1,720,974 research outputs found
Beyond reasonable doubt: catching the growth hormone cheats
No full textThere is widespread anecdotal evidence that growth hormone (GH) is used by athletes for its anabolic and lipolytic properties to improve their performance. Within adolescent athletes, GH may also be used to increase linear growth. The athletes put themselves at risk by doing so but there are also wider societal implications for this cheating. Although GH is on the World Anti-doping Agency list of banned substances, the detection of abuse with GH is challenging. Two approaches have been developed to detect GH abuse. The first is based on an assessment of the effect of exogenous GH on pituitary GH isoforms and the second is based on the measurement of markers of GH action. As a result GH abuse can be detected with reasonable sensitivity and specificit
The effect of sulphonylureas on the microvascular and macrovascular complications of diabetes
No full textINTRODUCTION: Type 2 diabetes mellitus is a chronic progressive disease that is characterised by hyperglycaemia and is associated with an increased risk of the development of microvascular complications, such as retinopathy, nephropathy and neuropathy, and cardiovascular disease. With the introduction of newer oral hypoglycaemic agents, there is a need to re-evaluate critically the effectiveness and safety of the older agents, including sulphonylureas, to assess their place in the modern management of type 2 diabetes. BACKGROUND: Though no clear benefit of sulphonylureas has been shown with respect to large vessel disease, long term studies have, however, shown benefits in patients with microvascular complications. Studies such as the University Group Diabetes Project raised concerns about the safety profile of sulphonylureas, but large prospective studies such as the UK Prospective Diabetes Study have helped to assuage such concerns to a large degree. Their utility in the peri-infarct period continues to be debatable because of the potential effect on cardiac pre-conditioning. CONCLUSION: Though sulphonylureas continue to be a mainstay of treatment in type 2 diabetes, future clinical trials addressing clinically relevant outcomes are indicated with the newer generation of sulphonylureas that are more beta cell-specific to address the concerns raised about sulphonylureas and cardiac myocyte
Growth hormone, IGF-I and insulin and their abuse in sport
No full textThere is widespread anecdotal evidence that growth hormone (GH) is used by athletes for its anabolic and lipolytic properties. Although there is little evidence that GH improves performance in young healthy adults, randomized controlled studies carried out so far are inadequately designed to demonstrate this, not least because GH is often abused in combination with anabolic steroids and insulin. Some of the anabolic actions of GH are mediated through the generation of insulin-like growth factor-I (IGF-I), and it is believed that this is also being abused. Athletes are exposing themselves to potential harm by self-administering large doses of GH, IGF-I and insulin. The effects of excess GH are exemplified by acromegaly. IGF-I may mediate and cause some of these changes, but in addition, IGF-I may lead to profound hypoglycaemia, as indeed can insulin. Although GH is on the World Anti-doping Agency list of banned substances, the detection of abuse with GH is challenging. Two approaches have been developed to detect GH abuse. The first is based on an assessment of the effect of exogenous recombinant human GH on pituitary GH isoforms and the second is based on the measurement of markers of GH action. As a result, GH abuse can be detected with reasonable sensitivity and specificity. Testing for IGF-I and insulin is in its infancy, but the measurement of markers of GH action may also detect IGF-I usage, while urine mass spectroscopy has begun to identify the use of insulin analogue
Intrauterine growth, the vascular system, and the metabolic syndrome
No full textThere is substantial evidence linking birth size with the risk of developing cardiovascular disease and its major biological risk factors in adulthood. The fetal origins hypothesis proposes that these diseases originate through adaptations, which the fetus makes when it is undernourished. These adaptations may be cardiovascular, metabolic, or endocrine. They permanently change the structure and function of the body. Prevention of the diseases may depend on prevention of imbalances in fetal growth or imbalances between prenatal and postnatal growth, or imbalances in nutrient supply to the fetus. The purpose of this article is to examine some of the more recent epidemiological associations between low birth weight and adult atherosclerotic vascular disease and its risk factors. We will also discuss mechanisms that might explain these associations. <br/
The addition of metformin in type 1 diabetes improves insulin sensitivity, diabetic control, body composition and patient well-being
