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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 18 (1980), S. 279-283 
    ISSN: 1432-0428
    Keywords: Diabetic impotence ; prevalence ; aetiological factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a survey of 541 diabetic males, aged 20–59 years, 190 (35%) had erectile impotence. Using linear logistic regression models for analysis the five most significant associations with impotence were age (p〈0.001), treatment with either insulin or oral hypoglycaemic agents (p〈0.001), retinopathy (p〈0.001), symptomatic peripheral neuropathy (p〈0.001) and symptomatic autonomic neuropathy (p〈0.005). The greatest correlations were found in patients with severe microangiopathy, as demonstrated by proliferative retinopathy and symptomatic autonomic neuropathy. In addition the duration of diabetes and the presence of ischaemic heart disease, nephropathy and poor diabetic control may also be associated with diabetic impotence. It is concluded that diabetic impotence is still a common problem and may have a multifactorial aetiology.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0428
    Keywords: HbA1 ; glycosuria ; insulin antibody ; C-peptide ; conventional beef insulin ; highly purified pork insulin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twenty patients were changed from a single daily injection of beef insulin (a mixture of soluble and protamine zinc insulin) to two daily injections (mixtures of soluble and isophane insulins). This was associated with a reduction, one month later, in the concentration of glycosylated haemoglobin (HbA1) and in the degree of late evening glycosuria. A reduction was shown 6 months later in antibody binding of beef and pork insulin by serum. Subsequent conversion to a twice daily regime of highly purified pork insulin was not associated with further improvement in diabetic control, but was associated after 1 month with a reduction in daily insulin dose, and after 5 months with a further reduction in antibody binding of beef and pork insulin by serum. Patients failing to show a C-peptide response to intravenous glucagon had a fall in HbA1 after conversion from a once to a twice daily insulin regime, which correlated inversely with insulin antibody binding estimated at the beginning of the study.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 17 (1979), S. 195-212 
    ISSN: 1432-0428
    Keywords: Diabetic autonomic neuropathy ; morphology ; pathogenesis ; clinical features ; assessment ; cardiovascular reflexes ; natural history ; prognosis ; treatment ; diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This review attempts to outline the present understanding of diabetic autonomic neuropathy. The clinical features have been increasingly recognised but knowledge of the localization and morphology of the lesions and their pathogenesis remains fragmentary. A metabolic causation as postulated in somatic nerves accords best with clinical observations. Most bodily systems, particularly the cardiovascular, gastrointestinal and urogenital, are involved with added disturbances of thermoregulatory function and pupillary reflexes. Possible effects on neuroendocrine and peptidergic secretion and respiratory control await definition. Current interest centres around the development of a new generation of tests of autonomic nerve function that are simple, non-invasive, reproducible and allow precision in diagnosis and accurate quantitation. Most are based on cardiovascular reflexes and abnormality in them is assumed to reflect autonomic damage elsewhere. Probably no single test suffices and a battery of tests reflecting both parasympathetic and sympathetic function is preferable. Little is known of the natural history. The prevalence may be greater than previously suspected and although symptoms are mild in the majority, a few develop florid features. The relation of control and duration of diabetes to the onset and progression of autonomic neuropathy is not clearly established. Once tests of autonomic function become abnormal they usually remain abnormal. Symptomatic autonomic neuropathy carries a greatly increased mortality rate possibly due to indirect mechanisms such as renal failure and direct mechanisms such as cardio-respiratory arrest. Improved treatment of some of the more disabling symptoms has been possible in recent years.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 26 (1984), S. 437-440 
