BLOOD GLUCOSE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Blood Glucose: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00151-9 1. Blood Glucose-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on blood glucose. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON BLOOD GLUCOSE ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Blood Glucose................................................................................ 6 E-Journals: PubMed Central ....................................................................................................... 65 The National Library of Medicine: PubMed ................................................................................ 66 CHAPTER 2. NUTRITION AND BLOOD GLUCOSE .......................................................................... 113 Overview.................................................................................................................................... 113 Finding Nutrition Studies on Blood Glucose............................................................................. 113 Federal Resources on Nutrition ................................................................................................. 114 Additional Web Resources ......................................................................................................... 115 CHAPTER 3. ALTERNATIVE MEDICINE AND BLOOD GLUCOSE .................................................... 117 Overview.................................................................................................................................... 117 National Center for Complementary and Alternative Medicine................................................ 117 Additional Web Resources ......................................................................................................... 120 General References ..................................................................................................................... 124 CHAPTER 4. DISSERTATIONS ON BLOOD GLUCOSE ...................................................................... 125 Overview.................................................................................................................................... 125 Dissertations on Blood Glucose.................................................................................................. 125 Keeping Current ........................................................................................................................ 127 CHAPTER 5. PATENTS ON BLOOD GLUCOSE ................................................................................. 129 Overview.................................................................................................................................... 129 Patents on Blood Glucose........................................................................................................... 129 Patent Applications on Blood Glucose ....................................................................................... 158 Keeping Current ........................................................................................................................ 194 CHAPTER 6. BOOKS ON BLOOD GLUCOSE..................................................................................... 195 Overview.................................................................................................................................... 195 Book Summaries: Federal Agencies............................................................................................ 195 Chapters on Blood Glucose......................................................................................................... 245 Directories.................................................................................................................................. 248 CHAPTER 7. MULTIMEDIA ON BLOOD GLUCOSE .......................................................................... 251 Overview.................................................................................................................................... 251 Video Recordings ....................................................................................................................... 251 Audio Recordings....................................................................................................................... 252 CHAPTER 8. PERIODICALS AND NEWS ON BLOOD GLUCOSE ....................................................... 255 Overview.................................................................................................................................... 255 News Services and Press Releases.............................................................................................. 255 Newsletters on Blood Glucose.................................................................................................... 257 Newsletter Articles .................................................................................................................... 257 Academic Periodicals covering Blood Glucose ........................................................................... 258 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 261 Overview.................................................................................................................................... 261 U.S. Pharmacopeia..................................................................................................................... 261 Commercial Databases ............................................................................................................... 262 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 267 Overview.................................................................................................................................... 267 NIH Guidelines.......................................................................................................................... 267 NIH Databases........................................................................................................................... 269 Other Commercial Databases..................................................................................................... 271 APPENDIX B. PATIENT RESOURCES ............................................................................................... 273
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Overview.................................................................................................................................... 273 Patient Guideline Sources.......................................................................................................... 273 Finding Associations.................................................................................................................. 280 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 283 Overview.................................................................................................................................... 283 Preparation................................................................................................................................. 283 Finding a Local Medical Library................................................................................................ 283 Medical Libraries in the U.S. and Canada ................................................................................. 283 ONLINE GLOSSARIES................................................................................................................ 289 Online Dictionary Directories ................................................................................................... 290 BLOOD GLUCOSE DICTIONARY............................................................................................ 291 INDEX .............................................................................................................................................. 373
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with blood glucose is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about blood glucose, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to blood glucose, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on blood glucose. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to blood glucose, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on blood glucose. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON BLOOD GLUCOSE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on blood glucose.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and blood glucose, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “blood glucose” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Blood Glucose Monitoring Update Source: Diabetes Self-Management. 19(1): 46-52. January-February 2002. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: In the 1970's, home blood glucose monitoring revolutionized the treatment of diabetes by providing the feedback required to manage diabetes. In the 1980's, the equipment improved, but was still fairly complicated and expensive to use on a regular basis. In the 1990's home blood glucose monitoring became a standard of care. This article brings readers up to date on blood glucose monitoring (self monitoring of blood glucose, or SMBG). The author notes that there has been further progression in glucose monitoring technology toward greater accuracy and elimination of most of the annoying
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parts of the process. For example, some meters no longer require a fingerstick, some no longer require the user to handle test strips, and at least one no longer requires the user to code the meter for each new batch of test strips. One sidebar lists meters by brand name and features. The author also explains data management software, which is now a standard feature for almost all meters. The author concludes by reviewing strategies to avoid common errors, including the use of defective or outdated strips, soiled meters, and exposing the meter to extremes of heat and cold. The article closes with a list of twelve steps to accurate and easy SMBG. 1 table. •
Self-Monitoring of Blood Glucose: The Basics Source: Clinical Diabetes. 20(1): 45-47. 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Self monitoring of blood glucose (SMBG) is an important component of modern therapy for diabetes mellitus. The goal of SMBG is to collect detailed information about blood glucose levels at many time points to enable maintenance of a more constant glucose level by more precise regimens, including adjustment of dietary intake, physical activity, and insulin doses. This article reviews the basics of SMBG for health care providers who will be working with patients with diabetes. The author discusses SMBG use and frequency and the specifics of different types and brands of meters. One table summarizes the more popular blood glucose meters, including their weight, the required blood sample size, test time, memory, and special features. The author concludes that SMBG is recommended for all patients treated with insulin and is desirable for all patients with diabetes. Judicious use of SMBG data can help to improve glycemic control, select an antidiabetes regimen, and provide powerful feedback to patients wishing to improve metabolic control. 1 table. 6 references.
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Bedside Blood Glucose Monitoring in Hospitals Source: Diabetes Care. 25(Supplement 1): S110. January 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: The modern management of hospitalized patients with diabetes includes capillary blood glucose (sugar) determinations at the bedside. The rapidity with which results can be obtained, and therapeutic decisions made, can improve management and conceivably shorten hospital stays. This article presents the American Diabetes Association position statement on bedside blood glucose monitoring in hospitals. Use of bedside blood glucose monitoring requires clear administrative responsibility for the procedure, a well-defined policy or procedure manual, a training program for those personnel doing the testing, quality control procedures, and regularly scheduled equipment maintenance. 1 reference.
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Programmable Meters: The Handy Blood Glucose Meter Meets the 21st Century Source: Diabetes Forecast. 55(5): 65-68. May 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article helps readers with diabetes understand programmable blood glucose meters. The author first introduces a person with diabetes who uses five
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different meters (one at home, one in each of the family cars, one at his office, one in his briefcase) and who uses computer software to reconcile all the data collected by these five meters. Every couple of weeks, the man hooks his meters up, one by one, to his computer and obtains his data as easy to read charts and graphs. The author then describes the benefits of getting this type of data, and the equipment that would be required. Other features available on most software programs include modal readings, physician tracking fields, and the ability to average blood glucose readings by time of day, mealtime, or even day of the week. The author then considers why so few people with diabetes (estimated at less than 1 percent) use these programs with their blood glucose meters. One side bar offers details about deciding which programmable blood glucose meter to purchase; another sidebar lists the contact information for eight manufacturers of blood glucose meters that interact with computer software. •
Impact of Self-Monitoring of Blood Glucose on Self-Efficacy and Pregnancy Outcomes in Women with Diet-Controlled Gestational Diabetes Source: Diabetes Educator. 28(3): 435-443. May-June 2002. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (312) 424-2426. Summary: This article reports on a study undertaken to examine the effects of selfmonitoring of blood glucose (SMBG) on feelings of self-efficacy, dietary compliance, and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus (GDM). The study included 58 women with GDM and a fasting blood glucose level less than 95 milligrams per deciliter (mg/dL) who were randomly assigned to 2 groups. The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory. Metabolic status was assessed in the control group by periodic monitoring at prenatal visits. Otherwise the management protocol was identical for both groups. The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy. Dietary compliance was assessed at each visit. Both groups of women achieved excellent glucose control; only 1 woman in each group required insulin therapy. There were no significant differences with regard to feelings of self-efficacy, dietary compliance, birth weight, gestational age at delivery, Apgar scores, and neonatal complications. Rates of macrosomia (large size baby), delivery by cesarean section, and occurrence of birth trauma were similar. The authors conclude that SMBG appears to have little effect on maternal feelings of self-efficacy, dietary compliance, or pregnancy outcomes in women with diet-controlled GDM. 7 tables. 20 references.
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Self-Monitoring of Blood Glucose Source: Clinical Diabetes. 20(1): 48. 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This patient education fact sheet reviews self monitoring of blood glucose (SMBG), the use of a home glucose meter to check and track blood glucose (sugar) levels. Designed for patients with diabetes, the fact sheet answers six common questions, covering the indications for SMBG, choosing a blood glucose meter, who should check their blood glucose, how often blood glucose levels should be checked, how to learn to use a blood glucose meter, and how the results of SMBG will be utilized. The fact sheet briefly describes how the results will let the health care provider and patient tailor the diabetes treatment plan to help avoid high or low blood glucose
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levels (hyperglycemia and hypoglycemia, respectively). The fact sheet is designed to be photocopied and distributed to patients.
Federally Funded Research on Blood Glucose The U.S. Government supports a variety of research studies relating to blood glucose. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to blood glucose. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore blood glucose. The following is typical of the type of information found when searching the CRISP database for blood glucose: •
Project Title: AGING AND MEMORY Principal Investigator & Institution: Gold, Paul E.; Professor; Psychology; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2003; Project Start 01-DEC-1996; Project End 31-JUL-2008 Summary: (provided by applicant): Administration of glucose enhances learning and memory in rodents and humans, and is especially effective in reversing age-related impairments in memory. This research project will examine whether age-related changes in the regulation of blood and brain glucose contribute to age-related impairments of learning and memory. Training is often accompanied by increases in circulating epinephrine levels, with subsequent increases in circulating glucose levels, in a manner related to endogenous modulation of learning and memory. Recent evidence suggests that, in aged male Fischer 344 rats, there is an uncoupling between epinephrine release from the adrenal medulla and subsequent increases in blood glucose levels, resulting in diminished responses of circulating glucose levels to training. The reduced responses of blood glucose levels may significantly influence brain processes important for learning and memory. In the brain, extracellular glucose levels in the hippocampus are depleted while rats are tested on a hippocampus dependent spontaneous alternation task. As compared to young adult rats, aged rats perform poorly on this task and exhibit exaggerated depletion of glucose in the hippocampus during behavioral testing. Injections (i.p.) of glucose block the depletion in the hippocampus and also enhance performance on the alternation task in aged rats. Together, these findings suggest that altered control of glucose levels in blood and brain during aging may contribute to agerelated impairments of memory. Using young and old rats, the proposed experiments will examine the contribution of age-related changes in responses of glucose to training to age-related changes in learning and memory. Proposed experiments will examine
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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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changes in circulating and brain glucose responses to training in aged rats, assessing the relationship of these changes to learning and memory. The experiments will determine whether the depletion of extracellular glucose levels in the hippocampus, prominent in aged rats, is evident also in the striatum and prefrontal cortex. These experiments include measures of changes in extracellular brain glucose levels during training with and without treatments that enhance learning and memory in aged rats and also assess the efficacy in enhancing learning and memory of microinjections of glucose directly into those brain areas in which glucose is depleted by training. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ANTAGONISTS OF A2B RECEPTORS IMPROVE INSULIN SENSITIVITY Principal Investigator & Institution: Figler, Robert A.; Adenosine Therapeutics, Llc Charlottesville, Va 22902 Timing: Fiscal Year 2004; Project Start 15-APR-2004; Project End 31-MAR-2006 Summary: (provided by applicant): This is a phase II SBIR grant to develop a new therapy for the treatment of type II diabetes. Adenosine Therapeutics, LLC (ATL) is a biotechnology company started in Charlottesville, Virginia in 1999. ATL owns patents on the formulation of selective antagonists of A2B adenosine receptors (A2BAR). Dr. Kathryn LaNoue of Penn State University discovered that A2BAR blockers lower blood glucose in insulin resistant animals. A use patent to this discovery has been licensed to ATL. In the phase I portion of this grant we found that novel highly selective A2BAR blockers lower blood glucose in mice or rats, but the efficacy of the early compounds was limited, probably due to very low aqueous solubility and low bio availability. A new family of antagonist that has much higher solubility has recently been formulated at ATL and found to be very effective in lowering blood glucose. In a continuing collaboration between ATL and the LaNoue laboratory, we now propose to identify a therapeutic candidate for the treatment of diabetes. More compounds will be screened for potency and selectivity in radio ligand binding assays. Promising compounds will be screened to determine their potency and efficacy in bioassays to lower blood glucose in insulin resistant animals. The most active compounds will be evaluated for oral activity and for pharmacokinetic and pharmacodynamic properties. A few compounds will be evaluated in euglycemic clamp studies with Zucker rats. Our goal is to identify a lead compound that has good characteristics as a potential new drug. If we identify such a compound our plan is to partner with a large pharmaceutical company for clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ASSESMENT OF A CHRONIC SUBCUTANEOUS GLUCOSE SENSOR Principal Investigator & Institution: Ward, W Kenneth.; Legacy Health System 1919 Nw Lovejoy St Portland, or 97209 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: (provided by applicant): In the United States, diabetes mellitus is the leading cause of end-stage kidney failure, blindness in adults under age 65, and is the second leading cause (after trauma) of limb amputation. Poorly-controlled glucose levels are the major cause of these complications, but tight glycemic control is difficult to safely achieve using present technology. While a continuously-functioning glucose sensor would assist in safely achieving tight glucose control, such devices are typified by instability and loss of output over time due to the formation of foreign-body scar tissue, which eventually surrounds the sensors. Miniaturized sensors could be implanted
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under the skin with minimal discomfort. It is possible that the surrounding scar capsule could be made much more "friendly" to a glucose sensor by the slow release of growth factor compounds from the sensor surface. The hypothesis is that such compounds would reduce the scar fibrosis and generate many blood vessels in the capsule. These blood vessels are important to the long-term function of the sensor given its need for continuous glucose and oxygen delivery. A study will initially be performed in order to ascertain the optimal dosage of the growth factor. Then the growth factor (or saline control) will be slowly released over one month from miniaturized pumps into the tissue, which directly contacts the sensor. The thickness of the capsule and the formation of new blood vessels will measured by standard histologic staining techniques and by endothelial Factor Vifi immunohistochemistry. Another major problem of glucose sensors is short-term drift. It is frequently observed but poorly understood. It now appears that it may be possible to obtain stable readings from simultaneous recordings of multiple sensor electrodes. The technique which will be used to separate the accurate electrode signals from the inaccurate (outlying) signals is from the field of median statistics and is called the ZMAD method of Rousseeauw. The ZMAD data processing will be performed prospectively and continuously. In addition, the sensors and their transmitters will be miniaturized with the help of a biotelemetry company, MiniMitter. The body can be hostile to compounds which coat implanted devices. We will compare two promising polyurethanes as sensor coats: a carbonate based- vs. ether-based polymer. We will compare their long term function in studies using rabbits, which will be also be used to ascertain the effect of the growth factors and the real-time data processing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CARDIOVASCULAR DISEASE IN THE PIMA INDIANS Principal Investigator & Institution: Howard, Barbara V.; President; Medstar Research Institute Hyattsville, Md 20783 Timing: Fiscal Year 2002; Project Start 30-SEP-1988; Project End 31-MAY-2005 Summary: MedStar (formerly Medlantic) Research Institute proposes to continue its participation in the Strong Heart Study to manage the Arizona field center and the core laboratory. For the field center, this proposal describes methodology for 1) morbidity and mortality surveillance of the original Strong Heart Study cohort (1099 surviving out of 1500 original men and women ages 45-74 years in Phase I); 2) recruitment and examination of 30 families of at least 30 members, each 15 years and older; and 3) reexamination of the 900 family members from the Phase Ill pilot study. The Arizona field center comprises three American Indian communities: Gila River, Salt River, and Ak Chin. The Arizona center had a 71% recruitment rate in Phase I and 90%+ completion rates in Phases II and III. Morbidity and mortality surveillance obtained data on 99% of the participants. The core laboratory will provide accurate, reliable, stable, and comparable phenotypic measures of coronary heart disease risk factors in blood and urine samples. Measurements to be made for the family cohort include lipoprotein profile, glucose, HbA1c, insulin, LDL size, fibrinogen, PAI-1, apoE phenotype, apoB, apoA1, chemistry profile, and urinary albumin and creatinine. In addition, some exciting new markers of evolving importance in the etiology of atherosclerosis will be evaluated on stored baseline samples using a case-cohort design. sVCAM and endothelin-1 will be measured in approximately 400 definite cardiovascular disease cases and suitable controls. TSH also will be measured in these samples to allow evaluation of its role in cardiovascular disease in American Indians. The core laboratory will store blood, urine, and DNA in a safe and organized manner for effective inventory
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so that the resources will be retrievable for other scientists and the American Indian communities. Laboratory performance during the previous exams has been excellent, with high completion rates and precision and accuracy exceeding those of most core laboratories. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CASEIN COATED CAP PARTICLES FOR ORAL INSULIN DELIVERY Principal Investigator & Institution: Morcol, Tulin; Biosante Pharmaceuticals, Inc 4600 Highlands Pky, Ste A&B Smyrna, Ga 30082 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2004 Summary: (provided by applicant): Parenteral administration of insulin via the subcutaneous route is the only commercially available therapy to treat insulindependent diabetes mellitus. Multiple daily injections are required to manage and maintain blood glucose control due to its relatively short duration of action (4 to 8 hours). Oral insulin would provide an attractive alternative. However, successful development of an oral insulin formulation has been hampered by the numerous and complex barriers to protein absorption inherent to the gastrointestinal tract. A novel delivery system has emerged that may overcome these obstacles. The design of this delivery system incorporates an understanding of the complex barriers to oral insulin absorption and results in the production of biodegradable, insulin-impregnated, calcium phosphate / polyethylene glycol microparticles coated with casein. The characterization of particle size and morphology, their associated physicochemical properties, and the critical factors affecting these parameters will assist in formula optimization and process development. Thus, the aims of Phase I are to prepare a lot of casein coated, insulinladen microparticles utilizing the most current manufacturing process; to fully characterize them in terms of particle size, particle morphology, % loading of insulin, insulin activity, relative component composition, moisture content, stability against digestive enzymes, pH-dependent dissolution characteristics, and storage stability; and to demonstrate a dose-dependent reduction in blood glucose with concomitant increase in serum insulin levels in rodents. Furthermore, modification and adaptation of the delivery system to another orally challenged therapeutic protein, such as human growth hormone, would demonstrate general utility of the delivery system. The long-range goal of this research is to develop a novel, safe, efficacious, long-acting, oral delivery system for insulin demonstrating a dose dependency with reduced variability that may be applicable to other therapeutically relevant proteins. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CEREBRAL RESPONSES TO INSULIN-INDUCED HYPOGLYCEMIA Principal Investigator & Institution: Seaquist, Elizabeth R.; Associate Professor; Medicine; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 03-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The overall goal of this project is to define the cerebral response to insulin-induced hypoglycemia. In diabetes, hypoglycemia limits our ability to achieve normoglycemia and thereby reduce the long-term complications of the disease. Recurrent episodes of hypoglycemia also lead to the clinical syndrome of hypoglycemia unawareness in which patients lose their ability to detect hypoglycemia until neuroglycopenia occurs. How the brain adapts to recurrent hypoglycemia is uncertain, but greater understanding of this process will provide insights into how we
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can better treat patients with diabetes. In this investigation, we will directly examine how the human brain responds to hypoglycemia in vivo using high field magnetic resonance imaging and 13C magnet resonance spectroscopy. We will take advantage of the relationship between cerebral blood flow and neuronal activation to determine if glucose sensing regions can be identified in humans and to determine if the response of the brain to hypoglycemia is altered by antecedent glycemia in diabetes. We will also determine if insulin has effects on the brain that are independent of glycemia. The hypotheses we intend to examine and the aims of the studies planned to address each hypothesis are below. Hypothesis #1: During hypoglycemia, regions of the brain with an abundance of glucose sensing neurons such as the hypothalamus, amygdala, and brainstem will increase blood flow at a higher glucose concentration than will other brain regions. Aim #1: To determine blood and brain glucose concentrations at which regional cerebral blood flow is increased during hypoglycemia. Hypothesis #2: Cerebral blood flow will increase during hypoglycemia at the same brain glucose but at different blood glucose concentration in patients with poorly controlled diabetes, patients with type 1 diabetes and hypoglycemia and in healthy volunteers.Aim #2A: To determine the blood and brain glucose concentrations at which regional cerebral blood flow increases during hypoglycemia in patients with poorly controlled diabetes and compare these values to those measured in healthy volunteers.Aim #2B: To determine the blood and brain glucose concentrations at which regional cerebral blood flow increases during hypoglycemia in patients with type 1 diabetes and hypoglycemia unawareness and compare these values to those measured in healthy volunteers. Hypothesis #3: Insulin has effects independent of glucose on cerebral blood flow.Aim #3: To determine if cerebral blood flow is altered by changes in serum insulin concentrations. Aim #4: To determine if insulin alters neuronal activation as measured event-related potentials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: COMPLEMENT IN THE VASCULAR COMPLICATIONS OF DIABETES Principal Investigator & Institution: Halperin, Jose A.; None; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): The major goal of this proposal is to investigate glycated human CD59 as a surrogate bio-marker and predictor of vascular diabetic complications, with special focus on diabetic nephropathy and peripheral and cardiovascular disease. CD59 is a key complement regulatory membrane protein that specifically inhibits formation of the membrane attack complex of complement (MAC), a transmembrane pore that triggers the release of growth factors and cytokines that stimulate cell proliferation, inflammation and thrombosis. Human CD59 is inactivated by glycation because it contains in its active site a glycation motif formed by amino acid residues K41-H44, as determined by NMR analysis of the human CD59 structure and site directed mutagenesis studies. We proposed that glycation-inactivation of CD59 leads first to increased MAC deposition in diabetic tissues and then to increased MACinduced release of growth factors and cytokines that synergistically with other hyperglycemia induced pathways promote the diverse tissue damage responsible for the vascular complications that characterize human diabetes. Consistent with this hypothesis, glycated CD59 and activated complement proteins including MAC are found in glomeruli, nerves, blood vessels and failed vein grafts from diabetic but not from nondiabetic patients. Importantly, we have shown that a soluble form of CD59, both glycated and non-glycated, can be measured in human urine and plasma by
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established ELISAs. Glycated CD59 levels seem to correlate with the level of glycemic exposure. These extensive preliminary data make it imperative to assess whether glycated CD59 represents a pathogenically relevant biomarker of diabetic vascular complications. Specifically we will investigate whether glycated CD59 in plasma and/or urine identifies sub-populations at risk of developing vascular complications of diabetes (Specific Aim 1), discriminates persons with impaired glucose tolerance who have a higher risk of cardiovascular disease (Specific Aim 2), and predicts the risk of developing diabetic nephropathy (Specific Aim 3) and/or the risk of vein graft failure after peripheral by-pass surgery (Specific Aim 4). Successful accomplishment of these Specific Aims will provide a novel biomarker of diabetic vascular complications; it will also open new avenues for the early treatment and perhaps prevention of those diabetic complications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CONTINUOUS GLUCOSE SENSORS IN YOUTH: BIOBEHAVIORAL STUDY Principal Investigator & Institution: Wysocki, Tim T.; Chief; Nemours Children's Clinic 807 Children's Way Jacksonville, Fl 322078482 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (prepared by applicant): Intensive therapy for youths with type 1 diabetes mellitus (DM) yields higher HbA1c and more frequent severe hypoglycemia (SH) than for adults. The advent of continuous glucose sensors (CGS) could yield medical and psychological benefits for these youths. The investigators submit that many patients may not realize these benefits and that psychosocial features of patients and families will affect the outcomes of adding CGS to DM therapy. To maximize the therapeutic benefits of CGS, we need clinically useful information about its glycemic and psychological effects and about psychological influences on its therapeutic utility. This information would be useful in selecting candidates for this technology and for assisting patients and families in achieving positive outcomes from its use. This application addresses four specific aims: 1.) Evaluation of the effects of 12 month?s use of a CGS device (GlucoWatch Biographer, Cygnus, Inc.) on HbA1G, the Kovatchev Low Blood Glucose Index and the frequency of severe hypoglycemia; 2.) Identification of behavioral and psychological consequence of CGS use; 3.) Analysis of psychosocial predictors of metabolic and psychological outcomes; and 4.) Evaluation of glycemic profiles of healthy youths without DM, construction of a normative glycemic profile for use in future studies and comparison of the glycemic profiles of youths with and without diabetes. Specific Aims 1 through 3 will be addressed in a randomized, controlled trial of three intensive therapy regimens that are based on different glucose monitoring methods: SMBG patients will receive current intensive therapy with four to six self-monitored blood glucose tests daily; CGS with Feedback patients will augment SMBG by using a CGS device that gives immediate glucose feedback and alarms for high, low, and rapidly falling levels; CGS without Feedback patients will augment SMBG by using the same CGS device with the feedback and alarm functions disabled. Patients and parents will complete periodic assessments of demographic factors and general and diabetes-specific psychological factors. Statistical analyses will include multivariate analyses of variance, survival analysis and individual growth modeling techniques. Specific Aim 4 will be addressed by studying a demographically similar sample of 240 healthy children and adolescents who will use the GlucoWatch Biographer without feedback for a total of 144 hours during a two-week period. The project results will enhance clinical adoption of CGS technology.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CONTRACEPTIVE IN WOMEN WITH PRIOR GESTATIONAL DIABETES Principal Investigator & Institution: Xiang, Anny H.; Preventive Medicine; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2005 Summary: (provided by applicant): This application is submitted in response to PA-02077, "Secondary Analyses in Diabetes, Digestive and Kidney Diseases". We propose to analyze data from an existing observational cohort database to assess the impact of different types of contraception on the risk of diabetes and on glucose levels, blood pressure and serum lipids in Latino women with prior gestational diabetes mellitus (GDM). We have previously shown that those women are at high risk of developing type 2 diabetes during their reproductive years. They require effective contraception because a) pregnancy planning is required to minimize the risk of conceiving with undetected hyperglycemia, which imparts a risk of congenital malformations to the baby and (b) additional pregnancies increase their risk of diabetes. Contraception should be safe regarding effects on glycemia and risk of diabetes, as well as on blood pressure and lipid levels, which can be elevated in association with the insulin resistance that is common in women with GDM. Using data from a subset of the current cohort available through 1994, we found that low-dose combination oral contraceptives (OCs) did not increase the risk of diabetes, but that a progestin-only oral preparation did increase that risk. Effects on lipids and blood pressure were not evaluated. Approximately 20% of hormonal contraception users in our patients elect to use an injectable progestin preparation, depomedroxyprogesterone acetate (DMPA) for longterm contraception. The impact of that preparation on the risk of diabetes is unknown. Accordingly, we now propose to use an expanded version of the cohort, including all patients through 1998 when accrual ended, to assess the impact of DMPA as compared to OCs and non-hormonal contraception, on the risk of diabetes and on glucose levels, blood pressure and lipid levels. Survival analysis will be use to compare diabetes rates among forms of contraception. Generalized linear models will be used to compare effects on glucose, blood pressure and lipid levels. Successful completion of these analyses will provide novel and clinically important information about the safety of several forms of hormonal contraception that are crucial for young Latino women at high risk for type 2 diabetes. The observational results will also be important to the design of future direct comparisons of different forms of contraception in this high-risk population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DEVELOPMENT NUTRACEUTICAL
OF
AN
ANTI-DIABETES
BOTANICAL
Principal Investigator & Institution: Ilic, Nebojsa; Phytomedics, Inc. 65 Stults Rd Dayton, Nj 08810 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-MAR-2003 Summary: (provided by applicant): This is a revised proposal for the pre-clinical development of PMI-5011, a standardized botanical extract, developed by Phytomedics Inc. and Rutgers University. PMI-5011 effectively lowers blood glucose in insulin deficient and insulin resistant animals, does not cause hypoglycemia, and is safe and non-toxic. All data suggest that PMI-5011 is an efficacious nutritional supplement for
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those suffering from diabetes or prediabetic conditions. Preliminary results demonstrate that PMI-5011 specifically affects hepatic gene expression in diabetic rats and promotes insulin mediated glucose uptake by muscle tissues as potential means of normalizing glycemia. Phytomedics will use the SBIR funds to complete the necessary pre-clinical investigation of PMI-5011 and to produce a sufficient supply of the standardized and optimized PMI-5011 material for the remaining preclinical and clinical testing. Phytomedics will also confirm the identity of the active ingredients of PMI-5011 and determine optimal hydroponic greenhouse methods for the source plant cultivation. Phytomedics will conduct limited clinical trials of PMI-5011 in Phase 2 of this proposal. Phase 3 of this proposal will involve the full-scale commercialization of PMI-5011 with a commercial partner, using PMI-5011 exclusively supplied by Phytomedics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SENSORS
DEVELOPMENT
OF
GENETICALLY-ENCODED
GLUCOSE
Principal Investigator & Institution: Altenberg, Guillermo A.; Physiology and Biophysics; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): In most living organisms, including animals, plants and bacteria, glucose is employed as energy source, for energy storage and in the synthesis of essential biological molecules. Glucose measurements are critical to elucidate the basic characteristics of glucose distribution at the cellular and subcellular level under normal conditions and in disease states. This is particularly important because in diabetes mellitus, one of the most common chronic diseases in humans, alterations in glucose metabolism (not well understood at the cell level) are the most important factor. Currently, there is no glucose sensor suitable for measuring glucose in cells and the sensors available for clinical and industrial applications are frequently unsatisfactory. This proposal presents a novel approach to develop glucose sensors based on the use of autofluorescent proteins (proteins that fluoresce in the absence of cofactors) and the glucose binding properties of the enzyme glucokinase (hexokinase IV), the glucose sensor protein of the pancreas. The most useful autofluorescent proteins derive from the green fluorescent protein from the jellyfish Aequoria victoria and the red fluorescent protein from a coral of the Discosoma genus (red fluorescent protein). Our plan is to develop a sensor that will be: 1) Suitable for "in vitro" measurements of glucose concentration, and 2) Genetically-encoded for targeting to specific cells and subcellular compartments, as well as specific cells and tissues of transgenic animals. The sensor can also be evaluated as the backbone for a continuous minimally invasive glucose monitoring system in diabetic patients. We plan to engineer glucose sensors by fusion of glucokinase to autofluorescent proteins. We will purify the sensor proteins expressed in E. coil, analyze their properties (fluorescence properties, response to glucose, specificity) and test their usefulness for measuring glucose in living cells. Although the goal of the project is to obtain a sensor for measurements in cells, to foster basic research under normal and disease conditions, potentially the new sensors can be adapted to industrial (e.g., glucose measurements in fruit juices) and medical (monitoring glycemia in diabetes mellitus) uses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Blood Glucose
Project Title: DIET THERAPY IN DIABETES MANAGEMENT OF MEXICAN AMERICANS Principal Investigator & Institution: Briones, Esperanza R.; Univ of Texas-Pan American Edinburg, Tx Timing: Fiscal Year 2002; Project Start 01-JUN-1977; Project End 31-JUL-2006 Summary: (provided by applicant): Diabetes in Hispanic Americans is a serious health problem. It affects 1.2 million or 10.6% of the Mexican American population. Approximately 24% of Mexican Americans in the U.S. between the ages of 45-74 have diabetes. In Hispanic adults, diabetes is primarily type 2, and its incidence is correlated with the occurrence of obesity. The purpose of the study is to conduct a two and half (21/2) year randomized trial of a culturally appropriate dietary and lifestyle education intervention designed for Mexican Americans with type 2 diabetes residing in Rio Grande Valley. Both males and females, with type 2 diabetes will be recruited, with two age subgroups, ages 45-59 and 60 and above. Eligible participants will be randomized into two groups. Group 1 will receive the conventional dietary counseling and group 2 will receive additional sessions and follow-up. The specific objectives of the study are: to assess the effectiveness of a culturally appropriate intervention to improve participants' adherence to dietary modifications, medication schedules, and promote sustained improvements in lifestyle behaviors; to assess the anthropometric measurements, health habits, and nutrient consumption of subjects at baseline and after dietary and educational sessions; to determine fasting serum glucose and glycosylated hemoglobin in assessing the level of diabetes control; and to assess the lipid profile (serum cholesterol, triglycerides, high density lipoprotein cholesterol) which are associated with the development of coronary heart disease in diabetes. Statistical calculations will be used to evaluate the differences between the two groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DIETARY GLYCEMIC LOAD, BODY WEIGHT, AND BLOOD LIPIDS Principal Investigator & Institution: Ma, Yunsheng; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2006 Summary: (provided by applicant): The overall goal of this 2 year proposal is to examine the association of glycemic load (GL), derived from 24-hour dietary recalls, with body weight and blood lipids (including total cholesterol, LDL, HDL, and triglycerides), and to study seasonal and short-term variation of GL in a free-living healthy population. Results from short-term experimental studies and a limited number of observational studies suggest that GL, a measure of the quality and quantity of carbohydrate in foods, may be related to body weight and serum lipids, and GL potentially should be considered in dietary recommendations. However, neither the glycemic index (GI) nor GL is considered in the dietary guidelines of the American Heart Association, the U.S Department of Agriculture, or the American Diabetes Association. We will use dietary data collected from the Seasonal Variation in Blood Cholesterol Levels (SEASONS) (NHLBI: R01-HL52745) (1. Ockene - P.I.) study, in which 641 healthy adults in central Massachusetts were followed quarterly (baseline and four consecutive quarters: five sampling points in all) during this a one-year observational study. A total of fifteen 24hour dietary and physical activity recalls were collected for each subject, with serum lipids and body weight measured five times. Serum lipids and body weight were measured once per quarter and three 24-hour recalls were administered (two weekdays and one weekend day) per quarter. If GL is found to be associated with body weight
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and blood lipids, a randomized clinical trial will be designed to evaluate the effects of a GL-based nutritional intervention program on hyperlipidemic patients. The methodology of this proposed study will involve several steps: 1) Data summarization of 9,067 24- hour diet recall records, 2) GL calculation and calculation of overall GI index, 3) Analysis of the relationship of GL to body weight and blood lipids, 4) Estimation of seasonal and short-term variations in GL, 5) Analysis of GL by meal type and identification of the top ten food contributors, 6) Analysis of the association of overall GI with body weight and blood lipids, and 7) Final report and manuscript preparation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DIFFERENTIATING BONE MARROW STEM CELLS TO CURE DIABETES Principal Investigator & Institution: Ramiya, Vijayakumar K.; Ixion Biotechnology, Inc. Box 13, 13709 Progress Blvd Alachua, Fl 32615 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 31-DEC-2002 Summary: (Scanned from the Applicant's Abstract): Type 1 diabetes is a polygenic, chronic metabolic disease characterized by the progressive ablation of insulin-producing beta cells by autoimmunity. Regular insulin injections do not maintain blood glucose near normal levels at all times and consequently patients develop serious secondary clinical complications. While pancreatic and islet transplantations consistently establish euglycemic states and significantly reduce long-term complications, availability of the grafts is severely limited. Thus, there is an urgency to develop a beta cell/islet replacement therapy for Type 1 diabetic patients. The mammalian hematopoietic stem cells (HSCs) produce at least 8 distinct lineages of mature blood cells while mesenchymal stem cells (MSCs) produce multiple lineages of mature cells. The wealth of information on the growth and differentiation of these stem cells is vast, and purified HSCs are routinely used in the clinical setting and both HSCs and MSCs are commercially available for research purposes. Thus, investigating the feasibility of differentiating human HSCs and MSCs into pancreatic pathway will be of immense importance in curing Type 1 diabetes, and in the realization of autologous stem cellderived insulin producing cell/islets for implantation. In this SBIR Phase I proposal, we will specifically: (1) characterize human bone marrow derived CD34+ HSCs and CD34MSCs for the expression of developmental genes involved in the generation of islets/pancreas following treatments with various factors in vitro; and (2) determine the functional capability of the differentiated cells in vitro. A successful completion of the Phase I study will lay the foundation for a more detailed Phase II grant proposal that will involve in vivo functional studies in diabetic animal models. PROPOSED COMMERCIAL APPLICATION: This research project has the potential to produce glucose-responsive insulin producing cells/islets for implantion into every single insulin?dependent Type 1 & 2 diabetics. All that would be required from the individuals is their peripheral blood, or bone marrow samples. Also, cells that are at different stages of differentiation can be used for drug discovery research related to mesenchymal and pancreatic systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DOES HYPERGLYCEMIA PREDICT PANCREATIC CANCER DIAGNOSIS? Principal Investigator & Institution: Chari, Suresh T.; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905
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Blood Glucose
Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Pancreatic cancer causes glucose intolerance and diabetes in up to 80% of patients. Pancreatic cancer induced diabetes (PaCDM) is often asymptomatic, of short duration (50 years of age may have PaCDM. We propose to establish whether newly elevated fasting blood glucose (FBG) is indicative of underlying pancreatic cancer as evidenced by diagnosis of pancreatic cancer within 3 years of the FBG measurement. If so, this would provide an entirely novel approach to screening for sporadic pancreatic cancer. We hypothesize that the 3-year likelihood of diagnosis of pancreatic cancer will be high in subjects: a) equal to or > 50 years of age with newly elevated FBG, b) with elevated fasting glucose who have known risk factors for pancreatic cancer (e.g. smoking), and/or c) who manifest an abrupt increase in FBG in serial measurements over time. We will identify visits to Mayo Clinic between years 1988 to 2002 by subjects equal to or >50 years of age who resided in its surrounding catchment area and had a routine physical examination that included a FBG. Preliminary data reveal that about 150,000 different subjects made >300,000 such visits during this time period providing >1 million person-years of follow-up. We will electronically retrieve clinical, and laboratory data and examine 3-year follow-up from date of FBG measurement to identify those diagnosed with pancreatic cancer. We expect 340 to 510 pancreatic cancer events in this cohort. Our Specific Aims are: Aim 1A). To test if FBG drawn during routine physical examination predicts likelihood of underlying pancreatic cancer and to test for non-linearity of this association. Aim 1B) To establish a FBG threshold that predicts a high 3-year likelihood of diagnosis of pancreatic cancer. Aim 2). To estimate the extent to which known risk factors for pancreatic cancer (age, smoking, obesity and family history) modify the likelihood of underlying pancreatic cancer in subjects with FBG greater than the threshold defined by Aim 1B. Aim 3). To test if patterns of change in serial measurements of FBG over time predict likelihood of underlying pancreatic cancer. The clinical and research implications of this study are considerable. These data may lead to delineation of individuals who have a high likelihood of existing pancreatic cancer, and who may be ideal candidates for more intensive screening or early detection regimens. The research described in this application is 100% relevant to pancreatic cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DPT-1 TRIALNET: CLINICAL CENTERS Principal Investigator & Institution: Raskin, Philip; Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 29-SEP-2001; Project End 31-AUG-2008 Summary: (provided by applicant) Type 1 diabetes affects more than one million individuals in the United States and many more worldwide. Type 1 diabetes arises in genetically predisposed individuals as a consequence of immune-mediated destruction of the pancreatic islet insulin-secreting beta-cells. The onset of clinical symptoms of diabetes represents the endpoint of a chronic progressive decline in beta-cell function and occurs when the majority of beta-cells have been lost. First-degree relatives of individuals with Type 1 diabetes are ten-fold more likely to develop the disease than the general population. The disease, which can begin at any age, characteristically begins in childhood or in young adults. The present treatment for Type 1 diabetes, which includes the early use of insulin, rigid dietary intervention, and frequent blood glucose monitoring, when implemented properly, can delay or prevent the horrible long-term complications of diabetes (i.e. blindness, renal failure, and amputation). However, proper diabetes treatment is quite difficult to do, expensive, and very invasive to the
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diabetic patient?s lifestyle. Diabetes is also a major factor in health care costs. Is it possible to prevent Type 1 diabetes? To date, several immune interventions have been tried in genetically susceptible individuals without success. Other trials have been attempted to intervene early in the course of Type 1 diabetes, in order to preserve betacell function. These immune interventions have likewise failed. Thus, the identification of agents that either prevent the disease or slow its progression would result in major health care cost savings and reduce complications related to diabetes in addition to the huge individual savings in terms of not having the disease. Our long-term goal is to prevent the development of Type 1 diabetes through the use of innovative immunebased therapies designed to prevent the development of the disease in genetically predisposed individuals. The objectives of this application, in pursuit of that goal and in response to the RFA, is completion of the DPT-1 protocol and the development of TrialNet, an enhanced network to develop and test innovative interventions to prevent or slow the progression of Type 1 diabetes. One such innovative approach to slow the progression of Type 1 diabetes is our proposed pilot protocol, "Thiazolidinediones Preserve C-Peptide in Type 1 Diabetes." The proposed work is innovative because it utilizes a drug that has a proven safety profile and is already widely used for the treatment of Type 2 diabetes but also is an immune modulator. Our Center has the experience, the personnel, and access to the appropriate patients to be a successful member of TrialNet and to be able to successfully complete our proposed pilot protocol or others that TrialNet may bring forward. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DYNAMIC FMRI ANALYSES OF HYPOGLYCEMIA UNAWARENESS Principal Investigator & Institution: Liu, Yijun; Assistant Professor; Psychiatry; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-JUL-2004 Summary: (provided by applicant): We propose a functional MRI (fMRI) study to probe the timing and location of neuro-hormonal interaction following food ingestion in humans. The proposal presents an explorative fMRI project by developing in vivo methods to characterize brain activity during hypoglycemia induced by prolonged fasting. We will examine brain responses during a real-time transition from fasting hypoglycemia to normoglycemia attained by eating (i.e., by oral glucose intake), focusing on the hypothalamus and its associated neural circuits. In particular, this project underscores two novel dynamic imaging approaches for tracing the time course of brain-hormone interaction during the transition. These approaches, namely (1) temporal clustering analysis (TCA) and (2) within-condition interregional covariance analysis (WICA), are critical to the timing of neuronal events that are interacting with hormonal processes, such as glucose-insulin regulation. Modeling of both temporal and spatial information about brain-hormone interaction will be our first step toward establishing a functional marker of hypoglycemia unawareness. By the functional marker we mean noninvasively -measured neuroendocrinal signals in response to a physiological challenge, such as fasting or eating. We hypothesize that alteration of such signals is implicated in the development of hypoglycemia unawareness, as in insulindependent diabetes mellitus (IDDM) accompanied by recurrent hypoglycemia. Although the ultimate goal of this project is to directly test this hypothesis in patient population under long-term intensive insulin treatment, which may require large-scale clinical trials, the current R21 proposal aims to develop new fMRI methodology involving a small number of subjects imaged under well-controlled conditions. While functional imaging methods may reflect a departure from traditional, symptom-
18
Blood Glucose
dependent assessment of hypoglycemia unawareness (e.g., cognitive task testing or objective neurophysiological evaluation), it is still important to correlate fMRI analyses with routine clinical measurements, such as counterregulatory hormone levels by blood sampling. This correlation may provide information for delineating the neural bases about how internal biochemical signals give rise to the awareness of hunger or satiation, and for understanding the phenomenon of hypoglycemia unawareness. Two specific aims are to be accomplished in this two-year project: Aim 1. Development of a fastingeating fMRI paradigm by correlating functional imaging signal with biochemical measurement; and Aim 2. Development of both temporal and spatial reference systems for the in vivo modeling of glycemia regulation and hypoglycemia unawareness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EDUCATION AND GROUP SUPPORT FOR DIABETIC HISPANICS Principal Investigator & Institution: Brown, Sharon A.; Professor; None; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, Tx 78712 Timing: Fiscal Year 2002; Project Start 01-AUG-1994; Project End 31-MAR-2003 Summary: Type 2 diabetes is three to five times more prevalent in Mexican Americans than in non-Hispanic whites and ranks as the third and fourth leading cause of death in Hispanic females and males, respectively. In Starr County, Texas, type 2 diabetes affects 50 percent of the adult Hispanic population. The Starr County Diabetes Education Study (1994-1998) sought to improve the health of diabetic Mexican Americans and their families with a culturally-relevant, community-based intervention of: (1) three months of instruction on nutrition, home glucose monitoring, exercise, etc.; and (2) nine months of group support to promote behavioral changes. Primary indicators of intervention effectiveness were diabetes knowledge and health beliefs, health behaviors, HbA1c, and FBS. Preliminary findings suggested that the intervention had a positive impact, statistically and clinically significant, on metabolic control. HbA1c and FBS were reduced significantly by the third month of the one-year intervention, and these changes were maintained at six-months and at one-year. The proposed continuation will adapt and test a three-month version of the current one-year intervention to determine if the shortened version, applicable to clinical practice, attains the same positive health outcomes in this Mexican American population. To identify key components of the current strategy, investigators will hold focus groups with subjects of the current study to explore differences between those who successfully integrated self-care components of the intervention and who experienced significant improvements in metabolic control and those who were not as successful. Following the focus groups, the current intervention will be revised and tested with a prospective, longitudinal, randomized, pretest/posttest control group design. 256 diabetic subjects and their family members will be randomly assigned to the shortened intervention (treatment) or the one-year intervention (control). In addition, a predictive model will be tested to explain metabolic control in subjects receiving longitudinal care versus compressed care. The proposed continuation is a critical step in translating this culturally-appropriate intervention into clinical practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EFFECT OF AGE AND GLYCEMIA ON TRANSCRIPTION FACTORS Principal Investigator & Institution: Fukagawa, Naomi K.; Associate Professor of Medicine; Medicine; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405
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Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: This application is for a Mentored Research Scientist Development Award in Aging through which the candidate, an experienced clinical investigator, will learn state-of-the-art techniques in cell physiology, cell imaging and signaling under the mentorship of Dr. Brooke Mossman. The goal will be to determine whether oxidative stress associated with aging and/or high glucose contributes to alterations in vascular smooth muscle cell (VSMC) apoptosis or proliferation. The research plan will focus on age- and glycemia-related effects on activation of the redox-sensitive transcription factors Nuclear Factor kappa B (NF-kappaB) and Activator Protein-1 (AP-1), testing the hypotheses that 1) aging and/or high glucose will induce mitochondrial oxidative stress in VSMC; 2) aging is associated with dysregulation of NF-kappaB and AP-1 activation; and 3) an imbalance between VSMC apoptosis and proliferation, i.e. phenotypic endpoints regulated by redox- sensitive transcription factors, will contribute to the development of vascular disease. Specific aims of the proposal will be to determine: 1) whether high glucose media causes mitochondrial oxidative stress in VSMC from old (22-24 mos) and young (6-8 mos) Fischer 344 rats using cell imaging of oxidative probes (dichlorofluorescin derivatives); 2) whether age, glucose or hydrogen peroxide (H2O2), conditions or agents associated with oxidative stress, alters mitochondrial gene integrity and expression that may influence cell function or viability; 3) whether VSMC from old compared to young rats exhibit differences in baseline or inducible redox-sensitive transcription factors by determining the effect of high glucose media or exogenously administered H2O2 on DNA binding and transcriptional activation of NF-kappaB and AP-1; and 4) whether aging and/or high glucose induces changes in the activation of NF-kappaB or AP-1 which are causally related to the development of apoptosis or proliferation in VSMC. In these latter studies, we will first quantitate the effect of different concentrations of H2O2 (as a positive control) and of glucose on apoptosis and proliferation. We will then block the separate pathways using transient transfection techniques with dominant negative mutant constructs to determine if the phenotypic expression can be altered. The data obtained will permit future studies aimed at interventions targeted to defined signaling pathways to attenuate the deleterious effects of oxidative stress in vivo. The long-term goal will be to apply the tools and approaches learned through the support of this award to examine the effect of oxidative stress and transcriptional regulation on muscle protein synthesis in vivo in humans. The mentor has an extensive background in the investigation of reactive oxygen species as mediators of cell injury and of signal transduction, and a successful track record of training undergraduate and graduate students, postdoctoral fellows, and faculty. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EFFECTS OF STRESS ON BEHAVIOR AND GLUCOSE IN TYPE 1 DM Principal Investigator & Institution: Helgeson, Vicki S.; Professor; Psychology; CarnegieMellon University 5000 Forbes Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2006 Summary: (provided by applicant): The goal of this research is to use daily diary methods to link stress and social interactions to mood, self-care behaviors, and blood glucose levels among adolescents (ages 14-16) with Type 1 diabetes. Previous research has relied on retrospective reports of stress rather than on-line measures. Eighty-eight adolescents (44 male, 44 female) will carry palm pilots for two separate 48-hour periods, which will prompt them every two hours during the day to complete a 2-minute questionnaire. The questionnaire will assess mood, stress, social interactions (conflict, social barriers), and self-care behaviors. Four prompts will also request that blood
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Blood Glucose
