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  • 1995-1999  (4)
  • 1870-1879
  • Critically ill  (2)
  • HbA1c  (2)
  • 1
    Electronic Resource
    Electronic Resource
    Social status and the quality of care for adult people with Type I (insulin-dependent) diabetes mellitus – a population-based study (1998)
    Springer
    Diabetologia 41 (1998), S. 1139-1150 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Type I (insulin-dependent) diabetes ; quality of care ; diabetes education ; late complications ; HbA1c ; hypoglycaemia ; diet ; cardiovascular complications ; quality of life.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The objective of this study was to assess the degree of diabetes care and education achieved for Type I (insulin-dependent) diabetes mellitus at the community level in relation to social status and to elucidate potential pathways that mediate any social class gradient. A population-based sample of 684 adults with Type I diabetes (41 % women, mean ± SD age 36 ± 11, diabetes duration 18 ± 11 years) in the district of North-Rhine (9.5 million inhabitants), Germany, were examined in their homes using a mobile ambulance. Results: HbA1c (normal 4.3–6.1 %) 8.0 ± 1.5 %, incidence of severe hypoglycaemia (injection of glucose or glucagon) 0.21 cases per patient-year; 62 % of patients had participated in a structured group treatment and teaching programme for intensification of insulin therapy; 70 % used 3 or more insulin injections per day, 9 % were on continuous subcutaneous insulin infusion; 91 % reported to have had measurements of HbA1c during the preceding year, and 80 % to have had an examination of the retina by an ophthalmologist. Care was insufficient with respect to the quality of blood pressure control (70 % of patients on antihypertensive drugs had blood pressure values ≥ 160/95 mmHg), patient awareness of proteinuria/albuminuria (27 % of patients had not heard about it) and prevention of foot complications (only 42 % with a diabetes duration over 10 years had remembered to have a foot examination during the preceding 12 months). There was a pronounced social gradient with respect to micro- and macrovascular complications (prevalence of overt nephropathy 7 vs 20 % for highest vs lowest quintiles of social class [OR 3.5, 95 % CI 1.6–7.5, p = 0.002]) and diabetes-specific quality of life. HbA1c, blood pressure and smoking accounted for part of the association between social class and microvascular complications. The social class gradient was not due to inequality to access to health services, but to lower acceptance among low social class patients of preventive and health maintaining behaviour. In conclusion, achieved standards of care are high with respect to the implementation of intensified treatment regimens, the level of patient education achieved, treatment control and eye care, whereas areas for improvement are blood pressure control and preventive measures for foot care. A substantial social gradient in diabetes care persists despite equal access of patients to health services. [Diabetologia (1998) 41: 1139–1150]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051043
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    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Are presently available insulin analogues clinically beneficial? (1997)
    Springer
    Diabetologia 40 (1997), S. S91 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Insulin analogues ; intensified insulin therapy ; HbA1c ; hypoglycaemia ; quality of life ; insulin-dependent diabetes mellitus.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A number of insulin analogues have been developed by genetic engineering in order to improve the possibilities of substituting prandial and basal insulin requirements in diabetic patients by subcutaneous injection. For some short acting insulin analogues, in particular for [Lys(B28),Pro(B29)]-human insulin, preclinical and clinical trials have been performed. Despite the favourable pharmacokinetic and pharmacodynamic characteristics of these short-acting insulin analogues resulting in an attenuation of prandial hyperglycaemia following subcutaneous injection in diabetic patents, up to now, actual clinical benefits have not become apparent when they were used in clinical trials. [Diabetologia (1997) 40: S 91–S 97]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051416
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Relations between the selenium status and the low T3 syndrome after major trauma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 575-581 
    Details
    ISSN: 1432-1238
    Keywords: Low T3 syndrome ; Selenium ; Deiodination ; Glutathione peroxidase ; Balance study ; Critically ill ; Trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Thyroxine (T4) is deiodinated to triiodothyronine (T3) by the hepatic type I iodothyronine deiodinase, a selenoprotein that is sensitive to selenium (Se) deficiency. After severe injury, T4 deiodination is decreased, leading to the low T3 syndrome. Injury increases free radical production, which inactivates the iodothyronine deiodinase. The aims were to study the Se status after major trauma and to investigate its relation to the low T3 syndrome. Design Preliminary prospective descriptive study. Setting Intensive care unit at a university teaching hospital. Patients and methods 11 patients aged 41±4 years (mean±SEM), with severe multiple injuries (Injury Severity Score 29±2 points). A balance study was performed from day 1 to day 7. Serum and urine samples were collected from the time of admission until day 7, then on days 10, 15, 20, 25 and 30. Nonparametric tests and Pearson's correlation coefficients were used for analysis. Results Cumulated Se losses were 0.88±0.1 μmol/24h. Serum Se was decreased from admission to day 7. T3, free T3, and the T3/T4 ratio were low until day 5, being lowest on day 2; T4 and thyroid stimulating hormone were normal. Serum Se was correlated with T3 (r=0.55,p=0.0001), and with free T3 (r=0.35). Conclusion Se status is altered after trauma, with decreased Se serum levels upon admission to the ICU but with no major Se losses. Se is probably redistributed to the tissues. The correlation between Se and T3, along with the parallel decrease in T4 deiodination, indicates that reduced deiodination might be related to the transient decrease in serum Se.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708099
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Relations between the selenium status and the low T3 syndrome after major trauma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 575-581 
    Details
    ISSN: 1432-1238
    Keywords: Key words Low T3 syndrome ; Selenium ; Deiodination ; Glutathione peroxidase ; Balance study ; Critically ill ; Trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Thyroxine (T4) is deiodinated to triiodothyronine (T3) by the hepatic type I iodothyronine deiodinase, a selenoprotein that is sensitive to selenium (Se) deficiency. After severe injury, T4 deiodination is decreased, leading to the low T3 syndrome. Injury increases free radical production, which inactivates the iodothyronine deiodinase. The aims were to study the Se status after major trauma and to investigate its relation to the low T3 syndrome. Design: Preliminary prospective descriptive study. Setting: Intensive care unit at a university teaching hospital. Patients and methods: 11 patients aged 41±4 years (mean±SEM), with severe multiple injuries (Injury Severity Score 29±2 points). A balance study was performed from day 1 to day 7. Serum and urine samples were collected from the time of admission until day 7, then on days 10, 15, 20, 25 and 30. Non-parametric tests and Pearson‘s correlation coefficients were used for analysis. Results: Cumulated Se losses were 0.88±0.1 μmol/24 h. Serum Se was decreased from admission to day 7. T3, free T3, and the T3/T4 ratio were low until day 5, being lowest on day 2; T4 and thyroid stimulating hormone were normal. Serum Se was correlated with T3 (r=0.55, p=0.0001), and with free T3 (r=0.35). Conclusion: Se status is altered after trauma, with decreased Se serum levels upon admission to the ICU but with no major Se losses. Se is probably redistributed to the tissues. The correlation between Se and T3, along with the parallel decrease in T4 deiodination, indicates that reduced deiodination might be related to the transient decrease in serum Se.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708099
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
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