabetes duration were representative for the male diabetes population. The prevalence of erectile dysfunction in this group was 49%. 7% of the patients were completely impotent. None of the patients reported the use of erection aids as a vacuum device or intracavernosal injection of smooth muscle-relaxant drugs. The prevalence of erectile dysfunction is high among patients with diabetes mellitus type I. Modern management offers satisfactory success in most cases, therefore screening for erectile dysfunction and adequate therapy should be offered to all patients.

Adolescent↗
PubMed1994

Direct plasma radioimmunoassay for rat amylin-(1-37): concentrations with acquired and genetic obesity.

Amylin (islet-associated polypeptide) is a 37-amino acid peptide that is cosecreted with insulin from the pancreatic beta-cell. Accurate measurement of its plasma levels is important for delineating the physiological range over which amylin acts. We describe a reproducible, highly specific, and sensitive radioimmunoassay for direct measurement of plasma amylin-(1-37). We measured changes in portal and systemic plasma amylin and insulin in three groups of anesthetized rats: lean young adult and old adult Wistar rats with acquired obesity, and Wistar fatty [WDF/TaFa (fa/fa)] rats, a model of genetic obesity and insulin resistance derived from the Wistar strain. Changes in response to fasting, feeding, and intravenous stimulation with glucose plus arginine were assessed. We find that the amylin-to-insulin ratio is constant in fasted or fed young and old rats because of proportionate increases in both entities with aging. In genetically obese Wistar rats, amylin and insulin levels are three- to tenfold higher than in lean young or obese old normal controls. Islet stimulation by feeding or intravenous glucose plus arginine resulted in a decreased amylin-to-insulin molar ratio in all groups. When normalized for the degree of islet stimulation, amylin-to-insulin ratios were significantly elevated in genetically obese vs. normal rats, both in the portal and systemic circulation. These results demonstrate that aging-related weight gain in normal rats is associated with moderate and proportional increases in amylin and insulin, whereas genetic obesity is characterized by elevated amylin and an increased amylin-to-insulin ratio. Implications for the pathogenesis of insulin resistance and obesity are discussed.

Aging↗
PubMed1993

Amylin-insulin relationships in insulin resistance with and without diabetic hyperglycemia.

To determine if increased secretion of amylin can be implicated in the pathogenesis of non-insulin-dependent diabetes mellitus (NIDDM) in vitro and in vivo, we studied its relationships to insulin in insulin-resistant rats with and without NIDDM. In obesity-associated and dexamethasone-induced insulin resistance without diabetes, basal and stimulated secretion of amylin and insulin by isolated pancreata were proportionately elevated, leaving the amylin-to-insulin ratio (A/I) unchanged. By contrast, whenever diabetes occurred in dexamethasone-treated rats or in spontaneously diabetic obese insulin-resistant ZDF-drt male rats, a doubling of A/I was invariably observed due to an increase in amylin without a proportional increase in insulin secretion. Correction of dexamethasone-induced hyperglycemia with the glucocorticord receptor antagonist RU-486 was accompanied by a decline in A/I. Longitudinal in vivo studies demonstrated in both spontaneous and dexamethasone-induced models of NIDDM an increase in plasma A/I at the onset of hyperglycemia. In dexamethasone-induced diabetes, the increased A/I was associated with a high proamylin mRNA relative to proinsulin mRNA. We conclude that amylin and insulin expression and secretion rise in concert in compensated insulin-resistant states, but when hyperglycemia is present the increase in amylin exceeds that of insulin. Although a role of an increased A/I in the pathogenesis of NIDDM has not been established directly, these studies indicate that such a role could be possible.

Amyloid↗