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

In order to evaluate the choice among alternatives quantitatively, a formal decision model must be developed. Yet the literature does not currently include the information required to develop this model. Data tell us very little about what factors should be considered in the choice of treatment for NIDDM patients. Table 1 summarizes some of the advantages and disadvantages of insulin, sulfonylureas, and dietary treatments. Insulin may have the greatest effect upon blood glucose, but may also be associated with the greatest likelihood of nuisance for the patient. At the other extreme, dietary treatment may be safe, but may have a low probability of achieving long-term blood glucose control. There is remarkably little in the literature that considers nuisance factors for the patient, minor but persistent side effects, or the likelihood of other physical changes such as weight gain. We know even less about how to integrate preferences for benefits and side effects into a comprehensive decision. Although some profiles of laboratory results clearly dictate a treatment protocol, there is considerable variability in the treatment options for a large number of NIDDM patients. Consider, for example, the patient who has a fasting blood glucose of 250 mg/dl but no symptoms. There may be several treatment alternatives. Yet the chances of therapeutic success could be influenced by the patient's concern about being dependent upon medication, willingness to comply with life-style changes, and fear of using needles. We suggest that the patient must be active in negotiating the choice of treatment, and that patient preferences for expected outcomes, side effects, and nuisance factors need to be considered.(ABSTRACT TRUNCATED AT 250 WORDS)
J Gen Intern Med
PMID:Trade-offs in treatment alternatives for non-insulin-dependent diabetes mellitus. 265 3

Metformin (dimethylbiguanide) is an antihyperglycaemic drug used to treat non-insulin dependent diabetes mellitus. It acts in the presence of insulin to increase glucose utilization and reduce glucose production, thereby countering insulin resistance. The effects of metformin include increased glucose uptake, oxidation and glycogenesis by muscle, increased glucose metabolism to lactate by the intestine, reduced hepatic gluconeogenesis and possibly a reduced rate of intestinal glucose absorption. Metformin appears to facilitate steps in the postreceptor pathways of insulin action, and may exert effects that are independent of insulin. In muscle, metformin increases translocation into the plasma membrane of certain isoforms of the glucose transporter. The effects of metformin are generally moderate, and do not cause clinical hypoglycaemia or increased weight gain. Metformin has an antihypertriglyceridaemic effect and exerts various potentially useful effects on haemostasis. A risk of lactic acidosis is negligible provided that the contraindications, particularly renal incompetence are respected.
Gen Pharmacol 1993 Nov
PMID:Metformin--an update. 811 99

1. Groups of lean and obese-diabetic (NIDDM) congenic male SHR/Nutl parallel-cp rats were fed a nutritionally adequate, high carbohydrate diet ad libitum with or without the alpha-glucosidase inhibitor miglitol (150 mg/kg diet) from 8 until 15 weeks of age, and key glycemic parameters were monitored throughout the study. 2. Miglitol treatment resulted in clinical improvement toward normal in percent glycosylated hemoglobin, glycemic and insulinogenic responses to an oral glucose tolerance, and in liver glucokinase activity, in concert with modest decreases in weight gain in obese rats. 3. These observations are consistent with improved insulin sensitivity in peripheral tissues following miglitol treatment, and indicate that this drug may be a useful adjunct to diet in the treatment of obesity, NIDDM, and possibly other disorders of carbohydrate metabolism.
Gen Pharmacol 1993 Mar
PMID:The effects of the intestinal glucosidase inhibitory BAY M 1099 (miglitol) on glycemic status of obese-diabetic rats. 848 29

The whole-cell configuration of the patch-clamp technique was employed to measure the transient outward potassium current in enzymatically isolated ventricular cells of spontaneously diabetic rats (BB/Wor) and mice (ob/ob). Healthy littermates (non-diabetic BB rats and lean mice) were used as controls. There was no significant difference between the non-diabetic and diabetic BB rats (Type I diabetes, IDDM) in the amplitude of either the current measured in the absence or the one found in the presence of 4-aminopyridine. The voltage dependence of the activation and steady-state inactivation was also similar in both populations, as no significant difference was observed in the rate of recovery from inactivation of Ito. The amplitudes of the total and 4-aminopyridine sensitive currents of lean and obese mice (Type II diabetes, NIDDM) were also similar. The voltage dependences of the activation and of the steady-state inactivation did not differ significantly, either. Our results might indicate certain limitations of the applicability of experiments carried out on genetically diabetic rats if the results are compared to those derived from the healthy littermates as controls.
Gen Physiol Biophys 1996 Jun
PMID:Characteristics of the ventricular transient outward potassium current in genetic rodent models of diabetes. 907 5

Differences in myocardial contractility were studied in type I (insulin-dependent, IDDM) and type II (non-insulin-dependent, NIDDM) diabetic rats. Using the streptozotocin-induced diabetes as an experimental model, the contractile properties of left ventricular myocardium of IDDM and NIDDM animals were compared to similar parameters of their age-matched controls. Contraction force was analyzed as a function of the pacing frequency. Paired-pulse stimulation and catecholamine treatment were applied to compare the inotropic responses obtained in the two types of diabetes. Diabetic and control preparations developed equal peak tension at each driving frequency upon the application of paired-pulse stimulation with fixed interpulse interval. The interpulse interval dependence of paired-pulse induced inotropy was altered and the velocity of contraction and relaxation decreased in IDDM, but not in NIDDM muscles. Sensitivity to isoproterenol and norepinephrine was decreased in both types of diabetes, however, the isoproterenol resistance of old diabetic animals was attributable to age rather than to the diabetic state. The results indicate that alterations in the contractile parameters and catecholamine sensitivity in IDDM differ from those observed in NIDDM form of diabetes mellitus.
Gen Physiol Biophys 1996 Oct
PMID:Changes in cardiac contractility in IDDM and NIDDM diabetic rats. 922 18