glucose levels are tested and recorded. Adolescents will wear the Actical, an accelerometer that measures frequency, duration, and intensity of movement during the same days of assessment. With this methodology, we can link stress and aspects of social interactions to mood, specific self-care behaviors, and blood glucose in a momentto-moment fashion. A second goal of the study is to examine whether individual difference variables moderate these relations. We will examine whether sex influences these relations, as interpersonal stress is associated with more negative health consequences for females than males. We also will examine whether unmitigated communion (focus on others to exclusion of self) influences these relations, as relationship stressors and social barriers to self-care behavior may be more strongly tied to negative outcomes for people high in unmitigated communion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ENDOTHELIAL PRECONDITIONING AND ISCHEMIC BRAIN INJURY Principal Investigator & Institution: Keep, Richard F.; Associate Professor; Neurosurgery; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 25-JUL-1996; Project End 31-MAY-2008 Summary: (provided by applicant): Ischemic preconditioning (IPC) has proved to be one of the most effective methods of reducing ischemic brain damage in animal models of stroke. Attention has focused on the mechanisms by which neurons may be protected by such preconditioning. However, we have found that IPC also protects the endothelium, which forms the blood-brain barrier, from ischemic damage. 'Ischemic' preconditioning also protects cerebral endothelial cells in vitro from oxygen glucose deprivation induced injury indicating that there can be direct preconditioning of the endothelium. Damage to the cerebral endothelium may potentiate ischemic brain injury in a number of ways and determining mechanisms to reduce endothelial damage is particularly pertinent at the moment considering the role of endothelial injury (hemorrhagic transformation) in limiting the use of tissue plasminogen activator for the treatment of ischemic stroke. We will examine the mechanisms involved in cerebral endothelial preconditioning both in vivo (rat middle cerebral artery occlusion) and in vitro (primary cultures of rat cerebral microvessel endothelial cells). The in vitro experiments will facilitate exploration of the mechanisms involved in preconditioning while assuring that the preconditioning acts directly on the endothelium. The in vivo experiments will ensure that the mechanisms elucidated in vitro also occur in the whole animal as well as allowing an assessment of the effects of preconditioning on other parameters (such as blood flow, capillary morphology and infarction). Overall the proposal has three main goals. 1) Determine the time course of preconditioning and the extent of its effects on the endothelium (Specific Aim 1). 2) Determine the events that can trigger endothelial preconditioning (Specific Aim 2). 3) Determine what mechanisms are triggered to protect the endothelium (Specific Aim 3). These experiments should provide information on: A) Endogenous defense mechanisms that protect the cerebral endothelium from ischemic injury and which may be therapeutic targets. B) The role of endothelial preconditioning in the effects of IPC on the brain. C) The role of endothelial injury in the overall effects of ischemia on the brain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ENGRAFTMENT OF PANCREATIC PROGENITORS Principal Investigator & Institution: Sarvetnick, Nora E.; Associate Member; Scripps Research Institute Tpc7 La Jolla, Ca 92037 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Insulin dependent diabetes mellitus results from the autoimmune destruction of the pancreatic beta cells. Once these crucial cells are lost they cannot be regained since the adult pancreas lacks the ability for regrowth. Therefore, IDDM patients are dependent on the possibility of receiving new endocrine cells to cure their disease. One therapy for IDDM patients is the possibility of utilizing islet progenitor cells for the in vivo or in vitro growth of new pancreatic islets. Indeed these cells could represent a limitless supply of differentiated beta cells for IDDM patients. However the exact identity of islet progenitor cells remains unknown despite dramatic progress in the area of islet ontogeny in recent years. Our laboratory has defined a novel cell surface antigen that is expressed on a cell population in the regenerating pancreas as well as in the normal adult small intestine, facilitating their purification. In this application we show that sorted intestinal cells give rise to insulinproducing cells following in vivo transfer experiments. This work suggests that stem cells that can give rise to functional islets can exist in the normal adult gut. Importantly, we have found in our preliminary studies that the transfer of sorted adult intestinal cells into STZ-treated diabetic mice significantly improves their blood glucose levels. The overall goal of this application is to develop these findings into a new therapy for clinical IDDM patients. This application is Bench to Bedside Partnership between investigators at Scripps Research Institute: Drs. Sarvetnick, Kritzik, Solomon, and Dabernat; Whittier Institute: Dr. Alberto Hayek; City of Hope National Medical Center Islet Cell Resource Center: Dr. Fouad Kandeel, and an outside consultant: Dr. Ronnda Bartel. The experiments proposed are designed to optimize conditions for the expansion of these intestinal-derived progenitor cells in vitro, an important consideration given the limited supply of donor cells. We will utilize the expanded cells in transfer experiments to assess their differentiation potential in vivo. Subsequently, we will define conditions for the intestinal cells to incorporate and expand in diabetic mice, optimizing conditions for their transfer, incorporation, and differentiation in the recipient. The proposed studies will allow the development of a new strategy for the isolation and expansion of intestinal islet progenitor cells, and their subsequent use in the treatment of diabetic conditions, which are clearly important goals for the establishment of therapies for IDDM patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ETHANOL ON OVERNIGHT GLUCOSE REGULATION IN DIABETES Principal Investigator & Institution: Burge, Mark R.; Assistant Professor; Medicine; University of New Mexico Albuquerque Controller's Office Albuquerque, Nm 87131 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-DEC-2008 Summary: (provided by applicant): Hypoglycemia is the principal barrier to the achievement of target glycemic goals in type 2 diabetes. Alcohol consumption is very prevalent in our society and a proven cause of hypoglycemia. Population studies suggest that elderly, insulin requiring type 2 diabetes patients are particularly vulnerable to severe hypoglycemia and that this problem accounts for an estimated $50 million or more in healthcare costs in the USA each year. We hypothesize that low dose ethanol significantly increases the vulnerability to overnight hypoglycemia and impairs
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the recovery of plasma glucose in elderly, insulin requiring patients with type 2 diabetes. Our preliminary studies suggest that low dose ethanol impairs recovery from day time insulin-induced hypoglycemia in type 2 diabetes patients but not in age matched healthy control subjects. The proposed studies will examine the effects of low dose ethanol on overnight glucose regulation in elderly, insulin requiring type 2 diabetes patients and will establish the mechanism of these impairments through a series of systematic evaluations. Specifically, these studies will document suppression of the dawn phenomenon by ethanol, and/or exacerbation of a deficient counterregulatory response to hypoglycemia during sleep, especially growth hormone. Specific mechanisms for the suppression of growth hormone to be examined include that evening ethanol (3) inhibits peak overnight ghrelin secretion and/or (4) reduces pituitary sensitivity to GHRH. Additionally, these studies will characterize (5) the dose response characteristics of ethanol on overnight glucose homeostasis and will (6) carefully evaluate the effect of the timing of ethanol administration in relation to meal ingestion on overnight hypoglycemic vulnerability. To address these aims, we will assess the effect of moderate doses of orally administered ethanol or placebo on overnight growth hormone release, ghrelin, total IGF- 1, free IGF- 1, insulin-like growth factor binding protein 1 (IGFBP- 1) concentrations, glucose production and other parameters of glucose homeostasis among elderly control subjects versus elderly, insulin requiring subjects with type 2 diabetes. These important studies will provide a scientific basis for the prevention of overnight hypoglycemia (and the attendant cost savings) by providing mechanistic insights into the causes of nocturnal hypoglycemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EVALUATION OF A NON-INVASIVE GLUCOSE MONITOR Principal Investigator & Institution: Buchert, Janusz M.; Infratec, Inc. 539 Danbury Rd Wilton, Ct 06897 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Sixteen million people in the United States live with the chronic disease diabetes; approximately 5 -10% are children. The seminal Diabetes Control & Complications Trial (DCCT) concluded that frequent glucose monitoring is necessary to reduce the complications of this disease. However, all glucose monitors available require invasive techniques with the most widely used method of selfmonitoring, obtaining blood from a finger stick, causing pain and discomfort which results in poor compliance. The development of a novel, hand-held, non-invasive glucose monitor will provide diabetics with the means for testing their glucose level more frequently, improving their quality of life, and reducing the costs and complications of this chronic disease. This application proposes the development, calibration and clinical validation of an advanced prototype based on a proprietary method of mid-infrared Thermal Emission Spectroscopy (TES). The method and instrument are based on the discovery that natural mid-infrared emissions, from the tympanic membrane, consist of spectral information of blood analytes. In recent years, infrared (IR) spectroscopy has emerged as a potential analytical method of choice for non-invasive glucose monitoring. The specific aims of this Phase I proposal are to develop the optical system and to integrate sensors into an ergonomic form for diabetic self-monitoring. The subsequent clinical studies are designed to demonstrate that a universal calibration for real time accurate measurements is possible for predictive results. The device will be calibrated and validated across a range of glucose concentrations from 40 to 400 mg/dL, using a total of 52 diabetic and normal subjects in hyperglycemic and hypoglycemic protocols. A trained nurse will perform the
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measurements. Subsequently, 19 diabetic subjects will test themselves using the hyperglycemic protocol in a full predictive study. The hypotheses will test that the intraindividual correlation coefficient of the non-invasive predicted serum glucose compared with the clinical laboratory serum glucose measurement will be greater than 0.85, and less than 1 percent of the measurements will fall outside the clinically acceptable range on the Clarke Error Grid. Successful conclusion of Phase I milestones will lead to Phase II clinical studies and modifications for younger pediatric subjects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EVALUATION OF DIABETES SELF-MANAGEMENT CONSULTANT CARE Principal Investigator & Institution: Anderson, Robert M.; Professor, Senior Research Scientist; Medical Education; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 20-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Evaluation of Diabetes Self-Management Consultant CareThe overall objective of this study is to develop, implement and evaluate the effectiveness of a collaborative care intervention to improve blood glucose control and diabetes-related quality of life for subjects with type 2 diabetes being cared for in two different health care systems. The effectiveness of their diabetes Self Management Consultant (SMC) Collaborative Care intervention will be evaluated by comparing it with a randomized usual care control group for subjects with type 2 diabetes.Specific Aims 1. Develop a diabetes Self-Management Consultant (SMC) intervention designed to improve blood glucose control and diabetes-related quality of life for adults with type 2 diabetes. 2. Recruit SMCs, Primary Care Physicians (PCP)s, and subjects for the study. 3. Pilot test the feasibility of all major elements of the SMC intervention including data collection and self-management consultant protocols and activities with a small number of subjects. 4. Implement the intervention in both the Detroit Department of Health and the University of Michigan Department of Family Medicine. 5. Conduct a randomized clinical trial to evaluate the relative effectiveness of the SMC intervention compared to usual care in improving blood glucose control and diabetes-related quality of life. 6. Identify variables (e.g., program site, demographic, psychosocial, resource, and health) that predict which subjects benefit from participating in the SMC intervention. 7. Estimate the cost-effectiveness of the SMC intervention, relative to the cost of usual care, in the short-term, from the perspective of the health care insurer. 8. Estimate the expected effect the SMC intervention has on end-stage subject outcomes (both microvascular and macrovascular complications) and long-term costs through the use of Monte Carlo simulation models. 9. Disseminate the results, materials, and protocols developed for this study, nationally, and provide training and technical assistance to health care professionals who wish to use the SMC intervention (or parts of it) in local settings.HypothesisThe SMC intervention will be more effective than usual care in improving blood glucose control and diabetes-related quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EVOLUTION OF CARDIOVASCULAR RISK WITH NORMAL AGING Principal Investigator & Institution: Berenson, Gerald S.; Professor and Director; Tropical Med & Parasitology; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002; Project Start 15-MAY-2000; Project End 31-AUG-2005
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Summary: (Adapted from the Applicant's Abstract): The cardiovascular (C-V) system is one of the organ systems most affected by the aging process. Significant differences in CV morbidity and mortality occur by race and gender that influence longevity. The proposed research involves a biracial (black-white) population that has been followed for C-V risk factors and lifestyles in the Bogalusa Heart Study over the past 25 years. The specific aim of the research is to characterize traits (intrinsic aging vs. The risk factor burden) in a population reaching middle age that influence the subclinical C-V disease process in normal aging. The extensive data base collected since childhood provides information related to silent underlying C-V disease and aging. The study cohort includes 1,200 individuals born between 1959 and 1969, who were examined at least four times since childhood. The cohort will be examined for: 1) C-V risk factor variables comprising obesity measures, blood pressure, lipids, lipoproteins, apoliproproteins, homocysteine, glucose, insulin, fibrinogen, plasminogen activator inhibitor 1, intercellular adhesion molecules -1, C-reactive protein, lipid peroxides and microalbuminuria; 2) lifestyle and psychosocial variables such as tobacco and alcohol use, physical activity, diet, and life change events; 3) subclinical changes of the heart and vasculature (outcome variables) observed by echo-Doppler measurements of cardiaccarotid structure and function and brachial and radial artery compliance; and 4) selected longevity-associated allele markers, like apoE. These variables (except for the allele markers) will be measured at two points in time, with a 3-year interval. In addition, a family history of longevity and health history information on study subjects and their parents and grandparents will be obtained to evaluate familial risk characteristics of the cohort. The proposed studies will provide insights into the interaction of normal aging and predisposing factors that influence the subclinical C-V disease process in a blackwhite population reaching middle age. Understanding the evolution of C-V risk in normal aging can lead to more rational programs for successful aging and longevity and C-V disease prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EXERCISE, DIABETES, AND CORONARY SMOOTH MUSCLE CALCIUM Principal Investigator & Institution: Sturek, Michael S.; Professor and Chair; Dalton Research Center; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2003 Summary: Our long-term goal is to determine if exercise training attenuates the excess coronary artery disease (CAD) in diabetes and the vascular smooth muscle (VSM) Ca (Cam) signaling mechanisms involved. In our porcine model of diabetic dyslipidemia coronary arteries show increases in contraction to prostaglandin F2alpha (PGF) and Cam responses to endothelin-1 (ET). Exercise of normal swine decreases Ca release from the sarcoplasmic reticulum (SR) and increases Ca influx, while decreasing ET-induced contraction and DNA synthesis. However, ET-induced contraction does not require Ca release that is dependent on tyrosine kinase, a signal for cell growth. Overall hypothesis: after exercise training increased ET-induced Ca influx attenuates contraction, while decreased SR Ca release attenuates growth of smooth muscle. Design: low fat control pigs (C), high fat fed (HF), and alloxan diabetic and high fat fed (D) pigs are maintained for 20 and 30 wk to study the progression of CAD and compared to D pigs exercise trained (D plus EX). Specific Aims are to test the hypotheses that in diabetes: 1) Exercise improves glycemic and lipidemic status. Diabetes will be defined by measures of blood glucose, glycated protein, insulin, etc. HDL, LDL, VLDL, triglycerides, apoproteins, glycated LDL, and ET will define features of diabetic dyslipidemia. 2) Exercise
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attenuates the increase in CAD. Intravascular ultrasound will assess atheroma and vasoconstrictor responses to PGF and ET in vivo. Histology and contractile tension responses of coronary rings to PGF and ET will provide in vitro measures of CAD. 3) Exercise attenuates the conversion of VSM from the contractile (cVSM) to synthetic (sVSM) phenotype. sVSM cell phenotype will be identified using digital imaging microscopy by the Cam response to UTP, perinuclear SR, DNA, smooth muscle actin, desmin, and vimentin. 4) Exercise attenuates the increased contraction of cVSM by increasing ET receptor-dependent Ca influx. Mn and Ba influx used as Ca surrogates will assess Ca influx. Subsarcolemmal Ca localization relative to ryanodine receptors will be digitally imaged. 5) Exercise attenuates the increased ET-induced Cam amplitude and nuclear Ca localization by decreasing tyrosine kinase-dependent Ca release from the SR. Imaging will assay in single cells the relative content and spatial distribution of ET, ryanodine, and IP3 receptors, tyrosine phosphorylation, DNA and Cam. Significance: the first study of Ca localization mechanisms involved in the excess CAD in diabetic dyslipidemia and the therapeutic effects of exercise on CAD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FLUORESCENT MICROSHELLS
GLUCOSE
SENSORS
FROM
POLYION
Principal Investigator & Institution: Mcshane, Michael J.; Assistant Professor; Biomedical Engineering; Louisiana Tech University Ruston, La 71272 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Non-invasive glucose monitoring is desired to reduce the pain of blood sampling, which is an important step toward improved control of blood glucose for diabetics. Poor control results in debilitating complications, but the bother associated with testing typically leads to low patient compliance with recommended monitoring frequencies. The concept of implantable fluorescent sensors that can be monitored transdermally would be an attractive solution to the problem, but many obstacles to practical use have been identified. This work aims to use polyelectrolyte microcapsules to overcome drawbacks of previously proposed systems. Methods for fabricating these structures have been developed over the past few years, with precision control over mechanical and chemical properties, thus, "tuning" of the structures to fit different applications may be possible. Recent work has produced fundamental knowledge on the properties of these nanostructured capsules, yet there has been little reported by way of practical application. Since biomedical applications have not been pursued, no work has been done to assess the biocompatibility of the materials used. An interdisciplinary research team will evaluate the potential for polyelectrolyte microcapsules to function as carriers for fluorescence sensing chemistry using an integrative approach to sensor design that considers material, chemical, optical, and biological properties. The work will clarify basic questions regarding the process of encapsulation, then use these data to engineer sensor properties that will possess clinically relevant response characteristics. The stability of the structures will be assessed over time in increasingly physiological conditions, and methods to overcome problems with fouling and enzyme degradation will be identified to allow progress to continue. Finally, the biocompatibility of the materials used will be studied from molecule to device level, in vitro and in vivo, to determine baseline host response and risk factors for device failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETIC ANALYSIS OF CVD RISK FACTORS Principal Investigator & Institution: Maccluer, Jean W.; Scientist; Southwest Foundation for Biomedical Res San Antonio, Tx 782450549 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 31-MAY-2007 Summary: (provided by the applicant): The objective of Project 1 is to detect, map and characterize polymorphic genes that contribute to variation in risk of cardiovascular disease (CVD). The focus in this Program Project (the San Antonio Family Hearth Study, SAFHS) is on extended Mexican American families ascertained without regard to disease status. During the current grant period each family member is being genotyped for 414 short tandem repeat markers in a 10 centimorgan map. Using genome screen data from the first ten genotyped families (Pedigree Set A, with nearly 500 individuals), QTLs have been detected and mapped that influence leptin, fat mass, BMI, insulin, 2 hour glucose, LDL-3-C, HDL-C, HDL2a unesterified cholesterol, evidence for linkage, additional, more closely spaced markers are being typed for use in finer scale mapping strategies. Identification of the functional alleles for a few of the best characterized of these genes will be pursued in Project 3. In Project 1, taking advantage of the resource of families with extensive genotypic and phenotypic data that has been created in the past ten years, linkage analyses will be pursued for phenotypes that exhibit substantial heritabilities but for which significant linkages were not detected in Pedigree Set A (e.g., apolipoproteins, selected lipoproteins size classes, fasting glucose, 2-hour insulin, fibrinogen, C-reactive protein, and measures of carotid intima-media thickness). Linkage signals also will be strengthened and refined for other QTLs for which significant evidence of linkage already has been detected (e.g., QTLs for BMI on chromosome 17, HDL-C on chromosome 16, insulin/glucose ratio on chromosome 3, and HDL2a unesterfied cholesterol on chromosome 8). These analyses will incorporate additional markers, and associations will be sought with polymorphisms in positional candidate genes. Several new phenotypes related to the role of adipose tissue as an endocrine organ will be examined, and the pleiotropic effects of QTLs detected in the current and proposed grant periods, on other CVD risk factors will be characterized. The longitudinal data being accumulated for the families in the SAFHS will be exploited to examine genetic effects on age-related changes in CVD risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETIC EPIDEMIOLOGY OF HYPERTENSION IN AFRICAN AMERICAN Principal Investigator & Institution: Rotimi, Charles N.; Associate Professor and Director; Howard University Washington, Dc 20059 Timing: Fiscal Year 2002; Project Start 01-JUN-1977; Project End 31-JUL-2006 Summary: The goal of this project in genomic research is to contribute to the growing attempts to fill a major void in resources available to the research community for dissecting the pathophysiology of hypertension (HTN) and related complications in African Americans. It is well documented that A experience one of the highest incidence of HTN in the world. Epidemiologic studies have demonstrated the important role of environmental factors including diet (e.g., high salt intake), lifestyle (e.g., lack of physical activity) and psycho-socio stressors (e.g., employment difficulty) in the etiology of HTN. However, a proportion of the total variance remains unexplained. Because of the importance of family history and observed differential susceptibility to HTN, it is now widely accepted that the etiology of HTN is the result of complex interplay of genetics and the environment. Based on an on-going family study, we propose to recruit
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a population of 350 AA families with 5 or more members (n> 1,750 persons) in Washington, DC. During a clinical exam, we will collect demographic data, measure BP, height, weight, fat mass, fat free mass, waist and hip circumference. Blood will be drawn for assays of physiologic intermediates including components of the renin-angiotensin aldosterone system (RAAS-Angiotensinogen-AGT, angiotensin-converting enzyme aldosterone system (RAAS-Angiotensinogen-AGT, angiotensin-converting enzyme-ACE and aldosterone), endothelin 1, C-reactive protein (CRP), sodium potassium, calcium, albumin, creatinine, glucose, insulin and leptin. Genomic DNA will be extracted. We propose to evaluate the association and linkage between BP, HTN and genes of the RAAS (ACE, AGT and angiotensin II receptor type 1), epithelial sodium channel beta subunit, endothelial nitric oxide synthase, CRP, endothelin 1, and beta2-adrenergic receptor. We will evaluate single nucleotide polymorphisms (SNP) variations in candidate genes and determine if variation in each SNP and in constructed haplotype, explain variations in BP and HTN risk. In addition, DNA will be stored for future application to conduct genome-wide scan with the goal of identifying novel genomic regions in linkage and association with BP and HTN in AA. Identified novel genomic regions may inform our understanding of the etiology of HTN in other human populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GENETIC LOCUS EXTENDING LIFE AND REDUCING INSULIN Principal Investigator & Institution: Harrison, David E.; Senior Staff Scientist; Jackson Laboratory 600 Main St Bar Harbor, Me 04609 Timing: Fiscal Year 2002; Project Start 01-JAN-2001; Project End 31-DEC-2005 Summary: Maximum life spans are significantly increased in mice by Leg 1a, a genetic variant in Mus m molossinus (MOLD) on chromosome 8 near microsatellite marker D8Mit171. The same chromosome region reduces blood insulin without affecting glucose levels or normal growth. Defining this gene that retards mammalian aging may suggest clinical treatments to improve health in old age. Aim 1 tests if Leg1a has effects on aging like those already defined for caloric restriction (CR) by comparing four groups of 84 mice: Leg1a carriers and non-carriers, each with a fed ad lib group and a CR group. At 4 and 24 months of age, biological aging will be assessed with a battery of nonharmful measures including blood insulin and glucose, T cell subset distributions, wound healing and collagen denaturation. In addition, growth will be followed from weaning, and life spans and pathology will be determined. Splenic T cell telomere lengths will be tested in separate groups. Aim 2 maps Leg1a to a 1 cM region, and tests if Leg1 is the locus that regulates insulin. Progeny will be produced from 10 males; each with a different chromosomal recombination carrying a unique subset of MOLD alleles in the 10 cM region now defined. For statistical power, each male will produce 84 progeny carrying the recombination and 84 non-carrier controls with no MOLD alleles in the 10 cM region. Insulin and glucose levels will be tested at 4 months in these mice, and life spans of the longest-lived 18 and 40 percent will be compared to map Leg1a to a 1 cM region. If the long-lived recombinant groups all have low insulin, it will strongly support the hypothesis that Leg1a regulates insulin. Aim 3 uses the progeny of Aim 2 to map the locus regulating insulin to within 1 cM. Subsequently, progeny from 10 males with recombinations within this 1 cM region will be used to refine the map location to 0.1 cM (roughly 10 genes), comparing 79 carriers of each recombination with 79 noncarrier progeny. Candidate genes will be tested to see whether MOLD alleles differ from those of NZW, LP and BALB. The gene will ultimately be identified by homologous recombination.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLIAL CELL GLYCOGEN AND STRESS-INDUCED DEPRESSION Principal Investigator & Institution: Bonsall, Robert W.; Associate Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): In this exploratory project, we propose to test a new hypothesis that deficiencies in the brain's reserves of energy make it vulnerable to stress and constitute a risk factor in the development of depression. Normal brain function is dependent on the expenditure of large amounts of energy (up to 20 percent of all energy needs in the human) and most of this energy is consumed in maintaining electrical potentials and ionic gradients across neuronal cell membranes. Exposure to stressful conditions induces greatly increased energy consumption in specific areas of the brain, and the ability of a neuron to respond normally to stressors and to survive the excited state that stressors produce is dependent on surrounding glial cells providing energy in the form of glucose and glucose metabolites. The glial cell's ability to provide energy sources to neurons is not only dependent on the transport of glucose from the blood but also on the mobilization of its own glycogen energy reserves. In response to excitatory neurotransmitters, glial cells break down glycogen into glucose and lactic acid and export them to neurons. We will determine if depression results when the brain is exposed to stressful conditions of sufficient intensity and duration as to deplete the glial glycogen reserve in specific regions of the brain. Depleted glial cells would then be unable to provide nearby neurons with sufficient glucose and lactic acid, and neuroprotective responses to the energy deficit would reduce local neural activity and cause symptoms of depression. We present new data using a well-established animal model of depression that support the glycogen hypothesis. These data indicate that stressful conditions sufficient to cause behavioral depression not only deplete cerebral glycogen but also cause a profound metabolic deficit. In the planned experiments, we shall (a) examine the effects of depression-inducing stressors on levels of glycogen in different brain areas, (b) monitor brain glucose and lactic acid release during exposure to the stressor and during the development and recovery from behavioral depression, and (c) examine the neurochemical and behavioral effects of manipulating brain glycogen levels. Results will provide entirely new insights into the mechanisms of stress induced depression and should suggest new approaches to the treatment and prevention of this devastating disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GLP-1 IN NORMAL AND ABNORMAL GLUCOSE TOLERANCE Principal Investigator & Institution: D'alessio, David A.; Associate Professor of Medicine; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2003; Project Start 30-SEP-1999; Project End 31-JAN-2004 Summary: The overall goal of this proposal is to determine the role of the insulinotropic GI hormone glucagon-like peptide 1 (GLP-1) in persons with normal glucose tolerance, and with type 2 diabetes. In normal subjects the action of GLP-1 and other gut factors accounts for 30-60 percent of the insulin secreted after eating. This effect is severely impaired in persons with type 2 diabetes suggesting defects in the secretion or action of gut peptides. In addition to its action on the -cell, we have recently observed a novel effect of GLP-1 to suppress endogenous glucose production (EGP) independent of its
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effects on islet hormone secretion. When given to persons with type 2 diabetes in pharmacologic amounts, GLP-1 normalizes both fasting and post-prandial hyperglycemia, and so has potential as a therapeutic agent. Therefore, it is important to understand the mechanisms by which GLP-1 lowers blood glucose levels in persons with diabetes, and whether defects in the secretion or action of the hormone contribute to the pathogenesis of diabetes. The specific aims of this project are to determine: 1) the mechanism by which GLP-1 normalizes fasting hyperglycemia in diabetic subjects. 2) whether GLP-1 suppresses EGP by inhibition of glycogenolysis, gluconeogenesis, or both. 3) whether the deficient incretin effect in persons with type 2 diabetes is due to decreased levels of GLP-1, or impaired sensitivity of insulin secretion to GLP-1. To address these aims: 1) Glucose turnover will be measured in diabetic subjects before and during GLP-1 infusions, to determine the contributions of islet hormones, and islet hormone-independent effects of GLP-1 to lower blood glucose. 2) EGP will be measured in healthy subjects, and rates of gluconeogenesis and glycogenolysis determined before and after GLP-1 using the 2H2O method. 3) Secretion, and metabolism of GLP-1 in diabetic and control subjects will be compared using a new assay we have developed with greatly increased specificity for GLP-1. In addition, GLP-1 will be infused over a wide range of doses to measure the sensitivity of the insulin response in diabetic and control subjects. The results of these studies will expand the understanding of glucose homeostasis, and promote the development of new strategies to treat type 2 diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLU6PASE AND 6P2K/FBASE GENE REGULATION IN SEPSIS Principal Investigator & Institution: Maitra, Subir R.; Emergency Medicine; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: Sepsis is that critical condition of the patient which, if uncorrected, leads to death. The initial hyperglycemia seen in sepsis is followed by hypoglycemia with concomitant hyperlacticacidemia. Glucose-6-phosphatase (Glu-6-Pase) is a key enzyme in the homeostatic regulation of blood glucose concentration, which catalyses the final step in gluconeogenesis and glycogenolysis. Another important enzyme for regulation of gluconeogenesis is 6-phosphofructo-2-kinase/fructose-2,6bisphosphatase (6PF2K/FBPase), which is responsible for the production and hydrolysis of fructose-2,6bisphosphate (Fru-2,6- P2), a modulator of glycolytic to gluconeogenic flux. We have demonstrated that gene expression of Glu-6-Pase and 6PF2K/FBPase are reciprocally modulated during hyperglycemic phase of hemorrhagic shock. In this proposal, we are focusing on the regulation of expression of these two genes as models of hormonal counter-regulation during sepsis. In addition to studying the hormonal regulation of these genes in sepsis, we also propose to determine the hormonal response elements of these genes by promoter analysis. Sepsis will be induced in fasted, anesthetized rats by cecal ligation and puncture (CLP) method and will be observed for 0.5 h, 3 h, and 20 h periods. Control rats will undergo sham operation and will be observed for the same time. The liver and kidney from control and CLP rats will be freeze-clamped in liquid nitrogen and stored at -70 degrees C for future assay of glucose-6- phosphate, fructose-6phosphate, glucose-6-phosphate dehydrogenase activity, Glu-6-Pase and 6PF2K/FBPase enzyme activity and gene expression. Blood samples will be collected at the same time periods to assay glucose, corticosterone, insulin and glucagon concentration in the plasma. Relatively selective pharmacologic antagonists of hormones and cytokines will be administered prior to CLP to observe their effects on Glu-6-Pase and 6PF2K/FBPase gene expression. Hepatocytes will be isolated from control and CLP rats and will be
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Blood Glucose
incubated with agonists to observe their effects on Glu-6-Pase and 6PF2K/FBPase gene expression. Freshly prepared, primary cultures of hepatocytes will be transfected and then incubated with hormones and hormonal response element will be confirmed by DNA footprinting. The results of this study are essential to understand the molecular basis of deranged metabolism in sepsis. Understanding the mechanism might be useful for developing appropriate therapeutic intervention during sepsis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLUCOSE MEDIATION OF NORADRENERGIC ACTIVITY IN VMH Principal Investigator & Institution: Beverly, Joseph L.; Associate Professor; Animal Sciences; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-AUG-2005 Summary: (Applicant's abstract): Circulating glucose concentration is monitored and maintained at appropriate concentrations by the central nervous system (CNS). Physiological and behavioral responses to glucose imbalances have been described, but the key mechanism by which fluctuations in glucose status are recognized and appropriate counter-regulatory responses initiated is not known. The immediate objective of the proposed research is to identify underlying neurochemical mechanisms in the ventral hypothalamus that sense changes in plasma glucose and initiate counterregulatory responses to restore glucose status. Noradrenergic activity in the ventromedial hypothalamus (VMH) has been demonstrated to influence blood glucose through effects on the autonomic nervous system, behavior, and neuroendocrine system. We have reported a consistent activation of noradrenergic systems in the VMH during hypoglycemia. The specific aims of this application are to determine the glycemic thresholds for the activation of noradrenergic systems in the VMH, to evaluate the effect of changes in interstitial fluid glucose concentrations in the VMH on noradrenergic activation, to determine if the activation of noradrenergic systems in the VMH is mediated through local intrinsic neurons within the VMH, to the effect of recurrent hypoglycemia on the noradrenergic activation in the VMH, and determine if increased levels of circulating leptin alter sensitivity of noradrenergic response to hypoglycemia. Intravenous catheters and microdialysis probes will be used to simultaneously monitor plasma glucose and concentrations of extracellular neurotransmitters in the VMH. Our hypothesis is that glucose responsive neurons in the VMH respond to changes in extracellular glucose concentrations that reflect circulating plasma glucose and activates noradrenergic inputs to the hypothalamus. The activation of these neurons is dynamic, so that the glycemic threshold for activating NE systems in the VMH will be altered by recurrent episodes of hypoglycemia. Further, we propose that leptin affects the sensitivity of glucose response neurons to interstitial glucose concentrations thereby altering the glycemic threshold for activation of glucoregulatory systems in the VMH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EXPRESSION
GLUCOSE
REGULATION
OF
PANCREATIC
ISLET
GENE
Principal Investigator & Institution: Robertson, R Paul.; Scientific Director and Ceo; Pacific Northwest Research Institute 720 Broadway Seattle, Wa 98122 Timing: Fiscal Year 2002; Project Start 01-DEC-1985; Project End 31-MAR-2006
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31
Summary: (provided by applicant) The overall goal of this proposal is to examine the hypothesis that the adverse effects of prolonged exposure of pancreatic islets to supraphysiologic glucose concentrations (i.e. glucose toxicity) is mediated at least in part by glucose oxidation and the subsequent generation of reactive oxygen species (ROS) that can impair insulin gene expression and beta cell function. The four specific aims are: Specific Aim #1: To determine whether intervention with antioxidants after establishment of hyperglycemia in ZDF rats is successful in decreasing plasma markers for oxidative stress, and, if so, also in decreasing plasma glucose levels and restoring islet PDX-1 and insulin mRNA, insulin content, and glucose-induced insulin secretion. We will also determine whether discontinuation of antioxidant treatment is followed by reversion to the pretreatment level of hyperglycemia and defects in beta cell function. Specific Aim #2: To determine whether progression of type 2 diabetes mellitus in db/db mice is accompanied by disruption of the balance between reactive oxygen species and islet antioxidant enzyme gene expression, enzyme levels, and enzyme activity and defects in PDX-1 and insulin gene expression, and to determine whether db/db mice transgenically modified to overexpress intraislet antioxidant enzymes as a preventive measure are protected from glucose toxicity-induced progression of type 2 diabetes. Specific Aim #3: To determine whether prolonged exposure of pancreatic islets to supraphysiologic glucose concentrations disrupts the intracellular balance between reactive oxygen species (ROS) and anti-oxidant enzyme gene expression, enzyme levels, and enzyme activity, thereby causing defective insulin gene expression and to determine whether in vitro overexpression of antioxidant enzymes islets prevents adverse effects of supraphysiologic glucose concentrations on PDX-1 and insulin gene expression, insulin content, and glucose-induced insulin secretion. Specific Aim #4: To ascertain whether measures of oxidative stress correlate positively with the level of hyperglycemia and negatively with residual beta cell function in type 2 diabetic patients; whether the intervention of improving glycemic control in type 2 diabetic patients leads to decreases in markers of oxidative stress and improvements in beta cell function; and whether interventional treatment with an antioxidant drug without changing current conventional drugs used for glycemic control diminishes hyperglycemia and improves beta cell function in poorly controlled type 2 diabetic patients. The methods used to achieve these specific aims will involve studies of insulin secretion, insulin content, PDX-1 and insulin mRNA levels, antioxidant enzyme levels and activity, and blood and islet markers for oxidative stress. We will conduct experiments using ZDF rats and antioxidant drugs, rat and human islets with adenoviral infection of cells to overexpress antioxidant enzymes, and db/db mice made transgenic to overexpress antioxidant enzymes, both singly and in combination. At the conclusion of these studies, we hope to have determined whether chronic oxidative stress is a mechanism of action for glucose toxicity in islets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLUCOSE SENSOR/TISSUE INTERACTIONS ENGINEERING Principal Investigator & Institution: Moussy, Francis; Associate Professor; Mechanical Engineering; University of South Florida 4202 E Fowler Ave Tampa, Fl 33620 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): A major obstacle to the widespread application of implantable glucose sensors is that they progressively lose function after a relatively short period of time in vivo. This loss of function is in part a consequence of inflammation and fibrosis resulting from the tissue trauma caused by the sensor implantation and by reactions within the tissue. For an implantable glucose sensor, mere
32
Blood Glucose
tissue toleration of the device is not sufficient; the sensor must also remain functional. It must be emphasize that although it is known that tissue reactions plays an important role in loss of sensor's function, the specific contribution of each tissue reactions (i.e. inflammation, fibrosis and loss of vasculature) has not yet been determined nor quantified. Furthermore, little work has been done so far on controlling these reactions to implanted biosensors. Based on the preceding information, we have developed the following hypotheses. Grant Hypotheses: We hypothesize that inflammation, fibrosis and loss of vasculature affect both the transport properties and the local concentration of glucose around the implanted sensor. As a result, implanted glucose sensors progressively lose function and become unreliable after implantation. We further hypothesize that our experiments and mathematical models will show that all threetissue reactions play a significant role in the loss of sensor function. However, we also hypothesize that use of an anti-inflammatory drug delivery system, with an anti-fibrotic decorated surface hydrogel, and VEGF gene transfer can enhance the function and lifespan of the implanted sensors by decreasing inflammation and fibrosis, as well as by enhancing neovascularization. To test these hypotheses, we propose to use the current electrochemical Nation-based glucose sensor developed in our laboratory and all in vivo experiments will be conducted in the rat model. Therefore, the goals of this proposal will be: 1) to determine the specific contributions of inflammation, fibrosis and blood vessel density on the sensor's loss of function, using in vitro and in vivo studies as well as mathematical models, and 2) to control these reactions using a combination of approaches (decorated hydrogels, drug delivery and gene transfer) to enhance the glucose sensor's function and lifetime in vivo. Our overall goal for this proposal is to have a glucose sensor that can be implanted and provide reliable and continuous monitoring for at least 4 weeks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLUCOSE SENSORS AND HYPOGLYCEMIA IN CHILDREN WITH DM Principal Investigator & Institution: Tsalikian, Eva; Associate Professor of Pediatrics; Pediatrics; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Intensive therapy is currently accepted as the standard of care to reduce the risk of long term complication in patients with diabetes of all ages. However, intensive therapy is frequently complicated by hypoglycemia. In comparison to adults, young children and adolescents have even more lifestyle characteristics that make them prone to hypoglycemia, which then becomes a dangerous complication and a major limiting factor of intensive treatment and good diabetes control. With current home glucose monitoring capabilities it is difficult to accurately define the true incidence, duration, and severity of hypoglycemia in children with diabetes. A continuous glucose monitoring system (CGMS) has recently become available as a tool to more closely examine blood glucose patterns, by recording up to 288 glucose measurements a day (864 glucose readings over a 72 hour period). The purpose of the proposed study is to elucidate the extent of hypoglycemia and the factors that contribute to hypoglycemia in children with and without diabetes. In this descriptive study, four age groups of children will be studied: defined by children 2-6, 610, 10-14, and 14-18 years of age. Grouping by age will assure an appropriate sample of children of different ages, as well as a large prepubertal cohort. Eighteen children with diabetes will be included in each age group for a total of 72 patients with diabetes. Nine children without diabetes will serve as controls for each age group in order to study the
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33
normal physiologic glucose variability. During the four years of data collection, subjects will participate for one to three years, depending on the time of enrollment. They will be fitted with the CGMS for three days, quarterly, alternating week, and weekend intervals. Data will be obtained on the child?s medical history, blood glucose levels, genotyping, and dietary intake. Activity will be monitored by accelerometry. Cognitive functioning, school performance, behavior, and adjustment to diabetes will be measured as potential factors contributing to the risk of hypoglycemia. In summary, CGMS in children with diabetes will provide valuable information on hypoglycemia frequency and severity, and the risk factors associated with this serious complication of intensive diabetes management in children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GLUCOSE SENSORS IN CHILDREN WITH TYPE I DIABETES Principal Investigator & Institution: Chase, Peter H.; Professor; B Davis Ctr/Childhood Diabetes; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (prepared by applicant): The specific aim of this application is to determine if glucose control can be safely improved in children with type 1 diabetes as a result of using continuous glucose monitoring (CGM). In an initial feasibility trial, accuracy of the two CGM devices will be compared to venous glucose levels in a Pediatric GCRC. Children with and without diabetes will spend 24 hours in the GCRC. This will also help to sort out children with diabetes (1 in 30) who have excessive skin reactions to the GlucoWatch, or who cannot tolerate subcutaneous CGM sensors. The children with diabetes will then be randomized to a feasibility three-month trial of either using the GlucoWatch Biographer or the MiniMed CGMS or serving as a control. Children will be selected for the feasibility and the two-year study who are either using intensive diabetes management or who are committed to moving toward intensive diabetes management. They must be willing to do at least four self-blood glucose monitoring (SBGM) tests each day. They will be randomized to two years of treatment, including six months of using four GlucoWatch Biographers per week (two day/two night), six months of using the MiniMed CGMS, and a six month control period. Primary end points will be change in HbA1c levels and the incidence of hypoglycemia. HbA1c levels will be determined initially and every three months, or at one and three months in the feasibility trial, with a goal of achieving HbA1c values less than seven percent. The incidence of all hypoglycemic events and of severe hypoglycemia will be compared for the three treatment groups in the three-month feasibility and the two-year longer trial. In addition, each person will serve as their own control in the longer trial as they are randomized to each of the three study groups. Secondary end points will be episodes of ketoacidosis, change in BMI, numbers of sensors used, insulin dose, use of an insulin pump, use of carbohydrate counting, number of SBGM tests done per day and changes in Fear of Hypoglycemia and Quality of Life Questionnaires. Quality of Life and Fear of Hypoglycemia Questionnaires will be used to evaluate psychological factors in both the factors in both the feasibility and the two-year trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GLYCEMIC INDEX, OBESITY, INSULIN RESISTANCE AND CVD RISK Principal Investigator & Institution: Ludwig, David S.; Assistant Professor of Pediatrics; Children's Hospital (Boston) Boston, Ma 021155737
34
Blood Glucose
Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2006 Summary: (provided by applicant): The prevalence of obesity has risen dramatically among children in the U.S. since the 1960s. Effective treatment of childhood obesity is widely recognized as instrumental to public health efforts to combat type 2 diabetes and heart disease. Evidence from animal studies, short-term human studies and epidemiology suggests that diets designed to minimize the rise in postprandial blood glucose, that is low glycemic index, may be useful in the treatment of obesity and related complications. This project proposes two studies involving obese adolescent subjects age 13 to 18 years: 1) a randomized controlled trial examining the effectiveness and practicality of a low glycemic index diet in the treatment of obesity and prevention of related complications; 2) a cross-over feeding study investigating the physiological effects of weight-maintaining diets differing in glycemic index on insulin resistance and CVD risk factors under controlled conditions. Study 1 involves 90 subjects randomly assigned to receive standard dietary treatment or a macronutrient-controlled low glycemic index diet. Each subject and at least one parent will received intensive nutritional counseling for 6 months, with follow-up for an additional 6 months. Both diet groups will receive identical treatment intensity, behavioral modification and physical activity recommendations. The primary endpoint will be change in percent body fat by dexa-scan at 12 months; other outcomes include insulin resistance and CVD risk factors. Compliance will be assessed by interviewer-administered, 24-hour dietary recalls. Study 2 involves 24 subjects who will be randomly assigned to received marconutrient-controlled low or high glycemic index diets prepared in a metabolic kitchen for 4 weeks. Subjects will be admitted to the GCRC at baseline and at the end of each dietary treatment for measurement of insulin sensitivity by hyperinsulinemic euglycemic clamp, endothelium-dependent flow-mediated dilation of the brachial artery and other cardiovascular disease-related outcomes. The two studies are expected to provide complementary information regarding the effects of dietary glycemic index on childhood health. The project's key personnel and consultants include individuals with a diversity of expertise and perspective, ensuring a rigorous and impartial evaluation of study hypotheses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEPATIC MECHANISM FOR CONTROL OF FOOD INTAKE Principal Investigator & Institution: Friedman, Mark I.; Associate Director; Monell Chemical Senses Center 3500 Market St Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-JAN-1986; Project End 31-MAR-2004 Summary: (Adapted From The Applicant's Abstract): Feeding behavior is controlled in part by post-absorptive fuel metabolism. In order for fuel metabolism to affect feeding, the brain must be informed. The liver monitors fuel metabolism and generates signals that the brain uses to control feeding behavior. The overall goal of this project is to understand the operation of this hepatic control of food intake. The experiments proposed in this application will provide important information about hepatic mechanisms that control feeding behavior, and thus will contribute to a fuller understanding of the etiology of overeating, obesity and anorexia, and to the development of appropriate strategies for their prevention and treatment. Two aims of this project pertain to the neural substrate for the transmission and processing of the hepatic hunger signal(s). Experiments will be performed to: 1) locate the neurons involved in the transmission and processing of hepatic metabolic hunger signals; and 2) determine where different peripheral metabolic hunger signals are integrated to control feeding behavior. Three aims of the project address questions concerning the hepatic
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35
mechanism that mediates satiety in glucose and fat. To address these issues experiments will be conducted to determine whether: 1) the difference in glucose concentration in the blood vessels supplying the liver (hepatic artery and hepatic portal vein) generates a satiety signal; 2) the sensory neurons in the vagus nerves mediate the satiating effect of high concentrations of hepatic portal vein glucose; and 3) the satiating effect of fat is due to its metabolism in the liver. Another aim of this project pertains to which cell types in the liver are the source of hepatic signals that control feeding behavior. To address this, an experiment will be performed to determine whether a metabolic hunger signal originates from hepatocytes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIF-1 AS A THERAPEUTIC TARGET IN DIABETIC RETINOPATHY Principal Investigator & Institution: Ihnat, Michael A.; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2002; Project Start 16-SEP-2002; Project End 31-AUG-2007 Summary: Diabetic retinopathy is a major complication of diabetes and a leading cause of blindness. In its later stages this disease is characterized by a hyperproliferation of retinal blood vessels, or angiogenesis. Hypoxia inducible factor -1 (HIF-1) is a transcription factor that is rapidly induced in response to hypoxia and regulates the expression of several genes critical to angiogenesis and glucose regulation. HIF-1 has been shown to be significantly increased in the retina in response to hypoxia and to advanced glycation products (AGEs), altered macromolecules associated with diabetes. The overall hypothesis driving these studies is that inhibition of angiogenesis through the specific disruption of HIF-1 is a novel, early target for potentially controlling proliferative retinopathy. The goal of specific aim one is to target HIF-lalpha, a critical subunit of HIF-1, at the messenger RNA level through the use of ribozymes, or catalytic pieces of RNA. The goal of specific aim two is to find specific peptide inhibitors of the interaction between the HIF-1alpha and the HIF-1beta (ARNT) subunit using phage peptide display. Both the ribozymes and the peptides will be introduced locally into the retina using adenovirus. The effect of these agents on angiogenesis and on downstream targets of HIF-1 (VEGF, PAl-l) will be examined using an oxygen-induced mouse ischemia model. Using these molecular approaches we seek to define a role for HIF-1 in proliferative diabetic retinopathy and to determine whether this transcription factor represents a valid target for therapy in this disease state. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HYPOGLYCEMIA PREVENTION
&
DRIVING:INCIDENCE,
MECHANISMS,
Principal Investigator & Institution: Cox, Daniel J.; Psychiatric Medicine; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2003; Project Start 01-JAN-1982; Project End 31-JAN-2006 Summary: (provided by applicant): Intensive insulin therapy for Type 1 Diabetes Mellitus (T1DM) is associated with an increased risk of hypoglycemia. Our past NIHfunded research, investigating the biopsychobehavioral causes and effects of hypoglycemia, has yielded important and unique, albeit post hoc, findings about hypoglycemia and driving in T1DM. We demonstrated that mild hypoglycemia (e.g., 65 mg/dl) impairs cognitive-motor, judgment and driving performance. Additionally, our 11-site retrospective survey of 600 drivers with and 300 drivers without diabetes found that those with T1DM had twice as many auto crashes and violations and experienced
36
Blood Glucose
hypoglycemic stupor 4 times as often while driving than either T2DM or nondiabetic drivers (p's<.01); Post hoc analyses revealed that T1DM drivers who had crashed/hypoglycemic stupor in the previous 2 years had a lower Blood Glucose (BG) threshold for deciding when not to drive, were less likely to measure BG before driving, were more likely to have mild hypoglycemia while driving, and were less likely to have carbohydrates in the car (p's<.03). Finally, our previous research demonstrates that judgment about driving when BG is low can be improved, and number of moving vehicle violations and crashes can be reduced, through psycho-behavioral interventions. Based on these findings, we propose the first, a priori, prospective, multi-center investigation of hypoglycemia and driving in T1DM drivers who are thought to be at High vs. Low risk for driving mishaps. This study has three phases: Phase 1 will involve recruiting 275 High and 275 Low risk T1DM drivers, from three diverse sites in the U.S., and prospectively tracking diabetes self-management behaviors and driving mishaps over a 12-month period. Phase 2 will be intensive and experimental UVA field and hospital-based studies investigating the physiological, behavioral and psychological parameters of driving and self-regulation during euglycemia and hypoglycemia. Phase 3 will include the pilot testing of an intervention aimed at preventing hypoglycemiarelated driving mishaps. The proposed research is designed to: A) document the frequency of hypoglycemia-related driving mishaps, e.g., driving errors that may or may not result in a crash or citation; B) determine mechanisms underlying these mishaps, testing a diabetes-specific causal model we have developed; and C) create a database on which to begin to develop an intervention program intended to reduce the factors associated with hypoglycemia-related driving mishaps; and, D) pilot test an intervention designed to reduce risk of driving mishaps due to hypoglycemia. Ultimately, this research may enhance driving safety for people with T1DM. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FUNCTION
HYPOGLYCEMIA
AND
AUTONOMIC
NERVOUS
SYSTEM
Principal Investigator & Institution: Freeman, Roy; Associate Professor of Neurology; Beth Israel Deaconess Medical Center St 1005 Boston, Ma 02215 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: The Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study have documented unequivocally that improved glycemic control decreases the incidence and progression of microvascular complicatons of diabetes. The implementation of regimens to rigorously control blood sugar in diabetic patients has led to an increased incidence of severe iatrogenic hypoglycemic events that have limited glycemic management of diabetes mellitus. Recent antecedent iatrogenic hypoglycemia impairs the neuroende:rine and autonomic response to subsequent hypoglycemia - a disorder known as hypoglycemia associated autonomic failure - thus increasing the predisposition to severe hypoglycemia. It is not known whether antecedent hypoglycemia has more general effects on autonomic nervous system function. Impaired autonomic function is associated with increased mortality and morbidity in individuals with diabetes mellitus. If hypoglycemia induces generalized autonomic dysfunction it may further increase the mortality and morbidity associated with diabetes mellitus. The goal of this research is to understand the mechanisms of hypoglycemia associated autonomic failure. The proposed studies test the hypothesis that antecedent hypoglycemia not only impairs the counterregulatory response to subsequent hypoglycemia but also impairs cardiovascular autonomic function in nonhypoglycemic individuals. These studies will examine those markers of cardiovascular
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37
autonomic function that, when impaired, are associated with increased morbidity and mortality in patients with diabetes. Furthermore, we hypothesize that antecedent hypoglycemia causes a rise in serum cortisol and that cortisol activation of glucocorticoid receptors mediates the development of hypoglycemia associated autonomic failure. The specific aims for the proposal are to assess autonomic control of cardiovascular function following antecedent euglycemia and hypoglycemia. In addition, we will determine whether administration of a glucocorticoid receptor antagonist, mifepristone, prior to antecedent hypoglycemia improves the autonomic and neuroendocrine response to subsequent hypoglycemia in healthy men and women. Thus, the broad long term objectives of the proposal are to fully understand the mechanisms and consequences of hypoglycemia associated autonomic failure with the ultimate goal of finding an efficacious treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMAGING PANCREATIC B-CELL FUNCTION BY MAGNETIC RESONANCE Principal Investigator & Institution: Roman, Brian B.; Research Assistant Professor; Physiology and Biophysics; University of Illinois at Chicago 1737 West Polk Street Chicago, Il 60612 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The use of MRI imaging as a non-invasive tool to assess encapsulated pancreatic beta cell viability is proposed. The immunoisolation of transplanted islets has emerged as a promising method of treating Type I Diabetes, and is potentially the only strategy that provides both the safety of avoiding immunosuppressant drugs and the effectiveness of measuring blood glucose as accurately as only living cells can. Since the device functions as an implantable homeostatic sensor-release system, it is fundamental for the encapsulated cells to be able to respond promptly to fluctuations in glucose concentrations of the interstitial fluid in order to retain a physiologic dynamic response. Currently, efficacy of the biocapsule is assessed indirectly by measuring serum glucose levels, and although insulin secretion may remain constant, levels of ATP, glucose consumption and lactate production may change, and may be indicators of irreversible damage to the encapsulated cells. In this proposal, NMR spectroscopy and microimaging will be used to analyze the physical and physiological status of the pancreatic beta cells. A novel MR imaging method is proposed to non-invasively assess cell activation. Pancreatic b-cells activated by increased glucose levels induce Ca2+ uptake through L-type voltage-gated Ca2+ channels. Mn2+ acts as a Ca2+ analog and enters cells through L-type voltage gated channels. Additionally, Mn2+ is a MR relaxation agent and reduces the T1 of water, resulting in a change in image contrast. Therefore beta cells activated by increased glucose in the presence of Mn2+ will demonstrate a change in MR signal intensity compared to non-activated cells. Using the high spatial resolution abilities of MRI, this approach will allow us to directly image beta cell function and viability. Simultaneously it will be possible to apply localized spectroscopic techniques to construct metabolic profiles of activated versus non-activated regions. In concert, these techniques will provide means to understand beta cell function, factors influencing successful islet transplantation, and the further development of encapsulated pancreatic beta cells necessary for a bioartificial pancreas. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Blood Glucose
