The American journal of medicine
-
The relationship between repetitive hemoglobin A1 values and daily blood glucose tests performed by 20 insulin-dependent diabetic outpatients was assessed over a six-week period using a modified reflectance meter capable of storing blood glucose determinations automatically. An average of four and a half determinations per subject per day was recorded with a range of average blood glucose values between 82 +/- 2 mg/dl and 316 +/- 5 mg/dl (mean +/- SE). The relationship between average blood glucose and hemoglobin A1 values was significant when hemoglobin A1 values at the end of the six-week period were correlated with the mean blood glucose level over that period (r = 0.55, p less than 0.02), but improved when a more remote hemoglobin A1 value obtained at 10 weeks was used (r = 0.64, p less than 0.005). ⋯ The average fasting blood glucose level in these subjects was highly correlated with the overall daily blood glucose values (r = 0.89, p less than 0.0001), although the coefficients of variation of these parameters averaged 43 +/- 3 percent and 47 +/- 2 percent, respectively, and were greater than that of the hemoglobin A1 values over six weeks (10 +/- 2 percent). It is concluded that labile blood glucose control in patients with insulin-dependent diabetes is accurately reflected by the average fasting blood glucose level, although multiple determinations must be employed. Satisfactory assessment may be made by use of hemoglobin A1 value provided that the hemoglobin A1 determination follows a sufficiently long period of time, presumably related to the turnover of glycosylated hemoglobin.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of terazosin as an antihypertensive agent.
A total of 713 patients with hypertension were evaluated in eight randomized, double-blind, placebo-controlled trials of terazosin administered in single daily doses ranging from 1 to 40 mg. In three of these studies, terazosin or placebo was added to ongoing antihypertensive drug therapy. Patient response was categorized (from excellent to inadequate) according to the change in supine diastolic blood pressure from baseline and the value at the final visit. ⋯ Overall, 52 percent of terazosin-treated patients in these eight studies, compared with 30 percent of placebo-treated patients, had good to excellent responses. Subgroup analysis revealed that blood pressure response was not dependent on sex or age, although white patients appeared to achieve better responses to terazosin in comparison with placebo than did black patients. These studies demonstrate that terazosin administered once daily, either as monotherapy or in combination with other antihypertensive agents, effectively controls blood pressure in patients with mild to moderate hypertension.
-
A group of 2,122 healthy men in the Honolulu Heart Program who participated in the Cooperative Lipoprotein Phenotyping Study, 1970 to 1972, were followed for 10 years by repeated examinations and surveillance of hospital discharge and mortality records in order to diagnose new cases of coronary heart disease, stroke, cancer, and other deaths. Total cholesterol and low-density lipoprotein cholesterol were significantly associated with all clinical types of coronary heart disease in multivariate analyses, whereas high-density lipoprotein cholesterol was inversely associated with nonfatal myocardial infarction and total coronary heart disease, but not with fatal coronary heart disease nor angina. ⋯ Thus, for total disease (coronary heart disease, stroke, cancer, and other deaths), the optimal range for lowest disease incidence was about 200 to 220 mg/dl for total cholesterol and 120 to 140 mg/dl for low-density lipoprotein cholesterol. A strong inverse pattern of total disease with high-density lipoprotein cholesterol indicated that the highest levels were the optimal levels.
-
The relation of blood pressure to fasting (basal) insulin and glycosylated hemoglobin (hemoglobin A1) was examined in 248 nondiabetic subjects (137 women and 111 men). None of the subjects was taking antihypertensive medication. ⋯ In a multiple regression analysis, the association between blood pressure and insulin level was diminished with an allowance for adiposity; however, it remained statistically significant. These data indicate that blood pressure is related to insulin levels in nondiabetic subjects and suggest that insulin may be a physiologic determinant of blood pressure.