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Query: UMLS:C0011860 (type 2 diabetes)
 57,723 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study evaluated the relationships between the alveolar integrity and the pulmonary function in 33 male subjects, including 18 COPD patients, 10 normal volunteers and 5 NIDDM patients. Alveolar integrity was evaluated by dynamic Tc-99m DTPA/HMPAO radioaerosol lung scintigraphies. The speed of radioaerosol clearance is represented as a slope from the lungs to the blood stream. Comprehensive pulmonary function tests included forced expiratory volume, flow-volume loop, and diffusion capacity of a single breath CO method. The results showed the following: that (1) there are no correlations between the slopes and the parameters of pulmonary function tests, and (2) that the clearance of DTPA aerosols is faster than the clearance of HMPAO, and that these differences are significant. In conclusion, the radionuclide alveolar integrity study should be considered as a new method for evaluating lung function, and should be differentiated from traditional pulmonary function tests, and, secondly, lipophilic HMPAO aerosols are slower to clear than those of hydrophilic DTPA, which suggests at least two different clearance mechanisms for radioaerosols.
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PMID:The relationships between the radionuclide alveolar integrity study and the pulmonary function test. 870 78

Physical training for patients with internal diseases differs in many points to the physical activity recommended for health maintenance. Cardiac patients are usually limited by symptoms (angina, ECG abnormalities, anaerobic threshold) therefore the intensity of the training (monitored by heart rate or ECG) must be setted by an ergometer exercise testing. Patients with obliterative peripheral artery disease may surpass the local anaerobic threshold during interval-type loads. Blood pressure limits the training intensity of the hypertensive patients if not an organ lesion. COPD patients use the rest periods of an interval training for expectoration and for restitution of their blood gas values. In insulin dependent diabetes the vascular complications can be avoided by a proper insulin regime, training and diet. Day-to-day training by an even energy need acts like the insulin therefore it must be carefully dosed. In NIDDM also the carbohydrate metabolism can improve significantly. In anxiety and depression the training and the social milieu offers a physiological trigger for the improvement. Other rehabilitative interactions (psychology, dietetics, behavioral modalities etc.) are built up in the basis of exercise training.
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PMID:[Training program for rehabilitation of patients with internal diseases]. 1037 66

Chronic care has to be organised in a way that care from any one caregiver is linked up to that provided by others so that disturbing gaps, contradictions and overlaps are avoided. In the search for the most effective and efficient combination of health professionals to deliver care to chronic patients, the role of the specialised nurse has become important. This article reviews a Medline search for publications about the effects of models of care for patients with NIDDM or COPD in which the specialised nurse has a central role. Main features of the models are identified and related to expected and statistically significant effects. In this young domain of effect evaluation ten publications met our criteria. Depending on the division of tasks between care providers, improvements are seen in self-care, quality of life and patient satisfaction, as well as increased medical consumption. More methodologically suitable evaluations with the use of only valid measures are needed.
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PMID:Effects on quality of care for patients with NIDDM or COPD when the specialised nurse has a central role: a literature review. 1104 27

The Programme for National Disease Management Guidelines (German DM-CPG Programme) was established in 2002 by the German Medical Association (umbrella organisation of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF)--umbrella organisation of more than 150 professional societies--and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The programme provides a conceptual basis for disease management, focussing on high priority healthcare topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organised by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network G-I-N. The main objective of the German DM-CPG Programme is to establish consensus among the medical professions on evidence-based key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year DM-CPGs have been published for asthma, COPD, type 2 diabetes and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for healthcare providers. The article describes background, methods and tools of the DM-CPG programme using the DM-CPG Method Report 2007.
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PMID:[Method report 2007 of the Programme for National Disease Management Guidelines--background and content]. 1760 Nov 83

Hypogonadism in males is a clinical syndrome complex which comprises symptoms with or without signs as well as biochemical evidence of testosterone deficiency. The diagnosis of hypogonadism thus includes both clinical history and examination as well as biochemical assessment of serum testosterone levels. Hypogonadal symptoms depend on the age at onset of hypogonadism, severity of the deficiency, its duration and sensitivity to androgen action. Prepubertal onset results in lack of virilization and pubertal development and produces features such as eunuchoid body proportions and undeveloped secondary sex characteristics. Development of hypogonadism in adult life is characterized by a loss of androgen-dependent functions such as reduction in muscle mass, a shift in body composition towards more adipose tissue, decreased sexual function with diminished libido, depressed mood, loss of psychological energy osteoporosis and several other possible symptoms. The majority of men who suffer from hypogonadism do not have classical endocrine disorders. These men present with concomitant disease such as metabolic syndrome or type 2 diabetes, chronic infections, inflammatory disease, COPD, or cardiovascular disease. All these conditions are associated with a high prevalence of hypogonadism. Pharmacological therapy with opiates and corticosteroids are also known to cause hypogonadism. Hypogonadal symptoms are precipitated at different testosterone levels. Total testosterone levels of less than 8 nmol/l highly support a diagnosis of hypogonadism whereas levels greater than 12 nmol/l are likely to be normal. The grey zone between 8 and 12 nmol/l requires further evaluation and assessment of free or non-sex hormone-binding globulin-bound (bioavailable) testosterone. A trial period of testosterone treatment may be required.
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PMID:Current guidelines for the diagnosis of testosterone deficiency. 1901 Dec 85

