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Results for “Glycemic variability”

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PubMed1996

Emotional adjustment and metabolic control in newly diagnosed diabetic persons.

Emotional reactions to diagnosis were examined in a random sample of newly detected diabetic patients (n = 71) and compared with the indicators of glycemic control in a one-year-follow-up period. The social and emotional factors subscale of the diabetes care profile was used to determine the subjectively experienced burden, negative feelings and positive coping abilities. The initial struggle against the disease indicated three characteristic emotional patterns. Feelings of being able to cope with the disease predominated in group 1 (n = 36), negative emotional reactions, but with the ability to cope were observed in group 2 (n = 17) and negative feelings combined with weak coping abilities in group 3 (n = 18). The long-term indicators of glycemic control were shown to be worst in group 3 and best in group 1. Subjective perception of the disease was not associated with sociodemographic variables, with the exception of perceived coping abilities which were better in more educated persons and those with more familial support.

Adaptation, Psychological↗

PubMedDate not supplied

Implications for clinical performance measurement of interlaboratory variability in methods for glycosylated hemoglobin testing.

In order to evaluate interlaboratory variation in glycosylated hemoglobin (GHb) testing in the context of quality assessment and performance measurement systems, we conducted a telephone survey of laboratories in Washington state. The survey focused on GHb testing methods, analytes measured, reference ranges, awareness of and adherence to the National Glycohemoglobin Standardization Program (NGSP) standards, and recent changes in methods. We contacted 30 (81%) of 37 laboratories known to conduct GHb testing. Among the 25 laboratories using 1 or more test methods in-house, 5 (20%) reported only total GHb levels rather than HbA1C. There was considerable variability in test methods used and in reported high and low reference ranges within and across methods. Eight (30%) of 27 individual methods used by the laboratories were not certified by the NGSP. From January 1997 through August 1998, 11 of 25 laboratories (44%) made changes in testing methods. Despite national efforts to decrease variability in GHb testing methods, substantial variability remained in Washington state in 1997. In addition to hindering management of individual patients, this variability poses challenges for clinical performance measurement systems such as the Health Plan and Employer Data Information Set that attempt to compare the adequacy of glycemic control among health systems. However, the high frequency of recent changes in testing methods may indicate an improving trend in test methods.

Clinical Laboratory Techniques↗

PubMed2005

Dietary glycemic index, glycemic load, fiber, simple sugars, and insulin resistance: the Inter99 study.

OBJECTIVE: To examine the relationship between daily glycemic index, daily glycemic load, simple sugars, dietary fiber, and the prevalence of a measure of insulin resistance in 30- to 60-year-old nondiabetic Danish men and women. RESEARCH DESIGN AND METHODS: The Inter99 study is a nonpharmacological intervention study. We used baseline data and examined cross-sectional associations between carbohydrate-related dietary factors and an estimate of insulin resistance in 5,675 subjects at 30-60 years. The dietary intake was estimated from a self-administered food frequency questionnaire, and insulin resistance was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR). Multiple regressions were performed with HOMA-IR as the dependent variable and carbohydrate-related factors as explanatory variables. All models were adjusted for age, sex, smoking, physical activity, total energy intake, BMI, and waist circumference. RESULTS: Intake of lactose was positively associated with HOMA-IR (P < 0.0001), whereas daily glycemic load and intake of glucose, fructose, dietary fiber, total carbohydrate, fruit, and vegetables were inversely associated with HOMA-IR (P < 0.05). Intake of dietary fiber explained the associations with daily glycemic load and total carbohydrate and attenuated the association with fruit and vegetables. No significant associations were observed for daily glycemic index or sucrose. CONCLUSIONS: Habitual intake of diets with a high glycemic index and high glycemic load or diets with a high content of total carbohydrate including simple sugars was not associated with the probability of having insulin resistance. Furthermore, intake of dietary fiber was inversely associated with the probability of having insulin resistance.

Adult↗

PubMed2000

Predictors of glycemic control in insulin-using adults with type 2 diabetes.

