Diabetes
NUMBER OF RECORDS LOCATED =    19
 

Insulin aspart
Anon
Formulary Monograph Service Jul 1999;233-236
Insulin aspart is an insulin analogue in which aspartic acid has been
substituted for the amino acid proline at the B28 position.  It has reduced
hexameric binding following subcutaneous injection, resulting in more rapid
absorption and onset of action than regular human insulin.  It should be
considered an alternative to insulin lispro over which it does not have any
apparent advantages. (13 refs.)



An investigation of asthmatic and diabetic patients' perceived satisfaction
with information about medicines
Horne R and Ward A
Pharmacotherapy Apr 1999;19(4):498
Paper presented at the International Congress on Clinical Pharmacy of the
American College of Clinical Pharmacy and the European Society of Clinical
Pharmacy, Orlando, Florida, 11-14 Apr 1999.  Abstract No. 130.  A validated
questionnaire, the Satisfaction with Medication Information Scale
questionnaire, was used to assess diabetic and asthmatic outpatients' ratings
of their satisfaction with the information they had received about their
medications.  The five possible ratings were dichotomised into satisfaction
(about right and none needed) and dissatisfaction (too much, too little, and
none received).  Data was collected between Sep 1997 and Feb 1998 by hospital
preregistration graduates within South Thames.  321 outpatients completed the
questionnaire; 49% were asthmatic and 52% diabetic.  The majority of patients
were satisfied with information provided regarding the practical aspects of
medicine use (e.g., name of medicine).  Patients were not satisfied regarding
the information received about the risks of getting side effects (62%), what to
do if they experienced side effects (58%), and the effect of their medicines on
their sex life (64%).  Health care professionals, particularly pharmacists,
need to address these issues to ensure this information is provided.



Are there good and bad carbohydrates for HDL cholesterol?
Katan WB
Lancet 27 Mar 1999;353:1029-1030 (editorial)
Discussion of whether low glycaemic index carbohydrates are more effective than
those with a high index in raising plasma concentrations of HDL cholesterol,
with reference to a paper in this issue (p.1045-1048). (5 refs.)



Glycaemic index as a determinant of serum HDL-cholesterol concentration
Frost G et al.
Lancet 27 Mar 1999;353:1045-1048
A cross-sectional study of 1420 middle-aged British adults showed that the
glycaemic index of the diet was the only dietary variable significantly related
to serum HDL-cholesterol concentration.  Thus, the authors conclude that the
glycaemic index of the diet is a stronger predictor than dietary fat intake of
serum HDL-cholesterol concentration.  See also editorial commentary,
p.1029-1030. (28 refs.)




An independent pilot study into the accuracy and reliability of home blood
glucose monitors
Urdang M et al.
Lancet 27 Mar 1999;353:1065-1066 (letter)
The 13 non-wipe meters available in the UK for home blood glucose monitoring
were simultaneously assessed with a commercial quality-control serum, a
commercial non-human blood-based quality control (Sugar-Chex, Streck
Laboratories), and heparinised fresh whole human blood at three glucose levels.
 Inconsistency was found with both commercial testing materials. (5 refs.)



Treating type 2 diabetes
Venkat Narayan KM et al.; Christiansen EH; Groetsch SM et al.; Richards J;
Turner R and Holman R
British Medical Journal 6 Mar 1999;318:666-668 (letters)
Comments on reports of the UK Prospective Diabetes Study Group (12 Sep 1998,
p.703-713, p.713-720 and p.720-728 and Lancet 1998;352:837-853).  The principal
authors reply.



Nisoldipine improves the impaired erythrocyte deformability correlating with
elevated intracellular free calcium-ion concentration and poor glycaemic
control in NIDDM
Fujita J et al.
British Journal of Clinical Pharmacology May 1999;47(5):499



Oral bedtime cornstarch supplementation reduces the risk for nocturnal
hypoglycaemia in young children with type 1 diabetes
Detlofson I et al.
Acta Paediatrica Jun 1999;88(6):595-597



Type 2 diabetes towards the new millennium - the relative importance of
glycaemic versus lipid control
Florkowski CM and Scott RS
Australian & New Zealand Journal of Medicine Apr 1999;29(2):249-253
Review covering the role of glycaemic control, outcomes of type 2 diabetes,
recognising the atherogenicity of diabetic dyslipidaemia, lipid lowering in
diabetes mellitus, new treatment options and prevention of type 2 diabetes. (35
refs.)



Drug interactions with tobacco smoking: an update
Zevin S and Benowitz NL
Clinical Pharmacokinetics Jun 1999;36(6):425-438
A literature review. (128 refs.)