    ISSN: 1432-0428
    Keywords: Diabetes ; impotence ; alcohol ; glycaemic control ; retinopathy ; neuropathy ; claudication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The natural history of erectile impotence in diabetic men has been defined in a 5-year prospective study of 466 patients initially aged 20–59 years. Of the 275 who were originally potent, 78 (28%) have become impotent. Five features present at first interview were found to be independently predictive of the subsequent development of impotence; age (p〈 0.0001), alcohol intake (p〈 0.0001), initial glycaemic control (p= 0.03), intermittent claudication (p= 0.04) and retinopathy (p= 0.05). The development of impotence was also significantly associated with the appearance of neuropathic symptoms (p= 0.003) and poor glycaemic control in the intervening 5 years (p= 0.01). Only 11 out of 128 (9%) of those originally impotent regained potency; they were young, had short duration of diabetes, and often features of psychogenic impotence. Those with impotence originally but no clinically apparent micro/macrovascular or neuropathic diabetic complications developed retinopathy (p= 0.001) and neuropathy (p= 0.01) more frequently than their comparable potent counterparts. It is concluded that diabetic impotence rarely reverses, that it is strongly associated with neuropathic and vascular complications of diabetes, and that moderation of alcohol consumption and improvement of glycaemic control are possible preventative factors.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; autonomic neuropathy ; QT interval ; sudden death ; autonomic function tests
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary QT intervals were measured over RR intervals ranging from 500 ms to 1000 ms in 13 normal male subjects, 13 male diabetic subjects without and 13 with autonomic neuropathy. There was a close linear relationship between QT and RR in all subjects. The slope of the regression line was significantly greater in the autonomic neuropathy group than the normal group. Thirty-two male diabetic subjects with varying degrees of autonomic dysfunction had repeat QT measurements 3 (range 2–6) years later. QT and QTC lengthened significantly at the second visit, unrelated to age or time between recordings, but which corresponded with changes in autonomic function. Of 71 male diabetic subjects under 60 years followed for 3 years, 13 had died, 8 unexpectedly. Of those with autonomic neuropathy, QT and QTC were significantly longer in those who subsequently died, despite similar ages and duration of diabetes. We conclude that QT/RR interval relationships are altered in diabetic autonomic neuropathy, and that changes in QT length with time parallel changese in autonomic function. There may be an association between QT interval prolongation and the risk of dying unexpectedly in diabetic autonomic neuropathy.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 17 (1979), S. 29-32 
    ISSN: 1432-0428
    Keywords: Seasonal incidence ; insulin dependent diabetes ; age at onset ; duration of symptoms ; sex
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary All newly diagnosed insulin dependent diabetics presenting consecutively to the Diabetic Department of the Royal Infirmary from the City of Edinburgh or its environs, between the years 1964 and 1977, were analysed for sex (297 males, 205 females), age at diagnosis (range 10–75 years), month of diagnosis, duration of symptoms and month of symptomatic onset. Males aged 10–19 years showed a significant seasonal variation in diagnosis (p〈0.025) with an increase in autumn and winter months which was not seen in females aged 10–19 years nor in patients of either sex aged more than 19 years at diagnosis. The duration of diabetic symptoms increased with increasing age at diagnosis in both males and females and was consistantly greater in females than in males for each age group at diagnosis. When the month of symptomatic onset was considered in relation to sex and age at diagnosis, having excluded patients with duration of symptoms of more than three months, only males aged 10–19 years at diagnosis showed a significant seasonal variation in incidence (p〈0.005).
