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  • 1
    Electronic Resource
    Electronic Resource
    Bicentric evaluation of a teaching and treatment programme for Type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months (1983)
    Springer
    Diabetologia 25 (1983), S. 470-476 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes education ; Type 1 diabetes ; severe hypoglycaemia ; diabetes care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In two hospitals an identical diabetes teaching and treatment programme (in-patient, Monday to Friday, group teaching) was set up. Seventy-eight consecutive, conventionally treated Type 1 diabetic patients (duration of diabetes 10±6 years), referred during a certain period, were reinvestigated after 1 year, and again (for assessment of metabolic control only) 22 months after the teaching and treatment programme. Initially, mean glycosylated haemoglobin was 2.6%, after one year 1.0%, and after 22 months 1.5% above the upper limit of the normal range (p〈0.001). Hospital admissions were reduced from a mean of 10 to a median of 1 day per patient per year (p〈0.001). The long-term quality of diabetes care achieved by the diabetes teaching and treatment programme was unrelated to intelligence quotient, diabetes duration, or diabetes-related knowledge. Patients with normal levels of glycosylated haemoglobin on follow-up (33% of all patients) had particularly good compliance rates, and significantly lower initial values of glycosylated haemoglobin than patients with glycosylated haemoglobin levels ⩾10%. The data indicate that the diabetes teaching and treatment programme resulted in a substantial long-term improvement of metabolic control and a striking reduction of hospital admissions. The study substantiates the feasibility of applying this teaching and treatment programme on a large scale to other hospitals, so as to improve the quality of diabetes care and decrease health care costs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00284453
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  • 2
    Electronic Resource
    Electronic Resource
    Evaluation of an intensified insulin treatment and teaching programme as routine management of Type 1 (insulin-dependent) diabetes (1987)
    Springer
    Diabetologia 30 (1987), S. 681-690 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; insulin therapy ; severe hypoglycaemia ; ketoacidosis ; patient education
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It has been questioned whether aiming at near-normoglycaemia by intensified insulin treatment regimens is feasible and safe for the majority of patients with insulin-dependent diabetes. In this study, intensified insulin injection therapy (including blood glucose self-monitoring and multiple insulin injections) based upon a 5-day inpatient group teaching programme was evaluated in Type 1 (insulin-dependent) diabetes mellitus in the centralised health care system of Bucharest. One hundred patients (group A, initial HbA1 12.5%) were followed for 1 year on their standard therapy (individual teaching, no metabolic self-monitoring), and thereafter for 1 year on intensified therapy. Another 100 patients (group B, HbA1 12.3%) were followed for 2 years on intensified therapy. A third 100 patients (group C, HbA1 11.7%) were assigned to a basic 4-day inpatient group teaching programme with conventional insulin therapy (including self-monitoring of glucosuria and acetonuria) and followed for 1 year. Mean HbA1 remained unchanged after standard treatment (group A: 12.8% at 12 months), but decreased during intensified therapy (group A: 10.1% at 24 months; group B: 9.3% at 12 months, 9.5% at 24 months; p〈0.0001). In group C, no change was found compared to standard treatment (i.e. group A at 12 months). Incidence rates of ketoacidosis were 0.16 episodes per patient per year during standard treatment, 0.01 during intensified treatment (p〈0.01) and 0.04 in group C (p〈0.025). Hospitalisation rates were reduced by 60% during intensified therapy and by 40% in group C. Frequency of severe hypoglycaemia was not significantly different between the three treatment regimens. Thus, under the condition that insulin treatment is based upon a structured and comprehensive training of the patient, intensified insulin injection therapy performed as routine treatment of Type 1 diabetes significantly lowers HbA1 levels without increasing the risk of severe hypoglycaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00296989
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  • 3
    Electronic Resource
    Electronic Resource
    Risk factors of severe hypoglycaemia in adult patients with Type I diabetes – a prospective population based study (1998)
    Springer
