Increase in stable glycosylated haemoglobin after induction of poor glycaemic control

Wettre, Staffan; Arnqvist, Hans J.; Cederblad, G.; Hermansson, Göran

doi:10.1007/bf00250152

Cited by 7 publications

(2 citation statements)

References 22 publications

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“…In addition, levels of HbA 1 did not alter with nifedipine. Although significant falls in HbA 1 after improved glycaemic control are often not apparent for several weeks 25 , it has been shown that increases in the non‐labile fraction of HbA 1 may be manifest after only seven days of relative hyperglycaemia 26 . Therefore, if a true deterioration in glycaemic control had developed with nifedipine, which was not obvious from the filter paper blood glucose profiles, then it should still have been reflected by a significant rise in HbA 1 after six weeks treatment with nifedipine.…”

Section: Discussionmentioning

confidence: 99%

Glycaemic control and exercise tolerance in hypertensive insulin‐treated diabetes during nifedipine therapy

Waldek

Cohen

et al. 1987

Int J Clinical Practice

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Controversy continues over the effects of calcium antagonists on glucose homeostasis and cardiac function, particularly in diabetics. Changes in blood pressure, exercise tolerance, insulin secretion and glycaemic control were studied therefore in 12 insulin-treated hypertensive diabetics with varying endogenous insulin reserve who were given nifedipine 20 mg twice daily for six weeks. Six hypertensive diabetic subjects off all antihypertensive medication served as controls.Glycaemic control and blood pressure did not alter in the control group over the six week period. In the nifedipine-treated group blood pressure levels remained significantly improved at six weeks with systolic pressure falling from 178 ±24 to 158 ±20 (p

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Section: Discussionmentioning

confidence: 99%

Glycaemic control and exercise tolerance in hypertensive insulin‐treated diabetes during nifedipine therapy

Waldek

Cohen

et al. 1987

Int J Clinical Practice

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“…However, HbAlc can vary rather rapidly (Boden et al 1980;Arnqvist et al 1982;Wettre et al 1983) and reflects mainly the recent few weeks. This means that for natural reasons a two month period with the same fluctuations during such a period will give different values of HbAic depending on when in relation to the fluctuations the determination is made (Fig.…”

Section: Glycosylated Proteinsmentioning

confidence: 99%

Strategy for self-monitoring of diabetic control

Ludvigsson

Hermansson

1985

Acta Endocrinologica

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Treatment of diabetes must aim at normal metabolism. Sporadic measurements of any known parameter is not a sufficient guarantee but continous regular self-monitoring is necessary. At least [ill]insulin dependent diabetes it seems reasonable that we should monitor the free insulin levels, but that still belongs to the future. As blood glucose gives us a good reflection of the hormonal and metabolic balance, this is a relevant parameter to follow. Glycosylated proteins, mainly hemoglobin, give only retrospective information of moderate value for the practical management of the disease. Furthermore, one should be aware of the different weak points of glycosylated hemoglobin which does not tell the only, total truth about glucose balance. Self-monitoring of blood glucose is a very valuable tool, especially when used in a systematic way. To get information covering the whole day every day tests for glucosuria have still a place, especially among children and young adults with rather short duration of diabetes. With a sensible approach it is possible to get good compliance among most patients. A combination of blood and urine glucose selfcontrol creates opportunities for a good metabolism in diabetes.Several studies both experimental and clinical (Ca¬ nili et al 1976; Skyler 1979) have given strong support for the importance of good metabolic control in pre¬ venting diabetic microangiopathy. Even without such proofs it is self-evident that people with diabetes shall have the same kind of metabolism as healthy people as long as nobody has shown that diabetics need an abnormal metabolism. The question is ra¬ ther: Which of all abnormal hormonal and metabolic parameters should first of all be normalized if we cannot normalize all, but have to choose? How do we know whether this goal can be reached? InsulinThe aim of diabetes treatment before the discovery of insulin was mainly to normalize the carbohydrate metabolsim as that seemed to the main error. How¬ ever, curiously enough this attitude has remained unchanged even after the insulin discovery. Thus the interest has been focused on blood glucose levels and to some extent on fat metabolism. If the main error in type I diabetes actually is the insulin deficiency or inadequate insulin levels, the main aim should reasonably be to normalize the insulin levels, but during decades this has become a secondary aim.Most treatment programmes have more or less in vain concentrated upon how to correct life of dia¬ betics including food an exercise habits to suit an abnormal insulin level. It seems reasonable that we should monitor the free insulin levels, but for the moment we know too little about what is physiolo¬ gical levels, and the less where and how to measure

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Elevated long-term glycated haemoglobin precedes proliferative retinopathy and nephropathy in Type 1 (insulin-dependent) diabetic patients

Kullberg

Arnqvist

1993

Diabetologia

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The importance of glycaemic control for the development of proliferative retinopathy and nephropathy was assessed by monitoring glycated haemoglobin for 5 years or more before the diagnosis of these complications. The study comprised Type 1 (insulin-dependent) diabetic patients diagnosed at an age less than 31 years, and with diabetes duration 25 years or less. They were followed for an average of 7.9 years with 3.3 measurements per year. Of 172 patients screened for retinopathy 60 had no retinopathy, 104 had background retinopathy, and 8 had proliferative retinopathy The mean HbAlc (95% confidence intervals) of the groups was 6.4% (6.2-6.7%), 7.3% (7.1-7.5%) and 8.9% (8.1-9.6%), respectively (p < 0.0001); the mean duration of diabetes was 12, 18, and 17 years. Of 186 patients 7 had nephropathy (albuminuria > 200 mg/l). Mean HbAlc in patients without nephropathy was 7.0% (6.8-7.1%) and in patients with nephropathy 8.8% (7.8-9.9%, p < 0.001). Mean diabetes duration was 16 years in both groups. Multiple logistic regression including mean HbAlc, age at onset, duration, sex, and hypertension, was for both proliferative retinopathy and nephropathy significant only for mean HbAlc. In all cases, proliferative retinopathy and nephropathy were preceded by poor glycaemic control over several years, suggesting that these complications are caused by poor glycaemic control.

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Increase in stable glycosylated haemoglobin after induction of poor glycaemic control

Cited by 7 publications

References 22 publications

Glycaemic control and exercise tolerance in hypertensive insulin‐treated diabetes during nifedipine therapy

Glycaemic control and exercise tolerance in hypertensive insulin‐treated diabetes during nifedipine therapy

Strategy for self-monitoring of diabetic control

Elevated long-term glycated haemoglobin precedes proliferative retinopathy and nephropathy in Type 1 (insulin-dependent) diabetic patients

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