ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08540.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.Altogether, histologic findings in animals and in man with diabetes mellitus, together with clinical findings in man with this disease and with biochemical abnormalities, suggest that the main cause of microangiopathy in persons with diabetes mellitus lies in metabolic disorders. The possibility that genetic and environmental factors are influential cannot, however, be ruled out. In a small although steadily increasing number of diabetics early microangiopathic and neuropathic abnormalities have proved to be reversible. This improvement includes functional abnormalities of the retina, glomeruli and nerves. Early morphologic changes of the retina also, seem to be preventable. On the other hand, more severe morphologic' changes such as proliferative retinopathy, and severe diabetic neuropathy have proved resistant to intensified insulin treatment. It remains to establish whether continuous optimal control by insulin treatment generally can prevent early although clinical microangiopathy. The development of instruments and other aids for improved metabolic control, such as transplantation of insulin‐producing tissue, would seem to be a logical step in this directio

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08541.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.The need for a comprehensive description of blood glucose control on the basis of blood glucose measurement has dramatically increased with the improved methods for blood glucose monitoring and the new devices for blood glucose regulation in diabetics. Blood glucose concentrations measured at approximately equidistant sampling times over a number of consecutive 24‐hour periods were analysed by a computerized method for time series analysis. This enabled an exhaustive, though simple description of the blood glucose variation based upon linear correlations between successive measured values and values measured with 24 hours interval. The method describes the day to day variation in blood glucose control as well as the blood glucose oscillations within the day. This information may be used to define in particular patients, patient groups and in normals the “degree of blood glucose control” which is the quantitative measure of the strength of the linear correlations mentioned above. Quantitative measures of the deviations in blood glucose control in patients from that found under comparable conditions in normal subjects then define the “goodness of blood glucose control”. These methods have been used for an evaluation of the blood glucose control in 10 normal subjects and in 8 type 1 diabetics treated with porcine insulin during one period and with human insulin during another period. Regimes with human and porcine insulin resulted in the same degree of control in the diabetics. The correlations which define the degree of blood glucose control were, on an average, of the same magnitude in the diabetics as in the normal controls. The “goodness of blood glucose control” in terms of mean blood glucose level and the unpredictable blood glucose variation was clearly inferior in the patients compared to the normals. However, a precise definition requires further experience with the method on diab

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08542.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.This study estimates the economic cost of diabetes mellitus in Sweden 1978. It also addresses the question of potential savings from improved metabolic control. Economic costs of illness include direct costs for medical care and indirect costs from lost production due to morbidity and premature death. The total costs of diabetes are estimated at 1300 million SEK in Sweden 1978. The direct costs for medical care accounted for 43% of these costs. Lost production due to permanent disability is the dominating indirect costs, and accounts for 60% of indirect costs and one third of the total costs. Institutional care accounts for two thirds of the direct costs. The costs for drugs and medical devices amount to 128 million SEK or 1000 SEK per insulin‐ or oraldependent diabetic. Costs for control of diabetes are estimated to 20% of the total cost and 50% of direct costs. The conclusion is that there are great potential benefits to be expected from improved self control of diabete

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08543.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.Home blood glucose monitoring is one of the corner‐stones in the management of type I diabetes. This paper summarizes the aims and effects of this method and will discuss the pros and cons with simple patient‐adapted meters and visual judgement of the blood glucose strip. It is underlined that a thorough handling of the strip is essential for the result whatever method used. The problem solving capacity of home blood glucose monitoring in unstable diabetes is illustra

