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  • 1
    Electronic Resource
    Electronic Resource
    Insulin resistance characterizes glucose uptake in skeletal muscle but not in the heart in NIDDM (1998)
    Springer
    Diabetologia 41 (1998), S. 555-559 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Myocardium ; insulin resistance ; non-insulin-dependent diabetes mellitus ; positron emission tomography.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Skeletal muscle insulin resistance and coronary heart disease (CHD) often precede non-insulin-dependent diabetes mellitus (NIDDM). A recent study showed the myocardium of patients with CHD to be insulin resistant, independent of blood flow. We determined whether myocardial insulin resistance is a feature of NIDDM patients with no CHD. Skeletal muscle and myocardial glucose uptake were determined in 10 patients with NIDDM and 9 age- and weight-matched normal men of similar age and body mass index men using [18F]-2-fluoro-2-deoxy-d-glucose and positron emission tomography under normoglycaemic hyperinsulinaemic conditions. Whole body glucose uptake, as determined by the euglycaemic clamp technique, was significantly lower in the patients with NIDDM (35 ± 3 μmol/kg body weight · min) than the normal subjects (45 ± 3 μmol/kg body weight · min, p 〈 0.02). Insulin-stimulated femoral muscle glucose uptake was significantly lower in the patients with NIDDM (71 ± 6 μmol/kg muscle · min) than in the normal subjects (96 ± 5 μmol/kg muscle · min, p 〈 0.01). Whole body glucose uptake was correlated with femoral muscle glucose uptake in the entire group (r = 0.76, p 〈 0.001), in patients with NIDDM and in normal subjects. Rates of insulin-stimulated myocardial glucose uptake were comparable between the patients with NIDDM (814 ± 76 μmol/kg muscle · min) and the normal subjects (731 ± 63 μmol/kg muscle · min, p 〉 0.4). Whole body or femoral muscle, and myocardial glucose uptake were not correlated in all subjects, patients with NIDDM or normal subjects. We conclude that insulin resistance of the myocardium is not a feature of uncomplicated NIDDM. [Diabetologia (1998) 41: 555-559]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050946
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  • 2
    Electronic Resource
    Electronic Resource
    Cardiovascular risk factors clustering with endogenous hyperinsulinaemia predict death from coronary heart disease in patients with Type II diabetes (2000)
    Springer
    Diabetologia 43 (2000), S. 148-155 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Type II diabetes, death from CHD, insulin, insulin resistance syndrome, lipids, hypertension, smoking, central obesity, urinary protein, sex.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. Information on the association of hyperinsulinaemia with coronary heart disease (CHD) in patients with Type II (non-insulin-dependent) diabetes is limited and controversial. Therefore, we carried out a prospective study to examine the predictive value of fasting plasma insulin and “hyperinsulinaemia cluster” with regard to the risk of CHD mortality.¶Methods. At baseline risk factors for CHD were determined in 902 patients aged 45 to 64 years with Type II diabetes not treated by insulin (499 men and 403 women). These patients were followed up to 7 years for CHD mortality.¶Results. Coronary heart disease mortality (16.2 % in men, 9.2 % in women) increased significantly in men with increasing plasma insulin tertiles (p = 0.006) and in both sexes combined (p = 0.010) but not in women (p = 0.090). The predictive value of hyperinsulinaemia with regard to death from CHD was independent of conventional cardiovascular risk factors but not of risk factors clustering with hyperinsulinaemia. By applying factor analysis and principal component analysis we showed that “hyperinsulinaemia cluster” (a factor having high positive loadings for body mass index, triglycerides and insulin; and a high negative loading for high-density lipoprotein cholesterol) was predictive of death from CHD in patients with Type II diabetes (hazard ratio with 95 % confidence intervals 1.43 (1.18, 1.73), p 〈 0.001).¶Conclusion/interpretation. Our results support the notion that cardiovascular risk factors clustering with endogenous hyperinsulinaemia increase the risk of death from CHD in patients with Type II diabetes not treated with insulin. [Diabetologia (2000) 43: 148–155]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050023
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Does NIDDM increase the risk for coronary heart disease similarly in both low- and high-risk populations? (1995)
    Springer
    Diabetologia 38 (1995), S. 487-493 
    Details
    ISSN: 1432-0428
    Keywords: Key words Coronary heart disease ; non-insulin-dependent diabetes mellitus. [Diabetologia (1995) 38: 487 ; 493].