Project Title: INDIVIDUALIZING DIABETES CARE FOR OLDER PEOPLE Principal Investigator & Institution: Huang, Elbert S.; Instructor of Medicine; Medicine; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2004; Project Start 01-FEB-2004; Project End 31-JAN-2008 Summary: (provided by applicant): Type 2 diabetes mellitus is a substantial health care burden for individuals over 65 but little clinical research has been specifically devoted to establishing preventive care guidelines for this population. Preventive care goals need to be individualized for older patients, a process that requires accounting for all treatment effects, patient heterogeneity, and individual preferences. I am a general internist who seeks to develop a career at the intersection of diabetes and geriatrics that is focused on the evaluation and individualization of diabetes care goals for older patients, using a decision modeling approach. In four years, I would like to be able to conduct a series of decision-analytic studies using available trial and epidemiological data that illustrate how patient heterogeneity and preferences should influence the setting and prioritization of prevention goals such as the control of blood glucose, blood pressure, and serum cholesterol. In order to reach this long-term goal, I will obtain additional research training and experience in multiple disciplines through formal coursework, one-on-one mentoring, and completion of a series of modeling projects and a patient survey over the next four years. The faculty and resources of the University of Chicago make it a rich environment for career development in aging-related research. This research plan is composed of four specific aims: 1) To develop a model of type 2 diabetes designed to analyze the effectiveness and cost-effectiveness of varying levels of glucose control for subjects over the age of 65; 2) To evaluate the impact of patient heterogeneity on the effectiveness and cost-effectiveness of varying levels of glucose control for older subjects; 3) To assess older patients' preferences regarding life with diabetes treatments and complications and to evaluate the effect of preferences on the effectiveness and cost-effectiveness of glucose control strategies; 4) To begin to evaluate the effectiveness and cost-effectiveness of non-glycemic control related treatments in older subjects. Optimizing the individualization of comprehensive diabetes care has the potential to dramatically reduce complications and improve quality of life for older patients. The development and evaluation of a glucose control module and the collection of patient preference data will be crucial to future decision-analytic studies of comprehensive diabetes care in older patients. Along with more research training, these studies will also help me reach my overall goal of becoming an independent investigator in the areas of geriatric diabetes and cost-effectiveness analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INFLUENCE ADOLESCENCE
OF
INSULIN
ON
BP
CHANGE
DURING
Principal Investigator & Institution: Sinaiko, Alan R.; Professor of Pediatrics; Pediatrics; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 05-MAY-1995; Project End 31-MAY-2004 Summary: (Adapted from the Investigator's Abstract) This research application is a continuation of a project initiated in 1995 to study insulin resistance in children. The primary objectives are (1) to define the relation of insulin resistance (defined by the euglycemic insulin clamp) during childhood and adolescence to the development of the insulin resistance syndrome (i.e., hypertension, dyslipidemia, obesity, and insulin resistance) in young adulthood; and (2) to define the relation of the insulin resistance syndrome within families and the importance of genetics to that relation. The original
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cohort consists of 357 children who have had two euglycemic insulin clamp studies (at mean ages 13 and 15 years). The specific aims are: to (1) repeat anthropometric and blood pressure measurements at mean ages 18, 19, and 20 and obtain insulin clamps, lipid levels, echocardiograms, and DEXA at mean age 21 in the children; and (2) obtain the measurements, blood and DNA samples, echocardiogram, and insulin clamp in the parents and siblings of the children. Statistical genetics methods will be used to estimate heritability and genetic correlations among the insulin resistance syndrome traits. These data will address the hypotheses that 1) insulin resistance in childhood will predict insulin resistance and cardiovascular risk factors in young adulthood; 2) insulin resistance in parents will be associated with insulin resistance and cardiovascular risk factors in their children; 3) in fat children, BMI and insulin resistance at mean age 13 will predict cardiovascular risk, but in thin children only insulin resistance will be a similar predictor; 4) insulin resistance has significant heritability; and 5) there are significant genetic correlations between insulin resistance and the insulin resistance traits. It is anticipated that at least 300 of the original cohort of 357 who have had two euglycemic insulin clamps will complete the five years of this continuation. The investigators state that the significance of this project lies in its potential to define the factors influencing development of the insulin resistance syndrome and provide the basic clinical data required to begin to study genetic patterns of cardiovascular disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INSTRUMENTAL DESIGNS FOR NEAR INFRARED GLUCOSE MONITORS Principal Investigator & Institution: Arnold, Mark A.; Professor; Chemistry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2004; Project Start 15-MAY-2004; Project End 31-MAR-2008 Summary: (provided by applicant): Two novel solid-state instrumental designs are described for use in the noninvasive measurement of blood glucose. Both instruments implement transmission measurements of near-infrared light through a tissue sample and allow the encoding of multivariate calibration models in hardware. Each instrument is based on the sequential measurement of pre-defined combinations of near- infrared wavelengths that are specified in the form of filter bandpass functions. In the two designs, these filter profiles are generated with either a digital micromirror array (MMA) or an acousto-optic tunable filter (AOT F). The MMA allows the specification of filter profiles of arbitrary complexity, while the AOTF allows the generation of filters with simpler square-wave shapes. A computational model and numerical optimization procedures are described for use in defining optimal filter profiles that result in the measurement of unique spectral patterns that are selective for blood glucose. These filter profiles are analogous to the components extracted by multivariate calibration models from contiguous spectral data acquired by a conventional spectrometer. Performing these discrete filter-based measurements gains both throughput and multiplex advantages, and allows the creation of rugged instrumental designs that are compatible with noninvasive blood glucose measurements made by diabetic patients outside the controlled environment of the laboratory. Both in vitro experiments and in vivo studies with a rat model are proposed for use in characterizing the performance and analytical utility of these instrumental designs. The experimental and computational work will be directed to the overall goal of developing a noninvasive nocturnal hypoglycemic alarm. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
40
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Blood Glucose
Project Title: INSULIN ACTION IN MUSCLE & FAT CELL Principal Investigator & Institution: Lawrence, John C.; Professor; Pharmacology; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-APR-1981; Project End 31-MAR-2006 Summary: Insulin lowers blood glucose by stimulating glucose uptake and storage in various target tissues, the most important being liver, skeletal muscle, and fat. The failure to respond appropriately to insulin results in a rise in blood sugar. Type II diabetes mellitus develops if beta cells become unable to release enough insulin to compensate for the insulin resistance. Determining the processes involved in the normal response to insulin will be essential for understanding insulin resistance, and the overall objective of this project is to define mechanisms involved in the actions of insulin in skeletal muscle and fat cells. Initial aims are to investigate the stimulation of glycogen synthesis by insulin. This effect is of particular importance in the control of blood glucose levels, as most of the glucose taken up following a meal is deposited as glycogen in skeletal muscle. Experiments in Aim 1 are proposed to investigate both the mechanism through which insulin activates glycogen synthase (GS), the enzyme that synthesizes glycogen from uridine diphosphoglucose (UDPG), and the importance of increasing GS activity in the stimulation of glycogen synthesis. Treating rats with insulin results in a marked decrease in muscle UDPG, implying that the activity of UDPG pyrophosphorylase (PPL) may limit the rate of glycogen synthesis. Objectives of Aim 2 are to determine whether UDPG PPL is subject to hormonal and/or metabolic control, and to investigate the potential limiting role of UDPG PPL in glycogen synthesis in rodent and human muscles. In the last two Aims we will investigate new targets of insulin action. We have recently discovered an adipocyte protein, designated betaip140, which is phosphorylated in response to insulin and coimmunoprecipitates with the beta isoform of protein kinase B (PKB). By purifying betaip140 and sequencing peptides by tandem mass spectrometry, we have shown that betaip140 is the product of the Kiaa0188 gene, recently identified by genetic fine mapping as a candidate gene for the fld mouse phenotype. Mice homozygous for the fld gene exhibit insulin resistance, glucose intolerance, and markedly diminished adipose tissue mass. Aim 3 is to investigate the potential interactions between betaip140 and PKBbeta, to define the mechanisms controlling betaip140 phosphorylation, and to determine the role of betaip140 in insulin action. Many other proteins that are phosphorylated in response to insulin can be detected, but have not been identified. This represents a serious gap in our understanding of insulin action, since at least some of the proteins are likely to represent downstream targets that are involved in the important metabolic responses to insulin. The objective of Aim 4 is to identify these new targets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INSULIN RESISTANCE AND CNS FUNCTION IN TYPE 2 DIABETES Principal Investigator & Institution: Craft, Suzanne; Professor; Psychiatry and Behavioral Scis; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2005 Summary: (provided by applicant): Type 2 diabetes mellitus (T2DM) is caused by insulin resistance (IR) and inadequate insulin secretion. T2DM affects one in five Americans over age 60 and has been associated with verbal memory deficits in older patients. These deficits are consistent with growing evidence that insulin contributes to the functioning of the hippocampus and adjoining medial temporal structures supporting memory. Furthermore, the hypothalamic-pituitary-adrenal (HPA) axis,
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commonly dysregulated in insulin resistant persons, interacts with the hippocampus and may influence memory. Therefore, IR may contribute to T2DM-related memory impairment. The proposed studies will examine the effects of improving IR on central nervous system (CNS) functions in T2DM and impaired glucose tolerance (IGT). Three hypotheses will be tested: that improving insulin sensitivity will (1) enhance memory and other cognitive functions, (2) increase cerebral glucose metabolism in the hippocampus and adjoining medial temporal structures, and (3) normalize cerebrospinal fluid (CSF) levels of insulin and the CSF-to-plasma insulin ratio. We will also characterize the effects of improving IR on plasma and CSF levels of amyloid peptides, which are regulated in part by circulating insulin. In a Core Study, newly diagnosed persons with T2DM and IGT will be randomized to receive the insulin sensitizer rosiglitazone (4 mg bid), the insulin secretagogue nateglinide (120 mg tid), or placebo for 16 weeks. Cognitive measures and blood samples for neuroendocrine assays will be obtained at baseline, treatment weeks 8 and 16, and after 8 weeks of washout. It is predicted that both agents will enhance memory, and that rosiglitazone will produce a greater degree of enhancement than nateglinide. A subset of Core Study subjects will receive either positron emission tomography (PET) imaging or lumbar puncture (LP) to obtain CSF at baseline and treatment week 16. In addition, a healthy control group will receive only baseline PETs or LPs. Significant findings will provide converging evidence that JR can adversely influence various CNS functions and suggest that an important therapeutic goal in IGT and T2DM is to improve insulin sensitivity. Furthermore, results of these studies should point to new avenues of research, such as examination of the cellular effects of IR on cerebral glucose metabolism and their relationship to cognition. Finally, these studies have the potential to elucidate relationships between T2DM and other disorders in which memory is impaired, such as Alzheimer?s disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: L-TYPE CA2+ CHANNEL MODULATION OF BETA CELL FUNCTION Principal Investigator & Institution: Hockerman, Gregory H.; Associate Professor; Medicinal Chem/Molecular Pharm; Purdue University West Lafayette West Lafayette, in 479072040 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-JAN-2009 Summary: (provided by applicant): In type II diabetes, the insulin secreting beta cells of pancreatic islets fail to secrete insulin in sufficient quantities to maintain normal blood glucose levels. The resulting hyperglycemia can Iead to many serious complications. Therefore, understanding the mechanisms that mediate insulin secretion could lead to new therapies to prevent the onset and complications of Type II diabetes. Two Subclasses of L-type Calcium channels, Cav1.2 and Cav1.3 are expressed in pancreatic beta cells. A "knock in" method to introduce Cav1.2 and Cav1.3 mutant channels that are insensitive to the dihydropyridine (DHP) class of L-type channel blockers into the insulinoma cell line INS-1 has been described. In this system, the endogenous L-type channels can be "shut off" with DHP drugs, thus pharmacologically isolating either Cav1.2 of Cav1.3 channels. Using this system, it is shown that Cav1.3 but not Cav1.2 channels can mediate glucose-stimulated insulin secretion, but that both channels can mediate KCI stimulated insulin secretion. Furthermore, the intracellular loop between homologous domains III and IV (II-III loop) of Cav1.3 but not Cav1.2 completely inhibits glucose-stimulated insulin secretion when over-expressed in INS-1 cells. To elucidate the mechanism and structural determinants of the specificity of Cav1.3 coupling glucose-stimulated insulin secretion in INS-1 cells, this proposal will: 1. Determine the mechanism whereby glucose stimulated insulin secretion is specifically coupled to
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Cav1.3. 2. Identify the molecular determinants of the preferential coupling of Cav1.3 to glucose-stimulated insulin secretion. 3. Identify proteins that interact with intracellular domains of Cav1.3 and mediate the specificity for glucose-induced insulin secretion. 4. Define functional roles for the distal C-terminal tails of Cav 1.2 and Cav1.3 in INS-1 cells. Although much of this work will be done in the INS-1 cell model, adenovirus vectors will be used to introduce mutant channels and channel fragments into primary rat beta cells to repeat key experiments in this more physiologically relevant system. This proposal will utilize techniques such as patch clamp whole-cell electrophysiology, confocal microscopy, and total internal reflection microscopy. This proposal is consistent with the PI's long-term goal of understanding L-type calcium channel modulation and cellular function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MANAGING DIABETES: USE OF A DIGITAL INTERCOM SYSTEM Principal Investigator & Institution: Flax, Stephen W.; Flextech Systems, Inc. 333 Bishops Way, Ste 109 Brookfield, Wi 53005 Timing: Fiscal Year 2003; Project Start 30-SEP-2001; Project End 31-JUL-2005 Summary: (provided by applicant): The long-term objective of this project is to develop a new and novel medical monitoring device aimed at benefiting a large class of diabetic individuals. The new device is being called an "Assisted Self- Management Monitor." There are many diseases, such as diabetes, which are considered "self-managed" diseases. With diabetes, it is expected that patients measure and monitor their own blood glucose levels, their own medication administration, and their own diet and exercise programs. When patients properly and actively manage their own disease, they will minimize the disease progression. Otherwise, the effects can be tragic in terms of disease progression and health care costs. Mismanaged diabetes will eventually put the patient at risk for coronary artery disease, stroke, kidney failure, blindness, and peripheral vascular disease. Furthermore, there is often a significant time lag between when a patient collects self-care information and when a medical staff is made aware of that information. The new device underdevelopment is designed to actually monitor and evaluate how well patients are self-managing their disease, and then provide feedback to the care staff and the patient when irregularities are detected. Initially, the system is intended to help diabetic patients living in an assisted living setting. The new device will automatically transfer a patient's glucose reading and medication usage information from his or her quarters to a central station. There, the information will be compared to a personal profile that has been developed for each individual patient. When something of concern is detected, the monitor will notify the care staff with an appropriate message on a computer screen. However, the resident will also be notified with a prerecorded voice message that pertains to the given condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MONITORING PREGNANT WOMEN WITH GDM VIA THE INTERNET Principal Investigator & Institution: Homko, Carol J.; Medicine; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2006 Summary: (provided by applicant): Gestational diabetes mellitus (GDM), which complicates between 3 and 5% of all pregnancies, is associated with an increase in perinatal morbidity. A significant relationship between maternal glycemic control and
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macrosomia as well as other adverse pregnancy outcomes has been clearly established. Therefore intensive management regimens, which aim to normalize blood glucose levels, are the mainstay of therapy in these pregnancies. Such an approach requires close medical surveillance with frequent communications between the health care provider and the woman with diabetes. However, current methods of surveillance, including frequent clinic visits and multiple telephone contacts, are labor intensive, costly, and not always uniformly applied particularly among inner city underserved populations. The purposed project enlists interactive technology between the health care provider and the patient at home to allow frequent monitoring of health status, to provide advice and education via a direct communication system. It is our hypothesis that the increased communication facilitated by this network will empower inner city women with GDM to take a more active role in their management, thereby improving maternal glucose control and leading to reductions in birth weight and ultimately other adverse outcomes. This preliminary study will attempt to determine if pregnant women with GDM can interact successfully with their health care providers via the diabetes health network. Eighty women with GDM will be randomized to one of two groups. Women in both groups will monitor their blood glucose levels four times a day, perform fetal movement counting three times day, and record insulin doses and episodes of hypoglycemia. Women in the experimental group will transmit their blood glucose levels and fetal movement counts to their health care providers via the diabetes health network three times a week. Women in the control group will record this information in a logbook, which will be reviewed by the medical team at prenatal visits. Key outcome variables will include infant birth weight, maternal blood glucose control and feelings of self-efficacy. Secondary outcome variables will include rate of macrosomia, neonatal morbidities, and admission to the Neonatal Intensive Care Unit. We expect this program to improve communications between patient and health care providers, enhance women's feelings of self-efficacy, improve glucose control and reduce birth weight. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NEAR-CONTINUOUS GLUCOSE MONITORING IN PEDIATRICS Principal Investigator & Institution: Buckingham, Bruce A.; Pediatrics; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (prepared by applicant): The investigators propose to develop a systematic approach to evaluating near continuous glucose sensors in children and adolescents. This approach can be used in the assessment of current sensors now available to the public, and for future sensors that become available during this project. Accuracy will be determined using normal controls and children with diabetes. Initial accuracy measurements will be performed in a CRC using a laboratory quality measurement of glucose. The sensors will then be assessed in the home environment to determine their usefulness in detecting changes in blood glucose levels and improving diabetes management. The investigators will collect detailed record of food intake, and a continuous record of physical activity will be obtained using an accelerometer as well as psychological assessments. These data will be integrated to evaluate the multiple factors leading to hypoglycemia and variability in blood glucose levels, as well as provide effective tools for improving diabetes management. In the future these data will be valuable in developing algorithms that incorporate this information into a closed loop insulin delivery system. Aim 1 is to determine the accuracy of near-continuous glucose monitors in normal children. This will allow assessment of the possible physiologic effects, such as sleep and physical activity on glucose levels. These studies will also
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allow determination of the incidence of sensor readings in the hypoglycemic range despite normal blood glucose levels. Aim 2 is to determine the accuracy of nearcontinuous glucose sensors in children with diabetes. Particular attention will be given to the detection of hypoglycemia, especially nocturnal hypoglycemia, and the accuracy of sensors during physical activity. Aim 3 is to assess hypoglycemia in a contemporaneous population of children with Type 1 diabetes using near continuous glucose monitoring. This will be an observational study in a home environment. Aim 4 is to assess the long-term effectiveness of near continuous glucose monitoring on decreasing the frequency and severity of hypoglycemic reactions, and improving glycemic control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NEUROENDOCRINOLOGY OF PUBERTY Principal Investigator & Institution: Foster, Douglas L.; Professor & Research Scientist; Obstetrics and Gynecology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-MAR-1984; Project End 31-JAN-2005 Summary: When nourishment is inadequate or energy expenditure is great, fertility is reduced in the adult, and puberty is delayed in the developing individual. This suppression of reproductive activity is not understood mechanistically. We believe this to be an integrative problem at this stage of inquiry that requires both physiologic and pharmacologic approaches to answer broad questions about how the brain discriminates how well nourished and how mature the body is. Our broad objective is to understand the physiological mechanisms by which changes in nutrition and metabolism control reproduction, specifically the signals, sensors, and pathways whereby blood-borne information regulates GnRH secretion. To progress further in understanding the relationship between growth, metabolism and production of high frequency GnRH pulses during development, we must first determine how energy metabolism regulates GnRH secretion. To progress further in understanding the relationship between growth , metabolism and production of high frequency GnRH pulses during development, we must first determine how energy metabolism regulates GnRH secretion in the adult. Thus, we will first evaluate how changes in glucose availability and leptin modify GnRH secretion during adulthood and then determine if such a mechanism might be timing puberty during growth. The sheep will be used because its large size and long lifespan permits individuals to be studied longitudinally through their development and permits detailed studies in adults. Importantly, it is well suited for the characterization of hypophysiotrophic hormone patterns. Specific Aim 1 will determine if the hindbrain and the liver contain sensors that transmit information about glucose availability to regulated GnRH secretion. We will both increase and decrease availability locally in each site to establish their function and their interrelationships. Specific Aim 2 will determine the role of leptin as a signal to regulate the pulsatile secretion of GnRH. This will be achieved through central administration of leptin during both acute fasting and chronic low nutrition. Although widely studied in feeding behavior, we have little understanding of its physiologic role in regulating GnRH secretion. Specific Aim 3 will assess "nutritional stress" as a cause hypogonadotropism through reduced GnRH secretion by monitoring of stress peptides in the pituitary portal circulation and by antagonizing their action during acute fasting and chronic low nutrition. Specific Aim 4 will determine if glucose availability times the pubertal GnRH increase by using the power of our large animal model in which we can chronically administer metabolically important signals such as insulin and leptin.
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Understanding the metabolic control of GnRH secretion has broad application both to growth and maturation and to other physiologic conditions in which reduced GnRH secretion may contribute to infertility because of altered energy metabolism. These include dietary malnutrition from eating disorders; during high-energy expenditure, as in exercise- induced amenorrhea and lactational anovulation; during type 1-diabetesinduced infertility. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NEUTRAL LIPID DYSREGULATION OF THE PANCREATIC BETACELL Principal Investigator & Institution: Poitout, Vincent; Associate Professor; Pacific Northwest Research Institute 720 Broadway Seattle, Wa 98122 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2005 Summary: (Scanned from the applicant's description) Type 2 diabetes mellitus is characterized by chronic hyperglycemia and is often associated with elevated plasma lipid levels. The overall objective of this proposal is to ascertain the mechanisms whereby prolonged exposure to elevated levels of fatty acids (FA) affects pancreatic beta-cell function in Type 2 diabetes. Previously, we have demonstrated that prolonged exposure to FA impairs insulin gene expression only in the presence of high glucose, and that this is associated with increased neutral lipid synthesis. Specific Aim I: To identify the metabolic intermediate(s) generated along the pathway of neutral lipid synthesis responsible for the impairment of insulin secretion and gene expression upon prolonged exposure to FA. Isolated rat islets, HIT-T15, and betaHC-l3 cells will be cultured for 1 to 7 days in the presence of increasing concentrations of glucose and FA. Pharmacological tools will be used to inhibit or stimulate each step of neutral lipid synthesis, in order to identify the metabolic intermediate(s) generated along the esterification pathway (i.e., long-chain Acyl-CoA, diacyiglycerols, or triacylglycerols) responsible for the FA-induced impairment of beta-cell function. Specific Aim II: To assess whether the glucose-dependent deleterious effects of prolonged exposure to elevated FA on beta-cell function are glucose-specific, and whether the mechanisms of these effects are transcriptional, post-transcriptional, or translational. beta-cell exhaustion will be distinguished from bona fide toxicity in experiments where diazoxide will be used to inhibit insulin release. The glucose-specificity of PA effects will be investigated by using a non-glucose secretagogue to stimulate insulin secretion and insulin gene expression. The glucose-dependent effects of FA on proinsulin biosynthesis, insulin mRNA stability, and endogenous insulin gene transcription will be assessed. The effects of FA on insulin promoter activity will be characterized in HIT-Tl5 and betaHC-13 cells and also investigated in primary islets using the recombinant adenovirus system. Specific Aim III: To determine whether high-fat feeding in hyperglycemic Goto-Kakizaki (GK) rats impairs insulin secretion, insulin biosynthesis, and insulin gene expression, and whether these effects are prevented by normalization of blood glucose levels. GK or control rats will be fed a high-fat diet for 6 weeks, after which insulin secretion, proinsulin biosynthesis, and insulin gene expression will be assessed. Blood glucose levels will be normalized in GK rats by phloridzin administration, in an attempt to prevent the deleterious effects of high-fat diet on betacell function. These experiments will provide important insights into the pathophysiology of beta-cell dysfunction of type 2 diabetes, and have clear implications for the treatment of this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NIDDM PRIMARY PREVENTION TRIAL (DPT-2) Principal Investigator & Institution: Haffner, Steven M.; Professor of Medicine; Medicine; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002; Project Start 22-SEP-1994; Project End 31-MAY-2003 Summary: As part of a multi-center grant we will attempt to prevent the development of NIDDM in 200 subjects with impaired glucose tolerance. The overall study will involve 20 clinical centers and 4000 subjects. This proposal will take seven years, with a one year protocol development, five year clinical trial and one year evaluation period. The proposed intervention will be a factorial design with one factor being diet and exercise versus usual cre and the second factor being an insulin sensitizer (e.g. Metformin) versus placebo. The primary endpoint will be the development of NIDDM. Secondary endpoints include changes in lipids, lipoproteins, ankle/arm ratio, urinary albumin and carotid wall thickness. Subjects will be obtained by several methods including: a) community advertising through radio and television advertisements; b) selective screening based on blood glucose from the Brady Green clinic; and c) subjects from the San Antonio Heart Study. Subjects identified with newly discovered diabetes but with normal fasting glycemia (2-hr glucose greater than or equal to 200 mg/dl, but fasting glucose <140 mg/dl) will be entered into a parallel secondary prevention trial to prevent the development of fasting hyperglycemia. In addition to the endpoints for the subjects in the primary prevention trial, these subjects will have assessment for diabetic neuropathy and retinopathy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NITRIC OXIDE-RELEASING GLUCOSE BIOSENSORS Principal Investigator & Institution: Schoenfisch, Mark H.; Chemistry; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 25-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The objective of the proposed research is to develop a new class of nitric oxide (NO)-releasing bioanalytical sensors and evaluate their utility for in vivo subcutaneous sensor applications. The concept of using local NO release to enhance the performance of in vivo subcutaneous sensors represents a novel approach to overcoming the difficulties that have thus far prevented the development of reliable in vivo biosensors. Current scientific knowledge regarding the role of NO in angiogenesis, phagocytosis, thrombosis, and wound healing suggests that controlled in situ NO release may effectively help reduce biofouling and increase blood flow to the sensor, thus minimizing physiological responses that tend to diminish the in vivo performance of subcutaneous sensors. Specifically, it is envisioned that slow release of NO locally at the implant site will both a) reduce bacterial adhesion and associated biofouling problems, and b) enhance overall wound healing and the formation of capillaries near the implant site such that analyte diffusion from blood to the sensor electrode is enhanced. The fundamental question to be answered by the proposed research is whether electrochemical bioanalytical sensors that continuously release NO can be prepared with improved biocompatibility without compromising the sensor's analytical response. Thus, we seek to determine if the chemistries required for sustained NO release can be made compatible with the chemistries required for selective and sensitive detection of glucose. In addition, we aim to employ micropatterning methods to create unique sensor architectures that support NO release while retaining superior analytical sensitivity. The versatility of the sol-gel process in terms of tuning NO release
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properties by varying the amount of aminosilane, combined with the variety of pattern geometries that may be created using micropatterning techniques, will allow for the development of numerous types of heterogeneous NO-releasing surfaces with a broad range of possible applications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OBESE FEMALE RESTRAINED EATERS : TWO TREATMENT OPTIONS Principal Investigator & Institution: Stern, Judith M.; Professor; Nutrition; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 956165200 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2004 Summary: Obesity continues to be a major challenge for medical management. Traditional treatment aimed at improving health has focused on energy/dietary restriction along with lifestyle modification. This cannot be the optimal treatment for all obese people, as obesity has wide ranging etiology, not all of which is addressed by the above treatment. Restrained eaters are individuals who are chronically concerned about their weight ant attempt to control or reduce it by limiting their energy intake. We propose that restrained eaters have low potential for success via energy/dietary restriction, and thus may be better served by a novel treatment oriented toward reducing their restrained eating and improving other health habits. An increasing number of practioners are utilizing this "non-diet" approach with restrained eaters. There are insufficient data to establish whether it is preferable to a conventional behavioral energy restriction intervention. Thus, we will test 30-45, body mass indices (BMI) 30-45, will be stratified based on activity level, degree of dietary restraint, degrees of flexible and rigid control of eating, BMI, and age. Fifty percent will be assigned to a non-restrictive treatment program oriented toward reducing their restrained eating (encouraging eating in response to physiologic cues, i.e., hunger and satiety), and 50% will be assigned to a control group, a conventional behavioral energy restriction weight loss program. Both groups will meet weekly for six months, followed by a monthly after-care program lasting one year. We hypothesize that on a long-term basis (12 months, 18 months), improvements in self-esteem and depression will be greater in the non- diet group compared to the weight loss group. We will also monitor body image, eating disorder data with respect to: 1) metabolic fitness (blood pressure; lipoproteinstotal cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol; markers of insulin sensitivity-glucose, insulin; percent body fat and intraabdominal fat by dual-energy x-ray absorptiometry (DXA); 2) physical activity (amount of physical activity; resting heart rate; daily energy expenditure); and 3) eating behavior (quality of diet; degree of restrictive eating; plasma leptin). These pilot data will provide a basis for future studies. The team assembled is experienced in running clinical studies including the use of proposed questionnaires and all assays and techniques. A manual of procedures will be generated to assist others in replicating the intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: OPTIMIZATION & AUTOMATION OF PANCREATIC ISLET ISOLATION Principal Investigator & Institution: Stuiver, Ingrid; Microislet, Inc. 6540 Lusk Blvd, C250 San Diego, Ca 92121 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-DEC-2003
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Summary: (provided by applicant): Islet allotransplatation has been demonstrated to greatly reduce or eliminate the requirement for exogenous insulin injection in patients with insulin-dependent diabetes mellitus. This experimental procedure offers diabetic patients hope for improved blood glucose regulation and, consequently, a reduced risk of long-term complications of the disease. In order to circumvent the problem of human donor tissue availability, the use of animal tissue, particularly that from the pig, has been studied in combination with a technology such as microencapsulation to "immunoisolate" the cells and prevent xenograft rejection. MicroIslets Inc. is developing an improved method for preparation of microencapsulated porcine islet cells for the treatment of Type I diabetes. MicroIslet has used technology licensed from Duke as a basis for generating improved methodology for the isolation, conditioning, storage and microencapsulation of islet cells. Here, we outline new methodology for porcine islet isolation whereby 400,000 islets will be harvested per pancreas. Preliminary data demonstrate that a singe intraperitoneal (ip) injection of encapsulated porcine islet cells prepared using this technology resulted in maintenance of normal blood glucose levels (100-150 mg/dl) in a previously diabetic baboon for 14 months, without the need for additional insulin injections or potentially harmful immunosuppressive drugs to prevent graft rejection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PACEI-DP: AN INTERVENTION FOR YOUTH AT RISK FOR DIABETES Principal Investigator & Institution: Patrick, Kevin M.; Adjunct Professor; Family and Preventive Medicine; University of California San Diego La Jolla, Ca 920930934 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Improved physical activity (PA) and dietary behaviors and reductions in overweight or obesity show great promise to reduce the risk of type 2 diabetes in adults. However, very few interventions have been reported that address this issue, and none that are useful for primary care providers or that address reducing diabetes risk in adolescents. We propose a randomized controlled trial to evaluate whether an integrated primary care and web-based intervention, PACEi-DP, can produce initial and sustained improvements in anthropometric, behavioral, metabolic, and physiological outcomes in adolescents who meet the ADA criteria for "high risk" for type 2 diabetes. PACEi-DP is a 1- year intervention involving: a) preprimary care visit web assessment and progress planning; b) clinician counseling; c) 12 months of web-based, phone and/or group-based follow-up. Pilot studies based upon selected elements of PACEi-DP demonstrate its promise in improving dietary & PA behaviors and in stabilizing BMI in overweight adolescents. We will recruit 93 adolescents, age 12 to 16 years, who meet the ADA criteria for high risk of Type 2 diabetes. Subjects will be recruited from 5 healthcare settings and the community and randomly assigned to one of three conditions: 1) usual medical care; 2) a web-based version of PACEi-DP where the follow-up component involves asynchronous webbased contact with subjects and their parent/guardian; or 3) a multi-modal PACEi-DP where the follow-up component adds phone and group contact. PACEi-DP will target 4 behaviors: 1) total energy expenditure from moderate and vigorous PA; 2) sedentary behavior and recreational media use; 3) Fruit/Vegetable/Fiber consumption (5 or more servings/day of fruits/vegetables and 3 or more servings/day of whole grains or legumes); and 4) total fat as percent of energy consumed. The intervention guides patients to select PA & diet target behaviors for which they develop action plans to discuss with the clinician. The clinician endorses or modifies the action plan and
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encourages participation in the ongoing intervention. Web-tutorials, continuous web access, e-mail interaction, and (in Group 3) phone counseling and group meetings guide patients and parent/guardian to use cognitive & behavioral skills to change behaviors. PACEi-DP enables participants to receive tailored, stage-appropriate intervention on their diet & PA goals. The primary outcome will be the effect of PACEi-DP on BMI at 12 months. Secondary outcomes (at 6 and 12 mo.) will be: a) metabolic and physiological measures of insulin resistance (fasting insulin, fasting blood glucose, blood lipids, microalbuminuria, acanthosis nigricans, and blood pressure; b) anthropometric measures ( percent body fat by DEXA (at 12 months), waist/hip ratios; c) behavioral measures (moderate & vigorous PA; total energy expenditure; CSA; measures of sedentary behavior & recreational media use; servings of fruits, vegetables & fiber; and total fat as a percent of energy consumed. Exploratory measures will include psychosocial mediators of change; measures of parent/guardians' BMI and waist/hip ratios, and process, satisfaction & cost-effectiveness measures of each study arm. The PACEi-DP intervention is particularly innovative because its three components - previsit web assessment and behavior change planning, primary care provider counseling, and the ongoing web or web/phone/group intervention -are unified through a common behavioral theoretical framework. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PALM-TOP DIETARY MANAGER FOR CHILDREN WITH DIABETES Principal Investigator & Institution: Sirotinin, Sergey V.; President & Ceo; Dbaza, Inc. 5001 Baum Blvd, Ste 770 Pittsburgh, Pa 15213 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-DEC-2003 Summary: (Scanned from the Applicant's Abstract): We are seeking SBIR Phase II support in order to produce and test the effectiveness of a technically refined, and commercially viable dietary self-management software suite for youngsters with Type I diabetes, a prevalent chronic disorder of childhood. The software suite called "Meals and Things" (MAT) consists of two modules: (a) a meal planning and recording software module that operates on a hand-held device; and (b) a supporting customizable management module that operates on a desktop PC (or commercial server). The final products will incorporate findings from a recent market test of the Phase I prototype. MAT seeks to help youths to adhere to their meal plans in order to facilitate better regulation of blood glucose and improve long-term medical outcomes. The final product will be examined with respect to: (a) its effectiveness to improve dietary selfmanagement; (b) its impact on blood glucose regulation (HbA1 levels); and (c) user's satisfaction. MAT will be tested in randomized trials with 50 recently diagnosed 8-13 year old children, using a pre-post-test design. The software suite will be targeted to youths with IDDM, parents, diabetes educators, and health care professionals. PROPOSED COMMERCIAL APPLICATIONS: The "Meal and Things" will serve as a valuable dietary self-management tool appropriate to school-age youths with Type I diabetes, their parents, diabetes educators, and health care professionals. The program, together with the Interactive CD-ROM "Kids and Diabetes" (also being developed by dbaza) will address components of diabetes self-care in a comprehensive fashion, with educational, conceptual, and visual continuity. It will appeal to health care providers, since it will reduce costs by providing more effective diabetes dietary education with no increase in staff; and to parents and youths, because it facilitates adherence to the medically recommended meal plan which then should impact positively on overall diabetes self-management and glycemic control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: 'PARENT-CHILD CO-REGULATION OF PEDIATRIC DIABETES' Principal Investigator & Institution: Gonder-Frederick, Linda A.; Associate Professor; Psychiatric Medicine; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Successful diabetes management relies on a process of self-regulation in which treatment behavior is guided by feedback about changing blood glucose (BG) levels and decision-making. The processes involved in selfregulation have been studied extensively in adults with Type 1 Diabetes Mellitus (T1DM), leading to the development of sophisticated research tools that have significantly advanced our understanding and ability to predict clinical outcome. Additionally, this research has led to the development of a highly effective, empirically based, psychobehavioral intervention, Blood Glucose Awareness Training (BGAT), developed by our research team, that improves self-regulation and clinical outcome in adults with T1DM. Unfortunately, the processes involved in the self-regulation of pediatric diabetes have received virtually no empirical attention. The purpose of the proposed project is to correct this scientific neglect by adapting the conceptual and methodological tools used in adult studies to 1) investigate the process of diabetes regulation by school-aged children (6-11 yrs) with T1DM and their parents and 2) develop and test an intervention to enhance the skills critical to this process. This is an important population to target for this line of inquiry because: 1) children with T1DM and their parents appear to be far less accurate than adult patients in symptom and BG detection; 2) As a group, pediatric patients are more likely to suffer from negative clinical sequelae (e.g., severe hypoglycemia (SH) and DKA); and, 3) Early intervention could have greater public health care benefit by achieving more reductions in acute and long-term complications, health care utilization, and disability. Phases 1A and 1B of the proposed project will provide the first systematic and comprehensive study of symptom recognition, BG detection, decision-making, and subsequent clinical sequelae in schoolaged children with T1DM and their parents. A theoretical model of co-regulation of pediatric diabetes is proposed and tested, in which the behaviors of both parent and child influence the sequence of events that determine avoidance or occurrence of negative outcomes, such as extreme hypo- and hyperglycemia. Based on the findings of these studies and our current BGAT for adults, Phase 1 C will pilot test a translation of this intervention designed for parents of school-aged children with T1DM, BGAT for parents (BGAT-P). This intervention will take advantage of the critical role parents play as the primary teachers of children about diabetes management by including training activities for parents to do with their children designed to improve children's ability to recognize BG symptoms, detect extremes in BG, and make appropriate self-treatment decisions. Based on the findings from this pilot study, and feedback from parents, in Phase 2 BGAT-P will be further refined and tested in a controlled clinical trial to assess its short-term efficacy. Phase 3 is a 12-month follow-up study to determine whether the improvements found in Phase 2 are maintained over time and also to assess the impact of BGAT-P on future clinical negative events, including frequency of SH and DKA experienced by children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PHARMACOGENETICS OF PRO12ALA PPAR GAMMA 2 IN DIABETES Principal Investigator & Institution: Shuldiner, Alan R.; Professor; Medicine; University of Maryland Balt Prof School Baltimore, Md 21201
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Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2005 Summary: (Verbatim from Applicant's Abstract): Clinical studies indicate that there is great variability in the ability of thiazolidinediones, a class of insulin-sensitizing agents, to improve glycemic control in patients with type 2 diabetes. The receptor for thiazolidinediones is peroxisome proliferator activated receptor-gamma (PPARgama), a nuclear receptor that plays an important role in adipogenesis and insulin signaling. We recently identified a common genetic variant in the PPARgamma gene (Pro12Ala PPARgamma2). In vitro studies indicate that this single amino acid substitution has functional consequences. Furthermore, Pro12Ala PPARgamma2 is associated with increased body mass index (BMI) in two Caucasian populations, increased insulin sensitivity in African Americans and Pima Indians, and more rapid weight regain after weight loss in postmenopausal Caucasian women. We hypothesize that inter-individual variability in therapeutic efficacy to thiazolidinediones is due, at least in part, to genetic factors. Specifically, we hypothesize that diabetic subjects who carry the Pro12Ala PPARgamma2 variant will be more insulin sensitive and therefore less responsive to the insulin-sensitizing and glucose lowering effects of rosiglitazone therapy as compared to subjects without the variant. To test this hypothesis, we will perform a prospective rosiglitazone intervention in subjects with type 2 diabetes who either carry or lack the Pro12Ala PPARgamma2 variant. We will compare between the two groups responsivity to rosiglitazone therapy as measured by changes in glycemic control (hemoglobin A1c, fasting blood glucose), lipoprotein profile, insulin sensitivity (euglycemic hyperinsulinemic clamp), and fat metabolism (lipolysis by microdialysis and fat oxidation by indirect calorimetry. Furthermore, to detect novel genes and pathways that predict rosiglitazone responsivity and/or influence insulin sensitivity, we will compare between rosiglitazone responders and nonresponders mRNA expression patterns of several thousand genes in muscle and adipose tissue biopsies using cDNA microarray technology. These studies will define the clinical significance of the Pro12Ala PPARgamma2 variant, and the role of PPARgamma in adipocyte metabolism and insulin signaling in humans more generally. Testing for the Pro12Ala PPARgamma2 may differentiate between patients who will be responsive or unresponsive to thiazolidinedione therapy, which would allow physicians to more rationally prescribe medications based on underlying genetic mechanisms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHYSICAL ACTIVITY, ENERGY BALANCE, AND COLON CANCER RISK Principal Investigator & Institution: Matthews, Charles E.; Assistant Professor; University of South Carolina at Columbia Byrnes Bldg., Room 501 Columbia, Sc 29208 Timing: Fiscal Year 2002; Project Start 29-SEP-2002; Project End 31-AUG-2007 Summary: There is consensus that low physical activity (PA) levels increase the risk of colon cancer in humans, particularly among individuals with elevated adiposity. However, the precise mechanism(s) of action for these associations have not been established. Although initial evidence indicates a role for inflammatory markers (e.g., prostaglandin-E2) among individuals with low PA or high levels of adiposity, simple descriptions of the patterns of cell proliferation and apoptosis, or markers of these processes, across PA levels are not available. Accordingly, the first aim of this proposal is to develop and refine hypotheses concerning the biologic mechanisms through which PA reduces risk for colon cancer by: (a) evaluating the independent and combined associations of physical activity/fitness, adiposity, and metabolic predictors (blood glucose, triglycerides) of colon cancer risk in the Aerobics Center Longitudinal Study
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(Dallas, TX) using a nested-case control design (N=600), and (b) evaluating the independent and combined associations of PA and adiposity on biomarkers for colon cancer associated with inflammation (cyelooxygenase-2), cell proliferation (mib 1), and apoptosis (bax, bak, bcl2) in cross-sectional analyses of the Markers of Adenomatous Polyps II Study (N=200, Columbia, SC). Results from these analyses will be used to select up to 10 biomarkers for evaluation in a longitudinal pilot study. The second aim is to quantify the effect of changes in PA levels on selected biomarkers in a randomized trial (N=50, intervention vs. usual care) among adults not meeting current PA recommendations. Intervention participants will receive a 12-month home-base walking intervention based on Social Cognitive Theory that includes monthly phone contact with a health educator. Potential mediators and moderators of behavior change will be quantified (e.g., self-efficacy, social support). PA goals for the intervention group will be to walk briskly at least 5 times per week for 40-45 minute per day (1125 kcal/wk). Outcome biomarker measures will be obtained via rectal biopsy at baseline and 12months. In summary, the series of investigations outlined in this proposal will examine the independent and combined effects of PA and energy balance (adiposity) on colon cancer and adenomatous polyp outcomes, and relate these findings to parallel analyses on tissue biomarker outcomes describing the biologic mechanisms linking PA and energy balance to colon cancer risk. This work will extend our understanding of the biological mechanisms underlying these causal relationships. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PILOT STUDY--GENETICS OF DIABETIC NEPHROPATHY IN BABOON Principal Investigator & Institution: Rincon-Choles, Hernan; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: Diabetic nephropathy (DN), a microvascular complication of diabetes mellitus (DM), is the main cause of end stage kidney disease worldwide. There is a great need to find animal models of DM and DN that better resemble the physiopathological changes in humans. Both DM and DN are influenced by environmental factors and heredity. The SFBR has approximately 2400 baboons in a pedigreed colony, with a 10 cM linkage map available for 800 of these animals, and additional animals are being currently genotyped. Some baboons in this colony have developed clinical features of type-2 DM and 4 animals biopsied thus far have histological features similar to those found in humans with DN. Preliminary fasting blood glucose (FBG) screening of 478 baboons showed 44% with FBG equal to or > 126 mg/dl. Preliminary screening for microalbuminuria (MA) in 298 animals showed 33.5% of 149 control and 42% of 149 diabetic baboons had MA. One of the control and 3 of the diabetic baboons had proteinuria. A subset of 7 age- and weight- matched female baboons averaging 20 years of age underwent kidney biopsy, 4 diabetics and 3 controls. Diabetic animals had FBG > 126 mg/dl, hemoglobin A1C > 6%, abnormal intravenous glucose tolerance test and normal C-peptide levels. Kidney histology showed that diabetic animals had larger glomeruli, thickened glomerular basement membrane, mesangial matrix expansion and areas of mesangiolysis with early nodule formation. These histological changes closely resemble those of DN in humans, making the type-2 diabetic baboon a useful model of DN. We hypothesize that the characterization of the DN phenotype in genotyped baboons from the pedigree, confirmed by kidney biopsy, will allow us to run a genomewide linkage analysis to identify genes and chromosomal regions associated with the development and progression of DN. We will conduct a population-wide screening in
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1000 animals to study the prevalence of DM and the pattern of microalbuminuria in the baboon. The intrarenal renin-angiotensin system (RAS) is activated in DN, as evidenced by the heightened hemodynamic response to blockade of the RAS in human DN. We will characterize the phenotype of DN in a subset of animals and investigate the kidney expression of components of the RAS and other cytokines and matrix proteins associated with DN. We will then perform a genome-wide search to find and localize quantitative trait loci that influence variation in albuminuria and disease progression. Our goal is to identify early markers of disease progression amenable to intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PILOT--EFFECTS OF MASSAGE THERAPY ON BLOOD GLUCOSE LEVEL Principal Investigator & Institution: Edwards, Bennett G.; Shaw University 118 E. South Street Raleigh, Nc 27601 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: Type II diabetes is a common problem among African-Americans and one with enormous medical and social impact. Stress may have a substantial impact on the level of blood gluose control. One approach to stress reduction is through nonmedicaition approaches such as massage therapy. The purpose for this study is to determine the effects of massage therapy on the Blood Glucose (BG) levels of patients with moderate forms of type II diabetes. "Moderate" will be designated as a person having BG levels 140 - 180 ml/dl (controlled) and elevated Hb A1c (7 - 8%). Ten subjects will be obtained from Project Direct that meet the fore mentioned criteria. Project Direct is a program sponsored by the Center for Disease Control to promote health education and treatment for African-Americans with diabetes. Patients 18 - 75 years old, on oral medication, will be recruited. Ten patients who volunteer and meet the criteria to participate in this study will become experimental subjects. Subjects will receive a full body massage for one hour 3 times per week for a total duraiton of 3 months. Stomach massage will be included with mild pressure application to the pancreas. Blood for Hb Alc will be obtained via venipuncture before the study and at the end of 12 weeks. Resting cortisol and and insulin levels will also be measured at the begining and end of the study. HR, BP, 02 saturation and pulse will be monitored before and after each exercise session. Weight will also be monitored. Patients' treating physicians will clear patients for participation. We will request patients and physicians to not alter medication type and dose for the duration of the study, unless absolutely necessary. The sample size will be too small to have statistical power, but we will be able to pilot enrollment procedures, assess measures to assure follow-up, and pilot the details of clinical research at Shaw University. A repeated measures ANOVA will be utilized to determine the effects of full body massage on Hb Alc. Resting insulin and cortisol levels, and vital signs will be measured before and after 12 weeks and a questionnaire measuring perceived stress will be administered (t-Tests) This study will provide valuable pilot information for a possible future randomized trial of massage therapy among patients with type II diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DELIVERY
PLACENTAL
VASCULAR
COMPROMISE
AND
PRETERM
Principal Investigator & Institution: Thorp, John M.; Professor; Obstetrics and Gynecology; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599
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Blood Glucose
Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): There is substantial interest in determining the etiology of preterm delivery (PTD). Despite much effort, the cause remains elusive and effective prevention measures do not exist. Uteroplacental vascular compromise (UPVC) via inflammation, thrombosis, or atherosis is a biologically plausible cause of preterm delivery, albeit not adequately explored. We propose to test his hypothesis by conducting a prospective, epidemiologic study of UPVC and by integrating information about known risk factors for PTD. Placental histopathologic examination and morphometric analysis of the basal plate will be done to assess compromise of placental vessels. We will explore novel, possible antecedents of such compromise, dyslipidemia and insulin resistance, using nuclear magnetic resonance analysis of lipid subclasses and fasting insulin-glucose ratios. Given the inaccessibility of the uteroplacental vasculature in ongoing gestations at midpregnancy, we will utilize non-invasive measures of UPVC, Doppler velocimetry of the uterine artery, and maternal serum alpha fetoprotein to indirectly evaluate vascular function. In addition, we will carefully evaluate tobacco and cocaine use, nutrition, and changes in vaginal microflora within our cohort. The data will enable us to thoroughly assess whether UPVC constitutes a distinct etiologic pathway for PTD and help to identify modifiable risk factors. We will utilize cohort and case-cohort techniques, refined in our present research, to answer these questions. Blood, urine and vaginal fluid are collected twice between 15 and 20 weeks and between 24 and 29 weeks gestation. Hair will be collected after delivery. All subjects will complete two telephone interviews and two self administered questionnaires regarding various behaviors, dietary intake, physical activity, and psychosocial stressors. Placentas will be collected at the time of delivery and histopathologic analysis will be completed by an experienced perinatal pathologist for cases and a non-case subgroup. Nuclear magnetic resonance measurement of lipoprotein subclasses will be done to assess dyslipidemia. Insulin glucose ratios will be measured from fasting blood samples. We expect to enroll a cohort of 1800 women with 250 preterm deliveries and a randomly selected non-case subgroup (n=500). We will analyze the relationship between UPVC and PTD using logistic regression. Given 1) the size of the study, 2) thorough histopathologic assessment of the placenta, 3) extensive questionnaire data, 4) biologic markers of exposure to bacterial vaginosis, insulin resistance, dyslipidemia, and cocaine use, and 5) the careful assessment of potential confounding factors, this study promises to markedly advance our knowledge of the potential role of UPVC in the etiology of PTD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PLAINS INDIANS TRADITIONAL DIETS AND DIABETES CONTROL Principal Investigator & Institution: Specker, Bonny L.; Professor; Nutrition, Food Science and Hospitality; South Dakota State University Brookings, Sd 57007 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): At present, there are no specific dietary guidelines for the Northern Plains Indian with type 2 diabetes. Current medical nutrition therapy practices base the diabetic therapeutic guidelines on the Food Guide Pyramid that encourages a grain-based diet. Anecdotally, Northern Plains Indians have reported a better control of their type 2 diabetes when following a diet higher in protein. Genetic differences may contribute to decreased adaptation to higher carbohydrate loads among Northern Plains Indians compared to Northern European descendents. A diet patterned after the historical hunter-gatherer type diet, or even the early reservation diet (with
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higher proportion of energy being supplied from protein), may lower the circulating insulin levels and provide better blood glucose control in Northern Plains Indians with type 2 diabetes. The hypothesis of this application is that Northern Plains Indians with non-insulin dependent, type 2 diabetes who receive an educational lesson that promotes a diet patterned according to the traditional consumption of macronutrients (25% calories from protein, 45-50% from carbohydrate, and 25-30% from fat) will have a better control of their diabetes as measured by their HbA1C, blood glucose, and circulating insulin concentrations compared to those educated to consume a grain-based diet that supplies a more typical mix of macronutrients (10-15% calories from protein, 50-55% from carbohydrate, and 30-35% from fat). A 26- week, dietary educational intervention given monthly will be conducted in the Northern Plains Indians from the Cheyenne River Reservation (Lakota Sioux). Adult Lakota volunteers with type 2 diabetes will be recruited and randomized to an experimental (Medicine Wheel Model) or control (Usual Care) group. The experimental group will receive dietary training using the Medicine Wheel Model for Native Nutrition, which promotes a diet patterned according to the traditional consumption of macronutrients. The control group will receive the usual care dietary training based on the Food Guide Pyramid. Primary outcome variables of HbA1C, fasting blood glucose, and circulating insulin concentrations and secondary outcome variables of blood lipid concentrations will be measured at the beginning and end of trial. Measurements of potential confounders of weight, height, usual dietary intake, activity levels, medication use, and incidence of infection will be taken at the beginning and end of the study period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PLANT-BASED DIETRY INTERVENTION IN TYPE 2 DIABETES Principal Investigator & Institution: Barnard, Neal D.; Physicians Committee for Responsible Med Responsible Medicine Washington, Dc 20016 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2005 Summary: (provided by applicant): Diabetes often leads to serious complications, including coronary heart disease, kidney disease, and blindness, among others. Previous studies have suggested that low-fat, plant-based diets can have a strongly favorable effect on the management of type 2 diabetes mellitus, as well as on the elevations of body weight and serum cholesterol that often accompany it, reducing the risk of complications, and raising the possibility of reducing or even eliminating medication use for many individuals. Evidence suggests that the dietary recommendations that are most effective in diabetes management may be similar to the low-fat, vegetarian diets that have demonstrated utility in reversing coronary artery blockages. However, no study to date has examined the effect of a low-fat, vegetarian diet as an intervention for diabetes in a substantial number of participants, and most studies using plant-based (near-vegetarian) diets have also included exercise as a major intervention component, making it impossible to separate the effects of physical activity from those of diet or to reach any definitive conclusion as to which type of dietary intervention is best. This study, which follows an encouraging preliminary trial reported in Preventive Medicine in 1999, will test the hypothesis that a low-fat, vegetarian diet yields significant improvements in key indices of diabetic control, including glycosylated hemoglobin, fasting serum glucose and insulin concentrations, microalbuminuria, and medication requirements, as well as in cardiovascular risk factors, such as body weight, serum lipids, and blood pressure, in a 22-week intervention controlled throughout for exercise, with a 1-year follow-up. Sixty-eight volunteers with type 2 diabetes will be randomly assigned to a low-fat, vegan (intervention) diet or a control diet deriving 15-20percent of