In order to calculate the cardiovascular risk in patients with chronic renal failure (CRF), we retrospectively analyzed 1482 acute myocardial infarctions (AMIs) treated in the ICU at C. Poma General Hospital, Mantua, Italy, from 1 December 2004 to 31 July 2007. Of these patients, 133 suffered from CRF at hospital admission (eGFR <40 mL/min/1.73 m2 body surface and/or serum creatinine >2 mg/dL). During hospitalization for AMI, the CRF-affected patients showed a 2.7 times higher relative risk of mortality than patients without CRF (Yates chi square 14.46; p = 0.0001432). The evaluated comorbidities (hypertension, type 2 diabetes, supra-aortic vascular stenosis >70%, previous PTCA, COPD, previous AMI, previous coronary artery bypass and chronic obliterative peripheral arteriopathy) increased the relative risk of death 1.2- to 3.76-fold in those affected. In accord with recent evidence in the international literature, our results point to the importance of early assessment of CRF for the prognosis of patients with AMI.
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PMID:[Mortality triplicates in acute myocardial infarction patients affected by chronic renal failure]. 1938 88

Chronic obstructive pulmonary disease and obesity are major causes of morbidity and mortality worldwide and, according to current data, the global burden of these conditions will increase further. Obesity plays a major role in the development of the metabolic syndrome and has been identified as an important risk factor for chronic diseases such as type 2 diabetes mellitus and cardiovascular disease. Adiposity is associated with insulin resistance even over relatively normal ranges of body fatness. There is strong evidence that altered adipose tissue function plays a crucial role in the pathogenesis of obesity-related insulin resistance and type 2 diabetes, as has recently been reviewed. Obesity is linked to respiratory diseases such as obstructive sleep apnea syndrome and obesity hypoventilation syndrome and accumulating evidence suggests an association between obesity and asthma. A potential link between obesity and COPD is also increasingly recognized although little data is known about the mechanisms underlying this association. The inflammatory and metabolic profile differs between obese with COPD and normo or underweight with COPD in part due to dysfunction of adipose tissue.
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PMID:The metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease. 2006 62

A 60-year old male patient with obesity and type 2 diabetes mellitus consulted due to high blood pressure, fearful of suffering ischemic heart disease. He also had a background of smoking 20 cigarettes/day for the last 30 years, but this did not concern him. In the questioning, he reported, although he did not consider it important, that he had cough and dyspnea on moderate exertions for some years. It is very unlikely that any internal medicine physician would doubt about whether to evaluate and treat his type 2 diabetes mellitus or high blood pressure, calculate his cardiovascular risk or if he has a metabolic syndrome, attempt to reduce his obesity and to make him stop smoking. However, should we label him as having chronic bronchitis or COPD? Should we perform a spirometry and bronchodilator test, treat his probable COPD? All his current symptoms are probably only due to COPD.
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PMID:[Approach to COPD management in Internal Medicine]. 2034 75

Acute exacerbations of COPD (AECOPD) are major clinical events. They are associated with a more rapid decline in lung function, poorer quality of life scores, and an increased risk of dying. Exacerbations that require hospitalization have particular significance. Approximately 40% of the AECOPD patients who require hospitalization will die in the subsequent year. Since many AECOPD require hospitalization, they account for most of the expense of caring for COPD patients. Treatment with long-acting bronchodilators and combination inhaled corticosteroid/long-acting bronchodilator inhalers reduces but does not eliminate AECOPD. Roflumilast, a selective phosphodiesterase 4 (PDE4) inhibitor, is an anti-inflammatory medication that improves lung function in patients with COPD. In patients with more severe airway obstruction, clinical features of chronic bronchitis, and a history of AECOPD, roflumilast reduces the frequency of AECOPD when given in combination with short-acting bronchodilators, long-acting bronchodilators, or inhaled corticosteroids. It is generally well tolerated but the most common adverse effects include diarrhea, nausea, weight loss, and headaches. In clinical trials, patients treated with roflumilast experienced weight loss that averaged just over 2 kg but was primarily due to the loss of fat tissue. Weight loss was least in underweight patients and obese patients experienced the greatest weight loss. An unexpected benefit of treatment with roflumilast was that fasting blood glucose and hemoglobin A1c levels improved in patients with comorbid type 2 diabetes mellitus. Roflumilast, the first selective PDE4 inhibitor to be marketed, is a promising drug for the management of COPD patients with more severe disease.
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PMID:Roflumilast, a Novel Phosphodiesterase 4 Inhibitor, for COPD Patients with a History of Exacerbations. 2208 17

Chronic obstructive pulmonary disease, metabolic syndrome and diabetes mellitus are common and underdiagnosed medical conditions. It was predicted that chronic obstructive pulmonary disease will be the third leading cause of death worldwide by 2020. The healthcare burden of this disease is even greater if we consider the significant impact of chronic obstructive pulmonary disease on the cardiovascular morbidity and mortality. Chronic obstructive pulmonary disease may be considered as a novel risk factor for new onset type 2 diabetes mellitus via multiple pathophysiological alterations such as: inflammation and oxidative stress, insulin resistance, weight gain and alterations in metabolism of adipokines. On the other hand, diabetes may act as an independent factor, negatively affecting pulmonary structure and function. Diabetes is associated with an increased risk of pulmonary infections, disease exacerbations and worsened COPD outcomes. On the top of that, coexistent OSA may increase the risk for type 2 DM in some individuals. The current scientific data necessitate a greater outlook on chronic obstructive pulmonary disease and chronic obstructive pulmonary disease may be viewed as a risk factor for the new onset type 2 diabetes mellitus. Conversely, both types of diabetes mellitus should be viewed as strong contributing factors for the development of obstructive lung disease. Such approach can potentially improve the outcomes and medical control for both conditions, and, thus, decrease the healthcare burden of these major medical problems.
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PMID:Chronic obstructive pulmonary disease and glucose metabolism: a bitter sweet symphony. 2310 36


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