Lars Wibell

Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus

To investigate important factors with respect to health-related quality of life (HRQOL) in patients with longstanding insulin dependent diabetes mellitus, a patient cohort was followed prospectively for 10 years. The degree of metabolic control and the presence of late complications was assessed and HRQOL was measured with a 61-item questionnaire (SWEDQUAL) in which reference values have been obtained in a population sample. The results indicate that diabetic patients (n=108) experienced a quality of life as good as a general population. When patients were divided into four groups based on metabolic control, those with poor control (HbA1c≥9%) rated their physical and emotional functioning significantly lower than those with lower HbA1c values. Nearly 15% of the patients reported 1–5 hypoglycaemic episodes during the latest 6 months. Despite a lower HbA1c they rated their general health as being poorer than patients without severe hypoglycaemia. Of the 108 patients 39% appeared to be free from late complications of diabetes. These patients rated their general health as better than patients who already had developed late complications. We conclude that a satisfactory metabolic control with a minimum of hypoglycaemic episodes is desirable not only to prevent late complications but also because poor metabolic control seems to be one reason why diabetic patients experience a poorer quality of life.

The effect of smoking on glucose homeostasis and fetal growth in pregnant women.

Abstract Objective: To examine the relationship between maternal blood glucose levels, cigarette smoking in pregnancy and fetal growth. Design A prospective study of healthy parous women from early pregnancy and their infants. Setting: Three Scandinavian university hospitals covering all deliveries from well defined geographical areas. Subjects: Study groups of non-smoking (150), light smoking (131) and heavily smoking mothers (218), para 1 and 2 and with > 37 weeks of gestational length. Main outcome measures: Oral glucose tolerance test performed in pregnancy week 37, glycated hemoglobin measured the 3rd day post partum and neonatal anthropometric parameters including skinfold measurements. Results: Among heavily smoking mothers 12.4% displayed a 2-hour glucose value in the range of gestational diabetes (> 8.5 mmol/l) compared to 9.2% among light smokers and 6.0% among nonsmokers (p < 0.05). Heavily smoking mothers also had significantly (p < 0.05) higher glycated hemoglobin compared to nonsmokers, 5.01 v.s. 4.86. These changes in glucose parameters in smokers were not associated with higher birthweights. Conclusions: Smoking in pregnancy affects parameters of glucose homeostasis in the direction of gestational diabetes. The retarding effect of smoking on fetal growth abolished any expected growth stimulation from the higher blood glucose levels seen in the smokers.

Concentration-dependent blood pressure effects of guanfacine

Central α2‐adrenoceptor stimulation decreases blood pressure, whereas stimulation of postjunctional peripheral adrenoceptors induces a pressor response. The net blood pressure response during multiple dosing is the sum of these effects and is dependent on drug kinetics, receptor affinity, and receptor occupancy. Guanfacine (2 to 6 mg/day), a selective α2‐adrenoceptor agonist, decreased blood pressure in patients with hypertension. At a dose >6 mg/day the antihypertensive response deteriorated. Steady‐state kinetics were linear but there was a tendency for a decrease in clearance after the highest dose. These results have practical implications for the therapeutic handling of the drug: Low doses for maximal therapeutic effect and longer dosage intervals at high‐dosage schedules are indicated.

Prevalences of risk factors and angiopathy in diabetic patients in Uppsala.

The prevalences of risk factors and angiopathy were studied in 260 diabetic patients, 100 females and 160 males, 35-54 years old, in Uppsala. The prevalence, in females and males separately, of hypertension (WHO-criteria) was 46-34%, of hypercholesterolaemia (greater than or equal to 6.7 mmol.l-1) 32-29%, and of obesity (relative BMI greater than or equal to 120%) 25-20%. Those smoking greater than 15 cigarettes/day were 11-20%. Mean HbA1 was 10.6-10.5%. The prevalence of angina pectoris was 11-6%, of possible infarction 4-6%, and of major ECG abnormalities 6-4%. Large vessel (cardiovascular) disease was independently related to HbA1 (strongly), hypertension, cholesterol, age and familial NIDDM. The prevalence of severe retinopathy (blindness, new vessels or large hemorrhage) was 0% with 7-13 years of diabetes duration, and 26% with greater than or equal to 14 years of duration. The prevalence of severe proteinuria was 4% with 7-13 years of diabetes duration, and 15% with greater than or equal to 14 years of duration. Small vessel (retinopathy and nephropathy) disease was independently related to diabetes duration (strongly), HbA1 and hypertension. The data were discussed related to data from the London, Berlin and Tokyo centres of the WHO Multinational Study of Vascular Disease in Diabetics, using the same study protocol in the present study.

Pulse Pressure, Mean Blood Pressure and Impaired Glucose Tolerance—A Study in Middle-aged Subjects

In a study of 695 middle-aged subjects, without antihypertensive agents, and without more pronounced obesity, both pulse pressure (PP) and mean blood pressure (MBP) were strongly related to 2-h blood glucose in 75 g OGTTs (p < 0.001). All hypertensives (DBP > or = 90 mm Hg) were separated into 39 with higher PP (> or = 60 mm Hg) and 137 with lower PP (< 60 mm Hg). The high PP hypertensives, compared with the low PP hypertensives and all 519 normotensives, had higher frequency of impaired glucose tolerance (IGT; WHO-criteria), 33%, 6%, and 4%, respectively (p < 0.001), and also higher mean 2-h blood glucose, 5.9, 4.5, and 4.2 mmol.l-1, respectively (p < 0.001). These differences were independent of MBP levels. Similarly, all 54 hypertensives with higher MBP (> or = 110 mm Hg) had more IGT and higher 2-h glucose than the 122 hypertensives with lower MBP (< 110 mm Hg) or the normotensives, 30%, 5% and 4%, respectively (p < 0.001), and 5.8, 4.4, 4.2 mmol.l-1, respectively (p < 0.001), independently of PP. Thus, both high PP and high MBP were related to IGT, independently of each other.