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energy from protein and < 7percent of energy from saturated fats, with carbohydrate and monounsaturated fats together providing 60-70percent of energy intake, based on current American Diabetes Association guidelines. Participants in both groups will be asked to attend weekly meetings for nutrition and cooking instruction and group support, and will be asked not to alter their exercise patterns. Physical activity will be monitored by use of the Bouchard 3-Day Physical Activity Record. (Bouchard 1983) Diets will be assessed at baseline and 11, 22, and 74 weeks, using a 3-day dietary record. Fasting serum glucose will be monitored for the study duration and will be used to adjust medications according to a set protocol. Glycosylated hemoglobin, insulin concentrations, 24-hour urinary albumin, body weight, blood pressure, serum lipids, and related cardiovascular risk factors will be measured at baseline, 22 weeks, and 74 weeks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RESISTANCE
POLYCYSTIC
OVARY
SYNDROME:
ROLE
OF
INSULIN
Principal Investigator & Institution: Nestler, John E.; Professor and Chairman; Internal Medicine; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (provided by applicant): This K24 Mid-Career Investigator in PatientOriented Research Award application is to support the continue development of Dr. John E. Nestler as a clinical investigator and research mentor. Dr. Nestler is Professor of Medicine at Virginia Commonwealth University's Medical College of Virginia, and has been a productive patient- oriented researcher whose research focus has been the pathophysiologic role of insulin resistance in the polycystic ovary syndrome (PCOS), a disorder that affects 6-10% of women of childbearing age. Dr. Nestler also has an established track record of mentorship of young clinical investigators. The broad longterm objective of Dr. Nestler's studies has been to conduct both mechanistic and translational studies exploring the role of insulin resistance in PCOS. The specific studies proposed in this application, which are currently funded by an NIH R0l grant and a U54 grant, are designed 1) to determine the effects of chronic insulin reduction on rates of spontaneous and clomiphene-induced ovulation in women with PCOS who were previously found to be refractory to clomiphene induction; 2) to determine whether reducing the serum insulin concentration beneficially influences gonadotropin secretory dynamics (i.e., decreases luteinizing hormone pulse amplitude and/or pulse frequency) in obese and/or lean women with PCOS; and 3) to explore whether insulin resistance causes an adverse cardiovascular risk profile in postmenopausal women with a history of PCOS during the premenopausal period. These studies will be conducted on the General Clinical Research Center using state-of-the-art methodologies, such as every 10 minute blood sampling for hormone pulse analysis by Cluster, Deconvolution Analysis and Approximate Entropy, and Reaven's steady-state plasma glucose (SSPG) technique for longitudinally monitoring insulin sensitivity. The K24 award will facilitate the completion of these studies, while also making it possible for Dr. Nestler to enhance his personal growth as a clinical investigator and to increase his mentoring activities. It will do so by providing Dr. Nestler with increased protected time, resulting from a decrease in administrative duties and clinical service responsibilities. As a result of the K24 award, Dr. Nestler will be able to devote 80% effort to research, further personal training in clinical research, and the training and mentorship of young investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PRIMARY PREVENTION OF WEIGHT GAIN FOR WOMEN AGED 2545 Principal Investigator & Institution: Willett, Walter C.; Professor and Chairman; Nutrition; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 14-JAN-2002; Project End 31-DEC-2004 Summary: (provided by applicant) This research will be conducted primarily in Brazil as an extension of NIH grants # R0l CA 50385 and R0l HL60712-0l. Overweight (BMI (Body Mass Index) 25.0-29.9) and obesity (BMI greater than or equal to 30 kg/m2) now affect more than 40 percent of adult Brazilians. Women at reproductive age are particularly at risk of obesity and a 70 percent increase in the prevalence was observed in the last two decades in Brazil. Increasing fat intake does not appear to explain this trend, whereas a steady decline in the consumption of beans has been shown for the whole country. Many studies have demonstrated changes in blood glucose levels due to the intake of specific carbohydrate foods, as measured by glycemic index (GI). An exceptionally low blood glucose response was associated with beans and it has been suggested that the consumption of low-GI diets may: 1) decrease hunger/ increase satiation; 2) reduce lipogenesis. In a nonrandomized follow-up of children attending a program of obesity treatment, children assigned to a low GI diet had a decrease in BMI greater than the high GI group. There are no long term clinical trials of weight loss or prevention of weight gain comparing low with high GI diets. However, a dietary pattern identified through factor analysis in a survey in the city of Rio de Janeiro, Brazil, that represents mainly rice and bean intake was associated with lower risk of obesity. The purpose of this study is to compare in Brazilian women the effectiveness of encouraging them to eat two different dietary patterns (low vs. high GI), with equal macronutrient composition, on weight control over the course of 18 months. The low GI dietary pattern will be heavily based on the traditional rice and beans combination. The comparison group will be encouraged to eat a diet with the same amount of macronutrients, but closer to a Western diet. Both diets are realistic prescriptions of foods consumed by Brazilians.Specifically, this study will compare changes in weight (main outcome), food intake, blood chemistries and hunger/satiation in 206 adult women at reproductive age, with BMI of 23-27 kg/m2, randomized to either one of the diets after 4-week run-in period eating a high GI diet. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PRIMARY PREVENTION PROGRAM -DATA COORDINATING CENTER Principal Investigator & Institution: Fowler, Sarah E.; Research Professor; Statistics; George Washington University 2121 I St Nw Washington, Dc 20052 Timing: Fiscal Year 2002; Project Start 20-AUG-1994; Project End 31-MAY-2003 Summary: (Directly incorporated from the application) The Biostatistics Center of The George Washington University proposes to work in cooperative agreement with the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK) to serve as the Data Coordinating Center (DCC) for a proposed multi-center clinical trial of the primary prevention of non-insulin dependent diabetes mellitus (NIDDM). Adiposity and inactivity have been established as critical factors in the etiology of glucose intolerance and are strongly associated with increased risk of glucose intolerance. We propose to determine the safety and efficacy of an intensive lifestyle intervention or prophylactic use of an oral hypoglycemic agent on the incidence of NIDDM among high
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risk patients (obese, minority, family history of NIDDM, history of gestational diabetes mellitus) in a state of impaired glucose tolerance (IGT). The objective of the one year planning phase is to develop a protocol, operations manual and data collection forms to be implemented in a five year full-scale clinical trial. The trial will require large-scale screening and randomization of 4,000 high risk patients with a diagnosis of IGT over a one year period in 20 clinical centers. Eligible patients will be randomized to "conventional" dietary counseling or one of the comparison groups (intensive lifestyle intervention or an oral hypoglycemic agent). Randomized patients will be followed for a minimum of four years with quarterly follow-up visits. Conversion from a state of IGT to overt NIDDM will be determined by semi-annual 2-hour oral glucose tolerance tests (OGTTs) following a 75 g glucose load confirmed by a central laboratory. Covariates and secondary outcomes include carotid ultrasound imaging, electrocardiograms, serum lipids, albumin excretion rate, adiposity, insulin sensitivity, hemoglobin A1c, and fundus photographs. The specific aims of the DCC are to provide centralized support and biostatistical consultation in the development of the patient management protocols, operations manual, data collection forms and randomization procedures; implementation of a data processing system including data quality assessment; interim analysis of protocol performance, patient safety and treatment efficacy; and final analysis for publication of the results in collaboration with the clinical investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RACE AND LONG-TERM DIABETES SELF-MANAGEMENT IN AN HMO Principal Investigator & Institution: Ross-Degnan, Dennis; Harvard Pilgrim Health Care, Inc. 93 Worcester St Wellesley, Ma 02481 Timing: Fiscal Year 2002; Project Start 15-JAN-2002; Project End 31-DEC-2004 Summary: (provided by applicant): This project will examine the complex relationships between race, diabetes self-management (including self-monitoring of blood glucose and diabetes drug therapy), glycemic control, and diabetes complications in a managed care setting over a nine-year period. African Americans with diabetes are less likely to be in glycemic control, a major risk factor for development of complications, including nephropathy, retinopathy, and peripheral vascular disease. Randomized controlled trials suggest that diabetes self-management including patient education, drug therapy, changes in diet, and regular exercise can improve glycemic control in the African American population. However, there is little epidemiological evidence regarding the role of race/ethnicity as a determinant of adherence to recommended diabetes selfmanagement practices, or regarding the relationship between self-management, glycemic control, and subsequent clinical outcomes. Further, previous studies of race and diabetes self-management have been limited by short study periods, inadequate sample size, and reliance on self-reported measures of self-monitoring of blood glucose. The clinical setting for this study is Harvard Vanguard Medical Associates (HVMA), a large multi-site, multi-specialty group affiliated with Harvard Pilgrim Health Care. HVMA consists of 14 health centers serving over 300,000 people in the Boston area. We will use an open cohort design to enroll all adult (l8 years) patients between 1991 and 1999 who have 24 months or more of uninterrupted enrollment in HVMA following ascertainment of non-gestational diabetes, defined by (1) hospital discharge diagnosis of diabetes mellitus, (2) outpatient diagnoses of diabetes mellitus, HbAlc lab test result 8.0, or use of a diabetes drug (insulin, sulfonylurea, or metformin). We estimate that the cohort will include approximately 1,800 adults identified as African American and 5,000 identified as Caucasian. Access to HVMA computerized medical records, hospital
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emergency room and inpatient claims, lab, and pharmacy data will allow us to create reliable, objective measures of self-monitoring (home glucose monitor test strip use), drug therapy. glycemic control (HbAlc lab results), and diabetes complications (as measured in outpatient visits, emergency room visits, and hospitalizations). Stratifying by type of drug therapy (insulin/combined therapy vs. oral therapy), we will use descriptive analyses, generalized linear mixed models, and proportional hazards models to (1) identify racial differences in self-management practices and diabetes-related health outcomes over time; (2) assess whether African American race is an independent predictor of self-monitoring practice or adherence to drug regimen; and (3) whether there are racial/ethnic differences in the association between self-management and specific clinical endpoints, including glycemic control (HbAlc<8.0) and the incidence of diabetes-related complications over the nine-year study period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLE OF O-GLCNAC TRANSFERASE IN INSULIN GENE EXPRESSION Principal Investigator & Institution: Ozcan, Sabire; Molecular/Cellula/Biochemistry; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2004; Project Start 15-JAN-2004; Project End 31-DEC-2005 Summary: (provided by applicant): Although several lines of evidence suggest that increased levels of O-GIcNAc modification interferes with normal glucose homeostasis, the exact functional consequences of this modification remain to determined. Recent data indicate that O-linked GIcNAc transferase (OGT1) in a complex with the corepressors Hdac1 and mSin3A mediates repression of gene expression in the HepG2 liver cell line. However, the target genes and the conditions under which this repressor complex is active in vivo are not known. Insulin gene expression in the pancreatic beta cells is induced by high blood glucose levels and is decreased when blood glucose levels are low. Using the deacetylase inhibitor trichostatin A, we have recently discovered that insulin gene expression is inhibited at low concentrations of glucose by the recruitment of deacetylases to the insulin promoter in the mouse insulinoma (MIN6) cell line. Furthermore, we found that OGT1 and Hdac1/2 are recruited to the insulin gene promoter and interact with each other only at low levels of glucose in the MIN6 beta cells. Based on these data, we hypothesize that OGT1 and Hdac1/2 are in a complex and repress insulin gene expression at low levels of glucose. We will test this hypothesis as described in the following three specific aims. 1) To analyze the role of OGT1 in repression of insulin gene expression in MIN6 beta cells. 2) To identify the transcription factor(s) that recruits the OGT1-Hdac1/2 repressor complex to the insulin gene promoter. 3) To identify genes with altered transcription in response to increased O-GIcNAc modification. Understanding the role of OGT1 in regulating insulin gene transcription will provide new insights into the mechanisms by which defects in OGIcNAc modification lead to symptoms associated with diabetes. In addition, the obtained data will be instrumental in the design of novel strategies for the treatment and prevention of type I and type II diabetes and the secondary complications associated with diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SELF-MONITORED MANAGEMENT
PHYSICAL
ACTIVITY
FOR
WEIGHT
Principal Investigator & Institution: Walker, Karen E.; Assistant Professor; Nursing; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122
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Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): This application for a Mentored Research Scientist Development Award (K01) is a re-submission by a new investigator. The goal of the award is to provide the investigator further training in the fields of obesity and community health nursing. As part of this training, the investigator will receive mentoring and pursue academic study in the following areas: 1) etiology and complications of obesity; 2) behavioral treatment of obesity; 3) community health nursing; 4) conduct of clinical trials; 5) exercise physiology; 6) biostatistics; and 7) nutrition. The proposal builds on a background in cardiovascular research, clinical study of weight loss maintenance, and community-based activities. Recent data show that 61% of US adults are overweight or obese. As a result, there is an epidemic of obesity-related health problems such as diabetes, coronary artery disease, and high blood pressure. Losses of only 5% to 10% of body weight significantly improve health, and individuals in programs that modify diet and lifestyle typically achieve weight losses of this magnitude. Unfortunately, the great majority of people cannot maintain the loss. Regular exercise is crucial to the maintenance of weight loss, but most individuals have problems with adherence due to a variety of barriers to exercise. Typical barriers are lack of time, lack of childcare, and lack of access to facilities. The goal of the proposed research is to improve the maintenance of weight loss by increasing physical activity in a low-income, primarily African American population that participates in a community-based behavioral weight loss program. All participants (n=152) will be treated with a 20-week weight reduction program followed by 52 weeks of maintenance. At the outset of the study, subjects will be randomized to one of two physical activity conditions. The research has two specific aims: The first is to compare at week 72 the maintenance of weight loss and physical activity adherence in individuals who are prescribed a standard structured exercise program of walking (Condition 1) versus a lifestyle activity intervention self-monitored via pedometer (Condition 2). Adherence will be determined by obtaining a common measure of physical activity across both conditions using accelerometers. The second aim is to compare short- (week 20) and long-term (week 72) differences between the two conditions in measures of physical (serum lipids, glucose/insulin ratio, interleukin-6, Creactive protein, resting blood pressure, cardiorespiratory fitness) and psychosocial health (mood, quality of life). This study has been selected to further develop the investigator's knowledge of the treatment of obesity using principles of community health nursing, and the training has been designed to facilitate the investigator's development as an independent clinical scientist studying innovative ways of reducing cardiovascular risks within urban communities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STRENGTH TRAINING FOLLOWING GASTRIC BYPASS FOR OBESITY Principal Investigator & Institution: Geliebter, Allan; St. Luke's-Roosevelt Inst for Hlth Scis Health Sciences New York, Ny 100191102 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 31-DEC-2004 Summary: (provided by applicant): As the incidence of obesity rises dramatically in the United States, more and more severely obese individuals are undergoing surgical treatment to reduce body weight and associated risk factors. Roux-en-Y gastric bypass (RYGB) is now the most common operation to treat morbid obesity in the US. However, little is known about the effects of RYGB on body composition and resting energy expenditure (REE). The main objectives of this study are to determine: 1) the
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composition of weight loss following surgery, 2) whether protein supplementation and strength training can limit the expected reduction of lean mass and REE. The study candidates will be morbidly obese women with a body mass index (BMI) of 40-56 kg/m2, be 18 - 49 y.o. and premenopausal. Except for severe obesity, they will be relatively healthy with a history of diet failure. They will be sedentary except for walking. There will be 36 study participants who, after stratifying by race, will be randomly assigned to three treatment groups (n = 12): 1) standard postoperative nutritional counseling only, 2) protein supplementation and standard postoperative nutritional counseling, or 3) protein supplementation plus strength training and standard postoperative nutritional counseling. The protein supplementation will begin shortly after surgery and increase from 40 g/day to 80 g/d at 4 weeks. Strength training will begin 8 weeks postoperation, to allow for adequate wound healing, and will consist of twice weekly progressive resistance training for upper and lower body for a period of 12 weeks. A battery of test measurements following a 12 h overnight fast will be conducted prior to surgery and repeated postoperatively at 8 and 20 weeks. These tests will include measurement of REE and body composition using underwater weighing, air displacement (BODPOD), dual xray absorptiometry (DEXA), magnetic resonance imaging (MRI), isotope dilution (D20), sodium bromide, and regional anthropometrics. There also will be assessments of arm and leg strength. Additionally, there will be measures of fasting glucose and body weight related hormones insulin, leptin, cortisol, and the recently discovered ghrelin. The predictions are that during the dramatic weight loss after surgery, the loss of some lean tissue, which could adversely impact skeletal muscle and vital organs, will be reduced by enhanced protein intake and weight training. There also may be greater conservation of REE and bone density. Plasma glucose and hormones should all decrease, especially with exercise, except for ghrelin, which should increase. The findings should improve understanding of surgical weight loss in morbidly obese patients and have clinical applications in the postoperative care of such patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE GLYCOSYLATION GAP AND DIABETIC COMPLICATIONS Principal Investigator & Institution: Cohen, Robert M.; Associate Professor of Medicine; Internal Medicine; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Hemoglobin A1c (Hb1c) is the gold standard for assessing diabetes control yet some patients have HbA1c discordant from plasma glucose. We developed a measure of the discordance between Hb1c and a plasma test of glycemic control, the "Glycosylation Gap" (GG). The GG is highly reproducible, correlates with an important clinical outcome, diabetic nephropathy, and appears genetically linked. A parallel measure of variance between HbA1c and glucose monitoring (Hb glycosylation index), has been shown to predict retinopathy and nephropathy in the DCCT. These data suggest that variation in HbA1c, expressed as the GG, arises from biological mechanism(s) that contribute to diabetic complications in here-to-fore unrecognized ways. Since HbA1c is determined by red blood cell (RBC) glucose concentration, the rate of Hb glycosylation and RBC lifespan, this proposal examines the variability of these factors in diabetic and non-diabetic populations. We found substantial variation in RBC glucose relative to extracellular glucose. This in vitro erythrocyte membrane glucose gradient (EMGG) correlated with GG and by inference with a higher risk of complications. The fact that the RBC and the endothelial cell - the major cell type in which diabetic complications occur - share the same glucose
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transporter, GLUT1, raises the question whether this finding is mediated by shared GLUT1 variation in the two tissues. These studies will seek to determine: (1) whether variation in GLUT1 function contributes to variation in HbA1c; (2) how variation in RBC lifespan or HbA1c formation rate contributes to HbA1c variability; (3) how long-term glycemic control affects the EMGG and the GG, and whether they represent reproducible phenotypes for genetic studies. These studies provide a comprehensive approach to understanding important sources of variation in HbA1c. The variation in EMGG could account for 11% of total variation in >30 million HbA1c measurements yearly in the United States. This proposal extends the consideration of complications risk from the glucose concentration in the plasma to the glucose concentration inside the cell. The proposal therefore has potentially important basic science, clinical and population implications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: USE OF NMR TO MEASURE TUMOR AND NORMAL TISSUE METAB DURING TUMOR ACIDIFICATION Principal Investigator & Institution: Glickson, Jerry D.; Research Professor; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2003 Summary: This subcontract to Project 4 will examine metabolic and physiological aspects of acidification of human melanoma xenografts that are amenable to noninvasive measurement by magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI). These methods will be applied to animals supplied by Dr. Leeper's laboratory to test the hypothesis that NMR can non-invasively detect tumor specific changes in extracellular and intracellular pH (pHe and pHi, respectively) induced by hyperglycemia and by hyperglycemia plus inhibition of oxidative metabolism (with meta- iodobenzylguanidine, MiBG), and/or by hyperglycemia plus inhibition of the Na+/H+ cation exchanger (with Cariporide mesilate, HOE642) and the HCO3- /Cl-anion exchanger (with 4,4-diisothiocyanstilbene 2,2-disulphonic acid, DIDS). In addition, it is proposed that NMR can help delineate the underlying mechanism of acidification by hyperglycemia plus regulatory inhibition. To test this hypothesis, 31P MRS will be employed to measure the pHi and pHe in the tumor, in host muscle, and brain under conditions of normoglycemia, hyperglycemia plus MIBG and/or HOE642 plus DIDS. Inorganic phosphate (Pi) and 3-aminopropylphosphonate will serve as indicators of pHi and pHe, respectively. To test the hypothesis that tumor acidification under conditions of hyperglycemia and hyperglycemia plus respiratory inhibition is mediated by production of lactic acid (i.e., glycolysis), steady state lactate concentrations will be monitored on 1H MRS employing a selective multiple quantum coherence transfer pulse sequence developed by the subcontractor's laboratory to edit out the lactate resonance from interfering lipid resonances. Further insight into the mechanism of tumor acidification under conditions of hyperglycemia +/- respiratory inhibition will be obtained by measuring flux through the glycolytic pathway and through the TCA cycle from the kinetics of 13C-labeling of lactate and glutamate, respective, following infusion of [1-13C]glucose. The spatial distributions of 13C-labeled glucose and lactate in the tumor at isotope steady state (for glucose) will be imaged by 13C chemical shift imaging at constant concentrations of labeled glucose in the blood (19+/-) mM), and the vascular volume distribution will be imaged by dynamic 1H MRI using Gd-DTPAalbumin as a vascular marker. Images will be correlated with histology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: VALIDATION OF LONG-TERM GLUCOSE SENSOR IN TISSUES Principal Investigator & Institution: Gough, David A.; Professor and Chair; Bioengineering; University of California San Diego La Jolla, Ca 920930934 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): There is an urgent need for a new glucose sensor that is: (1) highly reliable and continuous; (2) capable of automatic function, independent of user initiative, to warn of hypoglycemia; and (3) acceptable to users. We have an implantable electrochemical glucose sensor that can potentially meet this need. A prototype of this sensor has operated continuously as a central venous implant in dogs for over 100 days without the need for recalibration and now in humans for over one year. This achievement still represents the published world's record for implanted glucose sensor longevity. For reasons of safety, we are designing a tissue glucose sensor for long-term use in humans. The implant will include the sensor, electronics and telemetry, antenna, and battery. Glucose signals will be transmitted to an external receiver resembling a beeper that will display the actual glucose value and function as a hypoglycemia alarm. Our recent studies have focused on developing a complete understanding of the tissue sensor response to blood glucose. The working hypothesis is: "A useful analytical relationship exists between the signal of sensors implanted in tissue and blood glucose concentration." We have: defined sensor performance requirements, developed methods of sensor fabrication, implanted sensors in a welldefined hamster model, established novel confocal microscopy methods for nondestructive visualization of the tissue/sensor interface, and modeled sensor response. We will extend our studies by implanting sensors in pigs and carry out extensive analysis of sensor system dynamics, including development of a method for sensor recalibration, further documentation of implant biocompatibility, and establishment of system reliability. These studies will be carded out in addition to our continuing studies in hamsters and diabetic rats. These studies set the stage for trials in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: WEIGHT LOSS IN OBESE BREAST CANCER SURVIVORS Principal Investigator & Institution: Djuric, Zora; Associate Professor; Internal Medicine; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2002; Project Start 15-FEB-2001; Project End 31-JUL-2003 Summary: Obesity has been shown to be associated with a poor prognosis in breast cancer patients. Survival time is decreased and recurrence rates are increased with greater obesity. Whether or not weight loss can have favorable effects on prognosis in obese breast cancer survivors is not known, and that is the ultimate question we would like to ask. As a first step, effective methods for weight loss need to be established in this population. We started a pilot study with internal funds develop an individualized approach towards weight loss in obese breast cancer survivors, and preliminary data is encouraging. We would like to be able to extend this study for a full 18 months and analyze the blood samples that are being collected for markers of cancer risk. Forty eight obese cancer survivors have been enrolled. At baseline, a psychiatric evaluation was obtained for each women and questionnaires on diet, health, exercise and psychosocial factors were administered. Since we are asking women to make large lifestyle changes, we would like to extend the intervention for a full year (instead of 6 months) and add a 6-month follow-up point to examine maintenance of weight loss. A better understanding of the influence of behavioral factors on weight loss should help us design a successful larger study with recurrence as the endpoint. As a secondary aim,
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we propose to analyze the blood samples collected for markers of cancer risk which are expected to be affected by weight loss: oxidative DNA damage, insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3. The extent of changes in these markers will be compared with other plasma measures that are known to be affected by weight loss: leptin, glucose, lipids and triglyceride levels. This study should be useful to determine certain psychosocial are associated with extent of weight loss, and in turn whether weight loss is associated with changes in selected markers of breast cancer risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: YALE CENTER IN THE CHILDREN'S GLUCOSE SENSOR NETWORK Principal Investigator & Institution: Tamborlane, William V.; Professor of Pediatrics; Pediatrics; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (prepared by applicant): Results of the Diabetes Control and Complications Trial indicate that most patients with type 1 diabetes (T1DM) should receive intensive treatment to lower the risk of microvascular and neuropathic complications. It has been shown that strict diabetes control can be achieved in youth with T1DM but at the expense of unacceptably high frequency of severe hypoglycemic events, especially in younger patients. Moreover, pilot studies using new continuous glucose sensoring systems in youth with T1DM indicate that many glucose swings from high to low values are asymptomatic and are not detected by self blood glucose monitoring (SBGM). Thus the investigators are submitting an application to be a center in the Type 1 Diabetes in Children Research Network to evaluate the utility of continuous glucose monitoring devices in improving diabetes control and preventing hypoglycemia in youth with T1DM. As a first step, the investigators are proposing to validate the accuracy of the MiniMed Continuous Glucose Monitoring System (CGMS) in children with and without T1DM against frequent blood glucose measurements in an inpatient Clinic and Research Center setting. Next, the CGMS will be used in a large, cross-sectional study to characterize and compare the frequency and severity of hypo and hyperglycemia by age (pre-school versus school age versus adolescents), type of insulin treatment (injections versus pump), and by HbA1c level (within target versus above target). Validation and cross-sectional studies will also provide the opportunity to test the effectiveness of current management guidelines regarding carbohydrate counting and the composition of bedtime snacks, as well as the impact of afternoon exercise on nocturnal hypoglycemia. The investigators are also proposing a randomized, prospective clinical trial to examine whether repeated use of the CGMS every six weeks for 24 weeks in conjunction with conventional SBGM is more effective than SBGM alone in improving diabetes control, lowering the risk for hypoglycemia, and reducing patient?s and parents? anxiety and fears of hypoglycemia. The introduction of new methods of continuous glucose sensoring promises to be the most important advance in therapy of T1DM in the past 20 years. The resources for clinical research and the expertise in the Network will also allow the investigators to assess the usefulness for children with T1DM of current and future glucose sensoring systems in a scientifically rigorous and timely manner. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “blood glucose” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for blood glucose in the PubMed Central database: •
An open prospective randomised trial to reduce the pain of blood glucose testing: ear versus thumb. by Carley SD, Libetta C, Flavin B, Butler J, Tong N, Sammy I.; 2000 Jul 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27419
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Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: A cross sectional study. by Adams AS, Mah C, Soumerai SB, Zhang F, Barton MB, RossDegnan D.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=153532
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Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41). by Gray A, Raikou M, McGuire A, Fenn P, Stevens R, Cull C, Stratton I, Adler A, Holman R, Turner R.; 2000 May 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27380
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Discovery of a human liver glycogen phosphorylase inhibitor that lowers blood glucose in vivo. by Martin WH, Hoover DJ, Armento SJ, Stock IA, McPherson RK, Danley DE, Stevenson RW, Barrett EJ, Treadway JL.; 1998 Feb 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=19188
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Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database. by Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD.; 1999 Jul 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28155
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Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63). by Gray A, Clarke P, Farmer A, Holman R.; 2002 Oct 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=129631
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Increase in blood glucose concentration during antihypertensive treatment as a predictor of myocardial infarction: population based cohort study. by Dunder K, Lind L, Zethelius B, Berglund L, Lithell H.; 2003 Mar 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=152364
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Neutralization of Glucagon by Antiserum as a Tool in Glucagon Physiology LACK OF DEPRESSION OF BASAL BLOOD GLUCOSE AFTER ANTISERUM TREATMENT IN RATS. by Holst JJ, Galbo H, Richter EA.; 1978 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=371752
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Normalization of blood glucose in diabetic rats with phlorizin treatment reverses insulin-resistant glucose transport in adipose cells without restoring glucose transporter gene expression. by Kahn BB, Shulman GI, DeFronzo RA, Cushman SW, Rossetti L.; 1991 Feb; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=296344
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Overexpression of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase in mouse liver lowers blood glucose by suppressing hepatic glucose production. by Wu C, Okar DA, Newgard CB, Lange AJ.; 2001 Jan 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=198549
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Renal Net Glucose Release In Vivo and Its Contribution to Blood Glucose in Rats. by Kida K, Nakajo S, Kamiya F, Toyama Y, Nishio T, Nakagawa H.; 1978 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=371822
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The juice of fresh leaves of Catharanthus roseus Linn. reduces blood glucose in normal and alloxan diabetic rabbits. by Nammi S, Boini MK, Lodagala SD, Behara RB.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194756
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The Role of Aminogenic Glucagon Secretion in Blood Glucose Homeostasis. by Unger RH, Ohneda A, Aguilar-Parada E, Eisentraut AM.; 1969 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=322289
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with blood glucose, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “blood glucose” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for blood glucose (hyperlinks lead to article summaries):
6
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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•
A better mousetrap: what's new in blood glucose monitoring? Author(s): Cox M. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2002 November-December; 16(6): 314-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12436103
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A comparison of fructosamine and HbA1c for home self-monitoring blood glucose levels in type 2 diabetes. Author(s): Chen HS, Chen RL, Chang ZY, Li HD. Source: Zhonghua Yi Xue Za Zhi (Taipei). 2002 April; 65(4): 151-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12135193
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A low glycemic diet significantly improves the 24-h blood glucose profile in people with type 2 diabetes, as assessed using the continuous glucose MiniMed monitor. Author(s): Brynes AE, Lee JL, Brighton RE, Leeds AR, Dornhorst A, Frost GS. Source: Diabetes Care. 2003 February; 26(2): 548-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12547905
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A novel noninvasive blood glucose monitor. Author(s): Malchoff CD, Shoukri K, Landau JI, Buchert JM. Source: Diabetes Care. 2002 December; 25(12): 2268-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12453972
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A reappraisal of the blood glucose homeostat which comprehensively explains the type 2 diabetes mellitus-syndrome X complex. Author(s): Koeslag JH, Saunders PT, Terblanche E. Source: The Journal of Physiology. 2003 June 1; 549(Pt 2): 333-46. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12717005
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A study of forearm versus finger stick. Blood glucose monitoring. Author(s): Lee D, Weinert S, Miller E. Source: Diabetes Educ. 2001 June; Suppl: 6P. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211930
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Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Author(s): Osier FH, Berkley JA, Ross A, Sanderson F, Mohammed S, Newton CR. Source: Archives of Disease in Childhood. 2003 July; 88(7): 621-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12818911
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Accessibility of blood glucose monitoring systems for blind and visually impaired people. Author(s): Uslan MM, Eghtesadi K, Burton D. Source: Diabetes Technology & Therapeutics. 2003; 5(3): 439-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12828828
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Accuracy of glucose meters in measuring low blood glucose levels. Author(s): Choubtum L, Mahachoklertwattana P, Udomsubpayakul U, Preeyasombat C. Source: J Med Assoc Thai. 2002 November; 85 Suppl 4: S1104-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12549783
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Accuracy of home blood glucose monitors using forearm blood samples: FreeStyle versus One Touch Ultra. Author(s): Demers J, Kane MP, Bakst G, Busch RS, Hamilton RA. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 June 1; 60(11): 1130-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12816023
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Accuracy of self-monitoring of blood glucose: impact on diabetes management decisions during pregnancy. Author(s): Henry MJ, Major CA, Reinsch S. Source: Diabetes Educ. 2001 July-August; 27(4): 521-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12212340
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Adaptive low-vision and blindness techniques for blood glucose monitoring. Author(s): Sokol-McKay D, Buskirk K, Whittaker P. Source: Diabetes Educ. 2003 July-August; 29(4): 614-8, 620, 622 Passim. No Abstract Available. Erratum In: Diabetes Educ. 2003 September-October; 29(5): 858. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13677174
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Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus. Author(s): Stranders I, Diamant M, van Gelder RE, Spruijt HJ, Twisk JW, Heine RJ, Visser FC. Source: Archives of Internal Medicine. 2004 May 10; 164(9): 982-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15136307
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Afternoon hypoglycaemia in Type 2 diabetes: lessons from blood glucose profiles. Author(s): Trovati M, Traversa M, Cavalot F. Source: Diabetes Nutr Metab. 2002 December; 15(6): 439-43. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12678465
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Alternate site blood glucose testing: do patients prefer it? Author(s): Tieszen KL, New JP. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2003 April; 20(4): 325-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12675648
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Alternative-site blood glucose measurement at the abdomen. Author(s): Van Der Valk PR, Van Der Schatte Olivier-Steding I, Wientjes KJ, Schoonen AJ, Hoogenberg K. Source: Diabetes Care. 2002 November; 25(11): 2114-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12401776
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An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Author(s): Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. Source: The American Journal of Clinical Nutrition. 2003 October; 78(4): 734-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14522731
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An overview of human factors engineering at CDRH in the safety and effectiveness of blood glucose meters. Author(s): Kaye RD, Chenault VM. Source: Diabetes Technology & Therapeutics. 2002; 4(2): 247-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12079625
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Anemia associated with new-onset diabetes: improvement with blood glucose control. Author(s): Pinero-Pilona A, Litonjua P, Devaraj S, Aviles-Santa L, Raskin P. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2002 July-August; 8(4): 27681. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12173914
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Associations of blood glucose control with self-efficacy and rated anxiety/depression in type II diabetes mellitus patients. Author(s): Ikeda K, Aoki H, Saito K, Muramatsu Y, Suzuki T. Source: Psychological Reports. 2003 April; 92(2): 540-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12785638
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Barriers to blood glucose monitoring in a multiethnic community. Author(s): Zgibor JC, Simmons D. Source: Diabetes Care. 2002 October; 25(10): 1772-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12351476
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Bedside blood glucose monitoring in hospitals. Author(s): American Diabetes Association. Source: Diabetes Care. 2003 January; 26 Suppl 1: S119. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12502635
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Bedside blood glucose monitoring in hospitals. Author(s): American Diabetes Association. Source: Diabetes Care. 2000 January; 23 Suppl 1: S84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12017689
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Bimodality in blood glucose distribution: is it universal? Author(s): Lim TO, Bakri R, Morad Z, Hamid MA. Source: Diabetes Care. 2002 December; 25(12): 2212-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12453963
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Blood glucose and lipid control as risk factors in the progression of renal damage in type 2 diabetes. Author(s): Nosadini R, Tonolo G. Source: Journal of Nephrology. 2003 November-December; 16 Suppl 7: S42-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733300
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Blood glucose and the brain in diabetes: between a rock and a hard place? Author(s): Evans ML, Sherwin RS. Source: Curr Diab Rep. 2002 April; 2(2): 101-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12643129
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Blood glucose concentrations are reduced in children born small for gestational age (SGA), and thyroid-stimulating hormone levels are increased in SGA with blunted postnatal catch-up growth. Author(s): Cianfarani S, Maiorana A, Geremia C, Scire G, Spadoni GL, Germani D. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 June; 88(6): 2699705. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12788876
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Blood glucose concentrations of arm and finger during dynamic glucose conditions. Author(s): Szuts EZ, Lock JP, Malomo KJ, Anagnostopoulos A. Source: Diabetes Technology & Therapeutics. 2002; 4(1): 3-11; Discussion 45-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12017417
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Blood glucose dynamics and control of meal initiation: a pattern detection and recognition theory. Author(s): Campfield LA, Smith FJ. Source: Physiological Reviews. 2003 January; 83(1): 25-58. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12506126
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Blood glucose estimations in adolescents with type 1 diabetes: predictors of accuracy and error. Author(s): Meltzer LJ, Johnson SB, Pappachan S, Silverstein J. Source: Journal of Pediatric Psychology. 2003 April-May; 28(3): 203-11. Erratum In: J Pediatr Psychol. 2003 July-August; 28(5): Following Page 373. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12654946
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Blood glucose investigation--an experience. Author(s): Gurupadappa K. Source: Indian Journal of Medical Sciences. 2003 May; 57(5): 204-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14514252
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Blood glucose is correlated with cerebrospinal fluid neurotransmitter metabolites. Author(s): Umhau JC, Petrulis SG, Diaz R, Rawlings R, George DT. Source: Neuroendocrinology. 2003 December; 78(6): 339-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14688447
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Blood glucose management during critical illness. Author(s): Mizock BA. Source: Reviews in Endocrine & Metabolic Disorders. 2003 May; 4(2): 187-94. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12766547
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Blood glucose measurement in acute medicine: inadequate detection and management. Author(s): Hennessy AR, Reynolds RM, Walker JD. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2002 August; 19(8): 698. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12147155
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Blood glucose monitoring in gestational diabetes mellitus: 1- versus 2-h blood glucose determinations. Author(s): Leguizamon G, Krupitzki H, Glujovsky D, Olivera Ravasi M, Reece EA. Source: J Matern Fetal Neonatal Med. 2002 December;12(6):384-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12683648
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Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end-stage renal disease. Author(s): Oyibo SO, Pritchard GM, McLay L, James E, Laing I, Gokal R, Boulton AJ. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2002 August; 19(8): 693-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12147153
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Blood glucose responses and incidence of hypoglycaemia in elite tennis under practice and tournament conditions. Author(s): Ferrauti A, Pluim BM, Busch T, Weber K. Source: J Sci Med Sport. 2003 March; 6(1): 28-39. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12801208
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Blood glucose self-monitoring from abdominal skin: a precise and virtually pain-free method. Author(s): Holstein A, Thiessen E, Kaufmann N, Plaschke A, Egberts EH. Source: Acta Diabetologica. 2002 June; 39(2): 97-104. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120920
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Blood glucose testing in the classroom. What are the pros and cons for students and for school nurses? Author(s): Smaldone A, Dychkowski L. Source: School Nurse News. 2002 May; 19(3): 44-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12046172
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Blood glucose threshold and the metabolic responses to incremental exercise tests with and without prior lactic acidosis induction. Author(s): Simoes HG, Campbell CS, Kushnick MR, Nakamura A, Katsanos CS, Baldissera V, Moffatt RJ. Source: European Journal of Applied Physiology. 2003 August; 89(6): 603-11. Epub 2003 May 21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12759761
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Can capillary whole blood glucose and venous plasma glucose measurements be used interchangeably in diagnosis of diabetes mellitus? Author(s): Stahl M, Brandslund I, Jorgensen LG, Hyltoft Petersen P, Borch-Johnsen K, de Fine Olivarius N. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 2002; 62(2): 15966. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12004932
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Capillary blood glucose testing in older people: reliable and accurate. Author(s): Kabadi UK, Kabadi MU. Source: Journal of the American Geriatrics Society. 2003 January; 51(1): 136-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12534864
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Carbohydrate and the regulation of blood glucose and metabolism. Author(s): Wolever TM. Source: Nutrition Reviews. 2003 May; 61(5 Pt 2): S40-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12828191
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Carbohydrate ingestion, blood glucose and mood. Author(s): Benton D. Source: Neuroscience and Biobehavioral Reviews. 2002 May; 26(3): 293-308. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12034132
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Changes in corneal and lens autofluorescence and blood glucose levels in diabetics: parameters of blood glucose control. Author(s): Mori F, Ishiko S, Abiko T, Kitaya N, Kato Y, Kanno H, Yoshida A. Source: Current Eye Research. 1997 June; 16(6): 534-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9192161
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Changes in the count of pancreatic beta- and alpha-cells and blood glucose level in rats with alloxan-induced diabetes. Author(s): Aleeva GN, Kiyasov AP, Minnebaev MM, Burykin IM, Khafiz'yanova RKh. Source: Bulletin of Experimental Biology and Medicine. 2002 February; 133(2): 127-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12428279
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Choosing a blood glucose meter. Author(s): Spollett GR. Source: Diabetes Self Manag. 2003 July-August; 20(4): 99-100, 102-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12908446
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Clinical application of hair protein glycation in the assessment of blood glucose control and diabetic neuropathy. Author(s): Masuta S, Sakai M, Ohara T, Igaki N, Nakamichi T, Maeda Y, Hata F, Oimomi M, Baba S. Source: The Kobe Journal of Medical Sciences. 1989 February; 35(1): 1-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2507822
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Clinical impact of prandial state, exercise, and site preparation on the equivalence of alternative-site blood glucose testing. Author(s): Bina DM, Anderson RL, Johnson ML, Bergenstal RM, Kendall DM. Source: Diabetes Care. 2003 April; 26(4): 981-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663560
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Closed-loop control of blood glucose levels in critically ill patients. Author(s): Chee F, Fernando T, van Heerden PV. Source: Anaesthesia and Intensive Care. 2002 June; 30(3): 295-307. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12075636
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Colorectal cancer associated with BMI, physical activity, diabetes, and blood glucose. Author(s): Lund Nilsen TI, Vatten LJ. Source: Iarc Sci Publ. 2002; 156: 257-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12484182
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Comparability of blood glucose concentrations measured in different sample systems for detecting glucose intolerance. Author(s): Haeckel R, Brinck U, Colic D, Janka HU, Puntmann I, Schneider J, Viebrock C. Source: Clinical Chemistry. 2002 June; 48(6 Pt 1): 936-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12029012
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Comparison of blood glucose stability and HbA1C between implantable insulin pumps using U400 HOE 21PH insulin and external pumps using lispro in type 1 diabetic patients: a pilot study. Author(s): Catargi B, Meyer L, Melki V, Renard E, Jeandidier N; for the EVADIAC Study Group. Source: Diabetes & Metabolism. 2002 April; 28(2): 133-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11976565
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Comparison of glucose concentration in interstitial fluid, and capillary and venous blood during rapid changes in blood glucose levels. Author(s): Thennadil SN, Rennert JL, Wenzel BJ, Hazen KH, Ruchti TL, Block MB. Source: Diabetes Technology & Therapeutics. 2001 Fall; 3(3): 357-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11762514
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Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus patients in Germany--results from the CODE-2 study. Author(s): Liebl A, Neiss A, Spannheimer A, Reitberger U, Wieseler B, Stammer H, Goertz A. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 2002 January; 110(1): 10-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11835119
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Computer simulation and mathematical model of blood glucose behaviour. Author(s): Hebibovic M, Lacevic B, Velagic J, Alagic S, Kulenovic I. Source: Med Arh. 2004; 58(1 Suppl 2): 122-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15137226
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Considerations on blood glucose management in Type 2 diabetes mellitus. Author(s): Home P, Chacra A, Chan J, Emslie-Smith A, Sorensen L, Crombrugge PV; Worldwide Initiative for Diabetes Education (WorldWIDE). Source: Diabetes/Metabolism Research and Reviews. 2002 July-August; 18(4): 273-85. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12203943
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Continuous monitoring of blood glucose. Author(s): Robert JJ. Source: Hormone Research. 2002; 57 Suppl 1: 81-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11979031
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Coronary heart disease mortality in relation with diabetes, blood glucose and plasma insulin levels. The Paris Prospective Study, ten years later. Author(s): Eschwege E, Richard JL, Thibult N, Ducimetiere P, Warnet JM, Claude JR, Rosselin GE. Source: Horm Metab Res Suppl. 1985; 15: 41-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3908280
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Correlation between blood glucose concentration and glucose concentration in subcutaneous adipose tissue evaluated with microdialysis during intensive care. Author(s): Lourido J, Ederoth P, Sundvall N, Ungerstedt U, Nordstrom CH. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 2002; 62(4): 28592. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476927
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Database programs for use with blood glucose meters. Author(s): Lehmann ED. Source: Diabetes Technology & Therapeutics. 1999 Fall; 1(3): 391-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11475281
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Database software for use with blood glucose meters. Author(s): Lehmann ED. Source: Diabetes Technology & Therapeutics. 1999 Summer; 1(2): 229-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11475297
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Day-to-day consistency in amount and source of carbohydrate associated with improved blood glucose control in type 1 diabetes. Author(s): Wolever TM, Hamad S, Chiasson JL, Josse RG, Leiter LA, Rodger NW, Ross SA, Ryan EA. Source: Journal of the American College of Nutrition. 1999 June; 18(3): 242-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10376780
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Deteriorating ischaemic stroke. cytokines, soluble cytokine receptors, ferritin, systemic blood pressure, body temperature, blood glucose, diabetes, stroke severity, and CT infarction-volume as predictors of deteriorating ischaemic stroke. Author(s): Christensen H, Boysen G, Johannesen HH, Christensen E, Bendtzen K. Source: Journal of the Neurological Sciences. 2002 September 15; 201(1-2): 1-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12163186
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Determining the best method for first-line assessment of neonatal blood glucose levels. Author(s): Thomas CL, Critchley L, Davies MW. Source: Journal of Paediatrics and Child Health. 2000 August; 36(4): 343-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10940168
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Development of a quantitative weighted scoring instrument to evaluate bedside blood glucose testing programs. Author(s): Barr JT, Otto CN. Source: Clin Lab Manage Rev. 1998 March-April; 12(2): 70-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10178712
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Development of a scale to measure adherence to self-monitoring of blood glucose with latent variable measurement. Author(s): Wagner JA, Schnoll RA, Gipson MT. Source: Diabetes Care. 1998 July; 21(7): 1046-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9653593
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Development of noninvasive methods to monitor blood glucose levels in people with diabetes. Author(s): Marwick C. Source: Jama : the Journal of the American Medical Association. 1998 July 22-29; 280(4): 312-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9686536
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Diabetes, blood glucose and preoperative evaluation. Author(s): Story DA, Aldridge J. Source: Anaesthesia and Intensive Care. 2000 February; 28(1): 110. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10701048
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Diabetes, fasting blood glucose and age-related cataract: the Blue Mountains Eye Study. Author(s): Rowe NG, Mitchell PG, Cumming RG, Wans JJ. Source: Ophthalmic Epidemiology. 2000 June; 7(2): 103-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10934461
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Diabetes: blood glucose monitoring. Author(s): Burden M. Source: Nurs Times. 2001 February 22-28; 97(8): 36-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11954219
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Diagnosing diabetes: blood glucose and the role of the laboratory. Author(s): Higgins C. Source: British Journal of Nursing (Mark Allen Publishing). 2001 February 22-March 7; 10(4): 230-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12170647
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Dietary therapy in type 2 diabetes oriented towards postprandial blood glucose improvement. Author(s): Slama G. Source: Diabetes/Metabolism Reviews. 1998 September; 14 Suppl 1: S19-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9816483
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Direct measurement of whole blood glucose by a needle-type sensor. Author(s): Yamasaki Y, Ueda N, Nao K, Sekiya M, Kawamori R, Shichiri M, Kamada T. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1989 March 15; 180(1): 93-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2743572
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Discovery of a human liver glycogen phosphorylase inhibitor that lowers blood glucose in vivo. Author(s): Martin WH, Hoover DJ, Armento SJ, Stock IA, McPherson RK, Danley DE, Stevenson RW, Barrett EJ, Treadway JL. Source: Proceedings of the National Academy of Sciences of the United States of America. 1998 February 17; 95(4): 1776-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9465093
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Distribution of blood glucose in a national sample of Malaysian adults. Author(s): Lim TO, Ding LM, Zaki M, Suleiman AB, Kew ST, Maimunah AH, Rugayah B. Source: Med J Malaysia. 2000 March; 55(1): 65-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11072493
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Distribution of blood glucose in a national sample of Malaysian adults. Author(s): Lim TO, Ding LM, Zaki M, Suleiman AB, Kew ST, Maimunah AH, Rugayah B. Source: Med J Malaysia. 2000 June; 55(2): 65-77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10944904
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Doctors and the assessment of blood glucose testing sticks: does colour blindness matter? Author(s): Campbell JL, Spalding JA, Mir FA, Birch J. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2000 May; 50(454): 393-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10897539
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Does daily monitoring of blood glucose predict hemoglobin A1c levels? Author(s): Rose E, Ketchell D. Source: The Journal of Family Practice. 2003 June; 52(6): 485-90; Discussion 490. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12791231
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Does high blood glucose mean more insulin? Type 1 diabetes management in children and adolescents. Author(s): Yee KC, Edwards KN. Source: Aust Fam Physician. 2003 September; 32(9): 727-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14524211
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Effect of carbohydrate intake during warming-up on the regulation of blood glucose during exercise. Author(s): Brouns F, Rehrer NJ, Saris WH, Beckers E, Menheere P, ten Hoor F. Source: International Journal of Sports Medicine. 1989 May; 10 Suppl 1: S68-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2663744
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Effect of exercise mode on blood glucose disposal during physiological hyperinsulinaemia in humans. Author(s): Tsintzas K, Simpson EJ, Seevaratnam N, Jones S. Source: European Journal of Applied Physiology. 2003 April; 89(2): 217-20. Epub 2003 February 01. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12665988
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Effect of high altitude on blood glucose meter performance. Author(s): Fink KS, Christensen DB, Ellsworth A. Source: Diabetes Technology & Therapeutics. 2002; 4(5): 627-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12450444
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Effect of intraoperative fluid on blood glucose level in neurosurgery. Author(s): Ittichaikulthol W, Lekprasert V, Pausawasdi S, Suchartwatnachai P. Source: J Med Assoc Thai. 1997 July; 80(7): 461-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9277076
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Effect of modem transmission of blood glucose data on telephone consultation time, clinic work flow, and patient satisfaction for patients with gestational diabetes mellitus. Author(s): Kruger DF, White K, Galpern A, Mann K, Massirio A, McLellan M, Stevenson J. Source: Journal of the American Academy of Nurse Practitioners. 2003 August; 15(8): 371-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14509102
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Effect of single-dose dexamethasone on blood glucose concentration in patients undergoing craniotomy. Author(s): Pasternak JJ, McGregor DG, Lanier WL. Source: Journal of Neurosurgical Anesthesiology. 2004 April; 16(2): 122-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15021280
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Effects and correlates of blood glucose awareness training among patients with IDDM. Author(s): Cox DJ, Gonder-Frederick LA, Lee JH, Julian DM, Carter WR, Clarke WL. Source: Diabetes Care. 1989 May; 12(5): 313-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2721340
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Effects of multiple subcutaneous doses of rhIGF-1 on total and free IGF-1 levels and blood glucose in humans. Author(s): Stong DB, Raskin R. Source: Annals of the New York Academy of Sciences. 1993 August 27; 692: 317-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8215041
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Effects of short-term metformin treatment on insulin sensitivity of blood glucose and free fatty acids. Author(s): Iannello S, Camuto M, Cavaleri A, Milazzo P, Pisano MG, Bellomia D, Belfiore F. Source: Diabetes, Obesity & Metabolism. 2004 January; 6(1): 8-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14686957
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Efficacy of a new needleless insulin delivery system monitoring of blood glucose fluctuations and free insulin levels. Author(s): Katoulis EC, Drosinos EK, Dimitriadis GK, Hadjidakis DJ, Mavrokefalos PG, Raptis SA. Source: Int J Artif Organs. 1989 May; 12(5): 333-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2661445