    Diabetologia 41 (1998), S. 1274-1282 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Type I diabetes ; severe hypoglycaemia ; risk factors ; hypoglycaemia awareness ; patient education ; social class ; behaviour ; attitude ; C-peptide.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The objective of this study was to identify possible risk factors of severe hypoglycaemia (SH) in a prospective population based study of adult Type I (insulin-dependent) diabetic patients. A representative sample of 684 patients (41 % women, mean ± SD age 36 ± 11, diabetes duration 18 ± 11 years), living in the district of Northrhine (9.5 million inhabitants), Germany, were examined in their homes using a mobile ambulance. A comprehensive baseline assessment of possible predictors of SH included sociodemographic and disease related variables, hypoglycaemia awareness, diabetes management, and attitudes and behavioural aspects as expressed by the patients. After a mean of 19 ± 6 months 669 (98 %) patients were interviewed about events of SH since the baseline examination. Using the multiple Cox proportional hazards model, five risk factors of SH were identified: SH during the preceding year [hazard ratio (HR) 2.7, 95 % confidence intervals (CI) 1.8–4.2], any history of SH (HR 1.9, CI 1.1–3.4), C-peptide negativity (HR 4.0, CI 1.2–12.7), social status (HR 0.8 for a difference of 5 units for a value range of 0–24, CI 0.6–0.9), and patients' determination to reach normoglycaemia (HR 0.7 for a difference of 1 unit for a value range of 1–6, CI 0.5–0.9), indicating that the lower the social status and the higher the patients' determination to reach normoglycaemia, the higher the risk of SH. After eliminating the history of hypoglycaemia from the model, impaired hypoglycaemia awareness and patients' inappropriate denial of SH as their particular problem became additional significant risk factors of SH. In conclusion, in this population based study of adult Type I diabetic patients, C-peptide negativity, a previous event of SH, patients' determination to reach normoglycaemia and social class were risk factors of SH. [Diabetologia (1998) 41: 1274–1282]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051065
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  • 4
    Electronic Resource
    Electronic Resource
    Quality assessment of diabetes care according to the recommendations of the St. Vincent Declaration: A population-based study in a rural area of Austria (1992)
    Springer
    Diabetologia 35 (1992), S. 429-435 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes ; eye complications ; foot complications ; neuropathy ; hypertension ; quality of care ; patient education ; general practice ; hospitalisation ; severe hypoglycaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Using a mobile ambulance the quality of diabetes care was evaluated, according to the recommendations of the St. Vincent Declaration, in 95 % of all known diabetic patients (n = 395) in a geographically defined rural area of Austria with 7871 inhabitants. Fourteen of the 395 patients had Type 1 (insulin-dependent) diabetes with age at onset of diabetes below 30 years. Of the 375 patients examined (women 61%, age 66 ± 13 years, median diabetes duration 6 years) 16 % were treated with insulin and 47 % with oral agents; HbA1c levels were 7.3 ± 1.7 %. Prevalence of known hypertension was 54%; 68% of these patients had their blood pressure uncontrolled (systolic ≥ 160 and/or diastolic ≥ 95 mmHg); a further 15% of patients with previously unknown hypertension had blood pressure values of ≥ 160 and/or ≥ 95 mmHg. Urinary albumin concentrations of 〉 200 mg/l were found in 15% of patients, 2% had a serum creatinine level of 〉 177 μmol/l, no patient had renal replacement therapy. Six patients (1.5%) were blind. Screening for retinopathy identified six patients (out of 317 in whom the retina could be evaluated) for whom consultation with an ophthalmologist as soon as possible was recommended. Of the total patient group (n = 395) 20 patients (5%) had foot complications (amputations and/or ulcers): 14 patients had a total of 21 lower limb amputations (eight above knee, six below knee, seven below ankle); eight of these 14 patients lived in a nursing home; 11 patients had a total of 13 foot ulcers. In conclusion, in this diabetic population quality of diabetes care was satisfactory with respect to glycaemic control, whereas the high rates of uncontrolled hypertension and above ankle amputations appear amenable to improvement. This study shows that through systematic assessment of the quality of diabetes care specific local needs and deficiencies can be identified in order to propose respective interventions in health care practices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02342439
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  • 5
    Electronic Resource
    Electronic Resource
    Antineoplastic efficacy of melphalan andN-(2-chloroethyl)-N-nitrosocarbamoyl-ω-lysine, in combination with diazoxide or insulin in autochthonous mammary carcinoma of the Sprague-Dawley rat (1990)
    Springer
    Journal of cancer research and clinical oncology 116 (1990), S. 45-50 
    Details
    ISSN: 1432-1335