OBJECTIVE: To determine the characteristics that influence glycemic control among insulin-using adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: We studied all 1,333 eligible members of a large not-for-profit health maintenance organization who responded to a 1997 survey. We tested associations among demographic, treatment, and psychometric variables with mean 1997 HbA1c values. The Problem Areas in Diabetes (PAID) instrument was used to assess the emotional effect of living with diabetes, and the Short Form 12 Physical Function Scale was used to assess the effect of physical limitations on daily activities. Based on differences between and within treatment groups, we built models to predict glycemic control for subgroups of subjects who were using insulin alone and those who were using insulin in combination with an oral hypoglycemic agent. RESULTS: Younger age, lower BMI, and increased emotional distress about diabetes (according to the PAID scale) were all significant predictors (P < 0.05) of worse glycemic control. However, except among individuals with an HbA1c level of >8.0 who were receiving combination therapy, only approximately 10% of the variance in glycemic control could be predicted by demographic, treatment, or psychometric characteristics. CONCLUSIONS: Personal characteristics explain little of the variation in glycemic control in insulin-using adults with type 2 diabetes. Possible explanations are that the reduced complexity of control in type 2 diabetes makes the disease less sensitive to personal factors than control in type 1 diabetes, that health-related behavior is less driven by personal and environmental characteristics among older individuals, or that, in populations exposed to aggressive glycemic control with oral hypoglycemic agents and nurse care managers, personal differences become largely irrelevant.

Activities of Daily Living↗

PubMed2002

Austrian Moderate Altitude Study 2000 (AMAS 2000). The effects of moderate altitude (1,700 m) on cardiovascular and metabolic variables in patients with metabolic syndrome.

We investigated the changes in the cardiovascular system [resting blood pressure (BP) and heart rate (HR), measured by means of a 24-h ambulatory BP and a holter-electrocardiogram (ECG)], glycemic parameters, and lipid metabolism of subjects suffering from metabolic syndrome during a 3-week sojourn at 1,700 m in the Austrian Alps. A total of 22 male subjects with metabolic syndrome were selected. Baseline investigations were performed at Innsbruck (500 m above sea level). During the 3-week altitude stay the participants simulated a holiday with moderate sports activities. Examinations were performed on days 1, 4, 9, and 19. After returning to Innsbruck, post-altitude examinations were conducted after 7-10 days and 6-7 weeks, respectively. The 24-h ambulatory BP and holter ECG revealed a decrease in average HR, BP, and rate pressure product (RPP: systolic blood pressure x HR) after 3 weeks of altitude exposure. In some patients, an increase in premature ventricular beats was observed at the end compared to the beginning of the exposure to moderate altitude. The ECG revealed no ischemic ST-segment changes. Maximal physical capacity as measured by symptom-limited maximal cycle ergometry tests remained unchanged during the study. Six weeks after the altitude exposure the blood pressure increased again and returned to pretest levels. The Homeostasis Model Assessment index, which is a measure of insulin resistance, decreased significantly and glucose concentrations obtained after an oral glucose tolerance test were significantly lower after the stay at altitude compared to the basal values. We conclude that after a 3-week exposure to moderate altitude, patients with metabolic syndrome (1) tolerated their sojourn without any physical problems, (2) exhibited short-term favorable effects on the cardiovascular system, and (3) had significant improvements in glycemic parameters that were paralleled by a significant increase in high-density-lipoprotein-cholesterol.

Adaptation, Physiological↗

PubMed1988

Insulin: either alone or combined with oral hypoglycemic agents.

Non-insulin-dependent diabetes mellitus patients are those patients who do not require insulin for survival and do not have gestational, secondary, or malnutrition-related diabetes. They may require insulin to maintain good health. Therapy in NIDDM should attempt to reverse the coexisting defects of insulin deficiency and insulin resistance that lead to hepatic glucose over-production and diminished glucose tissue utilization. Both sulfonylureas and insulin can achieve near normal FPGs and HbA1c concentrations in mild to moderately severe NIDDM. Both can reduce insulin resistance and both increase insulin availability. Evidence exists, however, showing that prevention of post-prandial hyperglycemia, whose significance is unknown, may require soluble preprandial insulin. Treatment goals should be realistic and discussed with the patient. In younger patients, the aim should be to achieve normoglycemia, while in those who have other significant medical or social problems, or who are of advanced age, diabetic control may, out of necessity, need to be relaxed. At presentation a diet and exercise program should be initiated and the patient observed if clinically well. If diet fails to reduce the FPG below 108 mg/dl, additional therapy should be used. In mild to moderate NIDDM, sulfonylurea or basal insulin (given as once daily long- or intermediate-acting insulin) can be equally successful without the need for rigid dietary habits. More severe degrees of NIDDM or patients with sulfonylurea failure not caused by dietary indiscretion will require more complex insulin regimens. The socially dependent patient requiring insulin should have as simple a regimen as possible. The insulin-resistant patient undergoing surgery or with an intercurrent illness is most easily managed with a variable rate insulin infusion that allows prediction of subsequent subcutaneous insulin requirements. Combination insulin-sulfonylurea therapy should be reserved for patients failing to achieve acceptable glycemic control when insulin and sulphonylurea are used separately. It may improve control or lessen insulin requirements.