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Elevated albumin excretion and retinal changes in children with type 1 diabetes are related to long-term poor blood glucose control. Author(s): Norgaard K, Storm B, Graae M, Feldt-Rasmussen B. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1989 May-June; 6(4): 325-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2524337
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Estimation of in vivo capillary or venous blood glucose concentration from analysis on stored venous blood or its plasma and use in quality control of near-patient glucose tests. Author(s): Felding P, Jensen I, Linnet K, Manford G. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 2002; 62(3): 20110. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12088339
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Evaluating once- and twice-daily self-monitored blood glucose testing strategies for stable insulin-treated patients with type 2 diabetes : the diabetes outcomes in veterans study. Author(s): Hoffman RM, Shah JH, Wendel CS, Duckworth WC, Adam KD, Bokhari SU, Dalton C, Murata GH; Diabetes Outcome in Veterans Study. Source: Diabetes Care. 2002 October; 25(10): 1744-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12351471
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Evaluation of a new visual blood glucose reagent strip. Author(s): de Blieck G, Colagiuri S, Colagiuri R, Bransgrove A. Source: The Medical Journal of Australia. 1993 September 20; 159(6): 430. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8377707
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Evaluation of blood glucose meters during hypoglycemia. Author(s): Velazquez FR. Source: Diabetes Care. 1997 July; 20(7): 1204-5; Author Reply 1206-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9203465
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Evaluation of conventional blood glucose monitoring as an indicator of integrated glucose values using a continuous subcutaneous sensor. Author(s): Zavalkoff SR, Polychronakos C. Source: Diabetes Care. 2002 September; 25(9): 1603-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12196434
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Evaluation of portable blood glucose meters. Problems and recommendations. Author(s): Slingerland RJ, Miedema K. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2003 September; 41(9): 1220-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14598872
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Experience with an external quality assessment programme for point-of-care-testing (POCT) devices for the determination of blood glucose. Author(s): Wood WG, Hanke R, Meissner D, Reinauer H. Source: Clin Lab. 2003; 49(3-4): 151-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12705698
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Expert PID control system for blood glucose control in critically ill patients. Author(s): Chee F, Fernando TL, Savkin AV, van Heeden V. Source: Ieee Transactions on Information Technology in Biomedicine : a Publication of the Ieee Engineering in Medicine and Biology Society. 2003 December; 7(4): 419-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15000368
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Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients. Author(s): Nyomba BL, Berard L, Murphy LJ. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2004 February; 21(2): 129-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984447
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Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes. Author(s): Vincze G, Barner JC, Lopez D. Source: Diabetes Educ. 2004 January-February; 30(1): 112-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14999899
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Fasting blood glucose and risk of cardiovascular disease. Author(s): Balkau B, Jarrett RJ, Pyorala K, Eschwege E. Source: Diabetes Care. 1999 August; 22(8): 1385-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10480797
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Fasting blood glucose in determining the prevalence of diabetes in a large, homogeneous population of Caucasian middle-aged women. Author(s): Larsson H, Ahren B, Lindgarde F, Berglund G. Source: Journal of Internal Medicine. 1995 June; 237(6): 537-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7782724
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Fasting blood glucose is independently associated with resting and exercise blood pressures and development of elevated blood pressure. Author(s): Bjornholt JV, Erikssen G, Kjeldsen SE, Bodegard J, Thaulow E, Erikssen J. Source: Journal of Hypertension. 2003 July; 21(7): 1383-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12817188
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Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men. Author(s): Bjornholt JV, Erikssen G, Aaser E, Sandvik L, Nitter-Hauge S, Jervell J, Erikssen J, Thaulow E. Source: Diabetes Care. 1999 January; 22(1): 45-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10333902
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Feasibility and usefulness of dedicated software and e-mail for self-monitoring blood glucose in treating diabetes. Author(s): Perlemuter L, Yomtov B. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2002 August; 19(8): 701-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12147159
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Feasibility of measuring blood glucose concentration by near-infrared Raman spectroscopy. Author(s): Berger AJ, Itzkan I, Feld MS. Source: Spectrochimica Acta. Part A, Molecular and Biomolecular Spectroscopy. 1997 February; 53A(2): 287-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9097902
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Fetal cyclic motor activity in diabetic pregnancies: sensitivity to maternal blood glucose. Author(s): Robertson SS, Dierker LJ. Source: Developmental Psychobiology. 2003 January; 42(1): 9-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12471632
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Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus. Author(s): Kimmerle R, Klockenbusch W. Source: British Journal of Obstetrics and Gynaecology. 1997 January; 104(1): 120-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8988714
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Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus. Author(s): Persson B, Hanson U. Source: British Journal of Obstetrics and Gynaecology. 1996 May; 103(5): 427-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8624315
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Final adult height and its relationship to blood glucose control and microvascular complications in IDDM. Author(s): Penfold J, Chase HP, Marshall G, Walravens CF, Walravens PA, Garg SK. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1995 February; 12(2): 129-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7743759
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Finger infection resulting from self-monitoring of blood glucose and a new aid for reducing risk. Author(s): Suzuki Y, Atsumi Y, Matsuoka K. Source: Diabetes Care. 1998 August; 21(8): 1373-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9702457
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Forearm blood glucose testing in diabetes mellitus. Author(s): Greenhalgh S, Bradshaw S, Hall CM, Price DA. Source: Archives of Disease in Childhood. 2004 June; 89(6): 516-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15155393
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FreeStyle: a small-volume electrochemical glucose sensor for home blood glucose testing. Author(s): Feldman B, McGarraugh G, Heller A, Bohannon N, Skyler J, DeLeeuw E, Clarke D. Source: Diabetes Technology & Therapeutics. 2000 Summer; 2(2): 221-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11469262
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Frequency characterization of blood glucose dynamics. Author(s): Gough DA, Kreutz-Delgado K, Bremer TM. Source: Annals of Biomedical Engineering. 2003 January; 31(1): 91-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12572659
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Frequency of blood glucose monitoring in relation to glycaemic control: observational study with diabetes database. Author(s): Evans JM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ, Morris AD. Source: Bmj (Clinical Research Ed.). 1999 July 10; 319(7202): 83-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10398627
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Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Author(s): Blonde L, Ginsberg BH, Horn S, Hirsch IB, James B, Mulcahy K, Nettles A, Smout R, Wright H. Source: Diabetes Care. 2002 January; 25(1): 245-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11772926
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Frequency of blood glucose monitoring in relation to glycemic control in patients with type 2 diabetes. Author(s): Harris MI; National Health and Nutrition Examination Survey (NHANES III). Source: Diabetes Care. 2001 June; 24(6): 979-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11375356
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Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose data. Author(s): Cox DJ, Kovatchev BP, Julian DM, Gonder-Frederick LA, Polonsky WH, Schlundt DG, Clarke WL. Source: The Journal of Clinical Endocrinology and Metabolism. 1994 December; 79(6): 1659-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7989471
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Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration. Author(s): Holzapfel A, Festa A, Stacher-Janotta G, Bergmann H, Shnawa N, Brannath W, Schernthaner G, Stacher G. Source: Diabetologia. 1999 December; 42(12): 1410-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10651258
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Gastric myoelectrical activity, gastric emptying, and correlations with symptoms and fasting blood glucose levels in diabetic patients. Author(s): Soykan I, Lin Z, Sarosiek I, McCallum RW. Source: The American Journal of the Medical Sciences. 1999 April; 317(4): 226-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10210357
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Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies. Author(s): Schwartz DB, Daoud Y, Zazula P, Goyert G, Bronsteen R, Wright D, Copes J. Source: American Journal of Obstetrics and Gynecology. 1999 October; 181(4): 912-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10521752
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GHb (HbA(1c)) is more sensitive than fasting blood glucose as a screening test for diabetes. Author(s): Papoz L, Favier F, Clabe A, Sanchez A, Le Moullec N. Source: Diabetes Care. 2000 August; 23(8): 1206-7; Author Reply 1208. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10937531
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Gingival crevicular blood for assessment of blood glucose in diabetic patients. Author(s): Parker RC, Rapley JW, Isley W, Spencer P, Killoy WJ. Source: J Periodontol. 1993 July; 64(7): 666-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8366416
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Giving the fingers a rest: alternative site testing eases blood glucose monitoring. Author(s): Seley J. Source: The American Journal of Nursing. 2003 March; 103(3): 73, 75, 77. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12626946
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Gliclazide modified release: from once-daily administration to 24-hour blood glucose control. Author(s): Harrower A. Source: Metabolism: Clinical and Experimental. 2000 October; 49(10 Suppl 2): 7-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11078469
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Glipizide: preprandial multi-dose combination therapy capable of maintaining normal blood glucose throughout the day. Author(s): Bernstein RK. Source: Diabetes Care. 1985 May-June; 8(3): 306-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4006665
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Glomerular charge selectivity and the influence of improved blood glucose control in type 1 (insulin-dependent) diabetic patients with microalbuminuria. Author(s): Bangstad HJ, Kofoed-Enevoldsen A, Dahl-Jorgensen K, Hanssen KF. Source: Diabetologia. 1992 December; 35(12): 1165-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1478369
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Glucometers: accuracy and precision, Part II. Selection of a blood glucose monitor for standard hospital use. Author(s): Considine JM, Law T. Source: Journal of Pediatric Nursing. 1993 June; 8(3): 193-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8340886
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Glucose content in human skin: relationship with blood glucose levels. Author(s): Jensen BM, Bjerring P, Christiansen JS, Orskov H. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1995 August; 55(5): 427-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8545601
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Glucose monitoring at the thenar: evaluation of upper dermal blood glucose kinetics during rapid systemic blood glucose changes. Author(s): Jungheim K, Koschinsky T. Source: Hormone and Metabolic Research. Hormon- Und Stoffwechselforschung. Hormones Et Metabolisme. 2002 June; 34(6): 325-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12173073
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Glycated haemoglobin values: problems in assessing blood glucose control in diabetes mellitus. Author(s): Kilpatrick ES, Rumley AG, Dominiczak MH, Small M. Source: Bmj (Clinical Research Ed.). 1994 October 15; 309(6960): 983-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7950717
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Glycated haemoglobin, diabetes, and mortality in men. Maybe disturbance in physiological mechanisms regulating blood glucose is risk factor for cardiovascular death. Author(s): Jarrett RJ. Source: Bmj (Clinical Research Ed.). 2001 April 21; 322(7292): 996; Author Reply 996-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11339225
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Glycation of hair protein in the assessment of long-term control of blood glucose. Author(s): Oimomi M, Masuda S, Igaki N, Nakamichi T, Hata F, Matsumoto S, Baba S. Source: Jpn J Med. 1988 August; 27(3): 277-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3143025
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Glycosylated haemoglobin and blood glucose levels in Libyan diabetic patients. Author(s): Rao GM, Morghom LO, Abukhris AA, Mansori SS, Alphgih FA, Ragale LY. Source: Trop Geogr Med. 1986 December; 38(4): 391-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3810843
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Good blood glucose control characterizes patients without retinopathy after long diabetes duration. Author(s): Kullberg CE, Arnqvist HJ. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1995 April; 12(4): 314-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7600746
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Granuloma annulare secondary to self-monitoring of blood glucose. Author(s): Renfrow L, Beisswenger PJ, Austin B. Source: Diabetes Care. 1985 January-February; 8(1): 101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3971839
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Graphical display of capillary blood glucose data using Chernoff faces. Author(s): Phillipou G. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1992 April; 9(3): 293-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1576817
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Haematocrit and the Boehringer advantage blood glucose meter. Author(s): Wiener K. Source: Annals of Clinical Biochemistry. 1998 March; 35 ( Pt 2): 325-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9547911
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Has blood glucose level measured on admission to hospital in a patient with acute pancreatitis any prognostic value? Author(s): Lankisch PG, Blum T, Bruns A, Droge M, Brinkmann G, Struckmann K, Nauck M, Maisonneuve P, Lowenfels AB. Source: Pancreatology : Official Journal of the International Association of Pancreatology (Iap). [et Al.]. 2001; 1(3): 224-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120199
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Helping patients with diabetes select a blood glucose monitor. Author(s): Kulkarni K. Source: Journal of the American Pharmaceutical Association (Washington,D.C. : 1996). 2002 July-August; 42(4): 658-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12150366
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Helping your patient choose the right blood glucose meter. Author(s): Mensing C. Source: Nursing Management (Harrow, London, England : 1994). 2003 October; Suppl: 22-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694863
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HemoCue blood glucose analyser and haematocrit. Author(s): Jones GR. Source: Annals of Clinical Biochemistry. 1993 September; 30 ( Pt 5): 510-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8250515
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Hemoglobin Glycosylation Index is not related with blood glucose. Author(s): Merino-Torres JF, Fajardo-Montanana C, Ferrer-Garcia JC, Pinon-Selles F. Source: Journal of Diabetes and Its Complications. 2003 September-October; 17(5): 24953. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12954152
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Hemoglobin variant HbG-coushatta (beta-22 Glu --> Ala) found by dissociation of blood glucose from values of HbA1C measured by HPLC. Author(s): Ogawa K, Bando T, Ogawa M, Miyazaki A, Nakanishi T, Shimizu A. Source: Intern Med. 2003 September; 42(9): 781-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14518662
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Hepatitis C in a ward for cystic fibrosis and diabetic patients: possible transmission by spring-loaded finger-stick devices for self-monitoring of capillary blood glucose. Author(s): Desenclos JC, Bourdiol-Razes M, Rolin B, Garandeau P, Ducos J, Brechot C, Thiers V. Source: Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America. 2001 November; 22(11): 701-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11842991
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High viscosity hydroxypropylmethylcellulose reduces postprandial blood glucose concentrations in NIDDM patients. Author(s): Reppas C, Adair CH, Barnett JL, Berardi RR, DuRoss D, Swidan SZ, Thill PF, Tobey SW, Dressman JB. Source: Diabetes Research and Clinical Practice. 1993 October-November; 22(1): 61-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8137718
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High-fat versus high-carbohydrate enteral formulae: effect on blood glucose, Cpeptide, and ketones in patients with type 2 diabetes treated with insulin or sulfonylurea. Author(s): Sanz-Paris A, Calvo L, Guallard A, Salazar I, Albero R. Source: Nutrition (Burbank, Los Angeles County, Calif.). 1998 November-December; 14(11-12): 840-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9834926
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Home blood glucose monitoring. Author(s): Foster SA, Goode JV, Small RE. Source: The Annals of Pharmacotherapy. 1999 March; 33(3): 355-63. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10200862
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Home blood glucose monitoring. Author(s): Hounsome B. Source: Prof Nurse. 1998 August; 13(11): 765-8, 770. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9782992
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Home monitoring of blood glucose (HMBG) in Type-2 diabetes mellitus in a developing country. Author(s): Kibriya MG, Ali L, Banik NG, Khan AK. Source: Diabetes Research and Clinical Practice. 1999 December; 46(3): 253-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10624792
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Home monitoring of blood glucose concentration by owners of diabetic dogs. Author(s): Casella M, Wess G, Hassig M, Reusch CE. Source: The Journal of Small Animal Practice. 2003 July; 44(7): 298-305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12866927
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How well do patients with type 1 diabetes measure their blood glucose in daily life. Author(s): Heinemann L, Overmann H, Muhlhauser I. Source: Diabetes Care. 1998 March; 21(3): 461-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9540034
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Human amnion-isolated cells normalize blood glucose in streptozotocin-induced diabetic mice. Author(s): Wei JP, Zhang TS, Kawa S, Aizawa T, Ota M, Akaike T, Kato K, Konishi I, Nikaido T. Source: Cell Transplantation. 2003; 12(5): 545-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12953929
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Human oral mucosa studies with varying blood glucose concentration by noninvasive ATR-FT-IR-spectroscopy. Author(s): Heise HM, Marbach R. Source: Cell Mol Biol (Noisy-Le-Grand). 1998 September; 44(6): 899-912. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9763193
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Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes. Author(s): Spyer G, Hattersley AT, MacDonald IA, Amiel S, MacLeod KM. Source: Lancet. 2000 December 9; 356(9246): 1970-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11130525
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Hypoglycemic action of Cucurbita ficifolia on Type 2 diabetic patients with moderately high blood glucose levels. Author(s): Acosta-Patino JL, Jimenez-Balderas E, Juarez-Oropeza MA, Diaz-Zagoya JC. Source: Journal of Ethnopharmacology. 2001 September; 77(1): 99-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11483384
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Hypophosphataemia in the metabolic syndrome. Gender differences in body weight and blood glucose. Author(s): Haglin L, Lindblad A, Bygren LO. Source: European Journal of Clinical Nutrition. 2001 June; 55(6): 493-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11423926
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Impact of body mass index on fasting blood glucose concentration among Helicobater pylori carriers. Author(s): Kyriazanos ID, Sfiniadakis I, Dimakos P, Gizaris V, Datsakis K, Dafnopoulou A. Source: Digestive Diseases (Basel, Switzerland). 2003; 21(3): 262-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571101
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Implementing intensive control of blood glucose concentration and blood pressure in type 2 diabetes in England: cost analysis (UKPDS 63). Author(s): Gray A, Clarke P, Farmer A, Holman R; United Kingdom Prospective Diabetes Study (UKPDS) Group. Source: Bmj (Clinical Research Ed.). 2002 October 19; 325(7369): 860. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12386035
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Importance of using and understanding self-monitoring of blood glucose (SMBG) data in assessing ambient and long-term glycaemic control. Author(s): Nomura DM. Source: J Indian Med Assoc. 2002 July; 100(7): 448, 450-1. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12674169
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Increase in blood glucose concentration during antihypertensive treatment as a predictor of myocardial infarction: population based cohort study. Author(s): Dunder K, Lind L, Zethelius B, Berglund L, Lithell H. Source: Bmj (Clinical Research Ed.). 2003 March 29; 326(7391): 681. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12663403
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Influence of diazepam on blood glucose levels in nondiabetic and non-insulindependent diabetic subjects under dental treatment with local anesthesia. Author(s): Schaira VR, Ranali J, Saad MJ, de Oliveira PC, Ambrosano GM, Volpato MC. Source: Anesthesia Progress. 2004; 51(1): 14-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15106685
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Influence of initial hyperglycaemia, weight and age on the blood glucose lowering efficacy and incidence of hypoglycaemic symptoms with a single-tablet metforminglibenclamide therapy (Glucovance) in type 2 diabetes. Author(s): Garber A, Marre M, Blonde L, Allavoine T, Howlett H, Lehert P, Cornes M. Source: Diabetes, Obesity & Metabolism. 2003 May; 5(3): 171-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12681024
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Informal diabetes education: impact on self-management and blood glucose control. Author(s): Gillard ML, Nwankwo R, Fitzgerald JT, Oh M, Musch DC, Johnson MW, Anderson R. Source: Diabetes Educ. 2004 January-February; 30(1): 136-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14999901
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Injection of the insulin receptor alpha subunit increases blood glucose levels in mice. Author(s): Kanezaki Y, Matsushima R, Obata T, Nakaya Y, Matsumoto T, Ebina Y. Source: Biochemical and Biophysical Research Communications. 2003 September 26; 309(3): 572-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963028
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Inpatient blood glucose testing. Issues NPs should consider. Author(s): Nichols JH. Source: Adv Nurse Pract. 2003 August; 11(8): 67-8, 88. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13677087
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Intensified blood glucose monitoring improves glycemic control in stable, insulintreated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES). Author(s): Murata GH, Shah JH, Hoffman RM, Wendel CS, Adam KD, Solvas PA, Bokhari SU, Duckworth WC; Diabetes Outcomes in Veterans Study (DOVES). Source: Diabetes Care. 2003 June; 26(6): 1759-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12766106
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Interpretation of home blood glucose monitoring. Author(s): Goldberg LD. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003 July-August; 9(4): 329. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14569981
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Intragam can interfere with blood glucose monitoring. Author(s): Kannan S, Rowland CH, Hockings GI, Tauchmann PM. Source: The Medical Journal of Australia. 2004 March 1; 180(5): 251-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14984349
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Intrapulmonary administration of natural honey solution, hyperosmolar dextrose or hypoosmolar distill water to normal individuals and to patients with type-2 diabetes mellitus or hypertension: their effects on blood glucose level, plasma insulin and Cpeptide, blood pressure and peaked expiratory flow rate. Author(s): Al-Waili N. Source: European Journal of Medical Research. 2003 July 31; 8(7): 295-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12911866
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Intravenous glucagon-like peptide 1 normalizes blood glucose after major surgery in patients with type 2 diabetes. Author(s): Meier JJ, Weyhe D, Michaely M, Senkal M, Zumtobel V, Nauck MA, Holst JJ, Schmidt WE, Gallwitz B. Source: Critical Care Medicine. 2004 March; 32(3): 848-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15090972
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Inverse association between the effect of carbohydrates on blood glucose and subsequent short-term food intake in young men. Author(s): Anderson GH, Catherine NL, Woodend DM, Wolever TM. Source: The American Journal of Clinical Nutrition. 2002 November; 76(5): 1023-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12399274
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Investigation on the accuracy of the blood glucose monitoring device Prestige IQ. Author(s): Larbig M, Forst T, Mondok A, Forst S, Pfutzner A. Source: Diabetes Nutr Metab. 2003 August; 16(4): 257-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14768776
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Involving patients can work in home blood glucose testing. Author(s): Kerr D. Source: Bmj (Clinical Research Ed.). 2003 January 11; 326(7380): 103. Erratum In: Bmj. 2003 February 8; 326(7384): 321. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12521981
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Is fasting blood glucose a reliable parameter for screening for diabetes in hypertension? Author(s): Bur A, Herkner H, Woisetschlager C, Vlcek M, Derhaschnig U, Hirschl MM. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 2003 April; 16(4): 297-301. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12670746
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Is protein or sugar better for low blood glucose? Author(s): Spanheimer RG. Source: Postgraduate Medicine. 2003 October; 114(4): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14587202
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Knowledge, attitudes, technical competence, and blood glucose control of Type 1 diabetic patients during and after an education programme. Author(s): Lennon GM, Taylor KG, Debney L, Bailey CJ. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1990 November; 7(9): 825-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2148137
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Lack of compliance with home blood glucose monitoring predicts hospitalization in diabetes. Author(s): Burge MR. Source: Diabetes Care. 2001 August; 24(8): 1502-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11473098
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Lantus reduces blood glucose levels, less hypoglycemia in treatment of type 2 diabetes. Author(s): Walczak IM. Source: Diabetes Technology & Therapeutics. 2002; 4(5): 735-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12458566
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Laughter lowered the increase in postprandial blood glucose. Author(s): Hayashi K, Hayashi T, Iwanaga S, Kawai K, Ishii H, Shoji S, Murakami K. Source: Diabetes Care. 2003 May; 26(5): 1651-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12716853
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Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Author(s): Boland E, Monsod T, Delucia M, Brandt CA, Fernando S, Tamborlane WV. Source: Diabetes Care. 2001 November; 24(11): 1858-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11679447
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Long-term abstinent alcoholics have a blunted blood glucose response to 2-deoxy-dglucose. Author(s): Lloyd G. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 2003 May-June; 38(3): 287; Author Reply 287. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12711667
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Long-term abstinent alcoholics have a blunted blood glucose response to 2-Deoxy-dglucose. Author(s): Umhau JC, Petrulis SG, Diaz R, Riggs PA, Biddison JR, George DT. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 2002 November-December; 37(6): 586-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12414552
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Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Author(s): Giacco R, Parillo M, Rivellese AA, Lasorella G, Giacco A, D'Episcopo L, Riccardi G. Source: Diabetes Care. 2000 October; 23(10): 1461-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11023137
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Long-term effects of diltiazem and atenolol on blood glucose, serum lipids, and serum urate in hypertensive patients. Swedish-Finnish Study Group. Author(s): Thulin T, Lehtonen A, Dahlof C, Nilsson-Ehle P, Engqvist L, Lagerstedt C, Berglund E. Source: Int J Clin Pharmacol Ther. 1999 January; 37(1): 28-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10027480
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Low blood glucose and olanzapine. Author(s): Budman CL, Gayer AI. Source: The American Journal of Psychiatry. 2001 March; 158(3): 500-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11230004
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Low blood glucose levels and other complications during growth hormone supplementation in sepsis. Author(s): Faintuch J, Leme RB, Cruz ME, Lima AM, Giannella Neto D, GamaRodrigues JJ. Source: Revista Do Hospital Das Clinicas. 1999 July-August; 54(4): 135-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10779822
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Lowering of blood glucose in athymic nude mice and rats, grafted with human lung cancers. Author(s): Fortmeyer HP, Hick J, Blum U. Source: In Vivo. 1989 May-June; 3(3): 143-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2519847
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Maternal blood glucose and the baby. The origins of the hyperglycaemia and pregnancy outcome study The Scott-Heron Lecture at the Royal Victoria Hospital--17 January 2001. Author(s): Hadden DR. Source: Ulster Med J. 2001 November; 70(2): 119-35. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11795762
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Meal-related structured self-monitoring of blood glucose: effect on diabetes control in non-insulin-treated type 2 diabetic patients. Author(s): Schwedes U, Siebolds M, Mertes G; SMBG Study Group. Source: Diabetes Care. 2002 November; 25(11): 1928-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12401734
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Measuring and managing hyperglycemia in pregnancy: from glycosuria to continuous blood glucose monitoring. Author(s): Mazze RS. Source: Semin Perinatol. 2002 June; 26(3): 171-80. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12099306
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Menopausal hot flash frequency changes in response to experimental manipulation of blood glucose. Author(s): Dormire SL, Reame NK. Source: Nursing Research. 2003 September-October; 52(5): 338-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501548
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Methods for quantifying self-monitoring blood glucose profiles exemplified by an examination of blood glucose patterns in patients with type 1 and type 2 diabetes. Author(s): Kovatchev BP, Cox DJ, Gonder-Frederick L, Clarke WL. Source: Diabetes Technology & Therapeutics. 2002; 4(3): 295-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12165168
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Modulation by blood glucose levels of activity and concentration of paraoxonase in young patients with type 1 diabetes mellitus. Author(s): Kordonouri O, James RW, Bennetts B, Chan A, Kao YL, Danne T, Silink M, Donaghue K. Source: Metabolism: Clinical and Experimental. 2001 June; 50(6): 657-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11398141
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Monitoring blood glucose changes in cutaneous tissue by temperature-modulated localized reflectance measurements. Author(s): Yeh SJ, Hanna CF, Khalil OS. Source: Clinical Chemistry. 2003 June; 49(6 Pt 1): 924-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12765989
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Most infectious complications in parenterally fed trauma patients are not due to elevated blood glucose levels. Author(s): Kudsk KA, Laulederkind A, Hanna MK. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2001 July-August; 25(4): 174-9. Erratum In: Jpen J Parenter Enteral Nutr 2001 September-October; 25(5): 289. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11434646
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Myocardial infarction and prevalence of diabetes mellitus. Is increased casual blood glucose at admission a reliable criterion for the diagnosis of diabetes? Author(s): Tenerz A, Lonnberg I, Berne C, Nilsson G, Leppert J. Source: European Heart Journal. 2001 July; 22(13): 1102-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11428850
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n-3 fatty acids and blood glucose control in diabetes mellitus. Author(s): Vessby B. Source: Journal of Internal Medicine. Supplement. 1989; 225(731): 207-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2650692
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Natural progress of blood glucose in full-term low-grade low-birthweight infants. Author(s): Ishikawa N. Source: Pediatrics International : Official Journal of the Japan Pediatric Society. 2002 December; 44(6): 583-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12421252
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Near-patient testing of blood glucose using the Bayer Rapidlab 860 analyser in a regional neonatal unit. Author(s): Peet AC, Kennedy DM, Hocking MD, Ewer AK. Source: Annals of Clinical Biochemistry. 2002 September; 39(Pt 5): 502-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12227857
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Neurosis induced by home monitoring of blood glucose concentrations. Author(s): Beer SF, Lawson C, Watkins PJ. Source: Bmj (Clinical Research Ed.). 1989 February 11; 298(6670): 362. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2493934
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New ADA criteria in the Korean population: fasting blood glucose is not enough for diagnosis of mild diabetes especially in the elderly. Author(s): Choi YH, Ahn YB, Yoon KH, Kang MI, Cha BY, Lee KW, Son HY, Kang SK. Source: Korean J Intern Med. 2000 December; 15(3): 211-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11242809
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Nifedipine and blood glucose in normal human volunteers. Author(s): Purohit AK, Raval JD, Shah GF, Gandhi TP, Gibert RN. Source: J Assoc Physicians India. 1989 February; 37(2): 148-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2808280
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Noninvasive blood glucose measurements by near-infrared transmission spectroscopy across human tongues. Author(s): Burmeister JJ, Arnold MA, Small GW. Source: Diabetes Technology & Therapeutics. 2000 Spring; 2(1): 5-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11467321
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Non-invasive blood glucose monitoring by means of near infrared spectroscopy: investigation of long-term accuracy and stability. Author(s): Samann A, Fischbacher CH, Jagemann KU, Danzer K, Schuler J, Papenkordt L, Muller UA. Source: Experimental and Clinical Endocrinology & Diabetes : Official Journal, German Society of Endocrinology [and] German Diabetes Association. 2000; 108(6): 406-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11026754
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Occurrence of low blood glucose concentrations during the afternoon in type 2 (noninsulin-dependent) diabetic patients on oral hypoglycaemic agents: importance of blood glucose monitoring. Author(s): Trovati M, Burzacca S, Mularoni E, Massucco P, Cavalot F, Mattiello L, Anfossi G. Source: Diabetologia. 1991 September; 34(9): 662-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1955099
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On the effects of glucagon-like peptide-1 on blood glucose regulation in normal and diabetic subjects. Author(s): Holst JJ, Toft-Nielsen MB, Orskov C, Nauck M, Willms B. Source: Annals of the New York Academy of Sciences. 1996 December 26; 805: 729-36. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8993469
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On-line chemiluminescence assay using FIA and fiber optics for urinary and blood glucose. Author(s): Cattaneo MV, Luong JH. Source: Enzyme and Microbial Technology. 1993 May; 15(5): 424-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7763630
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Opioid antagonism alters blood glucose homeostasis during exercise in humans. Author(s): Hickey MS, Trappe SW, Blostein AC, Edwards BA, Goodpaster B, Craig BW. Source: Journal of Applied Physiology (Bethesda, Md. : 1985). 1994 June; 76(6): 2452-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7928870
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Optimal blood glucose control during 18 years preserves peripheral nerve function in patients with 30 years' duration of type 1 diabetes. Author(s): Larsen JR, Sjoholm H, Hanssen KF, Sandvik L, Berg TJ, Dahl-Jorgensen K. Source: Diabetes Care. 2003 August; 26(8): 2400-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12882869
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Optimizing blood glucose control in type 2 diabetes: an approach based on fasting blood glucose measurements. Author(s): Holman RR, Turner RC. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1988 September; 5(6): 582-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2974783
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Outcome of the glucagon test depends upon the prevailing blood glucose concentration in type I (insulin-dependent) diabetic patients. Author(s): Madsbad S, Sauerbrey N, Moller-Jensen B, Krarup T, Kuhl C. Source: Acta Med Scand. 1987; 222(1): 71-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3630779
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Oxidative stress in leukocytes is a possible link between blood pressure, blood glucose, and C-reacting protein. Author(s): Yasunari K, Maeda K, Nakamura M, Yoshikawa J. Source: Hypertension. 2002 March 1; 39(3): 777-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11897762
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Performance evaluation of the Precision PCx point-of-care blood glucose analyzer using discriminant ratio methodology. Author(s): Deyi VY, Philippe M, Alexandre KC, De Nayer P, Hermans MP. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2002 October; 40(10): 1052-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12476948
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Performance of Precision G blood glucose analyzer with a new test strip G2b on neonatal samples. Author(s): Meric B, Kilicaslan N, Kerman K, Ozkan D, Kurun U, Aksu N, Ozsoz M. Source: Clinical Chemistry. 2002 January; 48(1): 179-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11751555
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Point-of-care testing of blood glucose in the neonatal unit using the AVL Omni 9 analyser. Author(s): Newman JD, Pecache NS, Barfield CP, Balazs ND. Source: Annals of Clinical Biochemistry. 2002 September; 39(Pt 5): 509-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12227858
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Postprandial blood glucose as a risk factor for cardiovascular disease in Type II diabetes: the epidemiological evidence. Author(s): Bonora E, Muggeo M. Source: Diabetologia. 2001 December; 44(12): 2107-14. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11793012
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Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial. Author(s): Manderson JG, Patterson CC, Hadden DR, Traub AI, Ennis C, McCance DR. Source: American Journal of Obstetrics and Gynecology. 2003 August; 189(2): 507-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14520226
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Problems of comparing blood glucose molality and molarity determined with an Omni, an EML 105 and an Ebio analyser. Author(s): Haeckel R, Hanecke P. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2003 July; 41(7): 950-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12940524
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Prognostic value of blood glucose in Hodgkin's disease. Author(s): Bisagni A, de Gramont A, Brissaud P, Krulik M, Hubert D, Sirinelli A, Debray J. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 1985 January; 3(1): 128-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3965630
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Quality assessment of blood glucose testing in general practitioners' offices improves quality. Author(s): Stahl M, Brandslund I, Iversen S, Filtenborg JA. Source: Clinical Chemistry. 1997 October; 43(10): 1926-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9342014
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Quality assurance for blood glucose monitoring in health-care facilities. Author(s): Walker EA, Paduano DJ, Shamoon H. Source: Diabetes Care. 1991 November; 14(11): 1043-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1797485
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Quality assurance for blood glucose monitoring. The balance of feasibility and standards. Author(s): Walker EA. Source: Nurs Clin North Am. 1993 March; 28(1): 61-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8451217
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Quality control in patient self-monitoring of blood glucose. Author(s): Greyson J. Source: Diabetes Care. 1993 September; 16(9): 1306-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8404439
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Quality control of "one touch" II blood glucose meters used by nurses in clinical departments. Author(s): van 't Sant P, Hovenier JT, Kreutzer HJ. Source: Eur J Clin Chem Clin Biochem. 1994 September; 32(9): 723-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7865630
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Quality control of blood glucose meters is a must! (Contribution of the hemocue glucose analyser) Author(s): Meyer C, Schletzer-Mari A, Arcanger B, Leroux R, Lecomte F, Coconnier E, Lucas F. Source: Diabetes & Metabolism. 1998 November; 24(5): 455-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9881245
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Quality control of intensified insulin therapy: HbA1 versus blood glucose. Author(s): Bischof F, Meyerhoff C, Pfeiffer EF. Source: Hormone and Metabolic Research. Hormon- Und Stoffwechselforschung. Hormones Et Metabolisme. 1994 December; 26(12): 574-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7705761
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Quality of life, perceived difficulties in adherence to a diabetes regimen, and blood glucose control. Author(s): Hanestad BR, Albrektsen G. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1991 October; 8(8): 759-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1838068
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Quality-control materials for use with monitors of blood glucose. Author(s): Stejskal J, Wendland MA. Source: Clinical Chemistry. 1988 January; 34(1): 212. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3338175
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Quality-control materials for use with monitors of blood glucose: "Refloflux II" (Boehringer Mannheim) and "Sugar-Chex" (Streck Laboratories) controls. Author(s): Rawal N, Henderson AR. Source: Clinical Chemistry. 1987 July; 33(7): 1294-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3594892
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Rapid changes in postprandial blood glucose produce concentration differences at finger, forearm, and thigh sampling sites. Author(s): Ellison JM, Stegmann JM, Colner SL, Michael RH, Sharma MK, Ervin KR, Horwitz DL. Source: Diabetes Care. 2002 June; 25(6): 961-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12032099
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Rate of fall of blood glucose and physiological responses of counterregulatory hormones, clinical symptoms and cognitive function to hypoglycaemia in Type I diabetes mellitus in the postprandial state. Author(s): Fanelli CG, Pampanelli S, Porcellati F, Bartocci L, Scionti L, Rossetti P, Bolli GB. Source: Diabetologia. 2003 January; 46(1): 53-64. Epub 2002 November 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12637983
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Reduction in self-monitoring of blood glucose in persons with type 2 diabetes results in cost savings and no change in glycemic control. Author(s): Meier JL, Swislocki AL, Lopez JR, Noth RH, Bartlebaugh P, Siegel D. Source: Am J Manag Care. 2002 June; 8(6): 557-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12068962
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Reduction of blood glucose variability in type 1 diabetic patients treated by pancreatic islet transplantation: interest of continuous glucose monitoring. Author(s): Kessler L, Passemard R, Oberholzer J, Benhamou PY, Bucher P, Toso C, Meyer P, Penfornis A, Badet L, Wolf P, Colin C, Morel P, Pinget M; GRAGIL Group. Source: Diabetes Care. 2002 December; 25(12): 2256-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12453970
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Regulation of blood glucose level in diabetes mellitus using palatable diet composition. Author(s): Katiyar VK. Source: Australas Phys Eng Sci Med. 2003 September; 26(3): 132-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14626853
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Relationship between blood glucose control, pathogenesis and progression of diabetic nephropathy. Author(s): Nosadini R, Tonolo G. Source: Journal of the American Society of Nephrology : Jasn. 2004 January; 15 Suppl 1: S1-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14684663
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Repeated random blood glucose measurements as universal screening test for gestational diabetes mellitus. Author(s): Ostlund I, Hanson U. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2004 January; 83(1): 46-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14678085
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Research use of the AIDA www.2aida.org diabetes software simulation program: a review--part 2. Generating simulated blood glucose data for prototype validation. Author(s): Lehmann ED. Source: Diabetes Technology & Therapeutics. 2003; 5(4): 641-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14511419
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Reservations on the use of error grid analysis for the validation of blood glucose assays. Author(s): Gough DA, Botvinick EL. Source: Diabetes Care. 1997 June; 20(6): 1034-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9167120
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Rorschach variables related to blood glucose control in insulin-dependent diabetes patients. Author(s): Sultan S, Jebrane A, Heurtier-Hartemann A. Source: Journal of Personality Assessment. 2002 August; 79(1): 122-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12227663
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Selecting an accurate point-of-care testing system: clinical and technical issues and implications in neonatal blood glucose monitoring. Author(s): Sirkin A, Jalloh T, Lee L. Source: Journal for Specialists in Pediatric Nursing : Jspn. 2002 July-September; 7(3): 10412. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12236242
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Self monitoring of blood glucose in blind diabetic patients. Author(s): Windecker R, Heinemann L, Sawicki PT. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1997 August; 14(8): 703-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9272599
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Self monitoring of blood glucose. Author(s): Banerjee S, Mandal S, Daga S. Source: J Indian Med Assoc. 2002 July; 100(7): 418-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12674164
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Self monitoring of glucose by people with diabetes. Patients with non-insulin dependent diabetes should monitor urine urine rather than blood glucose. Author(s): Chantelau E, Nowicki S. Source: Bmj (Clinical Research Ed.). 1997 July 19; 315(7101): 185. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9251556
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Self-monitored blood glucose in pregnant women without gestational diabetes mellitus. Author(s): Montaner P, Dominguez R, Corcoy R. Source: Diabetes Care. 2002 November; 25(11): 2104-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12401765
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Self-monitored blood glucose: a common pitfall. Author(s): Raine CH 3rd. Source: Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2003 March-April; 9(2): 1379. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12917076
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Self-monitoring of blood glucose in gestational diabetes. Author(s): Homko CJ, Reece EA. Source: J Matern Fetal Neonatal Med. 2002 December;12(6):389-95. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12683649
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Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: the Auto-Surveillance Intervention Active (ASIA) study. Author(s): Guerci B, Drouin P, Grange V, Bougneres P, Fontaine P, Kerlan V, Passa P, Thivolet Ch, Vialettes B, Charbonnel B; ASIA Group. Source: Diabetes & Metabolism. 2003 December; 29(6): 587-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14707887
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Self-testing of blood glucose: biosensors and beyond. Author(s): Newman JD. Source: Medical Device Technology. 2002 May; 13(4): 12-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12066331
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Specificity of noninvasive blood glucose sensing using optical coherence tomography technique: a pilot study. Author(s): Larin KV, Motamedi M, Ashitkov TV, Esenaliev RO. Source: Physics in Medicine and Biology. 2003 May 21; 48(10): 1371-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12812453
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The effect of blood glucose regulation on retinal nerve fiber layer thickness in diabetic patients. Author(s): Lonneville YH, Ozdek SC, Onol M, Yetkin I, Gurelik G, Hasanreisoglu B. Source: Ophthalmologica. Journal International D'ophtalmologie. International Journal of Ophthalmology. Zeitschrift Fur Augenheilkunde. 2003 September-October; 217(5): 347-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913325
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The effect of combination treatment with acarbose and glibenclamide on postprandial glucose and insulin profiles: additive blood glucose lowering effect and decreased hypoglycaemia. Author(s): Rosak C, Haupt E, Walter T, Werner J. Source: Diabetes Nutr Metab. 2002 June; 15(3): 143-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12173728
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The effect of walking before and after breakfast on blood glucose levels in patients with type 1 diabetes treated with intensive insulin therapy. Author(s): Yamanouchi K, Abe R, Takeda A, Atsumi Y, Shichiri M, Sato Y. Source: Diabetes Research and Clinical Practice. 2002 October; 58(1): 11-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12161052
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The FDA reevaluates alternative site testing for blood glucose. Author(s): Ginsberg BH. Source: Diabetes Technology & Therapeutics. 2002; 4(3): 347-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12165174
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The random blood glucose level, a risk factor for mortality after acute myocardial infarction, in non-diabetic patients. Author(s): Mane AS, McHugh P, Conneely J, McCarthy C. Source: Ir Med J. 2003 July-August; 96(7): 214-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14518587
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The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study. Author(s): Oyibo SO, Prasad YD, Jackson NJ, Jude EB, Boulton AJ. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 2002 October; 19(10): 870-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358878
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The relationship between periodontal disease and blood glucose level among type II diabetic patients. Author(s): Almas K, Al-Qahtani M, Al-Yami M, Khan N. Source: The Journal of Contemporary Dental Practice [electronic Resource]. 2001 November 15; 2(4): 18-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12167917
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The role of blood glucose availability and fatigue in the development of cognitive impairment during combat training. Author(s): Owen G, Turley H, Casey A. Source: Aviation, Space, and Environmental Medicine. 2004 March; 75(3): 240-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15018292
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Timing of changes in interstitial and venous blood glucose measured with a continuous subcutaneous glucose sensor. Author(s): Boyne MS, Silver DM, Kaplan J, Saudek CD. Source: Diabetes. 2003 November; 52(11): 2790-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14578298
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Understanding the processes behind the regulation of blood glucose. Author(s): James P, McFadden R. Source: Nurs Times. 2004 April 20-26; 100(16): 56-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15132068
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Urine glucose testing: another look at its relevance when blood glucose monitoring is unaffordable. Author(s): Feleke Y, Abdulkadir J. Source: Ethiop Med J. 1998 April; 36(2): 93-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10214451
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Use of a blood glucose meter for radiochromic film analysis in blood irradiation. Author(s): Cheung T, Butson MJ, Yu PK. Source: Physics in Medicine and Biology. 2002 October 7; 47(19): N259-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12408483
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Use of an automated device for alternative site blood glucose monitoring. Author(s): Fineberg SE, Bergenstal RM, Bernstein RM, Laffel LM, Schwartz SL. Source: Diabetes Care. 2001 July; 24(7): 1217-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11423505
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Use of an enzyme thermistor for semi-continuous blood glucose measurements. Author(s): Carlsson T, Adamson U, Lins PE, Danielsson B. Source: Clinica Chimica Acta; International Journal of Clinical Chemistry. 1996 July 30; 251(2): 187-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8862473
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Use of the HemoCue blood glucose analyzer in research studies. Author(s): Rassam AG, Mcleod J, Burge MR, Schade DS. Source: Diabetes Care. 1998 August; 21(8): 1369-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9702453
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Usefulness of the hemocue blood glucose photometer in hypoglycaemic conditions. Author(s): M'Bemba J, Chevalier A, Bruzzo F, Slama G, Selam JL. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1997 August; 14(8): 711. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9272604
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User's guide for self-monitoring of capillary blood glucose levels. Author(s): Rasaiah B. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1989 January 1; 140(1): 25-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2909269
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Using A1C to gauge blood glucose control. Author(s): Griffin C. Source: Nursing. 2003 December; 33(12): 72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14708544
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Using statistical quality control techniques to monitor blood glucose levels. Author(s): Oniki TA, Clemmer TP, Arthur LK, Linford LH. Source: Proc Annu Symp Comput Appl Med Care. 1995; : 586-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8563353
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Vacuum-assisted lancing of the forearm: an effective and less painful approach to blood glucose monitoring. Author(s): Cunningham DD, Henning TP, Shain EB, Young DF, Elstrom TA, Taylor EJ, Schroder SM, Gatcomb PM, Tamborlane WV. Source: Diabetes Technology & Therapeutics. 2000 Winter; 2(4): 541-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11469617
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Validation of home blood glucose meters with respect to clinical and analytical approaches. Author(s): Brunner GA, Ellmerer M, Sendlhofer G, Wutte A, Trajanoski Z, Schaupp L, Quehenberger F, Wach P, Krejs GJ, Pieber TR. Source: Diabetes Care. 1998 April; 21(4): 585-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9571347
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Validity of home blood glucose reporting by geriatric patients. Author(s): Herndon CM, Dole EJ, Rhyne RL, Fike DS. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2001 February 15; 58(4): 320-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11225168
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Validity of random blood glucose as a predictor of the quality of glycaemic control by glycated haemoglobin in out-patient diabetic patients at Kenyatta National Hospital. Author(s): Otieno FC, Ng'ang'a L, Kariuki M. Source: East Afr Med J. 2002 September; 79(9): 491-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12625691
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Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting. Author(s): Fish LH, Weaver TW, Moore AL, Steel LG. Source: The American Journal of Cardiology. 2003 July 1; 92(1): 74-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12842253
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Variability of blood glucose levels in patients with type 1 diabetes mellitus on intensified insulin regimens. Author(s): Moberg EA, Lins PE, Adamson UK. Source: Diabete Metab. 1994 November-December; 20(6): 546-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7713278
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Variation in the calpain-10 gene affects blood glucose levels in the British population. Author(s): Lynn S, Evans JC, White C, Frayling TM, Hattersley AT, Turnbull DM, Horikawa Y, Cox NJ, Bell GI, Walker M. Source: Diabetes. 2002 January; 51(1): 247-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11756349
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Very low density lipoprotein subfraction abnormalities in IDDM patients: any effect of blood glucose control? Author(s): Patti L, Di Marino L, Maffettone A, Romano G, Annuzzi G, Riccardi G, Rivellese AA. Source: Diabetologia. 1995 December; 38(12): 1419-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8786015
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Visual function, blood pressure and blood glucose in diabetic patients undergoing continuous ambulatory peritoneal dialysis. Author(s): Rottembourg J, Bellio P, Maiga K, Remaoun M, Rousselie F, Legrain M. Source: Proc Eur Dial Transplant Assoc Eur Ren Assoc. 1985; 21: 330-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3991520
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Visual interpretation of blood glucose test strips. Author(s): Laux L. Source: Diabetes Educ. 1994 January-February; 20(1): 41-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8137703
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Walking for exercise - immediate effect on blood glucose levels in type 2 diabetes. Author(s): Fritz T, Rosenqvist U. Source: Scandinavian Journal of Primary Health Care. 2001 March; 19(1): 31-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11303544
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Weak magnetic fields antagonize the effects of melatonin on blood glucose levels in Parkinson's disease. Author(s): Sandyk R. Source: The International Journal of Neuroscience. 1993 January; 68(1-2): 85-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8063518
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What do statistics really tell us about the quality of the data from self-monitoring of blood glucose? Author(s): Dedrick RF, Davis WK. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1989 April; 6(3): 267-73. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2523790
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What is "normalization" of blood glucose? Author(s): Cheraskin E. Source: Southern Medical Journal. 1996 February; 89(2): 256-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8578367
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What is blood glucose: can it be measured? Author(s): Burrin JM, Alberti KG. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1990 MarchApril; 7(3): 199-206. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2139389
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What is the normal range of blood glucose concentrations in healthy term newborns? Author(s): Nicholl R. Source: Archives of Disease in Childhood. 2003 March; 88(3): 238-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12598390
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What is the real contribution of fasting plasma glucose and postprandial glucose in predicting HbA(1c) and overall blood glucose control? Author(s): Caputo S, Pitocco D, Ruotolo V, Ghirlanda G. Source: Diabetes Care. 2001 November; 24(11): 2011. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11679485
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White coat hyperglycaemia: disparity between diabetes clinic and home blood glucose concentrations. Author(s): Campbell LV, Ashwell SM, Borkman M, Chisholm DJ. Source: Bmj (Clinical Research Ed.). 1992 November 14; 305(6863): 1194-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1467722
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Whole blood glucose: what are we actually measuring? Author(s): Wiener K. Source: Annals of Clinical Biochemistry. 1995 January; 32 ( Pt 1): 1-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7762948
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Whole-body glucose metabolism in obese patients with type 2 diabetes mellitus: the impact of hypertension and strict blood glucose control. Author(s): Vestergaard H, Parving HH, Hansen L, Pedersen O. Source: Diabetic Medicine : a Journal of the British Diabetic Association. 1995 February; 12(2): 156-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7743763
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Xenografts of human fetal pancreas regulate blood glucose to human levels. Author(s): Tuch BE. Source: Transplantation Proceedings. 1992 June; 24(3): 977-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1604694
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CHAPTER 2. NUTRITION AND BLOOD GLUCOSE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and blood glucose.
