The current study comprised 376 living and 140 deceased diabetic patients. A majority of the patients had received oral hypoglycemic agents (tablets) or insulin, while a modified diet alone had been prescribed for a minority. The mean age of the tablet-treated patients (67 and 73 years for those now alive and deceased, respectively) was in general 6 1 0 years higher than that of insulin-treated patients. The mean morning blood glucose level ranged between 8.3 and 10.5 mmol/l. A considerable number of the tablet-treated patients were overweight and hypertriglyceridemic. About one third of the patients in both groups were considered to be in a fairly good state of metabolic control, arbitrarily defined as a urinary glucose excretion of less than 110 mmo1/24 h, a relative body weight of less than 115 % and a serum triglyceride level below 2.0 mmol/l. Cardiovascular disease was the cause of death in 60-70% of the patients. Patients with clinical evidence of atherosclerosis did not differ from age-matched pairmates without signs of macroangiopathy with regard to hyperglycemia and hyperglucosuria. However, the prevalences of hypertriglyceridemia, hypertension and overweight tended to be higher in the former. It is concluded that factors of importance for development of atherosclerosis in a non-diabetic population should be considered in the treatment of diabetes mellitus.Diabetes mellitus (DM) is known to be associated with premature development of macro-and microangiopathy. It has been suggested (4) but not yet generally agreed (21) that proper control of the blood glucose level will postpone the development of vascular complications. Evidence supporting this concept in DM ofjuvenile type was reported recently by Deckert et al. (6). However, the criteria of effective control were very strict and only a small proportion of the patients fulfilled them. The possibility of influencing cardiovascular disease in DM of the adult onset type by reducing blood glucose has been questioned. Thus, a long-term prospective study revealed only minor differences in the incidences of fatal and non-fatal events (myocardial infarction, cerebrovascular disease) among placeboand insulin-treated patients. in spite of marked differences in blood glucose levels ( 12). These findings focus interest on current knowledge about the mechanisms responsible for the development of various forms of angiopathy. As the Framingham study clearly showed. the atherosclerotic lesion is of multifactorial origin, the most potent risk factors (besides age) being hypertension. hypercholesterolemia and smoking, followed by glucose intolerance and overweight (10). A further risk factor. identified in other studies is hypertriglyceridemia ( 5 , 16). As the risk factors found in a general population are valid also for diabetic patients ( I I). it appears that metabolic control in DM should have a broader definition than just blood glucose reduction.The current investigation was undertaken to evaluate how routine DM care functions in a modem out-patient department wi...
ABSTRACT. A multiple choice questionnaire was used to test the level of knowledge about diabetes mellitus and diet‐nutrition in diabetic patients (n=317), non‐diabetic patients (n=70), nursing personnel (n=53) and third‐year medical students (n=43). The results concerning diabetes were better than those for diet‐nutrition. A score of ≥ 80% in diet‐nutrition was considered necessary for proper management of the diet at home. This level was reached by 84% of the students, 26% of the nursing personnel, 29% of the insulin‐treated diabetics (n=178), 9% of the tablet‐treated diabetics (n=124) and 4% of the non‐diabetic patients. It was concluded that the piecemeal instruction system used to teach the diabetic patients is inefficient and should be replaced by a formal educational program integrated into the patient care system. The level of knowledge among nursing personnel needs to be improved.
ABSTRACT. Between 1969 and 1979 a course of either propylthiouracil or carbimazole was given to 102 patients with Graves' disease. Ten of the patients discontinued the therapy because of adverse reactions or persisting symptoms, and 40 relapsed at some time after cessation of the therapy, giving a proportion of total failures of 49%. The proportion of such failures increased from 45% in 1969‐72 to 57% in 1973‐79. The probability of relapse was significantly higher in 1973‐79 than in the earlier period of study (p<0.01). Patients aged 30–39 years had the highest proportion of failures (55%), but the mean time until relapse (6 months) was shortest in patients older than that. Adverse reactions—agranulocytosis, leukopenia, urticaria and elevated serum levels of liver enzymes—were seen in 12 patients. Six patients developed hypothyroidism after a mean time of 3.5 years after termination of thionamide therapy.
A study of 27 cases of pseudoxanthoma elasticum (PXE) has been made from the point of view of internal medicine. This disease is hereditary and is characterized by typical manifestations of the eyes, skin, mucous membranes and cardiovascular system. Twelve patients died at the time of the investigation, two of malignant diseases, one of gastrointestinal bleeding, and nine of cardiocerebrovascular diseases. All the 15 living patients had typical skin lesions which caused only cosmetic discomfort. In most cases these skin lesions were the first symptom of the disease. Angioid streaks were found in all the patients, nearly all of whom had impairment of vision which had mostly occurred about 20 years later than the skin lesions. The patients with impaired vision also showed different degrees of macular and peripapillary atrophy and retinal‐pigment proliferation. Manifestations of cardiocerebrovascular disease appeared in many of the patients; these symptoms were recognized somewhat later than the eye lesions, but in some cases they had occurred at an early age. Gastrointestinal bleedings occurred in four patients, in one of whom they proved fatal. No characteristic abnormalities were found in the extensive laboratory survey.
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