Diabetes Mellitus, Type 2↗

PubMed2002

The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes.

OBJECTIVE: Treating dyslipidemia in diabetic patients is essential, particularly among minority populations with increased risk of complications. Because little is known about the impact of outpatient diabetes management on lipid outcomes, we examined changes in lipid profiles in urban African-Americans who attended a structured diabetes care program. RESEARCH DESIGN AND METHODS: A retrospective analysis of initial and 1-year follow-up lipid values was conducted among patients selected from a computerized registry of an urban outpatient diabetes clinic. The independent effects of lipid-specific medications, glycemic control, and weight loss on serum total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels were evaluated by analysis of covariance and multiple linear regression. RESULTS: In 345 patients (91% African-American and 95% with type 2 diabetes), HbA(1c) decreased from 9.3% at the initial visit to 8.2% at 1 year (P < 0.001); total and LDL cholesterol and triglyceride levels were significantly lower, and HDL cholesterol was higher. After stratifying based on use of lipid-specific therapy, different outcomes were observed. In 243 patients not taking dyslipidemia medications, average total cholesterol, LDL cholesterol, and triglyceride concentrations at 1 year were similar to initial values, whereas in 102 patients receiving pharmacotherapy, these lipid levels were all lower at 1 year relative to baseline (P < 0.001). Mean HDL cholesterol increased regardless of lipid treatment status (P < 0.001). After adjusting for other variables, changes in LDL cholesterol concentration were associated only with use of lipid-specific agents (P = 0.003), whereas improved HbA(1c) and weight loss had no independent effect. Lipid therapy, improved glycemic control, and weight loss were not independently related to changes in HDL cholesterol and therefore could not account for the positive changes observed. Use of lipid-directed medications, improvement in glycemic control, and weight loss all resulted in significant declines in triglyceride levels but only improved HbA(1c) and weight loss had an independent effect. CONCLUSIONS: Among urban African-Americans, diabetes management led to favorable changes in HDL cholesterol and triglyceride levels, but improved glycemic control and weight loss had no independent effect on LDL cholesterol concentration. Initiation of pharmacologic therapy to treat high LDL cholesterol levels should be considered early in the course of diabetes management to reach recommended targets and reduce the risk of cardiovascular complications in this patient population.

Black or African American↗

PubMed2006

Serum lipids and the progression of nephropathy in type 1 diabetes.

OBJECTIVE: Dyslipidemia contributes to the progression of microvascular disease in diabetes. However, different lipid variables may be important at different stages of nephropathy. This study examines the pattern of dyslipidemia associated with the progression of nephropathy in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 152 patients with type 1 diabetes were recruited in order to represent various phases of nephropathy. Patients were followed for 8-9 years, during which time they received standard care. Renal progression was defined a priori as a doubling in albumin excretion (in patients with normo- or microalbuminuria) or a decline in creatinine clearance (in those with macroalbuminuria). A panel of lipid variables was determined and correlated with indexes of progression. RESULTS: In patients with normoalbuminuria (n = 66), progression was associated with male sex (P < 0.05), borderline albuminuria (P = 0.02), and LDL-free cholesterol (P = 0.02). In patients with microalbuminuria (n = 51), progression was independently associated with triglyceride content of VLDL and intermediate-density lipoprotein (both P < 0.05). In patients with macroalbuminuria (n = 36), a significant decline in the renal function (>3 ml x min(-1) x year(-1)) was independently associated with poor glycemic control, hypertension, and LDL size (P < 0.05). When all patients with progressive nephropathy were analyzed together, only LDL cholesterol was predictive on multivariate analysis (P < 0.05), which masked the importance of triglyceride enrichment in microalbuminuria. CONCLUSIONS: Lipid variables are associated with progression of diabetic kidney disease, but the relationship is not the same at all stages. This finding has implications for the design of renoprotective strategies and the interpretation of clinical trials in type 1 diabetes.

Adult↗

PubMed2000

Influence of the initial management regimen and family social situation on glycemic control and medical care in children with type I diabetes mellitus.