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Finland has marked regional differences in the occurrence of coronary heart disease (CHD). Although the causes for these differences in CHD mortality and morbidity in the Finnish population are unknown, it offers an excellent opportunity to investigate the effects of non-insulin-dependent diabetes mellitus (NIDDM) on CHD risk in two populations differing significantly with respect to the occurrence of CHD. Therefore, we carried out a 7-year prospective population-based study including a large number of patients with NIDDM (East Finland: 253 men and 257 women; West Finland: 328 men, 221 women) and corresponding non-diabetic subjects (East Finland: 313 men, 336 women; West Finland: 325 men, 399 women). In both study populations the presence of NIDDM increased significantly the risk for CHD events (CHD mortality or all CHD events including CHD mortality or non-fatal myocardial infarction). Diabetic men had 3–4 fold higher and diabetic women 8–11-fold higher risk for CHD than corresponding non-diabetic subjects. Both non-diabetic and diabetic subjects had odds ratios (East vs West) for CHD events of about 2 indicating a similar East-West difference in the CHD risk. Regional difference was quite similar in men and women. These results imply that factors related to NIDDM, independently of conventional risk factors and the occurrence of atherothrombosis in the background population, must play a major role in the pathogenesis of atherosclerotic vascular disease in NIDDM diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00410288
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    The role of insulin in clustering of serum lipids and blood pressure in children and adolescents (1995)
    Springer
    Diabetologia 38 (1995), S. 1042-1050 
    Details
    ISSN: 1432-0428
    Keywords: Insulin ; longitudinal ; clustering ; children ; adolescents ; serum lipoproteins ; blood pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In adults hyperinsulinaemia is associated with an atherogenic risk profile including obesity, low levels of HDL-cholesterol, high levels of triglycerides and elevated blood pressure. To examine these associations in the young we studied the cross-sectional relationships of insulin with obesity indices (body mass index, subscapular skinfold thickness), serum lipids and blood pressure in 1,865 children, adolescents and young adults aged 6–24 years. We also used longitudinal data to study the value of a single insulin measurement to predict high risk factor levels and clustering of multiple risk factors after a 6-year follow-up. In cross-sectional analyses the levels of triglycerides, HDL-cholesterol, systolic blood pressure and obesity indices were usually significantly different across the quartiles of fasting insulin in both sexes among children, adolescents and young adults. In general, no associations were seen with total cholesterol or LDL-cholesterol. In prospective analysis elevated baseline insulin was related to the incidence of hypertriglyceridaemia (≥95th percentile) at the follow-up. This relationship persisted even after adjustments for baseline obesity or 6-year change in obesity status. Moreover, baseline insulin concentration was higher in subjects who subsequently showed clustering of high triglycerides, low HDL-cholesterol and high systolic blood pressure levels at the follow-up. We conclude that high fasting insulin levels measured in children and adolescents predict the development of hypertriglyceridaemia years later. In addition, high insulin levels seem to precede the development of a potentially atherogenic risk factor profile including low HDL-cholesterol, high triglycerides and high systolic blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00402173
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Troglitazone reduces hyperglycaemia and selectively acute-phase serum proteins in patients with Type II diabetes (1999)
    Springer
    Diabetologia 42 (1999), S. 1433-1438 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Type II diabetes, inflammation, troglitazone, hyperglycaemia, serum amyloid A, complement protein C3.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. Inflammation could play a part in insulin resistance. Thiazolidinediones, new antidiabetic drugs, possess anti-inflammatory effects in vitro. We investigated if acute-phase serum proteins are increased in patients with Type II (non-insulin-dependent) diabetes mellitus who had been treated with insulin and whether troglitazone has anti-inflammatory effects in vivo.¶Methods. A total of 27 patients (age 63.0 ± 1.7 years, HbA1 c 8.8 ± 0.3 %, BMI 32.7 ± 0.8 kg/m2, duration 15.2 ± 1.4 years, insulin dose 73.3 ± 7.0 U/day) participated in the study. The patients received daily either 400 mg troglitazone or placebo for 16 weeks. Blood samples were taken at baseline, at the end of therapy and after a follow-up time of 23 ± 4 days.¶Results. The concentrations of serum amyloid A (6.2 ± 1.1 mg/l) and C-reactive protein (6.1 ± 1.1 mg/l) were increased (p 〈 0.001) and complement protein C3 (1.69 ± 0.05 g/l) was also above the reference range for healthy subjects. Placebo treatment had no effect on glucose or inflammation, whereas troglitazone reduced fasting glucose (from 10.4 ± 0.6 mmol/l to 8.1 ± 0.5 mmol/l, p 〈 0.01), HbA1 c (from 8.7 ± 0.3 % to 7.5 ± 0.3 %, p 〈 0.01), insulin requirements (from 75 ± 10 U/day to 63 ± 10 U/day, p 〈 0.05), serum amyloid A (from 6.3 ± 1.5 mg/l to 4.0 ± 1.3 mg/l, p = 0.001), α-1-acid glycoprotein (from 906 ± 51 mg/l to 729 ± 52 mg/l, p = 0.001) and C3 (from 1.72 ± 0.07 g/l to 1.66 ± 0.06 g/l, p 〈 0.05) but not α-1-antitrypsin, ceruloplasmin, C-reactive protein or haptoglobin significantly. Concentrations of glucose and acute-phase reactants had returned to those before treatment at the follow-up visit.¶Conclusion/interpretation. In Type II diabetic patients serum amyloid A and complement protein C3 are raised. Troglitazone exerts a selective reversible action on some acute-phase proteins and C3 but not on others in conjunction with the improvement in glucose metabolism. [Diabetologia (1999) 42: 1433–1438]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051315