No full textAIM: As many overweight people with T1DM are insulin resistant, adjuvant therapy with insulin sensitising agents, such as metformin, may be beneficial. This study evaluated the effect of adjuvant metformin in T1DM on insulin sensitivity, diabetic control, body composition, quality of life (QOL) and treatment satisfaction. MATERIALS AND METHODS: A 3-month prospective open-labelled pilot study of 16 patients aged 18-40 with T1DM and body mass index (BMI) >25 kg/m(2) was performed. The patients received 500-850 mg metformin twice daily. Insulin sensitivity, assessed by a frequently sampled intravenous glucose tolerance test [n=5], body composition, HbA(1c) and quality of life (QOL) were measured before and after treatment. A retrospective review of 30 patients with T1DM treated with metformin for at least 4 months was also performed. BMI, HbA(1c) and insulin requirements during metformin treatment was compared to pre-metformin data, and to patients treated with insulin only. RESULTS: In the pilot study, insulin sensitivity increased significantly from 0.86 +/- 0.33 x 10(-4)/min/(microU/ml) to 1.17 +/- 0.48 x 10(-4)/min/(microU/ml) after 3 months adjuvant therapy (p = 0.043). This was associated with a decreased insulin requirement and mean daily blood glucose. There were no significant changes in HbA(1c) or body composition. QOL significantly improved (p < 0.002). The retrospective review revealed an initial reduction in HbA(1c) (0.8 +/- 1.4%, p = 0.001). This effect diminished with prolonged treatment. BMI decreased in patients remaining on metformin for a 2-year period (0.5 +/- 0.5kg/m(2), p = 0.042). CONCLUSION: Adjuvant metformin can improve QOL, insulin sensitivity and glycaemic control in overweight adults with T1D
Antipsychotic drugs and diabetes: an application of the Austin Bradford Hill criteria
No full textThere is concern that antipsychotic drugs cause diabetes. Although there has been an explosion in the quantity of literature about this subject, it remains confusing and inconsistent. To assess whether the association between antipsychotic drugs and diabetes is causative, we applied the Austin Bradford Hill criteria to the available evidence. In support of a causative relationship, there is temporality for some cases of diabetes, and there is a biologically plausible explanation. The causative link between antipsychotic drugs and diabetes is coherent with our understanding of diabetes and there are other analogies. However the strength of association is weak, there is lack of consistency or specificity, and there is little evidence to support a biological gradient. We should therefore conclude that the evidence surrounding a causative link between antipsychotic drugs and diabetes is inconclusive. Moreover, the risk is probably low and the attributable risk of developing diabetes is greater for traditional risk factors such as family history, ethnicity, obesity and ageing than it is for receiving an antipsychotic drug. Consequently, the majority of patients receiving second-generation antipsychotics will not develop diabetes as a result of their medication
Association of British Clinical Diabetologists (ABCD) and Diabetes-UK survey of specialist diabetes services in the UK, 2006. 1. The consultant physician perspective
No full textAIMS: To identify the views and working practices of consultant diabetologists in the UK in 2006-2007, the current provision of specialist services, and to examine changes since 2000.METHODS: All 592 UK consultant diabetologists were invited to participate in an on-line survey. Quantitative and qualitative analyses of responses were undertaken. A composite 'well-resourced service score' was calculated. In addition to an analysis of all respondents, a sub-analysis was undertaken, comparing localities represented both in 2006/2007 and in 2000.RESULTS: In 2006/2007, a 49% response rate was achieved, representing 50% of acute National Health Service Trusts. Staffing levels had improved, but remained below recommendations made in 2000. Ten percent of specialist services were still provided by single-handed consultants, especially in Northern Ireland (in 50% of responses, P = 0.001 vs. other nations). Antenatal, joint adult-paediatric and ophthalmology sub-specialist diabetes services and availability of biochemical tests had improved since 2000, but access to psychology services had declined. Almost 90% of consultants had no clinical engagement in providing community diabetes services. The 'well-resourced service score' had not improved since 2000. There was continued evidence of disparity in resources between the nations (lowest in Wales and Northern Ireland, P = 0.007), between regions in England (lowest in the East Midlands and the Eastern regions, P = 0.028), and in centres with a single-handed consultant service (P = 0.001). Job satisfaction correlated with well-resourced service score (P = 0.001). The main concerns and threats to specialist services were deficiencies in psychology access, inadequate staffing, lack of progress in commissioning, and the detrimental impact of central policy on specialist services. CONCLUSIONS: There are continued disparities in specialist service provision. Without effective commissioning and adequate specialist team staffing, integrated diabetes care will remain unattainable in many regions, regardless of reconfigurations and alternative service model
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