It is well known that social family factors are of importance in diabetes care, but it is not clear whether the initial management regimen can buffer these factors. In a prospective, randomized intervention study, 36 children with diabetes mellitus (type I) were followed, the aim being to study if a family psychosocial intervention at diagnosis could improve glycemic control and minimize hospital admissions. The control group was treated initially in a hospital ward, while the study group received problem-based learning and family-therapeutic and social support in an out-hospital training apartment. A number of family social variables were evaluated at the time of diagnosis and 6, 12 and 24 mo later. Family function was assessed using the self-estimated Family Climate Test at these same time-points. HbAlc values and information concerning in- and out-hospital visits to the pediatric clinic were collected for the 5-y period following diagnosis. We found no association between the offered management regimen and glycemic control or rate of readmission. In the study group only, both parents reported a significant improvement of the family climate. An increased risk for poor glycemic control was recorded in children living in one-parent families (p = 0.03) or in families where the father had a low level of education (p = 0.04). Younger age (p = 0.05), a single-parent family (p = 0.05) and poor glycemic control (p = 0.02) were associated with more days of rehospitalization. The rate of divorce in the whole group was at least as high as in the normal population but, surprisingly, maternal dysfunction was associated with lower HbAlc value. The conclusion is that even with an initial management regimen designed to offer a family-individual care regimen based on accurate estimation of the psychological and pedagogical needs, the social family background is a most important factor for the glycemic control and need for readmission.

Adolescent↗

PubMed2002

Troubleshooting the diabetic small animal patient.

Effective troubleshooting for a diabetic small animal patient starts with the initial diagnosis of diabetes. Preempting trouble with a thorough and complete history, physical examination, laboratory assessment, and extensive and thoughtful client education before discharge, are crucial first steps toward avoiding trouble altogether. As problems arise, careful consideration of the many variables that contribute to effective diabetic control is necessary. As monitoring strategies evolve and treatment options expand, the clinician's ability to accurately assess and adjust the glycemic control in his or her troubled diabetic patient improves. Common causes of trouble in diabetic patients are reviewed and various strategies for the diagnosis and management of these disorders are discussed in this article. Every effort was made to draw from recently published reports of clinical cases. Few diseases will tie together owner, patient, and therapy as intimately as diabetes mellitus, and few problems will be solved without fully considering all potential factors.

Animals↗

PubMed1992

Angiotensin-converting enzyme inhibitor therapy and diabetic retinopathy.

This pilot project suggested that angiotensin-converting enzyme (ACE) inhibitors may have an effect on delaying or reversing diabetic retinopathy. One patient who had Grade 5 (preproliferative) retinopathy improved to Grade 2 (microaneurysms only) after two years of treatment. Of the 450 patients followed in our eye and kidney clinic, no other patient showed a similar reversal from Grade 5 retinopathy without treatment. Improvement by one or more grades was seen in three other patients with variable grades of retinopathy after a mean of 3.3 years of treatment. Improvement was not related consistently to a decrease in blood pressure (0 of 4), better glycemic control (2 of 4), or reduction in albumin excretion rate (0 of 4). Proper double-blind controlled studies are needed to prove the effect of ACE inhibitors on diabetic microangiopathy of the eye.

Adolescent↗

PubMed1993

Increased fetal hemoglobin in insulin-treated diabetes mellitus contributes to the imprecision of glycohemoglobin measurements.

An increased prevalence of fetal hemoglobin (HbF) has been described in pediatric insulin-dependent patients. The popular electroendosmotic method for glycohemoglobin includes HbF. In an adult population comprising 50 insulin-treated and 57 non-insulin-treated diabetic patients and 57 control subjects, we measured HbF by HPLC and measured glycohemoglobin by both HPLC and an electroendosmotic method. Of the insulin-treated patients, 46% had concentrations of HbF > or = 0.5%, compared with 25% of non-insulin-treated patients and 23% of controls (P < 0.02). In the insulin-treated patients, the two glycohemoglobin methods correlated best when the HPLC measurements included HbF (r = 0.92 vs r = 0.84). Fructosamine concentrations correlated best with glycohemoglobin concentrations determined by methods that accounted for HbF. The true between-batch CV of the electroendosmotic assay increased (from 4.33% to 8.33%) when variable interpatient HbF concentrations were included. Thus, HbF must be considered when interpreting glycohemoglobin measured by an electroendosmotic method and when comparing it with other measures of glycemic control.

Adolescent↗

PubMed2001

Comorbidity of diabetes mellitus and eating disorders: a follow-up study.

