Epidemiology of severe hypoglycemia in the diabetes control and complications trial
Article Abstract:
Hypoglycemia, or low blood sugar levels, is often a side effect of insulin treatment in patients with insulin-dependent diabetes mellitus (IDDM). Hypoglycemia can cause mild to severe problems, often impairing basic functions and sometimes causing coma and death. Recent advances in insulin therapy, such as the insulin pump that is implanted in the patient and automatically delivers insulin, have increased fears that more frequent and severe hypoglycemic side effects would occur. These new intensive therapies are designed to keep blood sugar levels as close to normal at all times in patients, but they have not been completely perfected. Studies have been inconclusive as to whether these new intensive treatments lead to more frequent and severe hypoglycemic episodes. This study examined this issue by monitoring hypoglycemic episodes that occurred in patients from a group of 424 patients given intensive and 393 given traditional insulin therapy. In all, 216 patients experienced 714 severe hypoglycemic episodes. Of these 216 patients, 146 were from the group receiving the intensive therapy and 70 were from the group receiving traditional therapy. Out of the 714 hypoglycemic incidents, 77 percent (549) were from the intensive therapy group. Seventy percent of the hypoglycemic episodes either occurred during sleep or gave no warning symptoms. These results indicate that hypoglycemia is much more likely to occur in patients receiving intensive therapy than in those receiving traditional therapy. Patient screening should be more stringent and a cost-versus-benefit analysis carefully performed before intensive insulin therapy is given to IDDM patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Evolving natural history of coronary artery disease in diabetes mellitus
Article Abstract:
There are two forms of diabetes mellitus: insulin-dependent (IDDM), in which the insulin-secreting pancreatic beta cell is dysfunctional and insulin levels are low, and non-insulin-dependent (NIDDM) in which insulin levels are high, but the body loses its sensitivity to the actions of insulin. In both cases, blood sugar levels are excessively high, and must be controlled by pharmacological and dietary means. Patients with both types of diabetes are at greater risk than nondiabetics for developing coronary artery disease (occlusion of the coronary arteries which supply the heart with blood). This increased risk seems to result from premature development of atherosclerosis (formation of fatty plaques on the inner surface of blood vessels), but the mechanism responsible for this accelerated atherosclerosis remains unknown. In both IDDM and NIDDM patients, the risk of developing CAD increases with the duration of the diabetic condition, but does not increase as a constant multiple of the risk undergone by nondiabetic patients. This fact has been interpreted to mean that the diabetic condition increases the severity of existing atherosclerotic plaques, but has no influence on whether or not they develop in the first place. This notion is supported by the finding that diabetics in populations with low CAD incidence do not seem to be at greater risk of developing that condition. Evidence is accumulating that, at least in some diabetic patients, hyperinsulinemia (high insulin levels) may play an important role in the onset of CAD. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
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