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  • 1
    Electronic Resource
    Electronic Resource
    Weak relationship between symptom perception and objective hypoglycaemia-induced changes of autonomic function in hypoglycaemia unawareness in diabetes (1998)
    Springer
    Acta diabetologica 35 (1998), S. 1-8 
    Details
    ISSN: 1432-5233
    Keywords: Key words Hypoglycaemia unawareness ; Autonomic function ; Glucose counter-regulation ; Adrenaline ; Growth hormone
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess the relationship between symptom perception and neurophysiological characteristics in hypoglycaemia unawareness, we investigated the awareness of symptoms, objective changes of autonomic function and counter-regulatory neuroendocrine responses to hypoglycaemia in intensively treated type I (insulin-dependent) diabetic patients with different degrees of hypoglycaemia unawareness. Hypoglycaemia (venous plasma glucose below 2.2 mmol/l) was induced with an intravenous insulin bolus in subjects with a history of repeated severe hypoglycaemia and hypoglycaemia unawareness (n = 10) and in a comparable group with good awareness of hypoglycaemia (n = 8). Autonomic symptoms, selected parameters of autonomic function and counter-regulatory hormones were assessed serially. Although hypoglycaemia was more pronounced in unaware patients (1.6 vs 2.0 mmol/l, P = 0.05), their induced adrenaline response was markedly impaired (delta adrenaline: 1.25±1.10 vs 2.55±1.46 nmol/l, P = 0.05). Astonishingly, differences between both patient groups in the course of autonomic function changes did not reach the level of significance (P = 0.35–0.92), although the unaware group reported markedly fewer autonomic symptoms, both neurogenic (P = 0.001) and neuroglycopenic (P = 0.04) than the aware group. This study indicates that in hypoglycaemia unawareness even extensive changes in autonomic function are not sufficient for the perception of hypoglycaemia and confirms that the central nervous system plays an important role in the awareness of hypoglycaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005920050093
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  • 2
    Electronic Resource
    Electronic Resource
    Dealing with ceiling baseline treatment satisfaction level in patients with diabetes under flexible, functional insulin treatment: Assessment of improvements in treatment satisfaction with a new insulin analogue (2000)
    Springer
    Quality of life research 9 (2000), S. 915-930 
    Details
    ISSN: 1573-2649
    Keywords: Diabetes mellitus ; Functional insulin treatment ; Lifestyle ; Quality of life ; Randomised cross-over study ; Treatment satisfaction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Even a small improvement in satisfaction with treatment for a chronic disease can be valuable. However, sensitive measurements instruments are needed to assess the effects of treatment changes in patients already well satisfied with baseline treatment. Such instruments were thought to be necessary to deal with ceiling effects in scores of satisfaction with functional insulin treatment (FIT) accommodating full flexibility of food intake and lifestyle in diabetes by manipulation of insulin (FIT; Howorka etal. 2000). The Status(S) version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ, Bradley 1994) was extended with items measuring specific components of FIT and its psychometric properties investigated in a validation study with 171 FIT patients with diabetes. A new Change(C) version of DTSQ extended for FIT was used together with the DTSQ(S) by 52 participants in a subsequent randomised cross-over study involving new fast-acting lispro vs. regular insulin, where treatment satisfaction was the primary outcome variable. Insulin lispro use improved satisfaction (p ≤ 0.001) both, on classical and extended versions of DTSQ(S) and (C), despite high baseline levels of satisfaction. However, the DTSQ(C) augmented the effects of lispro (p = 0.0001) apparent on DTSQ(S) scores and revealed significant treatment effects (p ≤ 0.01) not significant with DTSQ(S). In parallel, glycaemic control improved with lispro (e.g., HbA1c, p = 0.023). Improved satisfaction with treatment was more apparent with DTSQ(C) than DTSQ(S) in patients who at baseline were at or near ceiling for treatment satisfaction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008921419108
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    Paper (German National Licenses)
    Fulltext
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