Finding Nutrition Studies on Blood Glucose The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “blood glucose” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following is a typical result when searching for recently indexed consumer information on blood glucose: •
Low blood glucose reactions: a review of the basics. Source: Heckman, M.S. Diabetes-forecast. Alexandria, Va. : American Diabetes Association Inc. August 1995. volume 48 (8) page 28-29. 0095-8301
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The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Author(s): Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy. Source: Franciosi, M Pellegrini, F De Berardis, G Belfiglio, M Cavaliere, D Di Nardo, B Greenfield, S Kaplan, S H Sacco, M Tognoni, G Valentini, M Nicolucci, A Diabetes-Care. 2001 November; 24(11): 1870-7 0149-5992
The following information is typical of that found when using the “Full IBIDS Database” to search for “blood glucose” (or a synonym): •
Effects of electroacupuncture at weiwanxiashu and zusanli points on blood glucose and plasma pancreatic glucagon contents in diabetic rabbits. Author(s): College of Basic Medicine, Chengdu University of TCM, Chengdu 610075. Source: Zeng, Z Li, Y J-Tradit-Chin-Med. 2002 June; 22(2): 134-6 0254-6272
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
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Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
The following is a specific Web list relating to blood glucose; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Vitamins Pyridoxine Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.drkoop.com
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Minerals Biotin Source: Healthnotes, Inc.; www.healthnotes.com Chromium Source: Prima Communications, Inc.www.personalhealthzone.com Selenium Source: Integrative Medicine Communications; www.drkoop.com Vanadium Source: Prima Communications, Inc.www.personalhealthzone.com
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Food and Diet Burdock Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,235,00.html
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Carbo-Loading Diet Source: Healthnotes, Inc.; www.healthnotes.com Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com
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CHAPTER 3. ALTERNATIVE MEDICINE AND BLOOD GLUCOSE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to blood glucose. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to blood glucose and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “blood glucose” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to blood glucose: •
Antidiabetic effect of diasulin, a herbal drug, on blood glucose, plasma insulin and hepatic enzymes of glucose metabolism in hyperglycaemic rats. Author(s): Pari L, Saravanan R. Source: Diabetes, Obesity & Metabolism. 2004 July; 6(4): 286-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15171753
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Aqueous extract of Ocimum canum decreases levels of fasting blood glucose and free radicals and increases antiatherogenic lipid levels in mice. Author(s): Nyarko AK, Asare-Anane H, Ofosuhene M, Addy ME, Teye K, Addo P. Source: Vascular Pharmacology. 2002 December; 39(6): 273-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14567064
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Daily variations of blood glucose, acid-base state and PCO2 in rats: effect of light exposure. Author(s): Challet E, Malan A, Turek FW, Van Reeth O. Source: Neuroscience Letters. 2004 January 23; 355(1-2): 131-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14729252
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Decreased insulitis and blood glucose levels after injection of GAD-transduced lymphocytes into NOD mice. Author(s): Li F, Filippova M, Fagoaga O, Nehlsen-Cannarella S, Escher A. Source: Molecular Therapy : the Journal of the American Society of Gene Therapy. 2002 December; 6(6): 701-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12498766
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Effect of Artemisia santonicum L. on blood glucose in normal and alloxan-induced diabetic rabbits. Author(s): Korkmaz H, Gurdal A. Source: Phytotherapy Research : Ptr. 2002 November; 16(7): 675-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12410552
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Effect of Casearia esculenta root extract on blood glucose and plasma antioxidant status in streptozotocin diabetic rats. Author(s): Prakasam A, Sethupathy S, Pugalendi KV. Source: Polish Journal of Pharmacology. 2003 January-February; 55(1): 43-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856825
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Effect of ficus relegiosa on blood glucose and total lipid levels of normal and alloxan diabetic rabbits. Author(s): Wadood N, Wadood A, Nisar M. Source: J Ayub Med Coll Abbottabad. 2003 October-December; 15(4): 40-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15067832
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Effect of Gymnema montanum on blood glucose, plasma insulin, and carbohydrate metabolic enzymes in alloxan-induced diabetic rats. Author(s): Ananthan R, Latha M, Pari L, Ramkumar KM, Baskar CG, Bai VN. Source: Journal of Medicinal Food. 2003 Spring; 6(1): 43-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804019
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Effect of Hibiscus rosa sinensis Linn. ethanol flower extract on blood glucose and lipid profile in streptozotocin induced diabetes in rats. Author(s): Sachdewa A, Khemani LD. Source: Journal of Ethnopharmacology. 2003 November; 89(1): 61-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14522433
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Effect of oral magnesium supplementation on the lipid profile and blood glucose of patients with type 2 diabetes mellitus. Author(s): Lal J, Vasudev K, Kela AK, Jain SK. Source: J Assoc Physicians India. 2003 January; 51: 37-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12693452
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Effect of specimen collection and storage on blood glucose and lactate concentrations in healthy, hyperthyroid and diabetic cats. Author(s): Christopher MM, O'Neill S. Source: Vet Clin Pathol. 2000; 29(1): 22-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12070820
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Effects of American ginseng berry extract on blood glucose levels in ob/ob mice. Author(s): Xie JT, Aung HH, Wu JA, Attel AS, Yuan CS. Source: The American Journal of Chinese Medicine. 2002; 30(2-3): 187-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12230007
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Effects of electroacupuncture at weiwanxiashu and zusanli points on blood glucose and plasma pancreatic glucagon contents in diabetic rabbits. Author(s): Zeng Z, Li Y. Source: J Tradit Chin Med. 2002 June; 22(2): 134-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12125491
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Effects of Petroselinum crispum extract on pancreatic B cells and blood glucose of streptozotocin-induced diabetic rats. Author(s): Yanardag R, Bolkent S, Tabakoglu-Oguz A, Ozsoy-Sacan O. Source: Biological & Pharmaceutical Bulletin. 2003 August; 26(8): 1206-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913280
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Extract of Ocimum canum lowers blood glucose and facilitates insulin release by isolated pancreatic beta-islet cells. Author(s): Nyarko AK, Asare-Anane H, Ofosuhene M, Addy ME. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 May; 9(4): 346-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12120816
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Increased intestinal permeability as a cause of fluctuating postprandial blood glucose levels in Type 1 diabetic patients. Author(s): Damci T, Nuhoglu I, Devranoglu G, Osar Z, Demir M, Ilkova H. Source: European Journal of Clinical Investigation. 2003 May; 33(5): 397-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12713453
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Inhibitory effect of aqueous extract from the gall of Rhus chinensis on alphaglucosidase activity and postprandial blood glucose. Author(s): Shim YJ, Doo HK, Ahn SY, Kim YS, Seong JK, Park IS, Min BH. Source: Journal of Ethnopharmacology. 2003 April; 85(2-3): 283-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12639753
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The effect of guar gum addition to a semisolid meal on appetite related to blood glucose, in dieting men. Author(s): Kovacs EM, Westerterp-Plantenga MS, Saris WH, Melanson KJ, Goossens I, Geurten P, Brouns F. Source: European Journal of Clinical Nutrition. 2002 August; 56(8): 771-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12122554
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The juice of fresh leaves of Catharanthus roseus Linn. reduces blood glucose in normal and alloxan diabetic rabbits. Author(s): Nammi S, Boini MK, Lodagala SD, Behara RB. Source: Bmc Complementary and Alternative Medicine [electronic Resource]. 2003 September 02; 3(1): 4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12950994
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Two herbal preparations, Cordyceps Cs4 and Cogent db: do they act on blood glucose, insulin sensitivity, and diabetes as “viscous dietary fibers?”. Author(s): Hockaday TD. Source: Journal of Alternative and Complementary Medicine (New York, N.Y.). 2002 August; 8(4): 403-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12230899
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to blood glucose; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Diabetes Source: Healthnotes, Inc.; www.healthnotes.com Diabetes Source: Prima Communications, Inc.www.personalhealthzone.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com High Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com Hypoglycemia Source: Healthnotes, Inc.; www.healthnotes.com Insulin Resistance Syndrome Source: Healthnotes, Inc.; www.healthnotes.com PMS Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com
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Alternative Therapy Massage Source: Integrative Medicine Communications; www.drkoop.com
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Herbs and Supplements Beta-Glucan Source: Healthnotes, Inc.; www.healthnotes.com
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Boswellia Alternative names: Frankincense; Boswellia serrata Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Crataegus Alternative names: Hawthorn; Crataegus oxyacantha L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Dandelion Alternative names: Taraxacum officinale Source: Integrative Medicine Communications; www.drkoop.com Docosahexaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com EDTA Source: Integrative Medicine Communications; www.drkoop.com Ethylenediaminetetraacetic Acid (EDTA) Source: Integrative Medicine Communications; www.drkoop.com Fenugreek Alternative names: Trigonella foenum-graecum Source: Healthnotes, Inc.; www.healthnotes.com Fenugreek Source: Prima Communications, Inc.www.personalhealthzone.com Fructo-Oligosaccharides (FOS) and Other Oligosaccharides Source: Healthnotes, Inc.; www.healthnotes.com Ginkgo Biloba Source: Healthnotes, Inc.; www.healthnotes.com Glimepiride Source: Healthnotes, Inc.; www.healthnotes.com Glipizide Source: Healthnotes, Inc.; www.healthnotes.com Glucomannan Source: Healthnotes, Inc.; www.healthnotes.com Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Glycyrrhiza Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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Gymnema Alternative names: Gurmar; Gymnema sylvestre Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Gymnema Alternative names: Gymnema sylvestre Source: Healthnotes, Inc.; www.healthnotes.com Gymnema Source: Prima Communications, Inc.www.personalhealthzone.com Horehound Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10036,00.html Insulin Source: Healthnotes, Inc.; www.healthnotes.com Insulin Alternative names: Humalog, Humulin, Iletin, Novolin, Velosulin Source: Prima Communications, Inc.www.personalhealthzone.com IP-6 Source: Healthnotes, Inc.; www.healthnotes.com Juniperus Alternative names: Juniper; Juniperus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Luffa Alternative names: Luffa sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Momordica Alternative names: Bitter Gourd, Karela; Momordica charantia Linn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Musa Banana Alternative names: Plantain, Banana; Musa sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Ocimum Alternative names: Basil, Albahaca; Ocimum basilicum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Oral Hypoglycemics Source: Prima Communications, Inc.www.personalhealthzone.com Origanum Alternative names: Oregano; Origanum vulgare Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Plantago Psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Repaglinide Source: Healthnotes, Inc.; www.healthnotes.com Silybum Alternative names: Milk Thistle; Silybum marianum (L.) Gaertn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Smilax Alternative names: Sarsaparilla; Smilax glabra Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Syzygium Clove Alternative names: Clove, Jamun; Syzygium sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Taraxacum Officinale Source: Integrative Medicine Communications; www.drkoop.com Trigonella Alternative names: Fenugreek; Trigonella foenum graecum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON BLOOD GLUCOSE Overview In this chapter, we will give you a bibliography on recent dissertations relating to blood glucose. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “blood glucose” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on blood glucose, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Blood Glucose ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to blood glucose. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
A SELF-CONTROL BEHAVIOR TECHNIQUES COURSE TO INCREASE ADHERENCE TO THE GOAL FOR FREQUENCY OF SELF-MONITORING OF BLOOD GLUCOSE (DIABETES MELLITUS) by JONES, PHYLLIS MARIE, PHD from University of Pittsburgh, 1989, 387 pages http://wwwlib.umi.com/dissertations/fullcit/8921397
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INFLUENCE OF SELF-MONITORING AND VISUAL DISCRIMINATION TRAINING ON CHILDREN'S ACCURACY IN BLOOD GLUCOSE MONITORING (DIABETES, TEACHING STRATEGIES, ERROR ANALYSIS) by KRAUSE, EVELYN RITTER, PHD from University of Denver, 1984, 202 pages http://wwwlib.umi.com/dissertations/fullcit/8500213
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Ingestion of caffeinated coffee impairs blood glucose homeostasis in response to either high or low glycemic index cereals in non-obese males by Kacker, Sita; MSc from University of Guelph (Canada), 2003, 126 pages http://wwwlib.umi.com/dissertations/fullcit/MQ85065
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Mediation and modulation of blood glucose responses to stress by adrenal hormones and brain norepinephrine implications for behavioral responses to stress by Bialik, Robert J; PhD from Carleton University (Canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL39349
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THE EFFECT OF A DIABETES EDUCATION PROGRAM ON SOCIAL SUPPORT, DIABETES KNOWLEDGE LEVEL, BLOOD GLUCOSE LEVEL, AND WEIGHT AMONG NONINSULIN-DEPENDENT DIABETICS by RODRIGUEZ, MAURILIA FLORES, PHD from Texas Woman's University, 1991, 208 pages http://wwwlib.umi.com/dissertations/fullcit/9219649
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THE EFFECT OF BREAKFAST ON THE MOTOR PERFORMANCE AND BLOOD GLUCOSE LEVEL OF UNIVERSITY WOMEN by YARBROUGH, EDNA ISABEL, EDD from University of Arkansas, 1973, 94 pages http://wwwlib.umi.com/dissertations/fullcit/7327392
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The effect of insulin, blood glucose levels and diazepam following transient forebrain ischemia in the rat by Voll, Christopher Laurence; PhD from University of Calgary (Canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54346
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THE EFFECT OF MENSTRUAL CYCLE ON FASTING BLOOD GLUCOSE PATTERNS OF INSULIN DEPENDENT WOMEN WITH DIABETES MELLITUS by KANDT, DENISE CHARMANE, EDD from University of Arkansas, 1992, 159 pages http://wwwlib.umi.com/dissertations/fullcit/9334094
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THE EFFECT OF STRESS INOCULATION TRAINING PROCEDURES ON THE CONTROL OF BLOOD GLUCOSE AND STRESS LEVELS IN INDIVIDUALS WITH DIABETES MELLITUS by AMORY, KEVIN VINCENT, PHD from The University of Iowa, 1987, 103 pages http://wwwlib.umi.com/dissertations/fullcit/8729432
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THE EFFECT OF THE INGESTION OF GLUCOSE AND FRUCTOSE ON BLOOD GLUCOSE CONCENTRATION OF RESTING AND EXERCISING UNIVERSITY STUDENTS by HASSON, SCOTT MATHER, EDD from University of Northern Colorado, 1982, 111 pages http://wwwlib.umi.com/dissertations/fullcit/8301154
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THE EFFECTS OF TIME OF TESTING AND ELEVATED BLOOD GLUCOSE ON COGNITIVE PERFORMANCE (GLUCOSE) by HILL, MARK RANDOLPH, PHD from The University of North Dakota, 1992, 120 pages http://wwwlib.umi.com/dissertations/fullcit/9312404
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THE RELATIONSHIP BETWEEN BLOOD GLUCOSE LEVEL AND READING COMPREHENSION IN DIABETIC CHILDREN by GRUBB, JAMES ALLEN, EDD from The University of Tennessee, 1990, 41 pages http://wwwlib.umi.com/dissertations/fullcit/9121718
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THE ROLE OF BLOOD GLUCOSE IN BINGE EATING BEHAVIOR (EATING DISORDERS) by TOTTEN, DEBORAH PALCZEWSKI, PHD from University of Virginia, 1990, 241 pages http://wwwlib.umi.com/dissertations/fullcit/9023486
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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. PATENTS ON BLOOD GLUCOSE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “blood glucose” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on blood glucose, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Blood Glucose By performing a patent search focusing on blood glucose, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on blood glucose: •
Analyte measurement device and method of use Inventor(s): Bennett; Gregory (Milpitas, CA), Bird; Dennis (San Jose, CA), Haviland; Alan (Morgan Hill, CA), Hufford; William (Milpitas, CA) Assignee(s): Lifescan, Inc. (Milpitas, CA) Patent Number: 6,576,416 Date filed: June 19, 2001 Abstract: Devices, systems, methods and kits are provided for use in determining the concentration of chemical and biochemical components in aqueous fluids. The subject devices include test strips which define a longitudinal axis and include a distal edge configured for insertion into a measurement instrument and having an alignment notch formed in the distal edge for engagement with an alignment member of the measurement instrument. The alignment notch has opposing edges wherein at least a portion of the opposing edges is in substantially parallel relation to the longitudinal axis. In using the subject devices, the devices are inserted into a measurement instrument having an alignment pin. When operatively engaged with the alignment pin, the notch serves to maintain the device in a substantially motionless position. The invention is useful in a variety of applications, particularly in the determination of blood glucose concentrations. Excerpt(s): The present invention is related to the field of medical diagnostic devices for determining the concentration of chemical and biochemical components (analytes) in aqueous fluids. Particularly, the present invention is directed to measuring the concentration of an analyte in, or a property of, a biological fluid such as blood and more particularly glucose in blood. The quantification or assay of chemical and/or biochemical constituents within biological fluids, such as blood, urine, and saliva, and within biological fluid fractions or derivatives such as blood serum and blood plasma, is of ever increasing importance for medical diagnosis and treatment, as well as the quantification of exposure to therapeutic drugs, intoxicants, hazardous chemicals, and the like. One such common application is the measurement of blood glucose levels in diabetics. Widely accepted assays involve measuring a change in a physical characteristic of the fluid being tested or an element of such fluid when exposed to a particular energy source. These physical characteristics are typically an electrical, magnetic, fluidic, or optical property of the fluid or a component thereof. For example, with a colorimetric assay system, an optical property may be monitored wherein a change in light absorption of the fluid can be related to an analyte concentration in, or a property of, the fluid. Web site: http://www.delphion.com/details?pn=US06576416__
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Apparatus and method for adjunct (add-on) neuromodulation with an external stimulator
treatment
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diabetes
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Inventor(s): Boveja; Birinder R. (P.O. Box 210095, Milwaukee, WI 53221) Assignee(s): none reported Patent Number: 6,615,081 Date filed: April 19, 2001 Abstract: A system and method of neuromodulation adjunct (add-on) therapy for Diabetes and blood glucose regulation, comprises an implantable lead-receiver and an external stimulator. Neuromodulation is performed using a pulsed electrical stimulation. The external stimulator contains a power source, controlling circuitry, a primary coil, and predetermined programs. The primary coil of the external stimulator inductively transfers electrical signals to the lead-receiver, which is also in electrical contact with a vagus nerve. The external stimulator emits electrical pulses to stimulate the vagus nerve according to a predetermined program. The patient acts as his/her own feedback loop. In a second mode of operation, an operator may manually override the predetermined sequence of stimulation, based on meal schedule. The external stimulator may also be equipped with a telecommunications module to control the predetermined programs remotely. Excerpt(s): This invention relates generally to medical device therapy for diabetes, more specifically to a medical device system for adjunct therapy of diabetes by neuromodulation of a selected nerve or nerve bundle utilizing an implanted leadreceiver and an external stimulator. Diabetes is a significant health problem affecting millions of Americans. It is the leading risk factor in coronary heart disease and stroke, leading cause of blindness, end-stage renal disease, and a major contributor to lower extremity amputations. Diabetes mellitus is a heterogeneous group of diseases, all of which ultimately lead to hyperglycemia (an elevation of glucose in the blood) and excretion of glucose in the urine as hyperglycemia increases. Diabetes mellitus is also characterized by the inability to reabsorb water, which results in increased urine production (polyuria), excessive thirst (polydipsia), and excessive eating (polyphagia). Nerves have trophic influences on tissues, and the secretion of insulin is stimulated by vagal nerve fibers. Decreased glucose tolerance following vagotomy (interruption of the imulses carried by the vagus nerve) has been reported in human subjects, and sympathetic stimulation via the splanchnic nerve inhibits insulin release. The central nervous system also plays a role in regulating insulin secretion, and the outflow probably occurs via the hypothalamus and the autonomic nervous system. Web site: http://www.delphion.com/details?pn=US06615081__ •
Automatic skin puncturing system Inventor(s): Kelly; Helen V. (1650 Sunset Strip, Sunrise, FL 33313) Assignee(s): none reported Patent Number: 6,530,892 Date filed: March 7, 2001 Abstract: An automatic skin puncturing system that was operable with one hand for allowing individuals with the use of only a single hand to take the blood samples needed to monitor their blood glucose levels. The automatic skin puncturing system
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includes a housing assembly, a power connecting jack, a battery holder, an indexable, motor driven turntable, an index switch, a reed switch, a lancet lifting assembly, a disposable lancet carousel cartridge, and an electronic, micro-processor controlled circuit. Excerpt(s): The present invention relates to medical accessories and more particularly to an automatic skin puncturing system that is operable with one hand to allow an individual paralyzed on one side to take a blood sample from a finger tip for use in blood glucose level monitoring. Many individuals suffer strokes and other paralyzing afflictions that render them paralyzed on one side of their bodies. Such paralysis limits the activities that can be performed by these individuals. In most cases, individuals with the use of only one half of their bodies cannot perform the physicals steps necessary to use a lancet to take a blood sample from their finger tip. Such a limitation can be life threatening for individuals who must monitor their blood glucose level on a regular basis in order to prevent diabetic comas, and other serious consequence of out of limit blood glucose levels. It wold be desirable, therefore, to have an automatic skin puncturing system that was operable with one hand for allowing individuals with the use of only a single hand to take the blood samples needed to monitor their blood glucose levels. It is thus an object of the invention to provide an automatic skin puncturing system that is operable with one hand to allow an individual paralyzed on one side to take a blood sample from a finger tip for use in blood glucose level monitoring. Web site: http://www.delphion.com/details?pn=US06530892__ •
Blood analyte monitoring through subcutaneous measurement Inventor(s): Bonnecaze; Roger T. (Austin, TX), Freeland; Angela C. (Austin, TX) Assignee(s): TheraSense, Inc. (Alameda, CA) Patent Number: 6,579,690 Date filed: July 24, 2000 Abstract: One embodiment of the invention is a method for obtaining an estimate of an analyte concentration in a first fluid. First, measurements of an analyte concentration in a second fluid are obtained using a sensing device. An analyte concentration estimate in the first fluid is determined from these measurements by minimizing the relation: f[b]=x.sup.2 [b]+.lambda.PSI.[b], where b is a vector representing analyte concentration in the first body fluid, X.sup.2 [b] is a function representing a fit between the estimates and the measurements,.lambda. is a weighting function, and.PSI.[b] is a function indicating smoothness of the analyte concentration estimates in the first fluid. Another embodiment includes a sensing device for obtaining the measurements of an analyte concentration in the first fluid and a processor configured and arranged to determine the analyte concentration in the first body fluid according to this method. This method and device can be used, for example, to determine blood glucose concentration from measurements of the glucose concentration in subcutaneous tissue. These measurements may be made using in vitro or in vivo samples. In some instances, a subcutaneously implanted sensing device, such as electrochemical sensor, is used to make the measurements. Excerpt(s): The present invention is, in general, directed to devices and methods for the monitoring of the concentration of an analyte, such as glucose, using a subcutaneous sensor. More particularly, the present invention relates to devices and methods for the
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monitoring of an analyte using a subcutaneous electrochemical sensor to provide information to a patient about the level of the analyte in blood. The monitoring of the level of analytes, such as glucose, lactate or oxygen, in certain individuals is vitally important to their health. High or low levels of these analytes may have detrimental effects. For example, the monitoring of glucose is particularly important to individuals with diabetes, as they must determine when insulin is needed to reduce glucose levels in their bodies or when additional glucose is needed to raise the level of glucose. A variety of methods have been used to measure analyte concentrations. For example, colorimetric, electrochemical, and optical methods have been developed for the determination of blood glucose concentration. Implanted electrochemical sensors may be used to periodically or continuously monitor glucose (or other analyte) concentration. Although sensors accurately measure the glucose concentration when inserted directly into the bloodstream, infection may occur at this implantation site. Web site: http://www.delphion.com/details?pn=US06579690__ •
Chromium picolinate compositions and uses thereof Inventor(s): Chakrin; Lawrence W. (Chatham, NY), de la Harpe; Jon (New York, NY), Komorowski; James R. (Stratford, CT), Price; Fredric D. (Bedford, NY), Skluth; Lauren K. (Goldens Bridge, NY) Assignee(s): Ambi Inc. (Purchase, NY) Patent Number: 6,713,469 Date filed: July 25, 2002 Abstract: Compositions comprising chromic tripicolinate or chromic polynicotinate in combination with at least one of a cyclooxygenase inhibitor, an acid, a mucolytic and a salicin-containing herb. The compositions are useful for supplementing dietary chromium, lowering blood glucose levels, lowering serum lipid levels and increasing lean body mass. Excerpt(s): The present invention relates to compositions comprising chromic tripicolinate or chromic polynicotinate in combination with at least one of a cyclooxygenase inhibitor, acid, mucolytic and salicin-containing herb, and uses of these compositions in lowering blood glucose levels, increasing lean body mass and lowering blood serum lipid levels. Chromium is a nutritionally essential trace element. The essentiality of chromium in the diet was established in 1959 by Schwartz, as cited in Present Knowledge in Nutrition, page 571, fifth edition (1984, the Nutrition Foundation, Washington, D.C.). Chromium depletion is characterized by the disturbance of glucose, lipid and protein metabolism and by a shortened lifespan. Chromium is essential for optimal insulin activity in all known insulin-dependent systems (Boyle et al., Southern Med. J. 70:1449-1453, 1977). Insufficient dietary chromium has been linked to both maturity-onset diabetes and to cardiovascular disease. The principle energy sources for the body are glucose and fatty acids. Chromium depletion results in biologically ineffective insulin and compromised glucose metabolism. Under these conditions, the body must rely primarily on lipid metabolism to meet its energy requirements, resulting in the production of excessive amounts of acetyl-CoA and ketone bodies. Some of the documented acetyl-CoA is converted to increased cholesterol biosynthesis, resulting in hypercholesterolemia. Diabetes mellitus is characterized in large part by glycosuria, hypercholesterolemia, and often ketoacidosis. The accelerated atherosclerotic process seen in diabetics is associated with hypercholesterolemia (Boyle et al., supra.).
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Combination therapy for type II diabetes or Syndrome X Inventor(s): Gwynne; John Thomas (Doylestown, PA), Randazzo; Bruce Paul (Rydal, PA), Vitou; Philippe John Robert (Paris, FR) Assignee(s): Wyeth (Madison, NJ) Patent Number: 6,734,197 Date filed: June 6, 2002 Abstract: This invention provides methods of using a pharmacological combination of a biguanide agents, such as metformin, and one or more PTPase inhibiting agents and, optionally, one or more sulfonlylurea agents, including glyburide, glyburide, glipizide, glimepiride, chlorpropamide, tolbutamide, or tolazamide, for treatment in a mammal of Syndrome X, type II diabetes or metabolic disorders mediated by insulin resistance or hyperglycemia. Further included in this invention is a method of modulating blood glucose levels in a mammal utilizing the combination of one or more PTPase inhibiting agents and one or more sulfonlylurea agents. Excerpt(s): This invention relates to pharmaceutical combinations of PTPase inhibiting compounds, a biguanide agent and, optionally, a sulfonylurea agent. Particularly, this invention concerns methods of treating or inhibiting type II diabetes or Syndrome X and related conditions in a mammal in need of such treatment utilizing combinations of these classes of pharmacological agents. The prevalence of insulin resistance in glucose intolerant subjects has long been recognized. Reaven et al (American Journal of Medicine 1976, 60, 80) used a continuous infusion of glucose and insulin (insulin/glucose clamp technique) and oral glucose tolerance tests to demonstrate that insulin resistance existed in a diverse group of nonobese, nonketotic subjects. These subjects ranged from borderline glucose tolerant to overt, fasting hyperglycemia. The diabetic groups in these studies included both insulin dependent (IDDM) and noninsulin dependent (NIDDM) subjects. Coincident with sustained insulin resistance is the more easily determined hyperinsulinemia, which can be measured by accurate determination of circulating plasma insulin concentration in the plasma of subjects. Hyperinsulinemia can be present as a result of insulin resistance, such as is in obese and/or diabetic (NIDDM) subjects and/or glucose intolerant subjects, or in IDDM subjects, as a consequence of over injection of insulin compared with normal physiological release of the hormone by the endocrine pancreas. Web site: http://www.delphion.com/details?pn=US06734197__
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Composition and method for maintaining blood glucose level Inventor(s): Dhawan; Sanju (Chandigarh, IN), Singla; Anil Kumar (Chandigarh, IN) Assignee(s): Council of Scientific & Industrial Research (New Delhi, IN) Patent Number: 6,703,045 Date filed: August 21, 2001 Abstract: A composition useful for reducing serum glucose levels by an oral controlled release system and a method for treating diabetes in a human being by controlling the blood glucose level (BGL) and reducing the complications associated with diabetic
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hyperglycemia and also the long term management of Non-Insulin Dependent Diabetes Mellitus (NIDDM) by avoiding the problems associated with the tight control of BGL, i.e., hypoglycemia tolerance and seizures. The composition is directed to a solid, hydrophilic matrix controlled release oral dosage form where the dosage form contains a therapeutically effective amount of antidiabetic drug in the matrix ensuring complete bioavailability of the drug from the matrix of the tablet. The formulation undergoes substantially or approaches zero order release of active drug and the concentration of the excepients and the water swellable polymers is chosen in such a way that the erosion or dissolution rate of the polymer is equal to the swelling rate of the polymer to get a constant release. Also, the concentration is chosen in such a way that the tablet will be fully dissolved at the same time the last of the drug is released and in addition a bioadhesive polymer may also be added to increase the residence time of the dosage form in the g.i.t. and at high concentration of the polymer, beta cyclodextrin may also be added to improve the release kinetics. Excerpt(s): (1) American Diabetes Association. Diabetes 1996 Vital Statistics. Rockville, Md.: American Diabetes Association, 1996. (2) Harris, M. I., Cowie, C. C., Stern, M. P. eds. Diabetes in America, 2nd. ed. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. NIH Publication No. 95-1468, 1995. (3) Clark, C. M., Vinicor, F. Introduction: Risks and benefits of intensive management in non-insulin-dependent diabetes mellitus. The Fifth Regensrief Conference. Ann Intern Med, 124(1, pt 2), 81-85, 1996. Web site: http://www.delphion.com/details?pn=US06703045__ •
Compounds to treat diabetes and associated conditions Inventor(s): Dey; Debendranath (Fremont, CA), Lakner; Frederick J. (Hayward, CA), Medicherla; Satyanarayana (Sunnyvale, CA), Nag; Bishwajit (Fremont, CA), Neogi; Partha (Fremont, CA) Assignee(s): Calyx Therapeutics Inc. (Hayward, CA) Patent Number: 6,525,093 Date filed: November 8, 1999 Abstract: Compounds are provided that lower blood glucose concentrations, lower serum triglyceride concentrations, lower systolic blood pressure, and increase glucose uptake by adipose tissue, but do not affect the expression of PPAR-.gamma. by adipose tissue. Excerpt(s): The present application is directed to novel antidiabetic compounds. The causes of Type I and Type II diabetes are still unknown, although both genetic and environmental factors seem to be involved. Type I diabetes (or insulin-dependent diabetes) is an autonomic immune disease in which the responsible autoantigen is still unknown. Patients with Type I diabetes need to take insulin intravenously to survive. Type II diabetes (formerly referred to as non-insulin dependent diabetes) is a metabolic disorder resulting from the body's inability either to make a sufficient amount of insulin or to properly use the insulin that is produced. Insulin secretion and insulin resistance are considered the major metabolic defects, but the precise genetic factors involved remain unknown. As is apparent from the above table, there are disadvantages to each of the currently available agents for use in the treatment of diabetes. Accordingly, there is a continuing interest in the identification and development of new agents, particularly orally administered, water-soluble agents that can be used for the treatment of diabetes.
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Device and method for enhancing transdermal flux of agents being sampled Inventor(s): Cormier; Michel J. N. (278 Andsbury Ave., Mountain View, CA 94043), Theeuwes; Felix (27350 Altamont Rd., Los Altos Hills, CA 94022) Assignee(s): none reported Patent Number: 6,537,264 Date filed: December 16, 1999 Abstract: A minimally invasive transdermal agent sampling device (2, 10) comprises a sheet (6) having a plurality of openings (8) and a plurality of microblades (4) for piercing the skin (20). A suction device (10) applies a negative pressure through the openings (8) to the microslits in the skin (20) for enhanced efflux of interstitial fluid. The device (2, 10) can be used for transdermal sampling of body analytes such as glucose for measuring/estimating blood glucose concentration. Excerpt(s): The present invention relates to transdermal agent sampling. More particularly, this invention relates to the transdermal sampling of agents, such as glucose, body electrolytes and substances of abuse, such as but not limited to alcohol and illicit drugs. The present invention uses skin-piercing microblades to enhance the transdermal flux of the agents during transdermal sampling. Obtaining a droplet of blood for the purpose of sampling a constituent (e.g., glucose) is commonly achieved by piercing the skin using a lancet or other blade-like element. Many such skin piercing devices are spring-driven so that the piercing is accomplished automatically by a pen or similar spring-loaded device. See for example, Suzuki et al. U.S. Pat. No. 5,368,047. Many blood sampling devices also apply suction to the wound following piercing by the lancet. The suction assists in obtaining a blood sample of appropriate size for testing blood components such as glucose. See for example, Suzuki et al. U.S. Pat. No. 5,368,047; Swierczek U.S. Pat. No. 5,054,499; Ishibashi U.S. Pat. No. 5,320,607; Haber et al., U.S. Pat. No. 5,231,993; and Swierczek U.S. Pat. No. 5,201,324. Web site: http://www.delphion.com/details?pn=US06537264__
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Device and method for obtaining interstitial fluid from a patient for diagnostic tests Inventor(s): Henning; Timothy P. (Vernon Hills, IL), Lowery; Michael G. (Wildwood, IL) Assignee(s): Abbott Laboratories (Abbott Park, IL) Patent Number: 6,537,243 Date filed: October 12, 2000 Abstract: A device for obtaining a sample of interstitial fluid from a patient for use in monitoring the level of blood glucose in the patient. The device comprises a hollow tube having a wall surrounding a cavity, wherein the wall of the tube contains a multiplicity of pores. Excerpt(s): This invention relates to a device and a method for obtaining interstitial fluid from the body of a patient for use in a diagnostic test. More particularly, this invention relates to a device and a method for obtaining interstitial fluid from the body of a patient at a rapid rate of collection. Interstitial fluid is the substantially clear, substantially colorless fluid found in the human body that occupies the space between
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the cells of the human body. Several methods have been used to obtain interstitial fluid from the body of a patient for diagnostic tests. Diagnostic tests that can be run with samples of interstitial fluid include, but are not limited to, glucose, creatinine, BUN, uric acid, magnesium, chloride, potassium, lactate, sodium, oxygen, carbon dioxide, triglyceride, and cholesterol. It is much more difficult to obtain a sample of interstitial fluid from the body of a patient than it is to obtain a sample of blood from the body of a patient. Blood is pumped under pressure through blood vessels by the heart. Consequently, a cut in a blood vessel will naturally lead to blood flowing out of the cut because the blood is flowing under pressure. Interstitial fluid, which is not pumped through vessels in the body, is under a slight negative pressure. Moreover, the amount of interstitial fluid that can be obtained from a patient is small because this fluid only occupies the space between the cells of the human body. Currently available methods for obtaining large amounts of interstitial fluid are unsatisfactory, because these methods are accompanied by undesirable side effects. Web site: http://www.delphion.com/details?pn=US06537243__ •
Device for isolating regions of living tissue Inventor(s): Agostino; Mark D. (Alameda, CA), Braig; James R. (Piedmont, CA), Cortella; Julian (Alameda, CA), Goldberger; Daniel S. (Boulder, CO), Rule; Peter (Los Altos Hills, CA) Assignee(s): OptiScan Biomedical Corporation (Alameda, CA) Patent Number: 6,631,282 Date filed: October 2, 2001 Abstract: A device and method are provided for use with a non-invasive optical measurement system, such as a thermal gradient spectrometer for improved determination of analyte concentrations within living tissue. In a preferred embodiment, a site selector is secured to a patient's forearm thereby isolating a measurement site on the patient's skin for determination of blood glucose levels. The site selector attaches to a thermal mass window of the spectrometer and thus forms an interface between the patient's skin and the thermal mass window. When the spectrometer must be temporarily removed from the patient's skin, such as to allow the patient mobility, the site selector is left secured to the forearm so as to maintain a consistent measurement site on the skin. When the spectrometer is later reattached to the patient, the site selector will again form an interface between the gradient spectrometer and the same location of skin as before. Excerpt(s): This invention relates generally to determining analyte concentrations within living tissue. More particularly, this invention relates to a device for isolating regions of living tissue for consistent transfer of thermal spectra to and from the tissue. Millions of diabetics are forced to draw blood on a daily basis to determine their blood glucose levels. A search for a non-invasive methodology to accurately determine blood glucose levels has been substantially expanded in order to alleviate the discomfort of these individuals. A significant advance in the state of the art of non-invasive blood glucose analysis has been realized by an apparatus taught in U.S. Pat. No. 6,198,949, titled SOLID-STATE NON-INVASIVE INFRARED ABSORPTION SPECTROMETER FOR THE GENERATION AND CAPTURE OF THERMAL GRADIENT SPECTRA FROM LIVING TISSUE, issued Mar. 6, 2001, and by methodology taught in U.S. Pat. No. 6,161,028, titled METHOD FOR DETERMINING ANALYTE CONCENTRATION USING PERIODIC TEMPERATURE MODULATION AND PHASE DETECTION,
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issued Dec. 12, 2000, both of which are hereby incorporated in their entirety by reference. U.S. Pat. No. 6,198,949 discloses a spectrometer for non-invasive transfer of thermal gradient spectra to and from living tissue. The spectrometer includes an infrared transmissive thermal mass, referred to as a thermal mass window, for inducing a transient temperature gradient in the tissue by means of conductive heat transfer with the tissue, and a cooling system in operative combination with the thermal mass for the cooling thereof. Also provided is an infrared sensor for detecting infrared emissions from the tissue as the transient temperature gradient progresses into the tissue, and for providing output signals proportional to the detected infrared emissions. A data capture system is provided for sampling the output signals received from the infrared sensor as the transient temperature gradient progresses into to the tissue. The transient thermal gradients arising due to the intermittent heating and cooling of the patient's skin generate thermal spectra which yield very good measurements of the patient's blood glucose levels. Web site: http://www.delphion.com/details?pn=US06631282__ •
Device for signal processing for measurement of physiological analytes Inventor(s): Berner; Bret (El Granada, CA), Dunn; Timothy C. (Menlo Park, CA), Farinas; Kathleen C. (San Carlos, CA), Garrison; Michael D. (Seattle, WA), Kurnik; Ronald T. (Foster City, CA), Lesho; Matthew J. (San Mateo, CA), Potts; Russell O. (San Francisco, CA), Tamada; Janet A. (Mountain View, CA), Tierney; Michael J. (San Jose, CA) Assignee(s): Cygnus, Inc. (Redwood City, CA) Patent Number: 6,595,919 Date filed: February 27, 2001 Abstract: A method is provided for continually or continuously measuring the concentration of target chemical analytes present in a biological system, and processing analyte-specific signals to obtain a measurement value that is closely correlated with the concentration of the target chemical analyte in the biological system. One important application of the invention involves a method for signal processing in a system for monitoring blood glucose values. Excerpt(s): The invention relates generally to methods for continually or continuously measuring the concentration of target chemical analytes present in a biological system. More particularly, the invention relates to methods for processing signals obtained during measurement of physiological analytes. One important application of the invention involves a method for monitoring blood glucose concentrations. A number of diagnostic tests are routinely performed on humans to evaluate the amount or existence of substances present in blood or other body fluids. These diagnostic tests typically rely on physiological fluid samples removed from a subject, either using a syringe or by pricking the skin. One particular diagnostic test entails self-monitoring of blood glucose levels by diabetics. Diabetes is a major health concern, and treatment of the more severe form of the condition, Type I (insulin-dependent) diabetes, requires one or more insulin injections per day. Insulin controls utilization of glucose or sugar in the blood and prevents hyperglycemia which, if left uncorrected, can lead to ketosis. On the other hand, improper administration of insulin therapy can result in hypoglycemic episodes, which can cause coma and death. Hyperglycemia in diabetics has been correlated with several long-term effects of diabetes, such as heart disease, atherosclerosis, blindness, stroke, hypertension and kidney failure.