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08544.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.The BM‐Test‐Glycemie 1–44 test strip facilitates self‐monitoring without the use of a photometer. In a population of 33 diabetic patients (age 24.8±2.9 years) 94% took part in home monitoring for 6–10 months. Of 29 who answered a questionnaire 25 preferred blood glucose testing to urine testing. In a “beta‐cell school” it was taught that it is rational if home monitoring of blood glucose is combined with a tailored insulin treatment consisting of long‐acting insulin (Ultralente) as a basal insulin and regular insulin (Actrapid) as a meal insulin. In a group of 24 labile diabetic patients 17 preferred this regime compared to earlier use of intermediate acting insulin and regular insulin. Six of these preferred the regular insulin to be taken in three doses. Hypoglycemia, when it occurred, was less distressing in symptoms than previously. Among patients with recent onset of diabetes active participation with dose reduction was seen during the honey‐moon stage. The regime is logical and generative, offers a basis for an individualized therapy and a high remission frequ

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08545.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.Diabur‐Test 5000 is a new semiquantitative test strip for the determination of urine glucose concentrations up to 5%. The results are comparable to those obtained with the Clinitest method, although Diabur‐Test 5000 has the advantage of being sensitive also for low glucose concentrations. Diabur‐Test 5000 is easier to use than the Clinitest method. It is well accepted by patients for self control, and might also be used for routine clinical

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08546.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.Glycosylated haemoglobin or HbA, is a valuable instrument and an objective method to evaluate the metabolic state in the management of diabetes mellitus. This paper summarizes the value of HbA1analysis from the clinical point of view, discussing errors and indications. Only 20% of a group of type I diabetic patients had acceptable HbA1niveau indicating that a lot of work has to be done to achieve normoglycaemia in ordinary diabetics outside the remission period and during pregnancy.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08547.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.It is rather difficult to draw conclusions from reported C‐peptide values, as the methods for determination differ, and C‐peptide may be measured in serum or in urine with the patient fasting or after stimulation. We have followed prospectively 49 children with IDDM with regular determinations of serum C‐peptide fasting and after a standardized breakfast. A subgroup of seven patients have been studied more thoroughly with 24‐hour‐profile of serum C‐peptide, C‐peptide excretion in urine, and stimulation by i.v. glucose + i.v. arginine. Our results indicate that the stimulation of the beta cells usually reaches a maximum around a blood glucose level of 10–12 mmol/l leading to a curve linear relationship between serum C‐peptide and blood glucose. Thus a simple quotient is not so useful but the degree of stimulation should be stated and actual blood glucose value noticed. Stimulation with a standardized breakfast gives roughly the same information as maximal stimulation with i.v. glucose + arginine, and little extra information is found by a 24‐hour‐profile. Urinary C‐peptide may give valuable information if it is related to the actual degree of metabolic balance. It can be of special interest in patients with very low

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08548.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

ABSTRACT.With the development of the C‐peptide assay more systematic studies of the endogenous insulin secretion have been possible in insulin‐dependent diabetes. Several reports now support the view that nearly 100% of patients have functioning beta‐cells at onset of disease. After start of insulin therapy most patients have a transient improvement in beta‐cell function, the remission period, with a maximum found between 2 and 5 months after diagnosis. Thereafter the beta‐cell function declines, but after 2 years duration of disease nearly 100% of the patients still will display residual beta‐cell function. The following years the prevalence of residual beta‐cell function will decrease to about 15% after 10 to 15 years duration, and thereafter no further decline in prevalence seems to occur. At present it is unclear why insulin‐dependent patients have different degree of beta‐cell function after years duration of disease. We have demonstrated that age at onset is of importance the first 10–15 years of disease, where the prevalence was highest in the elder patients. Thereafter the age at onset is without influence on prevalence of residual beta‐cell function. The degree of metabolic control is also of importance for beta‐cell function. Both at onset and in patients past their initial remission period has improvement in glucaemic control resulted in an improved beta‐cell function; but disappointingly this effect has only been transient. Whether poor metabolic control accelerates the destruction of the beta‐cells is not known. The importance of the many abnormal immunological parameters found in insulin‐dependent diabetics still has to be elucidated. Until now none of them have shown correlations to residual beta‐cell function. Therefore, at present it is impossible to predict at diagnose and during the first year of disease, which patients who will display residual bet

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1983.tb08549.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY