Robert F. Bradley

Role of oral blood sugar-lowering agents in the management of diabetes.

Four short years span the introduction and extensive clinical trial of sulfonylurea and biguanide compounds as oral blood sugar-lowering agents. The term “hypoglycemic” will be used sparingly in describing their ability to lower blood sugar because in responsive diabetic patients their use is directed toward the attainment of blood sugar levels that are within the normal range (normoor euglycemic). Since the sulfonylureas and biguanides are not insulin and do not directly produce metabolic effects comparable to those that follow insulin administration, the clinician may simply look upon their actions as those by which a certain minimum of insulin, available endogenously or exogenously, appears to be more effective. The steady stream of pills available to thousands of diabetics has been composed of 4 sulfonylurea and 3 biguanide compounds. With the possibility that additional oral agents may appear on the therapeutic scene, current evaluation is forced into a stern appraisal of the ultimate role of all oral agents in diabetic management. Ideally, a single agent or group of agents, in the absence of significant toxicity, will offer some positive gain through improved or simpler management without jeopardizing the many victories won for the diabetic in 35 years of experience with insulin. The major life-preserving demands of diabetic treatment are already well served by insulin, so that if toxicity in any of the currently available oral agents is to be acceptable it must be a t a level of incidence and severity much lower than if there were no other means of treatment.

Diabetic Glomerulosclerosis in Children

A boy died in diabetic acidosis at the age of nine, after seven years of known diabetes. At necropsy there was diffuse glomerulosclerosis by light microscopy, evidenced by diffuse mesangial thickening of the peripheral glomeru-lar loops and irregular thickening of the capillary basement membrane of the glomeruli. Glomerulosclerosis is a rare finding in a person of this age as revealed in a review of the literature.

Bragg peak proton beam irradiation of the pituitary gland for proliferative diabetic retinopathy.

Abstract Bragg peak proton beam irradiation of the pituitary gland for proliferative diabetic retinopathy was carried out in 56 patients. Most of them had been considered unsuitable for surgical hy...