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Web site: http://www.delphion.com/details?pn=US06595919__ •
Diphenylethylene compounds Inventor(s): Dey; Debendranath (Fremont, CA), Medicherla; Satyanarayana (Cupertino, CA), Nag; Bishwajit (Fremont, CA) Assignee(s): Calyx Therapeutics, Inc. (Hayward, CA) Patent Number: 6,624,197 Date filed: August 17, 2000 Abstract: Novel diphenylethylene and styrenes are provided which are administered orally to decrease blood glucose levels in rats. The glucose tolerance in insulin resistant rats is also shown, as well as lowering of triglyceride levels in serum insulin resistant, hyperinsulinemic and hypertriglycedemic rats. The compounds are orally effective antidiabetic agents that potentially may reduce abnormality of glucose and lipid metabolism in diabetes. Excerpt(s): The field of the invention is novel diphenylethylene compounds and their use for treatment of diabetes. Extracts of the leaves, flowers, and gum of the tree Pterocarpus marsupium Roxb. (Leguminosae), also known as the Indian Kino Tree, have been used traditionally for the treatment of diarrhea, toothaches, fever and urinary and skin infections. Extracts of the bark have been long regarded as useful for the therapy of diabetes. Hypoglycemic activity of a naturally occurring pterostilbene, trans1-(3,5-dimethoxyphenyl)-2-(4-hydroxyphenyl)-ethylene, isolated from the heartwood of pterocarpus marsupium as been reported by Manickam et al., J. Nat. Prod., 1997, 60:609610. However, this pterostilbene is water insoluble and has not been shown to be efficacious in the treatment of diabetes, particularly in instances where insulin is present but inactive. The cause of diabetes is yet unknown, although both genetics and environment appear to be factors. Insulin dependent (Type I) and non-insulin dependent (Type II) are the types of diabetes. Type I is an autonomic immune disease in which the responsible autoantigen is still unknown. Patients of Type I need to take insulin intravenously to survive. However, Type II diabetes, the more common form of the disease, is a metabolic disorder resulting from the body's inability to make a sufficient amount of insulin or to properly use the insulin that is produced within the body. Insulin secretion and insulin resistance are considered the major defects, however, the precise genetic factors involved in the mechanism remain unknown. Web site: http://www.delphion.com/details?pn=US06624197__
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Disposable lancet combined with a reagent carrying strip and a system for extracting and analyzing blood in the body utilizing such a disposable lancet Inventor(s): Klitmose; Lars Peter (Gentofte, DK) Assignee(s): Novo Nordisk A/S (Bagsvaerd, DK) Patent Number: 6,620,112 Date filed: March 14, 2001 Abstract: A disposable lancet combined with a reagent carrying strip which carries a reagent that indicates the concentration of a blood component in a blood sample placed in contact with the strip. The reagent carrying strip is connected to the lancet, e.g. by
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molding. One end of the lancet is sharpened for piercing the skin. The strip is sheet-like and has a first side and a second side, which sides are both accessible for the user, such that the reagent carrying strip can be inserted into a blood glucose meter. A weakened tear line is provided at a connection between the lancet and an edge of the reagent carrying strip so that the reagent carrying strip may be easily disconnected from the lancet. Excerpt(s): The invention relates to a disposable lancet combined with a reagent carrying-strip. The lancet has a sharp distal end for piercing the skin of a user, and a reagent carrying strip, which reacts to a blood sample. The invention furthermore relates to a system for extracting and analysing blood in a body utilizing a disposable lancet in combination with a reagent carrying strip. Patients with certain illnesses like diabetes must verify several times a day the sugar content of their blood. This is often done by placing a drop of blood on to a reagent carrying strip, which causes the reactive reagent on the strip to react with the blood. Usually the reagent carrying strip carries an enzyme that reacts with the blood component to be measured. The result of the test is read by a blood g lucose meter before or/and after applying blood. Most such blood glucose meters on the market today either read the change of colour due to the chemical reaction, or read the current produced from the chemical reaction between reagent or blood glucose. Web site: http://www.delphion.com/details?pn=US06620112__ •
Glucose measurement utilizing non-invasive assessment methods Inventor(s): Berman; Herbert L. (Los Altos Hills, CA), Blair; Robert N. (San Jose, CA), Roe; Jeffrey N. (San Ramon, CA) Assignee(s): MedOptix, Inc. (Cupertino, CA) Patent Number: 6,522,903 Date filed: October 19, 2000 Abstract: This involves non-invasive glucose measurement processes for determining blood glucose level in the human body. After achieving a static level of glucose at a surface of the skin over some period of time, the glucose may then be measured by a variety of different processes. A sample of the glucose may also first be extracted from the skin and this sample may then be measured. Clearly, these processes are especially suitable for monitoring glucose levels in the human body, and is especially beneficial to users having diabetes mellitus. These procedures may be used for other analyte materials that are found in appropriate regions of the outer skin. Excerpt(s): This invention involves non-invasive glucose measurement and a process for determining blood glucose levels in the human body. Preferably, the process is used on a fingertip or other part of the body, typically a skin surface of the body. The American Diabetes Association reports that nearly 6% of the population in the United States, a group of 16 million people, has diabetes. The Association further reports that diabetes is the seventh leading cause of death in the United States, contributing to nearly 200,000 deaths per year. Diabetes is a chronic disease having no cure. The complications of the disease include blindness, kidney disease, nerve disease, and heart disease, perhaps with stroke. Diabetes is said to be the leading cause of new cases of blindness in individuals in the range of ages between 20 and 74; from 12,000-24,000 people per year lose their sight because of diabetes. Diabetes is the leading cause of end-stage renal disease, accounting for nearly 40% of new cases. Nearly 60-70% of people with diabetes
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have mild to severe forms of diabetic nerve damage which, in severe forms, can lead to lower limb amputations. People with diabetes are 2-4 times more likely to have heart disease and to suffer strokes. Diabetes is a disease in which the body does not produce or properly use insulin, a hormone needed to convert sugar, starches, and the like into energy. Although the cause of diabetes is not completely understood, genetics, environmental factors, and viral causes have been partially identified. Web site: http://www.delphion.com/details?pn=US06522903__ •
Implantable blood glucose sensor system Inventor(s): Eglise; David (Snowdrop Villas, 53 Alma Road, Windsor, Berkshire SL4 3HH, GB) Assignee(s): none reported Patent Number: 6,579,498 Date filed: October 11, 2000 Abstract: An implanted sensing device (1) for monitoring an analyte (e.g. blood-glucose) includes a non-toxic macromolecular material (2) encapsulated within an envelope (3) of bio-compatible semi-permeable membrane. A sensor (4) responds to change of a physical property (e.g. viscosity) of the material (2) when the analyte contacts the material (2), to signal the change to a measurement circuit (5) that together with the sensor (4) and a transponder (6) are included within the envelope (3). The transponder (6) is interrogated externally of the implanted sensor (1) by an interrogation unit (7) to transmit measurement data for processing and storage. The interrogation signal is utilized within the device (1) to power the circuit (5) and transponder (6) and conveys data to the device for re-calibration or resetting of signal-datum values to compensate for aging or drift. Excerpt(s): This invention relates to sensing devices and systems, and is particularly concerned with sensing devices and systems for use in monitoring the presence or activity of specific chemical analytes. According to one aspect of the present invention a sensing device for use in monitoring the presence or activity of a specific chemical analyte, comprises an enclosure having a membrane-wall that is semi-permeable to said chemical analyte, macromolecular material contained within the enclosure, said material exhibiting physical change in response to contact with said chemical analyte, a sensor contained within the enclosure to respond to said physical change, and means for transmitting a signal from said sensing device dependent on the response of said sensor. The sensing device according to the invention is especially applicable for monitoring the presence or level of activity of a specific bio-chemical, drug or other analyte in vivo, within the body of a human or animal patient. In this context the sensing device may be provided for implant subcutaneously or otherwise within the patient so that the particular analyte can be sensed as it permeates the semi-permeable wall of the device. Web site: http://www.delphion.com/details?pn=US06579498__
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Insoluble compositions for controlling blood glucose Inventor(s): Brader; Mark Laurence (Indianapolis, IN) Assignee(s): Eli Lilly and Company (Indianapolis, IN) Patent Number: 6,531,448 Date filed: December 21, 1998 Abstract: The present invention relates to insoluble compositions comprising a protein selected from the group consisting of insulin, insulin analogs, and proinsulins; a derivatized protein selected from the group consisting of derivatized insulin, derivatized insulin analog, and derivatized proinsulin; a complexing compound; a hexamer-stabilizing compound; and a divalent metal cation. Formulations of the insoluble composition are suitable for both parenteral and non-parenteral delivery for treating hyperglycemia and diabetes. Microcrystal forms of the insoluble precipitate are pharmaceutically analogous to the neutral protamine Hagedorn (NPH) insulin crystal form. Surprisingly, it has been discovered that suspension formulations of such insoluble compositions possess unique and controllable dissolution properties that provide therapeutically advantageous glucodynamics compared with insulin NPH formulations. Excerpt(s): This invention is in the field of human medicine. More particularly, this invention is in the field of pharmaceutical treatment of the diseases of diabetes and hyperglycemia. It has long been a goal of insulin therapy to mimic the pattern of endogenous insulin secretion in normal individuals. The daily physiological demand for insulin fluctuates and can be separated into two phases: (a) the absorptive phase requiring a pulse of insulin to dispose of the meal-related blood glucose surge, and (b) the post-absorptive phase requiring a sustained delivery of insulin to regulate hepatic glucose output for maintaining optimal fasting blood glucose. Accordingly, effective therapy for people with diabetes generally involves the combined use of two types of exogenous insulin formulations: a rapid acting meal time insulin provided by bolus injections and a long-acting, so-called, basal insulin, administered by injection once or twice daily to control blood glucose levels between meals. An ideal basal insulin will provide an extended and "flat" time action--that is, it will control blood glucose levels for at least 12 hours, and preferably for 24 hours or more, without significant risk of hypoglycemia. Furthermore, an ideal basal insulin should be mixable with a soluble meal-time insulin, and should not cause irritation or reaction at the site of administration. Finally, basal insulin preparations that are suspension formulations should be able to be readily, and uniformly resuspended by the patient prior to administration. Web site: http://www.delphion.com/details?pn=US06531448__
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Insulin-dose calculator disk Inventor(s): Glaser; Nichole (937 Eucalyptus St., Davis, CA 95616) Assignee(s): none reported Patent Number: 6,543,682 Date filed: May 3, 2000 Abstract: This is a manual circular calculator for determining an appropriate insulin injection dosage to be taken with a meal. Preferably, the calculator has a pair of circular
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members which rotate around a single common center to allow calculation of the dosage. The front member includes a viewing panel showing an array of insulin injection dosage values that are printed on the rear circular member. The front member includes a series of measured blood glucose levels along a radius adjacent the viewing panel. The rear member typically has visible ingested carbohydrate values positioned along the outer perimeter of the member and, as noted above, a number of insulin injection dosage value arrays which become visible as one member is turned relative to the other. It is common that a physician would have a kit of these inventive devices, so that the appropriate one could be chosen depending on the insulin sensitivity, age, and size of the patient. In using the inventive calculator, a patient measures his or her blood glucose level and determines the weight of carbohydrates to be ingested at a particular meal. The carbohydrate ingestion is found on the outer perimeter of the back member of the device, the front member of the inventive device is turned so that an array of insulin values is visible, and the appropriate blood glucose level is read along the radius of the front circular member. The corresponding insulin injection dosage is seen in the window. Excerpt(s): This invention is a manual circular calculator for determining an appropriate insulin injection dosage to be taken with a meal. Preferably, the calculator has a pair of circular members which rotate around a single common center to allow calculation of the dosage. The front member includes a viewing panel showing an array of insulin injection dosage values which are printed on the rear circular member. The front member includes a series of measured blood glucose levels along a radius adjacent the viewing panel. The rear member typically has visible ingested carbohydrate values positioned along the outer perimeter of the member and, as noted above, a number of insulin injection dosage value arrays which become visible as one member is turned relative to the other. It is common that a physician would have a kit of these inventive devices, so that the appropriate one could be chosen depending on the insulin sensitivity, age, and size of the patient. In using the inventive calculator, a patient measures his or her blood glucose level and determines the weight of carbohydrates to be ingested at a particular meal. The carbohydrate ingestion is found on the outer periameter of the back member of the device, the front member of the inventive device is turned so that an array of insulin values is visible, and the appropriate blood glucose level is read along the radius of the front circular member. The corresponding insulin injection dosage is seen in the window. The American Diabetes Association reports that nearly six percent (6%) of the population in the United States, a group of about 16 million people, has diabetes. A significant number of these people do not know they have the disease. The Association further reports that diabetes is the seventh leading cause of death in the United States, contributing to nearly two hundred thousand deaths per year. Diabetes is a chronic disease having no known cure. The complications of the disease include blindness, kidney disease, nerve disease, and heart disease, perhaps with stroke. Diabetes is said to be the leading cause of new cases of blindness in individuals between the ages of twenty and seventy-four. Perhaps twelve to twenty-four thousand people per year lose their sight because of diabetes. Diabetes is the leading cause of end-stage renal disease, accounting for nearly forty percent of new cases. Nearly sixty to seventy percent of those with diabetes have mild to severe forms of diabetic nerve damage which, in severe forms, can lead to lower limb amputations. People with diabetes are two-to-four times more likely to have heart disease and to suffer strokes. Web site: http://www.delphion.com/details?pn=US06543682__
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Limiting weight gain of cats by feeding carbohydrate source that excludes rice Inventor(s): Sunvold; Gregory D. (Eaton, OH) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 6,630,159 Date filed: March 27, 2001 Abstract: A process is provided for limiting weight gain in cats. The process includes feeding the cat a pet food composition that includes a source of protein, a source of fat, and a source of carbohydrates from a grain source that excludes rice. Use of preferred low glycemic index grain sources that comprise a blend of corn and sorghum; a blend of corn, sorghum, and barley; or a blend of corn, sorghum, and oats, has the effect of decreasing the postprandial blood glucose and insulin response of the cat as compared to when feeding a rice-based diet. The result is that the animal becomes satiated and voluntarily decreases its intake of food, causing less weight gain. This effect is even more marked when the composition is fed to male cats. Excerpt(s): This invention relates to a process of administering a pet food composition to prevent obesity in companion animals, such as cats and dogs. More particularly, the invention relates to a process for limiting weight gain in cats. The invention is further directed to a process for decreasing the postprandial blood glucose and insulin response in cats to promote satiety and a voluntary decrease in food intake. Obesity is a significant health concern in companion animals. Veterinary care professionals have reported that approximately 20-40% of the pets in their care are overweight. These animals bear a greater risk for health problems associated with the respiratory, cardiovascular, and skeletal systems. More particularly, obese feline patients have demonstrated greater susceptibility to diseases such as diabetes mellitus, osteoarthritis, ligament injuries, perineal dermatitis, cardiomyopathy, and hepatic lipidosis. Accordingly, new technologies meeting the health needs of obese feline patients are in high demand by pet owners and veterinarians alike. The causes of feline obesity include sedentary lifestyle and confinement indoors, as well as improper nutrition, genetic predisposition, and hormonal disorders such as thyroid and pituitary gland dysfunction. Moreover, spayed and neutered cats often exhibit a decrease in their physical activity and metabolism and therefore, have a greater tendency to gain weight. Web site: http://www.delphion.com/details?pn=US06630159__
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Liquid formulation of metformin Inventor(s): Chandran; Ravi (Bolton Landing, NY), Gogia; Ashish (New Delhi, IN) Assignee(s): Ranbaxy Signature LLC (Princeton, NJ) Patent Number: 6,559,187 Date filed: August 7, 2001 Abstract: The present invention is directed to a liquid formulation of metformin or its pharmaceutically acceptable salts thereof. The liquid pharmaceutical composition comprises a therapeutically effective amount of metformin or its pharmaceutically acceptable salt, in a liquid carrier, which may also include a sweetener that does not increase the blood glucose level of a subject after ingestion thereof. In one embodiment, it may also include alkyl hydroxyethylcellulose, and/or a polyhydroxy alcohol. In
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another embodiment, the carrier may contain a sweetener, mineral acid, and bicarbonate salt maintained at a pH of 4.0 to 9.0. It is useful for treating hyperglycemia and diabetes. Excerpt(s): The present invention relates to a liquid formulation of metformin and salts thereof and to the use thereof in treating hyperglycemia and/or diabetes. Diabetes Mellitus is the most common of the serious metabolic diseases affecting humans. It has been estimated that there are over 200 million people that have diabetes in the world. Metabolically, diabetes is characterized by an inappropriate elevation of blood glucose levels. In Type I Diabetes Mellitus, this is due to an absence of insulin in the individual. In Type II Diabetes Mellitus, although there is circulating insulin, its signal is not efficiently transduced via the insulin receptor, giving rise to insulin resistance, where the body responds less and less well to a given amount of insulin. Insulin is a peptide hormone which is produced by the Langerhorn islets in the pancreas. Insulin triggers increased glucose utilization, protein synthesis, and the formation and storage of neutral lipids. The present invention focuses on Type II Diabetes Mellitus, or non-insulindependent diabetes. Web site: http://www.delphion.com/details?pn=US06559187__ •
Method and apparatus for non-invasive analysis of blood glucose Inventor(s): Fuller; Milton E. (Reno, NV) Assignee(s): Pindi Products, Inc. (Reno, NV) Patent Number: 6,723,048 Date filed: June 24, 2002 Abstract: An apparatus for non-invasive detection and quantitation of analytes in a sample, such as blood glucose, employs a novel amplifier that uses high-gauss permanent magnets to permit an Rf signal to be transmitted through the sample. The concentration of the analyte can be determined from the magnitude of the reduction in the amplitude of the Rf signal at a characteristic frequency. Excerpt(s): The present invention relates to an apparatus for noninvasive testing and monitoring of biological molecules such as glucose. Diabetes mellitus is a medical condition in which the body does not adequately produce the quantity or quality of insulin needed to maintain normal levels of glucose in the circulating blood. The two most common types of diabetes are type I, also known as Insulin Dependent Diabetes Mellitus (IDDM), which accounts for 5-10% of all cases, and type II or Non-Insulin Dependent Diabetes Mellitus (NIDDM), which accounts for 90-95% of all cases. IDDM occurs in childhood, and those suffering from the disease require insulin doses throughout their lives. NIDDM generally occurs in adults and, although insulin may be required, the disease may be controllable with oral medication, weight loss, a nutritious diet and a regular exercise program. Diabetes affects about 16 million people in the U.S. and over 100 million people worldwide. Diabetes can lead to severe health complications associated with the accumulated affects of poor blood glucose control, including blindness, kidney failure, heart failure, and peripheral neuropathy associated with limb pain, poor circulation, gangrene and subsequent amputation (Davidson, Diabetes Mellitus--Diagnosis and Treatment, 3rd Edition, Churchill Livingstone, N.Y., 1991). As a result, frequent self-monitoring of blood glucose is crucial for effective treatment and for reducing diabetes-associated morbidity and mortality. Web site: http://www.delphion.com/details?pn=US06723048__
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Method for controlling the membrane structure of a starch granule Inventor(s): Chawan; Dhyaneshwar B. (Liverpool, NY) Assignee(s): Heartland Health Solutions, LLC (Brentwood, TN) Patent Number: 6,720,312 Date filed: March 16, 2001 Excerpt(s): The invention relates to a method for treating patients with type 2 diabetes using a food composition able to control the release of glucose into the patient's blood. This is achieved by the introduction into the food composition of an additive, such as propylene glycol alginate, which reduces the cooking losses and enhances the starch cell wall membrane to thereby slow the enzymatic hydrolysis of the gelatinized starch by insulin. The result is a steady state release of glucose and a net reduction in the release of blood glucose (glycemic index) relative to release of glucose observed in a diabetes patient having consumed a food composition without propylene glycol alginate. In diabetic people either there is insufficient insulin (type 1) or insulin resistance (type 2 non-insulin dependent). In the U.S. alone, 10.3 million were recently reported as type 2 diabetes, mostly adults. Data in the literature suggest highly processed foods and foods high in carbohydrates are some of the causes for the onset of type 2 diabetes. Type 2 diabetes is the most common form of diabetes. When people eat, their bodies turn the food into glucose (sugar) to use as fuel. In healthy people, insulin helps the glucose get into the cells. In people with type 2 diabetes, glucose builds up in the blood beyond a normal or healthy level. In the absence of low insulin levels (as in diabetic patients) the blood glucose level rises above the safe levels. Web site: http://www.delphion.com/details?pn=US06720312__
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Method for creating spectral instrument variation tolerance in calibration algorithms Inventor(s): Cadell; Theodore E. (Conestogo, CA), Pawluczyk; Romuald (Conestogo, CA), Scecina; Thomas (Medfield, MA) Assignee(s): CME Telemetrix Inc. (Waterloo, CA) Patent Number: 6,615,151 Date filed: August 28, 2001 Abstract: The present invention relates to a method of building instrument variation tolerance into calibration algorithms for spectroscopic devices for chemical composition analysis with spectroscopic methods. The method of the present invention is particularly suitable for blood glucose, cholesterol and other chemical components prediction based on near-infrared spectrophotometry measurements. A method includes developing a calibration algorithm on a first instrument; applying the calibration algorithm to a second instrument; calibrating the second instrument and adjusting the calibration algorithm to account for differences between the first instrument and the second instrument; and repeating the step of applying (above) in respect of (n) further instruments to provide a calibration algorithm which may then be used on other instruments. Methods are also provided that develop calibration algorithms by adding instrument variations, based on mathematical manipulation, of the spectral data collected on calibration instruments. Excerpt(s): The present invention relates to the fields of spectroscopy, spectrophotometry, and chemometrics. In particular, the present invention relates to a
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method of building instrument variation tolerance into calibration algorithms for spectroscopic devices for chemical composition analysis with spectroscopic methods. The method of the present invention is particularly suitable for blood glucose, cholesterol and other chemical components prediction based on near-infrared spectrophotometry measurements. Spectroscopy is a well established method, which has extremely wide applications for chemical analysis of plasma, gases, liquids and solids practically in all field of modern science and technology as well in everyday life including food production, food processing, healthcare and medicine. The role of spectroscopy is to identify and to perform quantitative analysis of chemical composition of various bodies and substances or to recognize and measure concentration one or more selected chemical components (analytes) in the bodies and substances. One of such applications is a non-invasive measurement of different substances like glucose, cholesterol water, fat, protein, hemoglobin, melanin and other in human body, therefore a non-invasive glucose concentration measurement has been selected here as an illustrative example only and cannot be considered as an exclusive area of patent application. Biotechnological analysis and examination are often based on the measurement of various chemical analytes in the composition of a biological matrix such as blood, interstitial fluid, or living tissue. Such measurements may be used to evaluate a patient's state of health and to determine what, if any, treatment is necessary. For example, the frequent monitoring of blood glucose levels in diabetic persons with glucometers is often necessary to allow such persons to manage the diabetes mellitus disease, by taking insulin injections or oral drugs to lower blood glucose when required. Intensive treatment based on frequent blood glucose measurements can significantly reduce the incidence of blindness, kidney loss, and other complications associated with diabetes. Web site: http://www.delphion.com/details?pn=US06615151__ •
Method for treating, controlling, and preventing Diabetes Mellitus Inventor(s): Farouqi; Hafez Taji (Amman, JO), Murad; Osama Mansour (Amman, JO), Seir; Husni Abu (Amman, JO) Assignee(s): Diabex, Inc. (Wake Forest, NC) Patent Number: 6,555,126 Date filed: January 2, 2001 Abstract: This invention pertains to a method that can control, treat, and prevent Diabetes Mellitus. The method includes means of administering a potent product, including mainly the active ingredient Linalool, in any one of several forms, alone or with other additives and catalysts, such as vitamin E to enable the body to handle and control, then correct the complications of Diabetes Mellitus. A modest percentage of users suffering from this disease can be cured completely while the majority of others improve remarkably and experience lower blood glucose and reduce the glycated hemoglobin HbAlc readings to what are medically acceptable and healthy levels. Others, who are vulnerable to the disease due to hereditary factors, or other reasons, can help prevent it. The method works in several ways, including activation of the pancreas and re-establishing the ability of body cells to utilize and handle better and well, the glucose in the blood, and regulate the level of natural insulin in the body. The method employs Linalool in any one of its forms that can be found naturally or synthetically. Excerpt(s): This invention relates to a method that can be used to treat, control, cure, and prevent Diabetes Mellitus, of all types, through the administration of Linalool, alone, in
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any form, and possibly with other hypoglycemic additives in several forms, and by various means. The method does not cause any harmful or unpleasant side effects. Diabetes Mellitus is a feared and complex disorder. It has been a most distressing disease that can develop to a seriously life threatening condition. For ages, society was resigned to accepting various methods and medications that became a standard with no real hope for a cure, or drastic eradication of the disease. In fact, many of the drugs used cause serious side effects. A most important indicator of the ability of the body to deal with the complications of diabetes is the glycated hemoglobin HbAlc, that gives an integrated reading of the level of blood glucose. While all other known methods and medications help lower the glucose level at limited periods of the day or night time, the HbAlC remains higher than the normal 4.3 to 6.7 range regardless of the insulin dosage and other medicines. No full cure is expected or hoped for by the present regimens. The described method herein is new and unique, and actually reduces the HbAlc reading to the normal levels and for all patients. This method has actually cured some patients of both types I and II diabetes to such a degree that they stopped taking any medication while leading normal lives. Web site: http://www.delphion.com/details?pn=US06555126__ •
Methods for lowering viscosity of glucomannan compositions, uses and compositions Inventor(s): Ryan; Valerie J. (Boston, MA), Yuan; Chienkuo Ronnie (Chelmsford, MA), Crosby; Guy A. (Weston, MA) Assignee(s): Opta Food Ingredients, Inc. (Bedford, MA) Patent Number: 6,733,769 Date filed: May 6, 1999 Abstract: Methods of producing low viscosity glucomannan compositions by mixing a viscosity lowering compound with glucomannan under conditions suitable to form a low viscosity glucomannan composition are disclosed. The ability to modulate (increase or decrease) viscosity by combining glucomannan with compounds of differing molecular weights is described. Also, methods for lowering blood glucose and cholesterol in mammals by administering an effective therapeutic amount of maltodextrin-glucomannan complex are described. Additionally, methods for converting a food or beverage product from an initial low viscosity substance to a high viscosity end-product are also described herein. Excerpt(s): Starch and hydrocolloid mixtures are often employed to modify and control the texture of food products. It has been well established that the addition of hydrocolloids increases the viscosity of starch. Konjac flour interacts synergistically with hydrocolloids such as.kappa.-carrageenan, as well as other hydrocolloids in modifying the texture of food products. Yoshimura, M., et al., J. Agric. Food Chem., 44:2970 (1996). Konjac flour is produced from the tuber of the plant Amorphopallus konjac. Konjac flour contains a high molecular weight glucomannan polysaccharide consisting of mannose and glucose in a molecular ratio of approximately 3:2 respectively, with beta1,4-linkages. The molecular weight is greater than 300,000 daltons. Hydroxyl groups are present throughout the molecule providing some hydrophilicity, thereby imparting water solubility. Acetyl groups are important in controlling the gelling mechanism, but not critical in water solubility. Konjac flour has several properties that can be readily used in food formulations. When konjac flour is mixed with water, the small sacs containing the flour swell as they absorb the water. The viscosity of the dispersion begins to increase as the sacs swell with water and release the konjac flour. Konjac has a
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high capacity for water absorption. Tye, R. J., Food Technology, 45(3):82-92 (March 1991). Therefore, the addition of konjac flour may alter the viscosity of the preparation. Konjac flour may be used with starch, with or without other gums or stabilizers present. Generally, as the concentration of konjac increases in the presence of many starches there is a concomitant increase in the viscosity of the dispersion mixture. Konjac flour functionally interacts with most starches to give a considerable increase in viscosity that is maintained during cooking and cooling. Tye (March 1991). Web site: http://www.delphion.com/details?pn=US06733769__ •
Near infrared blood glucose monitoring system Inventor(s): Bynum; Kevin P. (Yonkers, NY), Ciurczak; Emil W. (Goldens Bridge, NY), Mark; Howard (Suffern, NY) Assignee(s): Euro-Celtique, S.A. (Luxembourg, LU) Patent Number: 6,675,030 Date filed: August 17, 2001 Abstract: An individualized modeling equation for predicting a patient's blood glucose values is generated as a function of non-invasive spectral scans of a body part and an analysis of blood samples from the patient, and is stored on a central computer. The central computer predicts a blood glucose value for the patient as a function of the individualized modeling equation and a non-invasive spectral scan generated by a remote spectral device. If the spectral scan falls within the range of the modeling equation, the predicted blood glucose level is output to the patient. If the spectral scan falls outside the range of the modeling equation, regeneration of the model is required, and the patient takes a number of noninvasive scans and an invasive blood glucose level determination. The computer regenerates the individualized modeling equation as a function of the set of spectral scans and corresponding blood glucose values. Excerpt(s): The present invention relates to the field of near infrared spectrometry for predicting patient blood glucose levels. There are roughly four million people in the United States currently diagnosed with Diabetes Mellitus. This disease causes blindness, loss of extremities, heart failure, and other complications over time. There is no "cure" for the disease, which is caused by either the failure of the pancreas to produce insulin or the body's inability to use insulin, but rather only treatment, most commonly with insulin injections in order to change the blood-glucose level. The majority of patients with Type I diabetes, as well as people with Type II diabetes or diagnosed as prediabetic, need to frequently monitor their blood glucose levels, establishing an individual blood glucose profile in order to adjust diet, medication, exercise, or to lower the blood glucose while avoiding hypoglycemia (low blood-sugar). In well-regulated patients, two or three blood samples are tested for glucose daily and are usually sufficient. In new or difficult patients, or when monitoring for hypoglycemia is required, blood samples may be required in rapid (every few minutes) succession. Web site: http://www.delphion.com/details?pn=US06675030__
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Non-invasive measurement of blood analytes using photodynamics Inventor(s): Rice; Mark J. (Johnson City, TN), Routt; Wilson (Lexington, KY) Assignee(s): Fovioptics, Inc. (Lexington, KY) Patent Number: 6,650,915 Date filed: October 22, 2001 Abstract: The determination of blood glucose in an individual is carried out by projecting illuminating light into an eye of the individual to illuminate the retina with the light having wavelengths that are absorbed by rhodopsin and with the intensity of the light varying in a prescribed temporal manner. The light reflected from the retina is detected to provide a signal corresponding to the intensity of the detected light, and the detected light signal is analyzed to determine the changes in form from that of the illuminating light. For a biased sinusoidal illumination, these changes can be expressed in terms of harmonic content of the detected light. The changes in form of the detected light are related to the ability of rhodopsin to absorb light and regenerate, which in turn is related to the concentration of blood glucose, allowing a determination of the relative concentration of blood glucose. Other photoreactive analytes can similarly be determined by projecting time varying illuminating light into the eye, detecting the light reflected from the retina, and analyzing the detected light signal to determine changes in form of the signal due to changes in absorptivity of a photoreactive analyte. Excerpt(s): This invention pertains to the field of non-invasive in vivo measurement of blood analytes. The measurement of blood glucose by diabetic patients has traditionally required the drawing of a blood sample for in vitro analysis. The blood sampling is usually done by the patient himself as a finger puncture, or in the case of a child, by an adult. The need to draw blood for analysis is undesirable for a number of reasons, including discomfort to the patient, resulting in many patients not testing their blood as frequently as recommended, the high cost of glucose testing supplies, and the risk of infection with repeated skin punctures. Many of the estimated three million Type 1 (juvenile) diabetics in the United States are asked to test their blood glucose six times or more per day in order to adjust their insulin doses for tighter control of their blood glucose. As a result of the discomfort, many of these patients do not test as often as is recommended by their physician, with the consequence of poor blood glucose control. This poor control has been shown to result in increased complications from this disease. Among these complications are blindness, heart disease, kidney disease, ischemic limb disease, and stroke. In addition, there is recent evidence that Type 2 (adult-onset) diabetics (numbering over 10 million in the United States) may reduce the incidence of diabetes-related complications by more tightly controlling their blood glucose. Accordingly, these patients may be asked to test their blood glucose as often as the Type 1 diabetic patients. Web site: http://www.delphion.com/details?pn=US06650915__
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Optical spectroscopy pathlength measurement system Inventor(s): Diab; Mohamed K. (Mission Viejo, CA) Assignee(s): Masimo Corporation (Irvine, CA) Patent Number: 6,640,116 Date filed: August 9, 2001
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Abstract: A physiological monitor utilizes Faraday rotation measurements to estimate mean photon pathlengths through tissue. These pathlength estimates, along with corresponding optical spectroscopy measurements allow the noninvasive monitoring of blood constituent concentrations. The technique is particularly applicable to noninvasive blood glucose measurements. The physiological monitor has a polarized light source for illuminating tissue and a magnetic field generator which creates a magnetic field within the tissue during illumination. The magnetic field imparts a Faraday rotation in the plane of polarization of the incident light beam as it propagates through the tissue and emerges as a transmitted light beam. A polarimeter is used to measure the rotation of the transmitted light. A signal processor then computes an estimate of the mean pathlength from the polarimeter output. The polarized light source has a multiple wavelength optical emitter and, in conjunction with the polarimeter detector, also functions as a spectrometer. The signal processor combines spectroscopic measurements at various wavelengths with corresponding mean pathlength estimates to compute blood constituent concentrations. Excerpt(s): Various optical spectroscopic measurement systems have been developed for the noninvasive monitoring of blood constituent concentrations. In such systems, light of multiple wavelengths is used to illuminate a thin tissue portion of a person, such as a fingertip or earlobe, to obtain a spectrum analysis of the light absorbed by blood flowing through the tissue site. Pulse oximetry systems, which perform such measurements to monitor blood oxygenation of hemoglobin constituents, have been particularly successful in becoming the standard of care. Extending this technology to the noninvasive monitoring of other blood constituents, such as blood glucose, is highly desirable. For example, current methods for accurately measuring blood glucose involve drawing blood from the subject, which can be onerous for diabetics who must take frequent samples to closely monitor blood glucose levels. If the medium is a tissue portion of a person, such as a fingertip, it includes a number of constituents that absorb light. Some of the principal absorbing constituents in tissue include water, oxyhemoglobin, reduced hemoglobin, lipids, melanin and bilirubin. A drawback to applying the Beer-Lambert Law to determine the concentrations of absorbing constituents, however, is that tissue is a turbid media, i.e. strongly scatters light, which violates an underlying assumption of equation (1). Scattering in tissue is due, in part, to the variations in refractive index at the boundaries of cells or other enclosed particles, such as collagen fibers, mitochondria, ribosomes, fat globules, glycogen and secretory globules. where c.sub.v is the speed of light in a vacuum and n.sub.s is the refractive index of the sample. Web site: http://www.delphion.com/details?pn=US06640116__ •
Peptide agonists of GLP-1 activity Inventor(s): Larsen; Bjarne Due (Br.o slashed.nsh.o slashed.j, DK), Mikkelsen; Jens Damsgaard (Lyngby, DK), Neve; S.o slashed.ren (Lyngby, DK) Assignee(s): Zealand Pharma A/S (Glostrup, DK) Patent Number: 6,528,486 Date filed: July 12, 2000 Abstract: The present invention relates to novel peptide conjugates which have increased stability and are useful in the treatment of excess levels of blood glucose.
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Excerpt(s): The present invention relates to novel peptide agonists of GLP-1 activity. More specifically the invention relates to novel peptides that lower blood glucose levels comprising variants of the exendin-4 polypeptide sequence and peptide conjugates comprising variants of the GLP-1 or the exendin-4 polypeptide sequences which are pharmacologically active and stable, and as agonists of GLP-1 activity are useful in the treatment of diseases that benefit from regulation or excess levels of blood glucose and/or regulation of gastric emptying, such as diabetes and eating disorders. The present invention also relates to methods of preparing said novel peptides, a composition, e.g., a pharmaceutical composition, comprising a peptide of the invention and a physiologically acceptable carrier, to said peptide for use in therapy, a method of treating a disorder and to the use of said peptide for the manufacture of a pharmaceutical composition for use in therapy. A number of hormones that lower blood glucose levels are released from the gastrointestinal mucosa in response to the presence and absorption of nutrients in the gut. These include gastrin, secretin, glucosedependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). The most potent substance known is GLP-1 (.O slashed.orskov, 1992, Diabetologia 35:701711). Glucagon-like peptide 1 (GLP-1) is a product of proglucagon, a 180 amino acid peptide (Drucker, 1998 Diabetes 47:159-169). The overall sequence of proglucagon contains the 29-amino acid sequences of glucagon, the 36 or 37 amino acid sequence of GLP-1 and the 34 amino acid sequence of glucagon-like peptide-2 (GLP-2), an intestinotrophic peptide. GLP-1 has a number of functions. It is a physiological hormone that enhances the effect on insulin secretion in normal humans and is therefore an incretin hormone. In addition, GLP-1 also lowers glucagon concentrations, slows gastric emptying, stimulates (pro)insulin biosynthesis, and enhances insulin sensitivity (Nauck, 1997, Horm. Metab. Res. 47:1253-1258). The peptide also enhances the ability for the.beta.-cells to sense and respond to glucose in subjects with imparted glucose tolerance (Byrne, 1998, Eur. J. Clin. Invest. 28:72-78). The insulinotropic effect of the GLP-1 in humans increases the rate of glucose disappearance partly because of increased insulin levels and partly because of enhanced insulin sensitivity (D'Alessio, 1994, Eur. J. Clin. Invest. 28:72-78). This has placed GLP-1 as a promising agent for treatment of type II diabetes. Active fragments of GLP-1 have been found to be GLP-1(736) and GLP-1(7-37). However, a major pharmacological problem with native GLP-1 is its short half-life. In humans and rats, GLP-1 is rapidly degraded by dipeptidyl peptidase-IV (DPP-IV) into GLP-1(9-36)amide, acting as an endogenous GLP-1 receptor antagonist (Deacon, 1998, Diabetologia 41:271-278). Several strategies circumventing this problem have been proposed, some using inhibitors of DPP-IV and other DPP-IV resistant analogues of GLP-1(7-36)amide (Deacon, 1998, Diabetologia 41:271-287; Deacon et al., 1998, Diabetes 47:764-769; Ritzel, 1998, J. Endocrinol. 159:93-102; U.S. Pat. No. 5,545,618; Pederson, 1998, Diabetes 47:1253-1258). Exendins, another group of peptides that lower blood glucose levels have some sequence similarity (53%) to GLP-1[736]NH.sub.2 (Goke et al., 1993, J. Biol. Chem. 268:19650-55). The exendins are found in the venom of Helodermatidae or beaded lizards (Raufman, 1996, Reg. Peptides 61:1-18). Exendin-3 is present in the venom of Heloderma horridum, the Mexican beaded lizard and exendin-4 is present in the venom of Heloderma suspectum, the Gila monster. Exendin-4 differs from exendin-3 at just positions two and three. The cDNA encoding the exendin-4 precursor protein, a 47 amino acid peptide fused to the amino terminus of exendin-4 has been cloned and sequenced (Pohl et al., 1998, J. Biol. Chem. 273:9778-9784 and WO98/35033). Both exendin-3 and exendin-4 stimulate an increase in cellular cAMP production in guinea pig pancreatic acinar cells by interacting with exendin receptors (Raufman, 1996, Reg. Peptides 61:1-18). Exendin-3 causes a biphasic increase in cellular cAMP production, but a monophasic increase in amylase release in pancreatic acinar
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cells. In contrast, exendin-4 causes a monophasic increase in cAMP production and does not alter amylase release. Web site: http://www.delphion.com/details?pn=US06528486__ •
Protein domains in the hepatic glycogen-targetting subunit of protein phosphatase 1 and methods of making and using the same Inventor(s): Armstrong; Christopher George (Dundee, GB), Cohen; Patricia Townsend Wade (Invergowrie, GB), Doherty; Martin John (Edinburgh, GB) Assignee(s): Medical Research Counsel (GB) Patent Number: 6,710,026 Date filed: September 26, 2001 Abstract: The present invention relates to compounds useful for treating disorders associated with abnormal blood glucose levels in mammals, such as Type I and Type II diabetes. The invention also relates to methods of making and using such compounds. Excerpt(s): The present invention relates to compounds useful in the treatment of disorders associated with abnormal blood glucose levels, particularly in the prevention of phosphorylase-a binding to the glycogen targeting subunit (G.sub.L) of protein phosphatase 1 (PP1). Such compounds are useful for increasing glycogen synthesis and thereby reducing blood glucose levels. The compounds find utility in the treatment of disorders, such as type I and type II diabetes, associated with higher than normal levels of blood glucose (hyperglycaemia). Most of the adverse physiological consequences in type I and type II diabetes arise from the higher than normal levels of blood glucose. Although high blood glucose levels can be reduced by administration of insulin in type I diabetes and by dietary restrictions in the case of type II diabetes, a drug which aids reduction of blood glucose levels would be advantageous in the treatment of these disorders. The liver, which is the main organ regulating glucose homeostasis, is able to store glucose in the form of glycogen and the synthesis of hepatic glycogen from glucose is under the control of hepatic glycogen synthase. Protein phosphatase 1 is major protein serine/threonine phosphatase in eukaryotic cells, which regulates numerous distinct cellular processes. This is achieved by the interaction of die catalytic subunit of PP1 (PP1C) with a diverse range of targeting subunits that localise PP1 C to specific sites within the cell, modulate its activity towards particular substrates and allow its activity to respond to extracellular signals. Web site: http://www.delphion.com/details?pn=US06710026__
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Recombinant vector for use in gene therapy for insulin-dependent diabetes mellitus and therapeutic composition thereof Inventor(s): Suh; Dongsang (Department Genetic Engineering, Sungkyunkwan University, Chunchun-dong, Jangan-ku, Suwon, Kyonggi-do, KR 440-746) Assignee(s): none reported Patent Number: 6,596,515 Date filed: February 5, 2001 Abstract: Disclosed are a recombinant vector for use in gene therapy for insulindependent diabetes mellitus and a therapeutic composition thereof. Following the
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injection of a.beta.-galactosidase expression vector having a K14 promoter gene, along with a Drosophola's P transposase expression helper vector, into murine skin in a liposome-mediated manner, the.beta.-galactosidase gene is expressed in the keratinocyte layer from 24 hours to 20 weeks after injection as measured by X-gal staining. With the enhancement effect and tissue specificity, the K14 promoter is applied for the expression of a human insulin gene in keratinocytes, thereby suggesting a new gene therapy method for treating insulin-dependent diabetes mellitus. When, in combination with the P-element expression helper vector, a human insulin expression vector with the K14 promoter is injected into the skin of diabetic mice, which lack insulin-producing.beta.cells of the pancreas, their blood glucose levels are maintained in a normal range. Excerpt(s): The present invention relates to a recombinant vector suitable for use in gene therapy for insulin-dependent diabetes mellitus and a pharmaceutical composition comprising the recombinant vector as an effective ingredient. More particularly, the present invention relates to a gene therapy system for effectively and safely treating insulin-dependent diabetes mellitus by taking advantage of the gene delivery capacity of Drosophila's P-transposon and the tissue specificity and expression enhancement of a K14 promoter. Gene therapy offers a new paradigm for curing human diseases. Rather than altering disease phenotypes by using agents that interact with gene products or are themselves gene products, gene therapy theoretically can modify specific genes, which results in a cure following a single administration. Initially, gene therapy was envisioned for the treatment of genetic disorders, but is currently studied for a broad spectrum of diseases, including cancer, peripheral vascular disease, arthritis, neurodegenerative disorders and other acquired diseases. Further, in combination with the Human Genome Project, gene therapy is expected to make a great progress in the treatment of far more diseases. With gene therapy, the delivery of genes into cells and their expression therein can be artificially regulated, so that the mutated genes of patients can be corrected by genetic recombination. There are disclosed patents regarding gene therapy. For instance, PCT publication No. 1997-27310 claims a retrovirus vector which can be used in gene therapy and PCT publication No. 199734009 discloses a recombinant adenovirus vector for gene therapy for human tumors. Virus vectors are, however, limited to only the treatment of hereditary diseases, owing to safety concerns and highly complex procedures. Also, the gene therapy utilizing virus vectors, as in such patents, suffers from the disadvantage of requiring much time and high expense. In prior arts, non-viral insulin vectors have been disclosed nowhere yet. Web site: http://www.delphion.com/details?pn=US06596515__ •
Saliva-monitoring biosensor electrical toothbrush Inventor(s): Kuo; Youti (88 Foxbourne Rd., Penfield, NY 14526) Assignee(s): none reported Patent Number: 6,623,698 Date filed: March 12, 2001 Abstract: A biosensor electrical toothbrush having a brush head with a test channel and a renewable biosensor system within the test channel for performing routine saliva tests. The brush head stimulates saliva production and collection in the test channel where measurement signals are produced by sensors. The signals are transmitted for storage and analysis to a microprocessor that provides readable data signals reflective of the presence or quantitative level of a specific component of saliva. The brush handle contains the micro-processor, a display means, a battery, a motor and a reservoir for
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storing a reagent which is supplied in controlled quantities to the channel during saliva testing. The toothbrush is used to detect fertility periods, pregnancy, labor onset, alcohol concentration, blood glucose concentration and indicators that signal a need for comprehensive HIV testing. A test head without bristles may be used in place of a brush head to provide a saliva-monitoring oral device which performs the same saliva tests as the electrical toothbrush. The bristles are replaced by an oral thermometer, a gum massage element or other element used for medical or dental functions. Excerpt(s): There is a growing need for a home diagnostic system for monitoring various personal physical health conditions and for the early detection of health problems. Such systems are typically used to determine fertility periods, pregnancy, labor onset, alcohol levels, glucose levels of diabetic persons and indicators that signal a need for comprehensive HIV testing. Home diagnostics systems are desirable because they are convenient to use and reduce health care costs. The present invention relates to salivamonitoring oral devices including saliva-monitoring electrical toothbrushes. Several patents describe various systems for collecting and diagnosing the contents of saliva. Some of the prior art diagnostic purposes and collection and testing procedures are summarized below. Web site: http://www.delphion.com/details?pn=US06623698__ •
System and methods for blood glucose sensing Inventor(s): Bell; Douglas E. (Coral Springs, FL), Neel; Gary T. (Weston, FL), Voss; Houston F. (Fort Lauderdale, FL), Wong; T. Philip (Coral Springs, FL) Assignee(s): Home Diagnostics, Inc. (Fort Lauderdale, FL) Patent Number: 6,743,635 Date filed: November 1, 2002 Abstract: A system for measuring a glucose level in a blood sample includes a test strip and a meter. The test strip includes a sample chamber, a working electrode, a counter electrode, fill-detect electrodes, and an auto-on conductor. A reagent layer is disposed in the sample chamber. The auto-on conductor causes the meter to wake up and perform a test strip sequence when the test strip is inserted in the meter. The meter uses the working and counter electrodes to initially detect the blood sample in the sample chamber and uses the fill-detect electrodes to check that the blood sample has mixed with the reagent layer. The meter applies an assay voltage between the working and counter electrodes and measures the resulting current. The meter calculates the glucose level based on the measured current and calibration data saved in memory from a removable data storage device associated with the test strip. Excerpt(s): The present invention relates to electrochemical sensors and, more particularly, to systems and methods for sensing blood glucose levels electrochemically. Many people, such as diabetics, have a need to monitor their blood glucose levels on a daily basis. A number of systems that allow people to conveniently monitor their blood glucose levels are available. Such systems typically include a test strip where the user applies a blood sample and a meter that "reads" the test strip to determine the glucose level in the blood sample. Among the various technologies available for measuring blood glucose levels, electrochemical technologies are particularly desirable because only a very small blood sample may be needed to perform the measurement. In electrochemical-based systems, the test strip typically includes a sample chamber that contains reagents, such as glucose oxidase and a mediator, and electrodes. When the
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user applies a blood sample to the sample chamber, the reagents react with the glucose, and the meter applies a voltage to the electrodes to cause a redox reaction. The meter measures the resulting current and calculates the glucose level based on the current. Web site: http://www.delphion.com/details?pn=US06743635__ •
System for delivering insulin Inventor(s): Houben; Richard P. M. (Berg & Terblijt, NL), Renirie; Alexis C. M. (Berg en Dal, NL), Weijand; Koen J. (Hoensbroek, NL) Assignee(s): Medtronic, Inc. (Minneapolis, MN) Patent Number: 6,558,345 Date filed: April 17, 2000 Abstract: There is provided an implantable system and method for monitoring pancreatic beta cell electrical activity in a patient in order to obtain a measure of a patient's insulin demand and blood glucose level. A stimulus generator is controlled to deliver stimulus pulses so as to synchronize pancreatic beta cell depolarization, thereby producing an enhanced electrical signal which is sensed and processed. In a specific embodiment, the signal is processed to determine the start and end of beta cell depolarization, from which the depolarization duration is obtained. In order to reduce cardiac interference, each stimulus pulse is timed to be offset from the QRS signal which can interfere with the pancreas sensing. Additionally, the beta cell signals are processed by a correction circuit, e.g., an adaptive filter, to remove QRS artifacts, as well as artifacts from other sources, such as respiration. The thus obtained insulin demand signal is used either to control delivery of insulin from an implanted insulin pump, or to control ongoing pancreatic stimulation of a form to enhance insulin production. Excerpt(s): This invention relates to systems for treatment of non-insulin-dependent diabetes mellitus and, in particular, systems for stimulating the pancreas to enhance sensing of beta-cell electrical activity, from which a measure of patient blood glucose level is obtained. It is known, from statistics published in 1995, that the number of diabetes patients in the United States is 7.8 million, or about 3.4% of the total U.S. population. This number has been steadily rising over the last 25 years. Approximately 90%, or about 7 million, are non-insulin-dependent diabetes mellitus (NIDDM) patients, in whom the sensitivity to rising glucose levels, or the responsiveness of insulin, is compromised to varying degrees. About 30%, or 2.3 million these patients, use insulin, and about 25% of these insulin users take daily measures of blood glucose levels. As a general proposition, most NIDDM patients are candidates for blood glucose level measurements and/or injections of supplemental insulin. The percentage of NIDDM patients receiving insulin treatment increases with the duration of NIDDM, from an initial rate of about 25% to about 60% after 20 years. For this population of patients, there is a need for a flexible and reliable system and method for measuring glucose level and supplying insulin when and as needed. The human pancreas normally provides insulin for metabolic control. Basically, the insulin acts to promote transport of glucose in body cells. The pancreas has an endocrine portion which, among other functions, continuously monitors absolute blood glucose values and responds by production of insulin as necessary. The insulin-producing cells are beta cells, which are organized with other endocrine cells in islets of Langerhans; roughly 60-80% of the cells in an islet are such beta cells. The islets of Langerhans in turn are distributed in the pancreatic tissue, with islets varying in size from only about 40 cells to about 5,000 cells.
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Web site: http://www.delphion.com/details?pn=US06558345__ •
Test strip for blood glucose determination Inventor(s): Cole; Gilbert W (Charlotte, NC), Phillips; Kevin J (Lancaster, SC) Assignee(s): ABB Diagnostics, Ltd. (Slough Berkshire, GB) Patent Number: 6,518,034 Date filed: June 25, 1998 Abstract: A test strip for determining blood glucose concentration includes a test strip and a photometer. The test strip comprises a substrate formed with an aperture, a polymeric membrane adhered to the aperture and in registration with the aperture, having a quantity of reagent on its bottom surface of the membrane. The polymeric membrane is adhered to the bottom of the substrate by double sided tape. The placement of the reagent on the bottom surface of the membrane allows filtration of the red blood cells from plasma before the glucose in the blood reaches the reagent and carries with it oxygen to drive the glucose-reagent reaction to completion. The photometer includes an infrared LED for detecting glucose components in the reacted test strip and simple, one-button operation. Excerpt(s): The present invention relates generally to blood glucose testing. In particular, the present invention advances a testing method and apparatus for use in determining blood glucose concentrations. The fast and accurate determination of one's blood glucose level is crucial to those with diabetes, especially for individuals who are insulin dependent. Failure to monitor blood glucose levels frequently and adequately can lead to severe health problems, diabetic coma, and, in some cases, death. Given the importance of monitoring blood glucose levels, the prior art includes devices for selfmonitoring. Self-monitoring permits diabetic patients to measure their own glucose level in a non-laboratory setting and at relatively low cost. Thus, self-monitoring improves the ability of diabetics, including those who have busy schedules and who travel frequently, to regulate their blood glucose levels. Web site: http://www.delphion.com/details?pn=US06518034__
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Visual blood glucose test strip Inventor(s): Chang; Carol (San Francisco, CA), Dao; Mimi Diemmy (San Jose, CA), Jurik; Franklin A. (Pleasanton, CA), Stubbs; Andrea (Palo Alto, CA) Assignee(s): Lifescan, Inc. (Milpitas, CA) Patent Number: 6,531,322 Date filed: November 27, 2000 Abstract: A visual blood glucose test strip has two membranes that each incorporate a reagent that reacts with glucose in a blood sample applied to the membranes to cause a color change. One of the membranes also includes an inhibitor and a dye. A blood sample applied to the strip causes the two membranes to form two different colors. Comparing the colors to a calibrated color chart permits a user to determine the glucose concentration in the blood sample. Excerpt(s): This invention relates to a dry reagent strip that measures blood glucose concentration; more particularly, a strip that makes the glucose measurement without
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requiring a meter. Many visual test devices have been developed for measuring the concentration of certain analytes in biological fluids. These devices have, for example, measured glucose, cholesterol, proteins, ketones, phenylalanine, or enzymes in blood, urine, or saliva. Among the devices that are in most widespread use today is the blood glucose monitor. In the U.S. alone, there are estimated to be more than 14 million people with diabetes. In order to avoid serious medical problems, such as vision loss, circulatory problems, kidney failure, etc., many of these people monitor their blood glucose on a regular basis and then take the steps necessary to maintain their glucose concentration in an acceptable range. Web site: http://www.delphion.com/details?pn=US06531322__
Patent Applications on Blood Glucose As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to blood glucose: •
Acceptance testing method for sets of multiple colored workpieces Inventor(s): Chang, Carol F.; (San Francisco, CA), Hoang, Vinh; (San Jose, CA), Jurik, Franklin A.; (Pleasanton, CA), Sharma, Manoj; (Milpitas, CA) Correspondence: Mayumi Maeda; Lifescan, INC.; 1000 Gibraltar Drive; Milpitas; CA; 95035; US Patent Application Number: 20030235923 Date filed: June 21, 2002 Abstract: A method for the acceptance testing of a set of multiple colored workpieces (e.g., paired color pads of a calibrated color chart or paired membranes of visual blood glucose test strip). The method includes first measuring a plurality of color parameters (e.g., L*a*b* color parameters) associated with the set of multiple colored workpieces, followed by conversion of the plurality of color parameters into a single response parameter. Next, the single response parameter for the set is compared to a predetermined single response parameter specification for the set and acceptance of the set of multiple colored workpieces determined based on the comparison. The method can be easily employed in conjunction with multiple (e.g., paired) membrane test strips used to measure, for example, glucose, cholesterol, proteins, ketones, phenylalanine or enzymes in blood, urine, saliva or other biological fluid and/or sample fluid characteristics such as pH and alkalinity. Excerpt(s): This invention relates, in general, to methods for the acceptance testing of colored workpieces and, in particular, to methods for the acceptance testing of sets of multiple colored workpieces, such as paired color pads of a calibrated color chart or paired membranes of a visual blood glucose test strip, based on color parameter data. In the manufacturing of colored objects (i.e., colored workpieces), it is often necessary to perform acceptance testing based on the color(s) of the colored workpiece. Such acceptance testing typically relies on any of a variety of standard color definition systems that specify color parameters for individual colors (e.g., one of the color systems
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This has been a common practice outside the United States prior to December 2000.
