Ohad Cohen

Key elements for successful intensive insulin pump therapy in individuals with type 1 diabetes

OBJECTIVE Clinical trials have demonstrated that in individuals with type 1 diabetes the use of CSII pump resulted in better glucose control. Advantages of pumps therapy include many features such as the bolus calculators (wizard). These features are optional and therefore it is important to determine whether their use is associated with better glucose control. Thus, the aim of this analysis was to assess which features and parameters of insulin pump use are associated with better glucose control. METHODS Data regarding consecutive patients with type 1 diabetes treated with an insulin pump and attending a tertiary referral for intensive glucose control was included in this analysis. The relationship between glycemic indices and treatment parameters (number of insulin units, number of glucose readings, bolus calculator use etc.) was assessed. RESULTS A statistically significant relationship was found between glycemic indices and wizard use. Thus, individuals that used the wizard function in 50% of their boluses had an A1C, mean blood glucose values that were 0.6% (p=0.008) and 25mg/dL (p=0.000) lower respectively. CONCLUSION The use of the bolus calculator feature was associated with better glucose control. Larger prospective clinical trials are needed in order to further validate this finding.

Evaluating reliability of ultra-short ECG indices of heart rate variability in diabetes mellitus patients.

Our aim was to investigate the reliability of ultra-short HRV in patients with DM. A good correlation was found between the 1 minute and 5 minute parameters for maximal-RR, minimal-RR, average-RR, SDNN, RMSSD, pNN50, and total power. Also, a good correlation between 10 second and 5 minute parameters was found for maximal-RR, minimal-RR, average-RR, and RMSSD. We suggest that certain ultra-short HRV parameters can be used efficiently in DM patients for autonomic evaluation.

Multidisciplinary intervention for control of diabetes in patients undergoing coronary artery bypass graft (CABG)

In Israel, as elsewhere, diabetes mellitus is highly prevalent among patients undergoing coronary artery bypass graft (CABG). The bulk of evidence, derived retrospectively, suggests that poor control of diabetes predisposes to complications of CABG and increases mortality; but the findings in a number of studies fail to support that impression. Anticipating a prospective investigation designed to resolve this issue, we have carried out a preliminary study of 147 consecutive patients with diabetes who were hospitalized for elective CABG during 1998. Our objective was to determine how well and how often diabetes could be controlled in accordance with selected metabolic goals in the brief interval between hospital admission and surgery and during the operation itself and in the postoperative period. The task was undertaken by a multidisciplinary team, in cooperation with the Department of Cardiac Surgery. The metabolic goals were: fasting blood glucose consistently between 65-140 mg/dl before and after surgery and 120-180 mg/dl at the time of surgery; and postprandial blood glucose consistently <180 mg/dl. These goals were achieved in 18.1% of fasting blood glucose measurements before and after surgery, 22.1% of preprandial and 14.6% of postprandial blood glucose levels consistently <180 mg/dl. There were no clinical episodes of hypoglycemia. Due to the low incidence of major infection related complications (deep sternal wound infection in only 3 patients (2.0%)) no significant statistical conclusions on the relations between glucose control and these complications could be drawn. The means of all values of FBG and of hemoglobin A1c were significantly higher among patients with complications (n=49) than in those without (P=0.01).

Prospective Evaluation of Liver Function Tests in Patients Treated with Aminoglycosides

We investigated the relationship between therapy with aminoglycoside antibiotics and alterations in serum liver enzymes and bilirubin. One hundred fourteen patients treated with aminoglycosides and 96 treated with other antibiotics were assessed prospectively during eight days. No elevation in serum alanine aminotransferase, lactic dehydrogenase, or bilirubin was detected in the aminoglycoside and control groups. Alkaline phosphatase increased significantly in the aminoglycoside group (average elevation of 28 ± 16 units/L on day 6), but no patient had an elevation greater than twice the upper limit of the normal range. We conclude that the abnormality in liver enzymes during aminoglycoside therapy is a mild elevation in alkaline phosphatase, probably with no clinical significance.

Carcinoma of the Prostate Presenting as Interstitial Lung Disease

Two patients were hospitalized because of fever, cough and dyspnea and an interstitial infiltrate of both lungs that was shown to be a lymphangitic spread of prostate carcinoma. The presentation of prostatic carcinoma as interstitial lung disease is rare, and emphasizes the importance of rectal examination and determination of acid phosphatase in the context of interstitial lung disease.

Pitfalls in the follow-up of cervical and mediastinal goitres: role of CT imaging

Four patients with cervical and mediastinal goitres were described. Routine investigation in these patients, including chest X-rays, oesophageal and tracheal X-rays and scintigraphy of the thyroid gland, failed to show significant changes over the years, or underestimated the true extent of the goitres. Three of the goitres caused severe mediastinal compression, evident only on computed tomography (CT) imaging, and requiring urgent surgery. The pros and cons of different diagnostic modalities for imaging cervical and mediastinal goitres are discussed, stressing the importance of CT imaging as exemplified in the cases presented.