The American journal of medicine
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Randomized Controlled Trial Clinical Trial
Concomitant insulin and sulfonylurea therapy in patients with type II diabetes. Effects on glucoregulation and lipid metabolism.
Recent evidence suggests concomitant insulin and sulfonylurea therapy has a theoretical potential in the management of type II diabetes mellitus. In a long-term double-blind, randomized placebo-controlled study of combination therapy, serum glucose, C-peptide, total cholesterol, triglyceride, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol concentrations were evaluated in insulin-treated patients with poorly controlled, type II diabetes mellitus after addition of either glyburide (n = 10) or placebo (n = 12). Oral glucose tolerance testing was performed at weeks 0, 4, and 16. ⋯ Despite significantly lower fasting serum glucose and glycosylated hemoglobin levels after 16 weeks, combination treatment did not normalize glycemic control. Glucose tolerance decreased further after 16 weeks despite persistence of increased endogenous insulin secretion. The role of the combination therapy in the long-term care of patients with type II diabetes mellitus needs further investigation.
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A cross-sectional study was conducted to determine whether normal, age-related declines in cognitive function are accelerated in non-insulin-dependent (type II) diabetes mellitus. Study participants ranged in age from 55 to 74 years. ⋯ Cognitive performance is poorer in diabetic patients with peripheral neuropathy or elevated hemoglobin A1c levels. The apparent cognitive impairment in aging patients with type II diabetes may complicate adherence to medical regimens.
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The pattern-shift evoked potential was measured in 19 hypothyroid patients before treatment, and after short- (one week) and long-term (12 to 24 weeks) thyroid hormone replacement therapy. Before treatment, nine patients had an abnormally prolonged visual evoked potential latency, more than 115 msec. After one week of therapy with 50 micrograms per day of L-triiodothyronine, the mean visual evoked potential latency for the entire group was unchanged, 114 +/- 8 to 114 +/- 7 msec. ⋯ The visual evoked potential amplitude was also significantly changed by long-term L-thyroxine, 4.8 +/- 0.7 to 9.0 +/- 1.0 microV (p less than 0.01). It is concluded that the visual evoked potential is reversibly altered in hypothyroidism. This neurophysiologic parameter permits quantitation of the effects of hypothyroidism on the central nervous system and the extent and rate of response to thyroid hormone replacement therapy.