    Keywords: Antineoplastic efficacy ; Melphalan ; Diazoxide ; Insulin ; Mammary carcinoma ; Sprague-Dawley rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The anticancer activity of melphalan andN-(2-chloroethyl)-N-nitrosocarbamoyl-ω-lysine (CNC-ω-Lys), was compared in the autochthonous, methylnitrosourea-induced mammary carcinoma of the Sprague-Dawley rat. In addition, the influence on the therapeutic efficacy of the combination with diazoxide, causing a mild, reversible diabetes, and with insulin was investigated. The comparison of melphalan and CNC-ω-Lys clearly showed the superiority of melphalan. Both compounds displayed a significant tumour inhibition in their medium and the highest dosages in comparison to the untreated control. The combination with diazoxide resulted for almost all groups in an increased tumour inhibition. Only the lowest dose of CNC-ω-Lys + diazoxide did not reduce the tumour volume significantly versus the control group. The combination with insulin, however, resulted in a loss of tumour inhibition compared to the effect of the cytotoxic drug alone, although in these groups, too, a significant decrease of tumour volumes versus controls could be observed. Mortality was within tolerable limits (〈20%) through the treatment period for all experimental groups. Median lifespans were increased in all therapy groups, but no additional benefit could be observed in the combination treatment groups.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01612639
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  • 6
    Electronic Resource
    Electronic Resource
    Androgen-linked alkylating agents: biological activity in methylnitrosourea-induced rat mammary carcinoma (1990)
    Springer
    Journal of cancer research and clinical oncology 116 (1990), S. 538-549 
    Details
    ISSN: 1432-1335
    Keywords: Androgen-linked alkylating agents ; Methylnitrosourea ; Mammary carcinoma ; Anticancer activity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This article gives a comprehensive survey on the anticancer activity of nitrosoureas linked to steroidal androgens in methylnitrosourea (MMU)-induced rat mammary carcinoma. cis-Androsterone, testosterone, 19-nortestosterone and 5-α-dihydrotestosterone were used as carrier hormones and were linked to various cytotoxic N-[N′-(2-chloroethyl)-N′-nitrosocarbamoyl] (CNC)-aminoacids and to N-(2-hydroxyethyl)-N′-(2-chloroethyl)-N′-nitrosourea hemisuccinate (HECNU-hemisuccinate). In the MNU-model used esters of dihydrotestosterone (DHT) invariably were more active and less toxic than those of testosterone, nortestosterone and cis-androsterone. Within the DHT esters of CNC-aminoacids those of CNC-glycine, CNC-methionine and CNC-alanine showed the highest antineoplastic activities and superiority compared with equimolar dosages of their unlinked mixtures. Additionally, CNC-alanine-DHT ester had the highest therapeutic ratio of all agents investigated. HECNU-hemisuccinate-DHT ester, on the other hand, achieved even higher antitumor activity at the optimal dose but had a narrower therapeutic ratio. No obvious correlation between antineoplastic efficacy and receptor binding affinity could be demonstrated, but, to be active, a conjugate apparently had to have some receptor binding affinity for both androgen and progesterone receptors. The results obtained indicate that linking antineoplastic agents to transport molecules with affinity to steroid receptors is a highly promising approach to obtain drugs with specific activity in steroid receptor containing tumors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01637072
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  • 7
    Electronic Resource
    Electronic Resource
    Differential relationship of vitamin A and E levels in methylnitrosourea-induced Sprague-Dawley rats following prolonged feeding of fatty diets enriched with the vitamins (1990)
    Springer
    Journal of cancer research and clinical oncology 116 (1990), S. 470-474 
    Details
    ISSN: 1432-1335
    Keywords: Vitamins A, E ; Semisynthetic fatty diet ; Methylnitrosourea ; Mammary carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Prolonged supplementation of vitamins A and E (2500 IU and 11.3 IU/rat daily) in 10.3% and 21.6% fatty diets administered to methylnitrosourea-induced Sprague-Dawley rats caused alterations in plasma and liver levels of both vitamins as well as of the total lipids. Liver vitamin A levels increased steadily (more than four-fold) until termination of the experiment, whereas plasma vitamin A levels only showed a minor increase at the end of the study in comparison to rats fed a standard diet. Liver vitamin E levels initially showed no difference from those of rats treated with a standard diet, and were decreased at the end of the experiment, whereas the respective plasma levels were increased throughout the study, only showing a decrease relative to initial values at termination of the experiment. Plasma total lipids increased with age and following supplementation of the vitamins in the high-fat diet, whereas liver total lipids were influenced less by aging than by the fat and vitamin contents of the respective diets. The observed alterations were, however, not related to significant chemopreventive activity of the vitamins A and E contained in high-fat diets.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01612996
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