OBJECTIVE: There is increasing evidence that the coexistence of diabetes and eating disorders (ED) leads to poor glycemic control and an increased risk of long-term complications. METHODS: In a questionnaire- and interview-based study, a sample of 36 out of originally 38 (94.7%) diabetic patients with an ED (type-1: n=13, type-2: n=23) was assessed after a period of about 2 years in order to determine the course of EDs, body mass index (BMI), glycemic control, and psychiatric symptomatology. RESULTS: Five patients (13.9%) of the total sample showed full remission for at least 12 consecutive weeks. Twenty-two patients (61.6%) showed no change in the diagnosis of the ED. Four patients (11.1%) shifted from subclinical to clinical EDs and five patients (13.9%) vice versa. Of the eight patients who went on to psychotherapy, only one patient (12.5%) showed full remission. Emotional distress of type-2 diabetics was considerably higher compared to type-1 diabetics, which was rather low at baseline. Except interpersonal distrust as one ED-related variable, no significant change of any psychological variable could be observed in the type-1 diabetic sample during follow-up. Of the 13 type-1 diabetic patients with an ED, five patients deliberately omitted insulin in order to lose weight. These patients showed a more serious psychopathology with regard to each measured psychological variable, a higher BMI, and worse metabolic control compared to those without insulin omission. Type-2 diabetics showed a significant increase in drive for thinness and body dissatisfaction. No considerable change could be observed with regard to BMI, glycemic control, and depressive and global psychiatric symptomatology in either diabetic subsample during follow-up. CONCLUSION: EDs tended to persist over time with a considerable shift within the different types of EDs. Insulin-purging in type-1 diabetics was associated with enhanced psychopathology, higher BMI, and worse metabolic control. Both mean body mass and ED-related symptoms such as "drive for thinness" and "body dissatisfaction" increased in the average obese type-2 diabetic sample, illustrating the vicious circle of low self-esteem, enhanced restraint eating, and binge eating in weight control measures.

Adult↗

PubMed1989

Inability to detect parasympathetic autonomic neuropathy in experimental canine diabetes mellitus in an electrocardiographic study.

Resting electrocardiography was used to evaluate parasympathetic control of the heart rate and heart rate variability in 25 adult alloxan-diabetic dogs and 34 nondiabetic controls. The duration of diabetes (mean +/- SEM) was 3.0 +/- 0.3 yr. Such long-term diabetes had no apparent effect on resting heart rate, maximum R to R interval variation, or percentage of subjects exhibiting respiratory sinus arrhythmia. In addition, despite significant differences in glycemic control between experimental groups, no differences in the above electrocardiographic parameters were demonstrated. Electrocardiographic indices of autonomic function were not significantly correlated with glycosylated hemoglobin concentration, age, or duration of diabetes. Up to 40% of diabetic humans develop autonomic neuropathy (diabetic autonomic neuropathy), with virtually all studies showing higher heart rates and greater heart rate variability in diabetics as compared to nondiabetic controls. The absence of electrocardiographic indicators of autonomic neuropathy in this study suggests that the dog is less susceptible to the development of diabetic autonomic neuropathy than is the diabetic human and therefore may be a poor model for many studies.

Animals↗

PubMedDate not supplied

Bootstrap confidence intervals for costs-of-illness of type 2 diabetes mellitus in Germany.

OBJECTIVE: The Costs of Diabetes in Europe-Type 2 study (CODE-2, SmithKline Beecham plc) measures costs of managing patients with type 2 diabetes mellitus in Germany. The aim of this analysis was to assess the uncertainty of these estimates. DESIGN AND SETTING: The German study arm was based on a sample of 809 patients with type 2 diabetes registered in general practices. Information on socioeconomic data, medical resource use, and clinical data was collected retrospectively for 1998. PATIENTS AND PARTICIPANTS: Patients were grouped in five strata based on their complication status, because of the high impact of complications on costs. To obtain higher credibility of resulting estimates, rare complication groups were overrepresented. To be representative, results were weighted using real prevalence data on complications from a prestudy. MAIN OUTCOME MEASURES AND RESULTS: Within each stratum, results were calculated as arithmetic mean except for demographic data, where the median was applied as input for weighted averages. Because the degree of precision of calculated estimates was not accessible analytically, 95% confidence intervals (CIs) were computed via bootstrapping of 10,000 independent bootstrap samples for each of the calculated estimates. All costs are given for the payers' perspective in German Deutsche Mark (DM). Costs per patient and year for ambulatory care were DM 775 with 95% CI (721-835), for hospitalizations DM 2771 (2242-3342), for drug treatment DM 1496 (1399-1598), and for rehabilitation DM 120 (70-177). The indirect cost was DM 372 (144-645). From the perspective of the sickness funds, cost per patient and year was DM 5539 (5184-5894). Mean HbA1c status was 7.51% (7.37-7.66) with the majority of patients not achieving glycemic control below 6.5%. CONCLUSION: Bootstrap CIs are remarkably narrow. Combining a weighted stratification with bootstrap estimation is an appropriate method for analyzing the weighted average of highly variable and skewed parameters such as costs of diabetes.