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 18 (1980), S. 353-357 
    ISSN: 1432-0428
    Keywords: Plasma beta-thromboglobulin ; radioim-munoassay technique ; prostaglandin E1 anticoagulant ; plasma layer ; diabetic microangiopathy ; diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Plasma beta-thromboglobulin was measured, using the Edinburgh radioimmunoassay technique and anticoagulant mixture (containing prostaglandin E1) in 61 normal subjects, 67 diabetics with and 54 diabetics without microangiopathic complications. Plasma beta-thromboglobulin was significantly higher in the diabetic patients (p 〈 0.01) but there was no significant difference between the two diabetic groups. Twenty-six normal subjects, 27 diabetics with and 39 diabetics without complications were studied further by measuring beta-thrombo-globulin in four different ways using two different radioimmunoassay techniques and two anticoagulant mixtures (with and without prostaglandin E1). The Edinburgh assay gave a value 1.97 times that obtained with the Amersham assay, and the Edinburgh anticoagulant a value 0.78 times that with the Amersham anticoagulant. Beta-thromboglobulin concentration in the meniscus layer was approximately twice that in the middle layer. The lower beta-thromboglobulin values obtained with the Edinburgh anticoagulant may result from a different sampling technique or from prevention of in vitro beta-thromboglobulin release, after venepuncture, by prosta-glandin E1. Abnormal platelet behaviour in diabetes was confirmed although its role in the pathogenesis of microangiopathic complications remains unclear.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 20 (1981), S. 602-606 
    ISSN: 1432-0428
    Keywords: Insulin-dependent diabetes ; non-insulin dependent diabetes ; autoimmune thyroid disease ; Graves' disease ; hypothyroidism ; diabetic treatment ; sex ; seasonal variation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A study was made of the clinical features of diabetics with coexisting Graves' disease (n=117) or primary hypothyroidism (n=98). Those with Graves' disease developed thyroid dysfunction and diabetes at an earlier age than patients with primary hypothyroidism. There was, however, no difference between the two groups in respect of sex ratio nor proportion of subjects requiring insulin treatment. In contrast to the general diabetic population, 87% of diabetics with thyroid disease were female, 56% required insulin treatment and of patients requiring insulin from diagnosis, the median age at diagnosis of diabetes was 36 years. A strong correlation was observed between age at diagnosis of diabetes and that of hyperthyroidism (r=0.71, p〈 0.001) or hypothyroidism (r=0.65, p〈0.001). With increasing age at diagnosis of diabetes the interval between diagnosis of diabetes and thyroid disease diminished. The mean ± SEM interval between diagnosis of diabetes and that of thyroid dysfunction was longer in hypothyroid (6.7±1.2 years) than in hyperthyroid diabetics (-2.4 ±1.2 years). Neither insulin-dependent nor non-insulin dependent diabetics with associated thyroid disease exhibited a significant seasonal variation in diagnosis or symptomatic onset of diabetes. It is conceivable that where diabetes accompanies autoimmune thyroid disease in the same patient, both conditions may share a common and coincident pathogenesis which is unrelated to acute environmental influences.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Diabetologia 24 (1983), S. 166-171 
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; sexual function ; women ; autonomic neuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sexual responsiveness in 82 Type 1 (insulin-dependent) diabetic women was compared with that of 47 normal control subjects, using an interview method for rating various aspects of sexual response, and attitude questionnaires. The diabetic women were questioned about symptoms of autonomic neuropathy, and cardiovascular autonomic nerve function tests were performed. There were differences between the two groups in the reports of vaginal lubrication, but in most other respects the groups were similar. The diabetic women were not less orgasmic, and reported significantly fewer unpleasant feelings during sexual intercourse. They saw themselves and their husbands as less ‘potent’ than did the normal subjects. The possible enhancing effect of diabetes on the marriage of some diabetic women possibly counteracted the relatively mild physiological deficits involved. There was very little difference in sexual response between women with and without symptomatic autonomic neuropathy.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1041
    Keywords: acarbose ; sulphonylureas ; alpha-glucosidase inhibitor ; non-insulin dependent diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The effect of acarbose, an alpha-glucosidase inhibitor, on glycaemic control, was compared with placebo in a double-blind, randomised, group comparison study during 16 weeks in 20 non-obese non-insulin dependent diabetic patients in whom sulphonylurea treatment had been withdrawn. There was significant deterioration in glycaemic control as assessed by HbA1 following withdrawal of the sulphonylurea. There was no significant improvement in HbA1 between weeks 0 and 16 in either the acarbose (11.3% and 12.4% respectively) or the placebo group (10.6% and 12.2% respectively). In both the acarbose and placebo treated groups fasting glucose and insulin concentrations were unaltered. This study also suggests that acarbose was not an effective substitute for sulphonylureas in non-obese Type 2 diabetes uncontrolled by diet alone.
    Type of Medium: Electronic Resource
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