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Does NIDDM increase the risk for coronary heart disease similarly in both low- and high-risk populations? (1995)
    Springer
    Diabetologia 38 (1995), S. 487-493 
    Details
    ISSN: 1432-0428
    Keywords: Coronary heart disease ; non-insulin-dependent diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Finland has marked regional differences in the occurrence of coronary heart disease (CHD). Although the causes for these differences in CHD mortality and morbidity in the Finnish population are unknown, it offers an excellent opportunity to investigate the effects of non-insulin-dependent diabetes mellitus (NIDDM) on CHD risk in two populations differing significantly with respect to the occurrence of CHD. Therefore, we carried out a 7-year prospective population-based study including a large number of patients with NIDDM (East Finland: 253 men and 257 women; West Finland: 328 men, 221 women) and corresponding non-diabetic subjects (East Finland: 313 men, 336 women; West Finland: 325 men, 399 women). In both study populations the presence of NIDDM increased significantly the risk for CHD events (CHD mortality or all CHD events including CHD mortality or non-fatal myocardial infarction). Diabetic men had 3–4 fold higher and diabetic women 8–11-fold higher risk for CHD than corresponding non-diabetic subjects. Both non-diabetic and diabetic subjects had odds ratios (East vs West) for CHD events of about 2 indicating a similar East-West difference in the CHD risk. Regional difference was quite similar in men and women. These results imply that factors related to NIDDM, independently of conventional risk factors and the occurrence of atherothrombosis in the background population, must play a major role in the pathogenesis of atherosclerotic vascular disease in NIDDM diabetes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00410288
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 7
    Electronic Resource
    Electronic Resource
    The role of insulin in clustering of serum lipids and blood pressure in children and adolescents The Cardiovascular Risk in Young Finns Study (1995)
    Springer
    Diabetologia 38 (1995), S. 1042-1050 
    Details
    ISSN: 1432-0428
    Keywords: Key words Insulin ; longitudinal ; clustering ; children ; adolescents ; serum lipoproteins ; blood pressure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In adults hyperinsulinaemia is associated with an atherogenic risk profile including obesity, low levels of HDL-cholesterol, high levels of triglycerides and elevated blood pressure. To examine these associations in the young we studied the cross-sectional relationships of insulin with obesity indices (body mass index, subscapular skinfold thickness), serum lipids and blood pressure in 1,865 children, adolescents and young adults aged 6–24 years. We also used longitudinal data to study the value of a single insulin measurement to predict high risk factor levels and clustering of multiple risk factors after a 6-year follow-up. In cross-sectional analyses the levels of triglycerides, HDL-cholesterol, systolic blood pressure and obesity indices were usually significantly different across the quartiles of fasting insulin in both sexes among children, adolescents and young adults. In general, no associations were seen with total cholesterol or LDL-cholesterol. In prospective analysis elevated baseline insulin was related to the incidence of hypertriglyceridaemia (≥ 95th percentile) at the follow-up. This relationship persisted even after adjustments for baseline obesity or 6-year change in obesity status. Moreover, baseline insulin concentration was higher in subjects who subsequently showed clustering of high triglycerides, low HDL-cholesterol and high systolic blood pressure levels at the follow-up. We conclude that high fasting insulin levels measured in children and adolescents predict the development of hypertriglyceridaemia years later. In addition, high insulin levels seem to precede the development of a potentially atherogenic risk factor profile including low HDL-cholesterol, high triglycerides and high systolic blood pressure. [Diabetologia (1995) 38: 1042–1050]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00402173
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    Cardiac rehabilitation and return to work after coronary artery bypass surgery (1994)
    Springer
    Quality of life research 3 (1994), S. 207-213 
    Details
    ISSN: 1573-2649
    Keywords: Aortocoronary bypass ; rehabilitation ; return to work ; randomized study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The work situation of 66 male patients who underwent elective coronary artery bypass surgery (CABS) and who had been randomly allocated to receive cardiac rehabilitation (group R) was compared with the work situation of 59 similar patients allocated to receive only standard care (group H). The follow-up time was one year. The proportions of subjects working in groups R and H were 26% and 20% (p=ns) before the CABS, 45% and 34% (p=ns) 6 months and 56% and 38% (p=ns) 12 months after the CABS, repectively. The increase in proportion of subjects who worked was significant in both groups at both 6 and 12 months after the CABS (p〈0.05 for all changes). The increases were not significantly different between the whole groups, but in patients younger than 55 years of age, return to work was more frequent in group R than in group H (at 12 months 60% vs. 35%, p for the difference in change=0.02). Stepwise logistic regression analysis of the factors influencing return to work showed that a patient's judgement of his own working capacity as good 6 months after CABS (odds ratio (OR) 8.5, confidence interval (CI) 2.3–32.0), functional class 16 months after the CABS (OR 6.7, CI 1.8–24.5), his desire to work (OR 6.4, CI 1.6–26.0) and absence from work of less than 3 months before the CABS (OR 4.9, CI 1.2–20.2) were significant positive predictors of return to work 1 year after the CABS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00435386
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    Paper (German National Licenses)
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