Adult↗

PubMed1994

Granulocyte deformability and F-actin content: relationship to diabetes mellitus and retinopathy.

Capillary closure in diabetic retinopathy may be initiated by lumenal occlusion by granulocytes. To determine whether subjects with diabetes mellitus have less deformable granulocytes than healthy subjects, granulocyte deformability was measured by mean entry time into a model capillary system in 16 diabetic-nondiabetic pairs. Granulocyte F-(filamentous) actin content between groups was compared, under basal conditions and after cellular stimulation. The relationship of granulocyte deformability to several diabetes-related variables was examined. Diabetic granulocytes were only 9% +/- 22% less deformable than normal granulocytes (p = 0.16). Deformability was increased in subjects with retinopathy and those with the worst glycemic control (r = 0.61, p = 0.026); both findings were in the opposite direction from that predicted. Basal and stimulated granulocyte F-actin content did not differ between the two groups (p > 0.2 for all assays). Although granulocytes may be important in the pathogenesis of diabetic retinopathy, granulocyte deformability (measured by mean entry time) and F-actin content are not significantly different between healthy patients and those with diabetes.

Actins↗

PubMed2004

Clinical use of sibutramine.

Since obesity is a chronic disorder, a long-term approach is essential, and modern obesity pharmacotherapy means medicating as an adjunct to diet and physical activity not only to achieve weight loss, but also to maintain it. Sibutramine is a US Food and Drug Administration- and European Committee for Proprietary Medicinal Products-approved medication with demonstrated efficacy in long-term obesity management. It is a norepinephrine-serotonin reuptake inhibitor and produces weight loss by a dual mechanism: reduction of food intake and increase in energy expenditure. Sibutramine is given once daily in doses ranging from 5-15 mg. The amount of weight lost with sibutramine is related to both the dose of the drug and the intensity of the behavioral therapy component. Sibutramine produces a weight loss from baseline of more than 5% in over 75% of patients who are prescribed 15 mg daily, and it produces weight loss that averages 5-8% from baseline, independently of the behavioral approach. Weight loss with sibutramine is associated with improvement in waist circumference, lipids, glycemic control, uric acid and health-related quality of life. Sibutramine use is associated with small increases in mean resting blood pressure, but the individual response is variable and not all patients will have blood pressure increases. The drug is also associated with small increases in mean heart rate and should therefore not be used in patients with a history of cardiac arrhythmia. Because it is a serotonin and norepinephrine reuptake inhibitor, sibutramine should not be used with monoamine oxidase inhibitors or noradrenergic agents, and caution is advised in prescribing sibutramine to patients on selective serotonin reuptake inhibitor antidepressants. Given the growing appreciation for the health benefits that can be achieved with even a relatively small weight loss, physicians must become adept in office approaches to achieve modest weight loss. Sibutramine is a useful adjunct to diet and physical activity approaches and can help selected patients achieve and maintain weight loss with concomitant health benefits.

Chronic Disease↗

PubMed2005

Glycemic status in women using combined oral contraceptive pill.

This study was undertaken to determine the effects of low-dose combined oral contraceptives(OCs) containing 30 gm Ethinyl estradiol with 150 microg Levonorgestrel on carbohydrate metabolism by a glycaemic variable -- fasting blood glucose level. It is now known that impairment of carbohydrate metabolism is a potential risk factor for cardiovascular disease and other metabolic disorder. Sixty women age between 15-35 years using OCs served as experimental group and thirty age matched hormonal contraceptive non users were selected for control group. Experimental group was again subdivided into OCP (Oral contraceptive pill) users for last one year group, three year group and five year group. The result showed that there were no significant differences on blood glucose level between users and non-users women. It is concluded that the cyclic administration of monophasic low dose OCs did not altered blood glucose levels and there by have no additional adverse impact on women health reaffirming the ongoing oral contraceptive pill distribution program.

Adolescent↗