J.H. Fuller

CORONARY-HEART-DISEASE RISK AND IMPAIRED GLUCOSE TOLERANCE The Whitehall Study

In the Whitehall Study of 18,403 male civil servants aged 40--64 years, 7 1/2 year coronary-heart-disease (CHD) mortality has been examined in relation to blood-sugar concentration 2 h after a 50 g oral glucose load. CHD mortality was approximately doubled for subjects with inpaired glucose tolerance (IGT), defined as a blood-sugar above the 95th centile (greater than or equal to 96 mg/dl). There was no trend of CHD mortality with blood-sugar below the 95th centile. Within the IGT group, age, systolic blood-pressure, and ECG abnormality (Whitehall criteria) were significantly predictive of subsequent CHD mortality. These findings are relevant to discussions on the criteria for diabetes which include the definition of an IGT category with increased risk of large-vessel disease, but without the high risk of small-vessel disease as occurs in diabetes mellitus.

Worsening to diabetes in men with impaired glucose tolerance (“borderline diabetes”)

SummaryTwo hundred and four men with impaired glucose tolerance (borderline diabetes) discovered in a screening examination have been observed for five years and repeated tests of glucose tolerance performed. By pre-determined criteria 27 men ‘worsened to diabetes’ and this metabolic deterioration was not significantly influenced by treatment with carbohydrate restriction with or without a daily dose of 50 mg phenformin. Of the baseline variables measured prior to treatment allocation only the blood glucose values were significantly predictive of ultimate worsening to diabetes.

Possible seasonal variation of plasma lipids in a healthy population

Abstract In the course of an epidemiological survey of a normal population sample of 1005 subjects, the effect of season on fasting plasma cholesterol and triglyceride levels was studied in two sub-samples — one group of 80 people seen in Spring and Autumn and another group of 73 subjects seen in Summer and Winter. No seasonal change in cholesterol levels was observed. However, there was a highly significant fall in plasma triglyceride from Summer to Winter and a smaller fall from Spring to Autumn. This apparently seasonal change in fasting triglyceride levels could not be explained in terms of changes in weight or in diet.

Borderline diabetics and their response to tolbutamide.

Publisher Summary This chapter presents a study of borderline diabetics. In the study, it was found that treatment of a group of mildly hyperglycemic diabetic individuals with tolbutamide appeared to protect them against the manifestations of arterial disease over a five-year period as compared to a closely similar group treated, double-blind, with an indistinguishable placebo. The 248 borderline diabetics involved in this study were newly detected in the Bedford population survey of 1962 and were defined as having capillary blood sugar values between 120 and 199 mg/100 ml 2 h after 50 gm of oral glucose. Shortly after their detection, the 248 subjects were randomly allocated to tolbutamide or placebo treatment groups, each of which was further randomly divided into approximately equal-sized carbohydrate-restricted and placebo diet subgroups.

The Concomitants of Raised Blood Sugar: Studies in Newly-Detected Hyperglycaemics II. Urinary albumin excretion, blood pressure and their relation to blood sugar levels

The albumin excretion rate following an oral glucose load was measured, using a sensitive radio-immunoassay method, in three groups drawn from the population of Bedford. The three groups – normal,borderline diabetic and diabetic – were classified by the level of the blood sugar 2 hours after the 50 -g glucose load. The degree of albumin excretion was positively correlated with the 2-hour blood sugar level, suggesting that hyperglycaemia may cause renal functional abnormality, which may be present at or before the time of diagnosis. In the diabetic group, only, the degree of albumin excretion was also positively correlated with the height of the blood pressure.

Intralipid triglyceride and oral glucose tolerance

SummaryThe inter-relation between hypertriglyceridaemia and glucose intolerance has been studied experimentally in fifteen male subjects by measuring the effect of acute elevation of plasma triglyceride (injection of Intralipid intravenously) upon oral glucose tolerance. The induced hypertriglyceridaemia did not alter the mean blood glucose or plasma insulin response to oral glucose. The associations between plasma triglyceride levels and glucose tolerance observed both in general population studies and in “patient” populations are probably due to a mutual link with a further factor or factors.

RED-CELL CHANGES IN HYPOTHYROIDISM

normal range, and an elevated basal T.S.H. level, with an exaggerated T.S.H. response to thyrotrophin-releasing hormone (LR.H.). These observations of diminished T.S.H. secretion during acute stress in a patient with primary hypothyroidism support the conclusions of McLarty et al. that hypothalamic and/or pituitary dysfunction is involved, as in starvation,2 in the abnormalities of thyroid function found during acute non-thyroidal illness.