Effects of calcium-channel blockade in older patients with diabetes and
systolic hypertension
Tuomilehto J et al.
New England Journal of Medicine 4 Mar 1999;340:677-684
4695 patients with systolic blood pressure of 160-219mm Hg and diastolic
pressure below 95mm Hg were randomly assigned to receive nitrendipine
(10-40mg/d) with the possible addition or substitution of enalapril (5-20mg/d)
or hydrochlorothiazide (12.5-25mg/d) or both, or placebo.  After 2yr, the
systolic and diastolic blood pressures in the placebo and active-treatment
groups differed by 8.6 and 3.9mm Hg respectively among the diabetic patients.
Among the 4203 without diabetes, systolic and diastolic pressures differed by
10.3 and 4.5mm Hg respectively in the two groups.  Active treatment was found
to have reduced overall mortality by 55%, mortality from cardiovascular disease
by 76%, all cardiovascular events combined by 69%, fatal and non-fatal strokes
by 73%, and all cardiovascular events combined by 63% in the group of patients
with diabetes.  It was concluded that nitrendipine-based antihypertensive
therapy is particularly beneficial in older patients with diabetes and isolated
systolic hypertension.



Effect of systemic glucocorticoids on exacerbations of chronic obstructive
pulmonary disease
Niewoehner DE et al.
New England Journal of Medicine 24 Jun 1999;340:1944-1947
A double-blind, randomised trial of systemic corticosteroids (given for 2 or
8wk) or placebo, in addition to other therapies, was undertaken for
exacerbations of COPD.  80 received an 8wk course, 80 a 2wk course, and 111
placebo.  Rates of treatment failure were significantly higher in the placebo
group than in the 2 glucocorticoid groups combined at 30d (33% vs 23%) and at
90d (48% vs 37%).  Systemic corticosteroids were associated with a shorter
initial hospital stay (8.5d vs 9.7d for placebo).  Significant treatment
benefits were no longer evident at 6mo.  The 8wk regimen of therapy was not
superior to the 2wk regimen.  The patients who received corticosteroid therapy
were more likely to have hyperglycemia requiring therapy than those who
received placebo (15% vs 4%).




Feasibility and outcomes of insulin therapy in elderly patients with diabetes
mellitus
Saudek CD and Golden SH
Drugs & Aging May 1999;14:375-385
Generally, older patients with diabetes mellitus can be managed for years,
often decades, with nutritional therapy and oral agents.  More options exist
now than did previously.  In addition to a variety of sulfonylureas, there is
metformin, troglitazone and/or alpha-glucosidase inhibitors, that are viable
options to be used before turning to insulin.  Most patients with type 2
diabetes mellitus can be managed with relatively simple insulin regimens thanks
to their endogenous insulin secretion.  More customised, 'intensive' insulin
regimens are needed when the glycaemia is unstable.  Hypoglycaemia is clearly
the most significant risk of insulin therapy.  Nocturnal hypoglycaemia, and, in
particular, hypoglycaemia unawareness, are clear signs that the insulin regimen
should be modified.  Risk/benefit considerations must be taken into account
when deciding which patients to treat with insulin and what insulin regimen to
use.



Update in nephrology
Goldfarb S and Henrich WL
Annals of Internal Medicine 1 Jan 1998;128(1):49-55



Pioglitazone
Anon
Formulary Monograph Service Jun 1999;211-214
Pioglitazone is a thiazolidinedione antidiabetic agent structurally related to
troglitazone and rosiglitazone.  It is currently under review by the FDA and
the manufacturer hopes to receive approval for use as monotherapy and in
combination with sulphonylureas, metformin and insulin in the treatment of Type
2 diabetes mellitus.  Its favourable effects on lipids is promising and if it
remains free of liver toxicity and signif drug interaction it may gain a signif
proportion of the antidiabetic market. (34 refs.)



Gabapentin for painful diabetic neuropathy
Schiebel NEE and Ebbert J; Margolis K
Journal of the American Medical Association 14 Jul 1999;282:133-134 (letters)
Comment on a paper by Backonja et al. (JAMA 2 Dec 1998;280:1831-1836) that
reported a randomised controlled trial of gabapentin in the treatment of
painful diabetic neuropathy.




Alcohol intake and the risk of coronary heart disease mortality in persons with
older-onset diabetes mellitus
Valmadrid CT et al.
Journal of the American Medical Association 21 Jul 1999;282:239-246
Among 983 patients with diabetes mellitus diagnosed after the age of 30 and
followed up for 12.3 years, the risk of death from coronary heart disease
declined progressively with increasing alcohol intake in the light to moderate
range.  Also see editorial, p.279-280.



Drug interactions, renal impairment and hypoglycaemia in a patient with Type II
diabetes
Collin M and Mucklow JC
British Journal of Clinical Pharmacology Aug 1999;48(2):134-137



Hypoglycemia associated with high doses of sertraline and sulphonylurea
compound in a noninsulin-dependent diabetes mellitus patient
Takhar J and Williamson P
Canadian Journal of Clinical Pharmacology Spring 1999;6(1):12-14
A patient with schizoaffective disorder with noninsulin-dependent diabetes
mellitus treated with sertraline, risperidone and glyburide who developed
hypoglycaemia is presented.  Greater inhibition of the P450 system was likely
induced at doses higher than those recommended.  This process was reversed
within 10 days of discontinuing the sertraline.  Good glycaemic control
followed discontinuation of psychotropic drugs and the oral hypoglycaemic
agent.