Little is known about which factors may adversely affect response to psychotherapy in diabetic patients with major depression. We studied the relationship of various demographic, diabetes, and depression characteristics to change in depression in 42 patients with type 2 diabetes who completed a randomized clinical trial of cognitive behavior therapy (CBT). Depression remitted in a significantly greater percentage of the patients treated with CBT than with the control intervention (85.0% vs 27.3%, p < 0.001). In the sample as a whole, nonremission of depression was associated with lower compliance with blood glucose monitoring, higher glycated hemoglobin (GHb) levels, higher weight, and a history of previous treatment for depression. In the group treated with CBT, the presence of diabetes complications and lower compliance with blood glucose monitoring were significant independent predictors of diminished response. These findings show that factors related to the medical illness, such as the presence of diabetes complications, may negatively influence the prognosis for recovery from depression. Specific coverage of these issues during psychotherapy may optimize the likelihood of treatment success in patients with diabetes.
Gen Hosp Psychiatry 1998 Sep
PMID:Predicting response to cognitive behavior therapy of depression in type 2 diabetes. 978 30

Obesity is common in schizophrenia, and people with schizophrenia appear to be at increased risk for certain obesity-related conditions, such as type 2 diabetes and cardiovascular disease. Antipsychotic drugs, used chronically to control symptoms of schizophrenia, are associated with often-substantial weight gain, a side effect that is a special concern with the latest generation of highly effective "novel" agents. That the most effective (e.g., novel) antipsychotic medications lead to substantial weight gain presents the field with a critical public health problem. Although preliminary data have been reported regarding the beneficial use of behavior therapy programs for short-term weight control in patients with schizophrenia, the available data are quite limited, and there are no data regarding the long-term beneficial effects of these programs in this population. The obesity field recently has developed programs emphasizing "lifestyle changes" (e.g., diet, exercise, and problem-solving skills) to successfully manage weight in patients without schizophrenia. Such programs can be adapted for patients with schizophrenia through the use of highly structured and operationalized modules emphasizing medication compliance, social skills development, and participation in outpatient programs. Moreover, these programs can potentially be combined with the use of adjunctive pharmacotherapy to maximize and maintain weight loss. The field must solve the paradox that some of our most effective medications for schizophrenia produce substantial weight gain and its associated troubling health risks.
Gen Hosp Psychiatry
PMID:Weight gain from novel antipsychotic drugs: need for action. 1093 29

A survey was mailed to a probability sample of primary care physicians in Indiana to assess their use of and barriers to nutritional therapy for patients with type 2 diabetes. Most (62%) primary care physicians reported referring their type 2 diabetes patients for nutrition counseling, while 38% reported providing counseling themselves. Patient-centered barriers were most frequently cited as reasons for poor effectiveness of nutrition therapy. This differs from previous research that cites system-level factors as barriers.
J Gen Intern Med 2000 Nov
PMID:Nutrition management of type 2 diabetes by primary care physicians: reported use and barriers. 1111 75

This study of 845 patients with type 2 diabetes was conducted in 12 primary care general practices in a geographically cohesive region in Germany. It showed that about a fifth of these patients with known diabetes had a HbA1c of 8% or over, and therefore are in need of better glycaemic control. Younger patients seem to be at special risk for high HbA1c values, and they should receive particular attention with respect to preventive measures for better glycaemic treatment.
Br J Gen Pract 2003 May
PMID:Younger patients with type 2 diabetes need better glycaemic control: results of a community-based study describing factors associated with a high HbA1c value. 1283 May 67

The United Kingdom Prospective Diabetes Study (UKPDS) is one of the longest and largest clinical trials ever conducted. It explored the effects of intensive blood glucose and blood pressure control on the development of complications in patients with type 2 diabetes. Patients took part in this trial for up to 20 years and the drop-out rate was extremely low. The aim of this discussion paper is to explore patients' motivations for joining the UKPDS and for remaining in the trial, and to examine the implications of findings for good practice before, during, and after clinical trials. A qualitative, exploratory study was undertaken, involving former UKPDS patients (n = 10) at Northampton General Hospital, England. In-depth, semi-structured interviews were undertaken and the data analysed using grounded theory approaches. The results showed that patients were motivated to join the UKPDS because they believed this would give them the best clinical care and reduce the threat of the disease. However, all of the patients identified unanticipated benefits of trial participation, to which they attributed their strong commitment to the UKPDS. These included the reassurance provided by regular clinical examinations, the personal nature of clinical care, and the welcome discipline imposed by UKPDS professionals. Transition back to primary care at trial closure could be a lonely experience, despite follow-up being seen as competent. Practitioners involved in recruiting patients for clinical trials should be aware that participants may be motivated by the desire for better clinical care, irrespective of randomisation consequences. Those taking back the clinical care of trial participants with chronic disease may wish to consider a 're-entry' interview, to minimise trial bereavement.
Br J Gen Pract 2003 May
PMID:Participating in the United Kingdom Prospective Diabetes Study (UKPDS): a qualitative study of patients' experiences. 1283 May 61


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