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defined by the Commission Internationale de l'Eclairage [CIE] including the systems based on the L*a*b* color space and L*C*h* color space) or visual evaluation. Acceptance testing of colored workpieces is frequently performed by obtaining CIE L*, a* and b* colorimetric parameter data (hereinafter referred to as "L*a*b*" color parameters) on individual (i.e., single) colors of the colored workpiece and then comparing each of the three L*a*b* color parameters to an associated color parameter specification. Alternatively, the L*a*b* color parameters can be used to compute a.DELTA.E*.sub.ab value with respect to a color reference standard using methods known to one skilled in the art. Such a.DELTA.E*.sub.ab value is an absolute quantity indicative of the difference of a single color of the colored workpiece undergoing acceptance testing to the color reference standard. The.DELTA.E*.sub.ab value, however, merely represents the magnitude of color difference but does not identify the direction of bias from the color reference standard. Acceptance testing of colored workpieces can also be similarly performed by using other color systems. Using these conventional methods, an individual color of a colored workpiece can be compared to color parameter specifications or a color reference standard and the colored workpiece either rejected or accepted based on that comparison. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Amphiphilic networks, implantable immunoisolatory devices, and methods of preparation Inventor(s): Isayeva, Irada S.; (Akron, OH), Kennedy, Joseph P.; (Akron, OH) Correspondence: Renner, Kenner, Greive, Bobak, Taylor & Weber; Fourth Floor; First National Tower; Akron; OH; 44308; US Patent Application Number: 20030232925 Date filed: April 1, 2002 Abstract: The present invention provides high mechanical strength amphiphilic polymeric networks and implantable biological devices made therefrom that are capable of encasing and, thus, immunoisolating biological material from an immunological response of a host individual. The present invention also provides methods for making the amphiphilic networks and implantable biological devices. The present invention also provides a method for the treatment of type I diabetes mellitus comprising the steps of encasing a sufficient amount of islet of Langerhans cells within said biological device, wherein said biological device is capable of immunoisolating said encased islet cells upon implantation into an individual; implanting said biological device into a diabetic host individual; allowing said implanted biological device to remain implanted in said diabetic individual for a time sufficient to normalize the blood glucose level in said diabetic individual. Excerpt(s): The present invention relates to amphiphilic polymer networks and methods for their preparation. The networks comprise the reaction product of hydrophobic crosslinking agents and hydrophilic monomers. The present invention is more particularly related to an amphiphilic polymer network comprising the reaction product of multi-arm multi-telechelic polyisobutylene stars as hydrophobic crosslinking agents and acrylate or methacrylate hydrophilic monomers. Applications include implantable biological devices comprising the amphiphilic networks that are capable of encapsulating and immunoisolating biologically active moieties, such as cells, from the immune response of a host individual. Many medical deficiencies and diseases result from the inability of cells to produce normal biologically active moieties. Many of these
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deficiencies can be remedied by implanting the needed biologically active moieties or pharmacological agents into the individual having the deficiency. A well known disease that can be remedied by implanting biological material or a pharmacological agent is Type I diabetes mellitus, wherein the production of insulin by pancreatic Langerhans islet cells is substantially deficient, impaired, or nonexistent. Encapsulating human islet cells or tissues within a biologically compatible device followed by implanting the device into a host individual has been proposed as a means for providing insulin to an individual with Type I diabetes. However, an individual's immune response frequently attacks foreign biological material such as cells, tissues, and organs. And the response severely limits the effectiveness of methods that involve implanting foreign biological material. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
ANTIDIABETIC AGENTS Inventor(s): Bigge, Christopher F.; (Ann Arbor, MI), Schaum, Robert P.; (Ann Arbor, MI) Correspondence: Heidi M. Berven; Warner-Lambert Company, Llc; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20030220381 Date filed: March 17, 2003 Abstract: Compounds of formula I: 1wherein X, Y, B, E, J, K, L, Z, and R.sub.9-R.sub.12 have any of the meanings described herein, their pharmaceutically acceptable salts, lower blood glucose levels and are useful for treating diseases in mammals such as Non-Insulin Dependent Diabetes Mellitus. Also disclosed are pharmaceutical compositions, processes for preparing compounds of formula (I) and intermediates useful for preparing compounds of formula I. Excerpt(s): This application claims benefit of priority from U.S. Provisional Application Serial No. 60/369,787 filed on Apr. 3, 2002. The present invention relates to compounds that are useful as antidiabetic agents. Type II diabetes, or non-insulin dependent diabetes (NIDDM) is a significant healthcare problem whose incidence is on the rise. Between 1990 and 1998, the prevalence of NIDDM in the United States increased by 33 percent, to about 13 million persons. An additional 5 million persons are presumed to have undiagnosed NIDDM, while another 14 million persons have impaired glucose tolerance. Direct medical costs associated with diabetes were $44 billion in 1997, due mainly to hyperglycemia-related diabetic complications, including diabetic angiopathy, atherosclerosis, diabetic nephropathy, diabetic neuropathy, and diabetic ocular complications such as retinopathy, cataract formation, and glaucoma. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Antidiabetic preparation for oral administration Inventor(s): Kato, Nobuo; (Tokyo, JP), Makino, Chisato; (Kawasaki-Shi, JP), Ninomiya, Nobutaka; (Kawasaki-Shi, JP), Orita, Haruo; (Kawasaki-Shi, JP), Sakai, Hidetoshi; (Kawasaki-Shi, JP), Shioya, Shigeru; (Tokyo, JP), Yabuki, Akira; (Kawasaki-Shi, JP) Correspondence: Oblon, Spivak, Mcclelland, Maier & Neustadt, P.C.; 1940 Duke Street; Alexandria; VA; 22314; US Patent Application Number: 20040002544 Date filed: June 28, 2002 Abstract: There is provided a single preparation which directly decreases both of the post prandial blood glucose level and the fasting blood glucose level close to normal levels, by release-sustaining a drug capable of decreasing the post prandial blood glucose level of diabetic patients close to the normal level, or mixing a controlled release drug capable of decreasing the post prandial blood glucose level close to the normal level with an immediate release drug. It is particularly preferable that the drug capable of decreasing the post prandial blood glucose level close to the normal level is nateglinide, repaglinide, or mitiglinide (KAD-1229). Excerpt(s): The present invention relates to an antidiabetic, particularly to a preparation for directly controlling, namely decreasing both a post prandial blood glucose level and a fasting blood glucose level of diabetic patients with one preparation to make these levels close to normal levels. Ordinary antidiabetics are antidiabetics for decreasing either a post prandial blood glucose level or a fasting blood glucose level to make it close to a normal level. As antidiabetics for decreasing a post prandial blood glucose level to make it close to a normal level, nateglinide has been developed, and it is described in, for example, Japanese Patent Publication No. 15,221/1992 or Japanese Patent Laid-Open No. 194,969/1998. Further, antidiabetics for decreasing a fasting blood glucose level to make it close to a normal level are described in, for example, Kondo Nobuo, Nippon Rinsho, vol. 55, 1997, extra ed., p. 159 and the like. In recent years, for treating diabetes, it has been considered important that both a post prandial blood glucose level and a fasting blood glucose level are decreased to make them close to normal levels. However, there have been no preparations for decreasing both levels to make them close to normal levels. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Apparatus and method for monitoring blood glucose levels including convenient display of blood glucose value average and constituent values Inventor(s): Ginsberg, Barry H.; (Wyckoff, NJ) Correspondence: Stacey J. Longanecker; Roylance, Abrams, Berdo & Goodman, L.L.P.; Suite 600; 1300 19th Street, N.W.; Washington; DC; 20036; US Patent Application Number: 20040059201 Date filed: September 10, 2003 Abstract: A method of presenting glucose data to a person with diabetes from a blood glucose meter is provided in which an effective meal average (EMA) value is presented, followed by two or more of the individual values that make up the EMA, to provide improved feedback data for clinical decisions by patients who need to alter their dose of insulin. The EMA can also comprise a measure of the variability of its constituent
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values. The EMA encompasses those values that occur at specified times such as 1 hour before and 1 hour after a specified meal time. The EMA is calculated over a limited number of days previous to the calculation (e.g., 3 days) and has a minimum number of values that must be obtained within the time and date ranges. An algorithm allows for exclusion of any given reading from the average (e.g., post-prandial or control solution readings). Patients can use 1 to 8 EMA on any given date range (e.g., preferably 4, that is, breakfast, lunch, supper and bedtime snack). Excerpt(s): This application claims priority from U.S. Provisional Application Serial No. 60/409,965 filed Sep. 11, 2002, the contents of which are expressly incorporated herein by reference in their entirety. Related subject matter is disclosed in a copending U.S. patent application of Gordon et al, entitled "A System and Method for Integrating Data with Guidelines to Generate Displays Containing the Guidelines and Data", Ser. No. 09/985,173, filed Nov. 1, 2001; and in a copending U.S. patent application of Gordon, entitled "System and Method for Assessment and Corrective Action Based on Guidelines", Ser. No. 10/153,883, filed May 24, 2002; the entire contents of both applications being incorporated herein by reference. The invention relates generally to blood glucose meters and glucose monitoring for managing diabetes and, more particularly, to presentation of glucose data to a user in a convenient format, including an effective meal average and its constituent values and/or a measure of variability among the constituent values. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Apparatus and method for pattern delivery of radiation and biological characteristic analysis Inventor(s): Yen, Brian; (Portola Valley, CA) Correspondence: Squire, Sanders & Dempsey L.L.P; 600 Hansen Way; Palo Alto; CA; 94304-1043; US Patent Application Number: 20040087844 Date filed: October 8, 2003 Abstract: The present invention uses a high signal to noise ratio method and apparatus to analyze a characteristic of a biological object, such as blood glucose level. The method and apparatus can also have surgical applications, such as coagulation or ablation of a pattern on a biological object. Excerpt(s): This application claims benefit of and incorporates by reference U.S. patent application Ser. No. 60/423,345, entitled "System and Method for Pattern Delivery of Radiation and Glucose Detection," filed on Nov. 1, 2002, by inventor Brian Yen. This invention relates generally to radiation delivery and characteristic analysis, and more particularly, but not exclusively, provides a system and method for characteristic analysis using pattern delivery of radiation to a biological object. Diabetes is a disease of the pancreas in which the pancreas produces little or no insulin or when the body does not respond properly to insulin ("insulin resistance"). There is no cure for diabetes and diabetics must generally manage the disease on a daily basis. One aspect of management includes injecting insulin, such as Lantus, multiple times a day or dispensing it continuously via a pump. Improper administration of insulin can lead to severe side effects including hyperglycemia in which blood glucose levels are too high, which can lead to damage to nerves, blood vessels, and other body organs. Improper administration can also lead to hypoglycemia, in which blood glucose levels are too
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low, which can lead to passing out and even coma in worst case scenarios. Accordingly, as the amount of insulin dispensed needs to be varied based on blood glucose levels, diabetics must frequently monitor their blood glucose levels. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Atraumatic insertion of a subcutaneous device Inventor(s): Sabra, Mads C.; (Copenhagen N, DK) Correspondence: Reza Green, ESQ.; Novo Nordisk Pharmaceuticals, INC.; 100 College Road West; Princeton; NJ; 08540; US Patent Application Number: 20030225361 Date filed: March 19, 2003 Abstract: The invention relates to a concept for placing a subcutaneous device such as a sensor at a selected site within the body of a patient, e.g. to obtain blood glucose readings. In a first aspect, an insertion needle comprises an oblong needle body and a distal end portion, the distal end portion having a pointed distal tip allowing the needle to be introduced subcutaneously and a distally facing generally smooth surface, the body comprising along a portion thereof a longitudinal groove adapted to at least partially accommodate the subcutaneous device. In a second aspect, a combination of an insertion needle and a subcutaneous device form an oblong body portion and a distal end portion formed by either of the members or in combination by the two members, the distal end portion having a pointed distal tip and a distally facing generally smooth surface. By the above configuration, a concept is provided reducing the severity of the body response following transcutaneous placement of a device as well as reducing the pain associated with the insertion. Excerpt(s): The present invention relates generally to the insertion of subcutaneous devices. More specifically, the invention relates to an insertion device for placing a subcutaneous device at a selected site within the body of a patient, a needle-formed subcutaneous device as well as combinations of such devices. Especially, the invention relates to insertion means for easy transcutaneous placement of a sensor of the type used, for example, to obtain blood glucose readings. In the treatment of patients it would often be desirable to monitor a given parameter indicating the actual state of the treatment, e.g. monitoring the concentration of a drug dispensed to the patient or a body substance influenced by the drug. A given monitor system for measuring the concentration of a given substance may be based on invasive or non-invasive measuring principles. An example of the latter would be a non-invasive glucose monitor arranged on the skin surface of a patient and using near-IR spectroscopy, however, the present invention is concerned with the introduction of a transcutaneous device such as a sensor element. In recent years, a variety of electrochemical sensors have been developed for a range of applications, including medical applications for detecting and/or quantifying specific agents in a patient's blood. As one example, glucose sensors have been developed for use in obtaining an indication of blood glucose levels in a diabetic patient. Such readings can be especially useful in monitoring and/or adjusting a treatment regimen which typically includes regular administration of insulin to the patient. In this regard, blood glucose readings are particularly useful in conjunction with feedback controlled medication infusion devices, e.g. of the external type carried by the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Automated mechanical mechanism for a blood glucose sensor dispensing instrument Inventor(s): Brown, Michael K.; (Elkhart, IN), Micinski, Russell J.; (South Bend, IN), Miller, Norman S.; (Elkhart, IN), Whitson, Robert C.; (Elkhart, IN) Correspondence: Jerome L. Jeffers, ESQ.; Bayer Corporation; P. O. Box 40; Elkhart; IN; 46515-0040; US Patent Application Number: 20040069793 Date filed: October 15, 2002 Abstract: A sensor dispensing instrument adapted to handle a sensor pack containing a plurality of sensors and to perform a test using one of the sensors. The sensor dispensing instrument includes an outer housing and a disk drive mechanism contained therein for rotating the sensor pack and ejecting one of the sensors from the sensor pack and through a sensor opening on the housing. The disk drive mechanism of the sensor dispensing instrument is operated by pressing a button which activates a motor. The motor moves a disk drive pusher in a first direction to rotate the sensor pack, and then moves the disk drive pusher in a second direction to eject a sensor from the sensor cavity and through the sensor opening. Excerpt(s): The present invention generally relates to a fluid monitoring system, and, more particularly, to a new and improved instrument for handling multiple sensors that are used in analyzing blood glucose or other analytes contained therein. People suffering from various forms of diabetes routinely need to test their blood to determine the level of blood glucose. The results of such tests can be used to determine what, if any, insulin or other medication needs to be administered. In one type of blood glucose testing system, sensors are used to test a sample of blood. Such a sensor may have a generally flat, rectangular shape with a front or testing end and a rear or contact end. The sensor contains biosensing or reagent material that will react with blood glucose. The testing end of the sensor is adapted to be placed into the fluid being tested, for example, blood that has accumulated on a person's finger after the finger has been pricked. The fluid is drawn into a capillary channel that extends in the sensor from the testing end to the reagent material by capillary action so that a sufficient amount of fluid to be tested is drawn into the sensor. The fluid then chemically reacts with the reagent material in the sensor with the result that an electrical signal indicative of the blood glucose level in the blood being tested is supplied to contact areas located near the rear or contact end of the sensor. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Compositions for reducing hypercholesterolemia and controlling of postprandial blood glucose and insulin levels Inventor(s): Christmas, Kevin Patrick; (Mason, OH), Elsen, Joseph James; (St. Bernard, OH), Helmers, Ralph Lawrence JR.; (Cincinnati, OH), Kester, Jeffrey John; (West Chester, OH), Prosise, Robert Lawrence; (Cincinnati, OH), Wehmejer, Thomas Joseph; (Cincinnati, OH) Correspondence: Michael Best & Friedrich, Llp; 100 E Wisconsin Avenue; Milwaukee; WI; 53202; US Patent Application Number: 20040086547 Date filed: October 21, 2003
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Abstract: Beta-glucan soluble fiber and non-digestible fats are administered orally to reduce blood cholesterol levels and to control postprandial blood glucose and insulin levels. The beta-glucan soluble fiber and non-digestible fat may be administered as separate compounds, as a mixture, or combined with other materials and administered in the form of an appealing food. Excerpt(s): This application claims the benefit of U.S. Provisional Application Serial No. 60/196,410 filed on Apr. 12, 2000, in the name of Prosise et al. The present invention relates to methods and compositions for reducing blood cholesterol levels, and for controlling of postprandial blood glucose and insulin levels, by oral administration of beta-glucan soluble fiber and a non-digestible fat. High blood cholesterol (hypercholesterolemia) is recognized as a risk factor for coronary heart disease, which is a major health care problem. Epidemiological studies have demonstrated that, with few exceptions, populations consuming large quantities of saturated fat and cholesterol have a relatively high concentration of serum cholesterol and a high mortality rate from coronary heart disease. While it is recognized that other factors can also contribute to the development of cardiovascular disease, there appears to be a causal relationship between the concentration of serum cholesterol, in which hypercholesterolemia results in the accumulation of undesirable amounts of cholesterol in various parts of the circulatory system (arteriosclerosis) or in soft tissues (xanthomatosis), and coronary disease and coronary mortality rates. It is well accepted that lowering of blood cholesterol levels will reduce the risk of heart disease, as well as slow the progression of this chronic disease in individuals already suffering its effects. Typical therapy for persons with hypercholesterolemia includes strict control of dietary intake of fat, saturated fat, and cholesterol. In certain cases, this dietary regimen may be combined with a treatment of cholesterol lowering drugs, such as the bile acid sequestrants (e.g., colestipol and cholestyramine). Patient adherence to a stringent and prolonged dietary and drug regimen is often poor. The cholesterol lowering drugs can have unpleasant side effects and palatability is often extremely poor. Therefore, it would be particularly advantageous to have palatable food products that can replace or enhance the effectiveness of cholesterol lowering drugs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Compounds active at the glucocorticoid receptor II Inventor(s): Gustafsson, Annika; (Ekero, SE), Kym, Philip R; (Grayslake, IL), Pelcman, Benjamin; (Stockholm, SE) Correspondence: Wiggin & Dana Llp; Attention: Patent Docketing; One Century Tower, P.O. Box 1832; New Haven; CT; 06508-1832; US Patent Application Number: 20040063781 Date filed: October 14, 2003 Abstract: 1This invention relates to novel compounds that are liver selective glucocorticoid receptor antagonists, to methods of preparing such compounds, and to methods for using such compounds in therapy and in the regulation of metabolism, especially lowering blood glucose levels. The compounds referred to are compounds according to the formula 1: wherein X is selected from: CH.sub.2, CHYR.sup.7, CHYC(O)R.sup.7, C.dbd.O, C.dbd.S, and C.dbd.NOR.sup.8,; Y is selected from: O, S, and NR.sup.8; R.sup.1 is selected from: COOH and heteroaryl; R.sup.2 and R.sup.3 are independently of each other selected from: hydrogen, halogen, and C.sub.1-6 alkyl, provided that one of R.sup.2 or R.sup.3 is other than hydrogen; R.sup.4 is selected from:
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C.sub.1-6-alkyl, C.sub.2-6 alkenyl, C.sub.2-6-alkynyl, halogen, (R.sup.9)(R.sup.10)N, R.sup.8C(Z)N(R.sup.11), R.sup.8OC(Z)N(R.sup.11), (R.sup.9)(R.sup.10)NC(Z)N(R.sup.11),R.sup.8S(O).sub.2N(R.sup.11), (R.sup.9)(R.sup.10)NS(O).sub.2N(R.sup.11), and R.sup.8SC(Z)N(R.sup.11);R.sup.5 is selected from: (i) C.sub.1-6-alkyl which is substituted by a group selected from A, provided that A is not halogen; (ii) C.sub.7-12-alkyl, C.sub.2-12-alkenyl and C.sub.2-12alkynyl; (iii) C.sub.1-2-alkyl, where one or more carbon atoms are replaced by Y, and where one or more carbons are optionally substituted by a group selected from A, provided that if more than one carbon is replaced by Y, the said Y groups are not directly connected to each other; R.sup.6 is selected from: C.sub.1-12-alkyl, C.sub.3-8cycloalkyl, C.sub.3-8-heterocycloalkyl, C.sub.2-6-alkenyl, and C.sub.2-6-alkynyl, aryl, and heteroaryl; R.sup.7 is optionally selected from hydrogen; R.sup.8, R.sup.9, R.sup.10 and R.sup.11 are independently of each other selected from: hydrogen, C.sub.1-6-alkyl, C.sub.3-8-cycloalkyl, C.sub.2-6-alkenyl, C.sub.2-6-alkynyl, and C.sub.3-8heterocycloalkyl, aryl and heteroaryl; or where any pair of R.sup.8, R.sup.9, R.sup.10 and R.sup.11 together with the atom or atoms to which they are bound form a ring having 3-7 ring members; or pharmaceutically acceptable salts, stereoisomers or prodrugs thereof. Excerpt(s): This invention relates to novel compounds that are liver selective glucocorticoid receptor antagonists, to methods of preparing such compounds, and to methods for using such compounds in therapy and in the regulation of metabolism, especially lowering blood glucose levels. A major problem with both Type 2 and Type 1 diabetes is that there is an excessive and inappropriate production of glucose by the liver. This abnormality is the primary cause of fasting hyperglycemia and occurs in addition to defects in regulation of insulin release and in peripheral sensitivity to insulin. Thus, agents that decrease liver glucose production would be beneficial for treating both Type 2 and also Type 1 diabetes. Intensive treatment of the hyperglycemia of Type 1 diabetes mellitus has been shown to markedly decrease the development of ocular, renal and neuropathic complications, and there is evidence that intensive treatment is also beneficial for Type 2 diabetes. The available data also indicate that most patients are currently not receiving ideal and state-of-the-art treatment for either Type 2 or Type 1 diabetes. This inadequacy exists in spite of the availability of several different types of preparations of insulin for treatment of both Type 2 and Type 1 diabetes, and of a number of additional modalities, including agents that stimulate insulin release (e.g. sulfonylureas), influence liver glucose production (e.g. metformin), affect the sensitivity to insulin (e.g. compounds interacting with the PPAR.gamma. such as troglitazone, rosiglitazone and pioglitazone) and glucose absorption (e.g.alpha.glucosidase inhibitors such as acarbose). In spite of the availability of several different orally active agents that lower blood glucose levels, many patients with Type 2 diabetes also require insulin for control of their blood sugar levels. Overall, insulin usage in Type 2 diabetes exceeds that for Type 1 diabetes, and there is general agreement that there is a need for additional orally active agents to treat Type 2 diabetes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Compounds for treatment of inflammation, diabetes and related disorders Inventor(s): Chen, Liang; (San Bruno, CA), Dey, Debedranath; (Fremont, CA), Fuller, Joseph C.; (South San Francisco, CA), Li, Ta-Kai; (Cupertino, CA), Neogi, Partha; (Fremont, CA) Correspondence: Pillsbury Winthrop, Llp; P.O. Box 10500; Mclean; VA; 22102; US Patent Application Number: 20040097593 Date filed: May 7, 2003 Abstract: Novel acyl urea, thiourea, carbamate, thiocarbamate and related compounds are provided which are effective in inhibiting the cytokine-mediated inflammatory response in cultured cells, in ameliorating bone destruction in an animal model of arthritis and in lowering blood glucose levels in animal models of Type II diabetes mellitus. The compounds are disclosed as useful for a variety of treatments including the treatment of diabetes mellitus, insulin resistance, inflammation, inflammatory diseases, immunological diseases and cancer. Excerpt(s): This application is a continuation-in-part of International Application No. PCT/US02/38150, filed Nov. 27, 2002, which claims the benefit of U.S. Provisional Application No. 60/334,818, filed Nov. 29, 2001, which are both incorporated herein, in their entirety, by reference. The invention is directed to compounds, for example, heterocyclic derivatives of acyl urea, thiourea, carbamate and thiocarbamate compounds, that provide a variety of useful pharmacological effects. The compounds are useful, for example, in lowering blood glucose levels in hyperglycemic disorders, such as diabetes mellitus, and for treating related disorders, such as obesity and hyperlipidemia. Furthermore, these compounds are useful for treatment of disorders associated with insulin resistance, such as polycystic ovary syndrome, and for the treatment of inflammation, inflammatory and immunological diseases, particularly those mediated by pro-inflammatory cytokines (such as TNF-alpha, IL-1 beta and IL-6), type 4 and type 3 phosphodiesterase (PDE4 and PDE3, respectively), p44/42 mitogenactivated protein (MAP) kinase, cyclooxygenase-2 (COX-2) and/or inducible nitric oxide synthase (iNOS). The causes of diabetes mellitus are not yet known, although both genetics and environment seem to be major factors. Type 1 diabetes, also known as insulin-dependent diabetes mellitus (IDDM), is an autoimmune disease in which the responsible autoantigen is still unidentified. Since their insulin-producing pancreatic cells are destroyed, Type 1 diabetics need to take insulin parenterally to survive. On the other hand, type 2 diabetes, also called non-insulin-dependent diabetes mellitus (NIDDM), the more common form, is a metabolic disorder resulting from the body's inability to make a sufficient amount of insulin or to properly use the insulin that is produced. Impaired insulin secretion and insulin resistance are considered the major defects; however, the precise genetic factors involved in the mechanism remain unknown. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Diagnostic kit with a memory storing test strip calibration codes and related methods Inventor(s): Aquino, Maria; (Fremont, CA), Hayter, Paul G.; (Mountain View, CA), Ohara, Timothy J.; (Danville, CA), Poulos, Darwin; (Los Altos, CA), Sharma, Manoj K.; (Milpitas, CA) Correspondence: Mayumi Maeda; Lifescan, INC.; 1000 Gibraltar Drive; Milpitas; CA; 95035; US Patent Application Number: 20040038411 Date filed: August 21, 2002 Abstract: A diagnostic kit for measuring a characteristic of a fluid sample includes a test strip (e.g., a disposable blood glucose test strip) and device (e.g., a hand-held meter) for measuring a property (e.g., an optical or electrochemical property) of the test strip. The device also calculates, based on the measured property of the test strip, a characteristic (e.g., blood glucose concentration or INR) of a fluid sample applied to the test strip. Stored in a memory of the device are test strip calibration codes that represent geometric regions (e.g., polygonal or hexagonal geometric regions) of a multi-dimensional calibration parameter space. The test strip calibration codes and geometric regions are distributed across the multi-dimensional calibration parameter space such that a quantization error of assigning one of test strip calibration codes to the test strip is optimally reduced. Also, a method for optimally associating test strip calibration codes to calibration parameters for use in such a diagnostic kit that includes first optimally distributing a plurality of test strip calibration codes and geometric regions represented thereby across a multi-dimensional calibration parameter space. The distribution is conducted such that a quantization error of assigning one of the test strip calibration codes to the test strip of the diagnostic kit is optimally reduced. The method also includes storing the distributed test strip calibration codes in a memory of the diagnostic kit. Excerpt(s): The present invention relates, in general, to diagnostic kits for the measurement of a fluid sample characteristic and, in particular, to diagnostic kits that include test strip calibration codes and related methods. Typical diagnostic kits for the measurement of a fluid sample characteristic include a device, such as a hand-held meter, and a test strip (e.g., a disposable blood glucose test strip) to which a fluid sample is applied. The device and test strip are used in tandem to measure an analyte concentration(s) (e.g., blood glucose concentration) or other characteristic(s) (e.g., prothrombin time [PT] and/or International Normalization Ratio [INR]) of the fluid sample. The device typically measures a property or properties of the test strip (e.g., an optical reflectance, optical transmittance or an electrochemical property) and then employs an algorithm(s) to calculate the characteristic based on the measured property or properties. Such conventional diagnostic kits are described in, for example, U.S. Pat. Nos. 6,084,660, issued on Jul. 4, 2000 and U.S. Pat. No. 6,261,519, issued Jul. 17, 2001 and U.S. patent application Ser. No. 10/100,531, filed Mar. 14, 2002, each of which is hereby fully incorporated by reference, as well as PCT patent applications WO 0248707 A2 and WO 0157510 A2. In order to account for lot-to-lot variation in the test strips of such diagnostic kits, it is commonplace for test strip lots to be calibrated during their manufacture. Such calibration typically includes the determination of calibration parameters and the assignment of a test strip calibration code, associated with those calibration parameters, to each of the test strip lots. For example, in order to assign a test strip calibration code to a lot of prothrombin test strips, coagulation and PT calibration parameters can be experimentally determined using orthogonal regression routines. In such orthogonal regression routines, the bias between experimental test results and
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reference test results is minimized using a sum of squares function by adjusting various calibration parameters. The result of such an orthogonal regression routine is a set of experimental calibration parameters. If these calibration coefficients were assigned as calibration codes, there would be infinite number of calibration codes. In order to make a finite and manageable number of calibration codes, the experimental calibration parameters are then shifted to coincide with the closest calibration parameters contained in a pre-defined calibration parameter table. A calibration code associated with the closest calibration parameters is subsequently assigned to the lot of prothrombin test strips. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Food composition and weight loss method for treating obesity Inventor(s): Chawan, Dhyaneshwar Bhujangarao; (Liverpool, NY) Correspondence: Dennis H. Rainear; 13400 College Valley Lane; Richmond; VA; 23233; US Patent Application Number: 20040038909 Date filed: August 23, 2002 Abstract: The invention relates to a method for treating overweight persons or patients with obesity using a food composition able to control the release of glucose into the patient's blood. This is achieved by the introduction into the food composition of a therapeutically effective amount of an additive, such as propylene glycol alginate (PGA) or other hydrophilic agent or pharmaceutically acceptable salts thereof, which reduces the cooking losses and enhances the starch cell wall membrane to thereby slow the enzymatic hydrolysis of the starch by insulin. The result is a steady state release of glucose and a net reduction in the release of blood glucose (glycemic index) relative to release of glucose observed in an overweight or obese patient having consumed a food composition without propylene glycol alginate, whereby the patient experiences a loss in body weight. Excerpt(s): The invention relates to a method for treating overweight individuals or patients with obesity using a food composition able to control the release of glucose into the patient's blood. This is achieved by the introduction into the food composition of a hydrophilic food grade agent, such as propylene glycol alginate, which reduces the cooking losses and enhances the starch cell wall membrane to thereby slow the enzymatic hydrolysis of the gelatinized starch. The result is a steady state release of glucose and a net reduction in the blood glucose (glycemic index) relative to blood glucose observed in an overweight or obese patient having consumed a comparable food composition without propylene glycol alginate. Obesity is a serious health threat throughout the industrialized nations. It can lead to significant illnesses and premature death. Unfortunately, its rate of incidence is increasing. Obesity is a major disorder affecting as much as one third of the North American population. Several studies have shown that such individuals are at increased risk in developing cardiovascular disease (hypertension and hypercholesterolemia), diabetes and several types of cancer. The effective treatment of obesity, however, remains a largely unachieved goal. Existing pharmacotherapeutic approaches to weight loss involve the use of amphetamine-based agents such as amphetamine, diethylpropion, mazindol and fenfluramine which act directly on the CNS to lower food intake by modulating dopaminergic, adrenergic and/or serotonergic mechanisms. Although weight loss can be achieved with such agents, their use is restricted due to CNS side-effects, potential addiction liability and
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the production of tolerance to their actions, with chronic administration leading to potential depression, vestibular disturbances, hallucinations and addiction, as well as interference with the actions of other drugs such as MAO inhibitors and antihypertensives. There is also a subpopulation of obese patients that is refractory to present anorectic drug treatments. The medical need is high for an effective agent which overcomes the above disadvantages of existing therapies. Of particular need are agents which act by alternative mechanisms to modulate food intake and/or metabolism. When people eat, their bodies turn the Carbohydrates in food into glucose (sugar) to use as fuel. In healthy people, insulin helps the glucose get into the cells. In people with obesity, glucose builds up in the blood beyond a normal or healthy level. In the absence of low insulin levels (as in obese patients) the blood glucose level rises above the safe levels. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Formulation of a mixture of free-B-ring flavonoids and flavans as a therapeutic agent Inventor(s): Jia, Qi; (Superior, CO) Correspondence: Swanson & Bratschun L.L.C.; 1745 Shea Center Drive; Suite 330; Highlands Ranch; CO; 80129; US Patent Application Number: 20030232763 Date filed: June 13, 2003 Abstract: The present invention provides a novel composition of matter comprised of a mixture of two specific classes of compounds--Free-B-ring flavonoids and flavans--for use in the prevention and treatment of diseases and conditions mediated by the COX-2 and 5-LO pathways. The present invention further provides a novel method for simultaneously inhibiting the cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LO) enzymes, and reducing cox-2 mRNA production. Finally, the present invention includes a method for weight loss and blood glucose control. The methods of this invention are comprised of administering to a host in need thereof an effective amount of the composition of this invention together with a pharmaceutically acceptable carrier. This invention relates generally to the prevention and treatment of diseases and conditions mediated by the cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LO) pathways, including but not limited to the relief joint discomfort and pain associated with conditions such as osteoarthritis, rheumatoid arthritis, and other injuries that result from overuse. Excerpt(s): This application is a continuation of U.S. patent application Ser. No. 10/427,746, filed Apr. 30, 2003, entitled Formulation Of A Mixture Of Free-B-Ring Flavonoids And Flavans As A Therapeutic Agent, which application claims priority to U.S. Provisional Application Serial No. 60/377,168, filed Apr. 30, 2002, entitled Formulation With Dual COX-2 And 5-Lipoxygenase Inhibitory Activity. Each of these references is hereby incorporated by reference in its entirety. This invention relates generally to the prevention and treatment of diseases and conditions mediated by the cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LO) pathways. Specifically, the present invention relates to a novel composition of matter comprised of a mixture of a blend of two specific classes of compounds--Free-B-ring flavonoids and flavans--for use in the prevention and treatment of diseases and conditions mediated by the COX-2 and 5-LO pathways. Included in the present invention is a method for the simultaneous inhibition of the protein function of the COX-2 and 5-LO enzymes, and a method for modulating the production of mRNA by administration of the novel composition of this invention.
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Also included in the present invention is a method for the prevention and treatment of COX-2 and 5-LO mediated diseases and conditions, including but not limited to joint discomfort and pain associated with conditions such as osteoarthritis, rheumatoid arthritis, and other injuries that result from overuse. Further included in the present invention is a method for reducing blood glucose levels and promoting weight loss. The liberation and metabolism of arachidonic acid (AA) from the cell membrane results in the generation of pro-inflammatory metabolites by several different pathways. Arguably, two of the most important pathways to inflammation are mediated by the enzymes 5-lipoxygenase (5-LO) and cyclooxygenase (COX). These parallel pathways result in the generation of leukotrienes and prostaglandins, respectively, which play important roles in the initiation and progression of the inflammatory response. These vasoactive compounds are chemotaxins, which promote infiltration of inflammatory cells into tissues and serve to prolong the inflammatory response. Consequently, the enzymes responsible for generating these mediators of inflammation have become the targets for many new drugs aimed at the treatment of inflammation that contributes to the pathogenesis of diseases such as rheumatoid arthritis, osteoarthritis, Alzheimer's disease and certain types of cancer. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
GLP-1 gene delivery for the treatment of type 2 diabetes Inventor(s): Ko, Kyungsoo; (Seoul, KR), Lee, Minhyung; (Seoul, KR), Oh, Seungjoon; (Seoul, KR) Correspondence: Thorpe North Western; 8180 South 700 East, Suite 200; P.O. Box 1219; Sandy; UT; 84070; US Patent Application Number: 20030220274 Date filed: May 21, 2002 Abstract: This patent discloses compositions and methods of use thereof to normalize the blood glucose levels of patients with type 2 diabetes. It relates particularly to a plasmid comprising a chicken.beta. actin promoter and enhancer; a modified GLP-1 (737) cDNA (p.beta.GLP1), carrying a furin cleavage site, which is constructed and delivered into a cell for the expression of active GLP-1. Excerpt(s): This invention relates to compositions and methods of use thereof to normalize the blood glucose levels of patients with type 2 diabetes. More particularly, the invention relates to a composition and method for the delivery of the GLP-1 gene, both in vitro and in vivo, for the treatment of type 2 diabetes. It relates particularly to a plasmid comprising a chicken.beta. actin promoter and enhancer; a modified GLP-1 (737) cDNA (p.beta.GLP1), carrying a furin cleavage site, which is constructed and delivered into a cell for the expression of active GLP-1. The invention also encompasses transfecting compositions comprising a complex of a plasmid containing a modified GLP-1 (7-37) cDNA (p.beta.GLP1) and poly(ethylenimine) (PEI) (for in vitro gene delivery) or PAGA (for in vivo gene delivery). Type 2 diabetes is characterized by hyperglycemia, insulin resistance, absolute or relative insulin deficiency, hyperglucagonemia, and increased hepatic glucose production. Although many treatment trials for type 2 diabetes have been held, there is still no definitive treatment for the disease. Insulin secretion is modulated by incretin hormones which are produced by the intestinal enteroendocrine cells and constitute one arm of the enteroinsular axis. There are two major incretins. One is glucose-dependent insulinotrophic polypepetide (GIP) and the other is glucagon like peptide-1 (GLP-1). These two incretin hormones
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account for 20% and 80% respectively, of the intestinal incretin effect. Holst J J: Glucagonlike peptide 1: a newly discovered gastrointestinal hormone. Gastroenterology 107:1848-1855, 1994 GIP, but not GLP-1, tends to lose its actions in patients with type 2 diabetes. Nauck M A, Heimesaat M M, Orskov C, Holst J J, Ebert R, Creutzfeldt W: Preserved incretin activity of glucagons-like peptide 1 [7-36 amide] but not of synthetic human gastric inhibitory polypeptide in patients with type-2 diabetes mellitus. J Clin Invest 91:301-307, 1993. GLP-1 was recently used for the treatment of type 2 diabetes. See U.S. Pat. Nos. 5,614,492; 5,545,618 and 6,048,724 which are incorporated herein by reference. Gene therapy is generally considered as a promising approach, not only for the treatment of diseases with genetic defects, but also in the development of strategies for treatment and prevention of chronic diseases such as cancer, cardiovascular disease and diabetes. However, nucleic acids, as well as other polyanionic substances are rapidly degraded by nucleases and exhibit poor cellular uptake when delivered in aqueous solutions. Since early efforts to identify methods for delivery of nucleic acids in tissue culture cells in the mid 1950's, steady progress has been made towards improving delivery of functional DNA, RNA, and antisense oligonucleotides in vitro and in vivo. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method and apparatus for non-invasive glucose sensing through the eye Inventor(s): Baba, Justin S.; (College Station, TX), Cote, Gerard L.; (College Station, TX) Correspondence: Neil Steinberg; Steinberg & Whitt, Llp; 2665 Marine Way, Suite 1150; Mountain View; CA; 94043; US Patent Application Number: 20030225321 Date filed: May 27, 2003 Abstract: There are many inventions described and illustrated herein. In one aspect, the present invention is a system and technique for non-invasively measuring, monitoring, inspecting, characterizing, determining and/or evaluating the blood glucose level in the aqueous humor of the eye of a patient (for example, a diabetic). In one embodiment, the present invention employs a plurality of wavelengths of light (for example, more than three) to measure, monitor, characterize, determine and/or evaluate the blood glucose level or concentration of a patient. The plurality of wavelengths of light may be directed into the aqueous humor of the eye and the reflected light (i.e., the light reflected by the eye) is detected and analyzed to provide information which is representative of the blood glucose level or concentration of the patient. Excerpt(s): This application claims priority to U.S. Provisional Application Serial No. 60/383,737, entitled "Method and Apparatus for Noninvasive Glucose Sensing Through the Eye", filed May 28, 2002. The contents of this provisional application are incorporated by reference herein in their entirety. This invention relates to techniques, systems and devices that are used to characterize, measure, monitor and/or evaluate the blood glucose level of a patient, for example, a human. More particularly, in one aspect, the present invention measures, monitors and/or evaluates, in a non-invasive manner, the glucose concentration in the aqueous humor of the eye as a way of monitoring blood glucose levels of a patient. More than ten million people in the United States of America suffer from diabetic hyperglycemia (an increased level of glucose in the blood) and hypoglycemia (a reduced level of glucose in the blood). Individuals afflicted with either disease in a severe form typically perform an invasive blood glucose level analysis four or more times a day. Typically, such an analysis requires the patient to do a finger or
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forearm stick to remove blood. Thereafter, the blood is placed on an electrochemical sensor or enzymatic-based calorimetric strip to determine the glucose level. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method and apparatus for the non-invasive measurement of blood glucose levels in humans Inventor(s): Ansari, Rafat R.; (Avon, OH), Rovati, Luigi; (Brescia, IT) Correspondence: James W. Mckee, ESQ.; Fay, Sharpe, Fagan, Minnich & Mckee, Llp; 1100 Superior Avenue, Seventh Floor; Cleveland; OH; 44114-2579; US Patent Application Number: 20030233036 Date filed: June 14, 2002 Abstract: An apparatus (10) for determining a diagnostic glucose level in a human subject includes a light source (30) that produces collimated light at a selected wavelength. The collimated light is arranged such that it passes through a portion of an eye (12) of the subject and reflects off an eye lens (16) at a selected angle (.theta.sub.B) as reflected light. A polarization analyzer (70) measures a polarization of the reflected light that exits the eye (12). A path length processor (68) determines an optical path length (L.sub.lambda.) of the reflected light within an aqueous humor (22) of the eye (12). A glucose level processor (90) computes a glucose concentration based on the measured polarization and the determined optical path length (L.sub.lambda.). Excerpt(s): This application claims the benefit of U.S. Provisional Application serial No. ______ of inventors Rafat R. Ansari and Luigi Rovati, entitled "Method and Apparatus for the Non-Invasive Measurements of Blood-Glucose Levels in Humans", filed on Jun. 16, 2001. The present invention relates to the medical arts. It particularly relates to the measurement of a diagnostic glucose level in a human subject, especially for the monitoring of diabetic patients, and will be described with particular reference thereto. However, the invention will also find application in conjunction with the non-invasive measurement of concentrations of other proteins and other optically active substances in the human body for medical diagnosis and monitoring. For example, the invention is contemplated to be applied for measuring.beta.-amyloid protein concentrations in the body, which are indicative of Alzheimer's disease. Diabetes is presently the fourth leading cause of mortality in the United States. Diabetes can lead to severe complications over time, including blindness, renal and cardiovascular diseases, and peripheral neuropathy associated with limbs. Diabetics typically exhibit poor blood circulation in lower extremities of the body which can lead to gangrene and subsequent amputation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method and device for predicting physiological values Inventor(s): Dunn, Timothy C.; (San Francisco, CA), Jayalakshmi, Yalia; (Sunnyvale, CA), Kurnik, Ronald T.; (Foster City, CA), Lesho, Matthew J.; (San Mateo, CA), Oliver, Jonathan James; (Oakland, CA), Potts, Russell O.; (San Francisco, CA), Tamada, Janet A.; (Mountain View, CA), Waterhouse, Steven Richard; (San Francisco, CA), Wei, Charles W.; (Fremont, CA) Correspondence: Barbara G. Mcclung; Cygnus, INC.; Intellectual Property DEPT.; 400 Penobscot Drive; Redwood City; CA; 94063; US Patent Application Number: 20040018486 Date filed: July 24, 2003 Abstract: The invention relates generally to methods, systems, and devices for measuring the concentration of target analytes present in a biological system using a series of measurements obtained from a monitoring system and a Mixtures of Experts (MOE) algorithm. In one embodiment, the present invention describes a method for measuring blood glucose in a subject. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/241,929, filed Feb. 1, 1999, which is a continuation-in-part of U.S. patent application Ser. No. 09/198,039, filed Nov. 23, 1998, which is a continuation-in-part of U.S. patent application Ser. No. 09/163,856, filed Sep. 30, 1998, all applications are herein incorporated by reference in their entireties. The invention relates generally to a method and device for measuring the concentration of target chemical analytes present in a biological system. More particularly, the invention relates to a method and monitoring systems for predicting a concentration of an analyte using a series of measurements obtained from a monitoring system and a Mixtures of Experts (MOE) algorithm. The Mixtures of Experts model is a statistical method for classification and regression (Waterhouse, S., "Classification and Regression Using Mixtures of Experts, October 1997, Ph. D. Thesis, Cambridge University). Waterhouse discusses Mixtures of Experts models from a theoretical perspective and compares them with other models, such as, trees, switching regression models, modular networks. The first extension described in Waterhouse's thesis is a constructive algorithm for learning model architecture and parameters, which is inspired by recursive partitioning. The second extension described in Waterhouse's thesis uses Bayesian methods for learning the parameters of the model. These extensions are compared empirically with the standard Mixtures of Experts model and with other statistical models on small to medium sized data sets. Waterhouse also describes the application of the Mixtures of Experts framework to acoustic modeling within a large vocabulary speech recognition system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method for selectively combining multiple membranes for assembly into test strips Inventor(s): Gopalan, Ramanan; (Sunnyvale, CA), Messamer, Jon Michael; (San Jose, CA), Sharma, Manoj; (Milpitas, CA) Correspondence: Mayumi Maeda; Lifescan, INC.; 1000 Gibraltar Drive; Milpitas; CA; 95035; US Patent Application Number: 20030235858 Date filed: June 21, 2002
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Abstract: A method for selectively combining multiple membranes for assembly into test strips (such as visual blood glucose test strips with side-by-side membranes). The method includes first measuring a plurality of color parameters (e.g., L*, a* and b* color parameters) associated with membrane samples from at least two membrane lots. Next, response characteristics (e.g., blood glucose response levels) are simulated for a speculative test strip that includes, for purposes of the simulation, combined multiple membranes tentatively selected from the at least two membrane lots. The simulated response characteristics are based on the measured plurality of color parameters of the tentative selection of combined multiple membranes. Optionally, the simulated response characteristics can also be based on simulated color parameters of the tentative selection of combined multiple membranes. Subsequently, assembly of the at least two membrane lots into a test strip with combined membranes is contingent on acceptable simulated response characteristics. Any suitable color parameters can be employed. The method can be used to selectively combine two or more membranes based on any number of color parameters. The assembled test strips can be used to measure glucose, cholesterol, proteins, ketones, phenylalanine or enzymes in blood, urine, saliva or other biological fluid, as well as sample fluid characteristics (e.g., pH and alkalinity). Excerpt(s): This invention relates, in general, to methods for the manufacturing of test strips and, in particular, to methods for selectively combining multiple membranes for assembly into test strips. Various test strips have been developed for measuring the concentration of certain analytes in fluids and/or chemical properties of a fluid (e.g., pH or alkalinity). Such test strips can be used to measure, for example, glucose, cholesterol, proteins, ketones, phenylalanine or enzymes in blood, urine or saliva. These test strips frequently include multiple membranes that facilitate the determination of the analyte concentration or chemical property. For example, U.S. Pat. No. 6,162,397, which is fully incorporated herein by reference, describes a visual blood glucose test strip with two side-by-side membranes (i.e., paired membranes). Such paired membranes contain reagents which react with blood glucose to form visibly different colors (see also, Sherwood, M. et al., A New Reagent Strip (Visidex.TM.) for Determination of Glucose in Whole Blood, Clinical Chemistry, 438-446 [1983]). A user can subsequently compare the two colors thus formed to a calibrated color chart (e.g., a color chart that includes sets of paired color pads) to ascertain blood glucose concentration. The acceptance testing of a lot of test strips is conventionally conducted after multiple membranes (each from a separate lot of membranes) have been combined and assembled into the lot of test strips. However, a particular combination of multiple membranes that has been assembled into a lot of test strips may not be optimal or even acceptable in terms of result accuracy. If a lot of test strips undergoing acceptance testing does not meet acceptance criteria for result accuracy, the entire lot of test strips is subject to rejection. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method of normalizing glucose levels in blood of patients with diabetes mellitus by oral administration of proanthocyanidins containing plant extracts Inventor(s): Rohdewald, Peter; (Muenster, DE) Correspondence: Gibbons, Del Deo, Dolan, Griffinger & Vecchione; 1 Riverfront Plaza; Newark; NJ; 07102-5497; US Patent Application Number: 20040115285 Date filed: December 13, 2002
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Abstract: A method for reducing blood glucose levels in patients with diabetes mellitus using as pharmaceutically effective agent a plant extract containing a high percentage of proanthocyanidins is provided. The method includes administering to hyperglycemic patients a proanthocyanidins containing plant extract in preparations suitable for oral intake in a dosage that is therapeutically effective to decrease elevated glucose levels or elevated glycosylated hemoglobin levels in blood of diabetics. Excerpt(s): The present invention relates to the use of plant extracts containing proanthocyanidins to lower the elevated blood glucose levels of patients with diabetes mellitus. Diabetes mellitus is a wide spread disease affecting a substantial part of the population. The most obvious sign of diabetes mellitus is an abnormally elevated concentration of glucose in the blood. The high glucose level signals a pathological condition of metabolism, affecting the metabolism of carbohydrates, lipids and proteins. Diabetes mellitus is characterized by hyperglycemia resulting from impaired insulin secretion and is associated with a host of late complications including retinopathy, nephropathy, atherosclerotic coronary and peripheral arterial disease, and peripheral and autonomic neuropathies. There are two main types of diabetes mellitus. In Type I, or insulin dependent diabetes (also known as juvenile diabetes), the insulin-secreting cells in the pancreas are destroyed and insulin production ceases almost completely. Type II, or non-insulin-dependent diabetes (adult-onset diabetes), is usually marked by gradual onset wherein insulin is produced, but not in sufficient quantity to fully metabolize blood glucose. Both types result in an abnormally high level of glucose in the blood, which, if left uncorrected, can cause coma and death. To overcome the lack of insulin, substitution of insulin is a logical and successful way to treat type I diabetes. Conventional insulin treatment for diabetes includes one or two injections per day of intermediate-acting insulin, with or without smaller added doses of rapid-acting insulin in the same syringe. Treatment of type II diabetes starts with diet. In a more intensive treatment of type II diabetes sulphonylurea derivates, such as, for example, tolbutamide, or biguanidines, such as metformin, or alpha glucosidase inhibitors, such as acarbose, and finally insulin are used. More recently, glitazons have been added to the therapy as insulin sensitizers which reinforce or start the action of insulin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method of use of monomeric insulin as a means for improving the reproducibilty of inhaled insulin Inventor(s): Farr, Stephen J.; (Orinda, CA), Gonda, Igor; (San Francisco, CA), Rubsamen, Reid M.; (Oakland, CA) Correspondence: Bozicevic, Field & Francis Llp; 200 Middlefield RD; Suite 200; Menlo Park; CA; 94025; US Patent Application Number: 20040062722 Date filed: October 8, 2003 Abstract: The need for the delivery of insulin by injection can be reduced or eliminated by delivering an aerosolized monomeric insulin formulation. Repeatability of dosing and more particularly the repeatability of the blood concentration versus time profile is improved relative to regular insulin. The blood concentration versus time profile is substantially unaffected by specific aspects of the patient's breathing maneuver at delivery. Further, the rate at which blood glucose is lowered is increased by the use of monomeric insulin. Particles of insulin and in particular monomeric insulin delivered to the surface of lung tissue will be absorbed into the circulatory system. The monomeric
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insulin may be a dry powder but is preferably in a liquid formulation delivered to the patient from a hand-held, self-contained device which automatically releases an aerosolized burst of formulation. The device includes a sensor which is preferably electronic which measures inspiratory flow and volume which measurement can be used to control the point of drug release. Excerpt(s): This application is a continuation-in-part of U.S. application Ser. No. 08/792,616 filed Jan. 31, 1997 which application is incorporation herein by reference and to which application we claim priority under 35 U.S.C.sctn.120. This invention relates generally to a method of aerosolized drug delivery. More specifically, this invention relates to the controlled intrapulmonary delivery of a monomeric insulin alone or in combination with other treatment methodologies which are combined to significantly reduce or eliminate the need for administering insulin by injection. Diabetes Mellitus is a disease affecting approximately 7.5 million people in the United States. The underlying cause of this disease is diminished or absent insulin production by the Islets of Langerhans in the pancreas. Of the 7.5 million diagnosed diabetics in the United States, approximately one-third are treated using insulin replacement therapy. Those patients receiving insulin typically self-administer one or more doses of the drug per day by subcutaneous injection. Insulin is a polypeptide with a nominal molecular weight of 6,000 Daltons. Insulin has traditionally been produced by processing pig and cow pancreas to allow isolation of the natural product. More recently, recombinant technology has made it possible to produce human insulin in vitro. It is the currently common practice in the United States to institute the use of recombinant human insulin in all of those patients beginning insulin therapy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Methods for regulating gastrointestinal motility Inventor(s): Keating Brown, Kathleen Ann; (Wake Forest, NC), Kolterman, Orville G.; (Poway, CA), Rink, Timothy J.; (La Jolla, CA), Young, Andrew A.; (Alpine, CA) Correspondence: Arnold & Porter; Attn: IP Docketing Department; Room 1126b; 555 Twelfth Street, NW; Washington; DC; 20004-1206; US Patent Application Number: 20040097415 Date filed: August 18, 2003 Abstract: Methods for treating conditions associated with elevated, inappropriate or undesired post-prandial blood glucose levels are disclosed which comprise administration of an effective amount of an amylin agonist alone or in conjunction with other anti-gastric emptying agents. Methods for reducing gastric motility and delaying gastric emptying for therapeutic and diagnostic purposes are also described. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 08/118,381 filed Sep. 7, 1993 which is incorporated herein by reference. The present invention relates to methods for regulating gastrointestinal motility. More particularly, the invention relates to the use of amylin and agonists of amylin in the treatment of disorders which would be benefited with agents useful in delaying and/or slowing gastric emptying. The invention also relates to the use of amylin antagonists to accelerate gastric emptying, for example, in treating gastric hypomotility and associated disorders. Amylin is a 37-amino acid protein hormone. It was isolated, purified and chemically characterized as the major component of amyloid deposits in the islets of pancreases of human Type 2 diabetics (Cooper et al., Proc. Natl. Acad. Sci., USA,
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84:8628-8632 (1987)). The amylin molecule has two important post-translational modifications: the C-terminus is amidated, and the cysteines in positions 2 and 7 are cross-linked to form an N-terminal loop. The sequence of the open reading frame of the human amylin gene shows the presence of the Lys-Arg dibasic amino acid proteolytic cleavage signal, prior to the N-terminal codon for Lys, and the Gly prior to the Lys-Arg proteolytic signal at the CLAIMS-terminal position, a typical sequence for amidation by protein amidating enzyme, PAM (Cooper et al., Biochem. Biophys. Acta, 1014:247-258 (1989)). Amylin is the subject of United Kingdom patent application Serial No. 8709871, filed Apr. 27, 1987, and corresponding U.S. applications filed Apr. 27, 1988, Nov. 23, 1988 and May 2, 1989. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Modified peptide Inventor(s): Flatt, Peter Raymond; (County Antrim, GB), O'Harte, Finbarr Paul Mary; (County Londonderry, GB) Correspondence: Daniel A Monaco; Drinker Biddle & Reath; One Logan Square; 18th & Cherry Streets; Philadelphia; PA; 19103-6996; US Patent Application Number: 20040116657 Date filed: February 5, 2004 Abstract: The invention provides a peptide based on biologically active CCK-8 having improved characteristics for the treatment of obesity and/or type 2 diabetes wherein the primary structure of CCK-8 is: Asp.sup.1Tyr.sup.2(SO.sub.3H)Met.sup.3Gly.sup.4Trp.sup.5Met.sup.6Asp.sup-.7Phe.sup.8amide and wherein the peptide has at least one amino add substitution and/or modification and is not Asp.sup.1-glucitol CCK-8. The invention also provides the use of the peptide in the preparation of a medicament to inhibit food intake, induce satiety, stimulate insulin secretion, moderate blood glucose exursions, enhance glucose disposal and/or exhibit enhanced stability in plasma compared to native CCK-8 and/or for treatment of obesity and/or type 2 diabetes. Excerpt(s): The present invention relates to the regulation of feeding and control of energy metabolism. More particularly the invention relates to the use of peptides to suppress food intake and pharmaceutical preparations for the treatment of obesity and type 2 diabetes. Cholecystokinin (CCK), is a neuropeptide hormone found in the brain and secreted from gut endocrine cells, which was originally identified from its ability to stimulate gall bladder contraction. CCK is now known to play a significant role in many physiological processes including regulation of satiety, bowel motility, gastric emptying, insulin secretion, pancreatic enzyme secretion and neurotransmission. CCK exists in multiple molecular forms in the circulation ranging from 58, 39, 33, 22, 8 and 4 amino acids in length. CCK-33 was the original form purified from porcine intestine. The Cterminal octapeptide CCK-8 is well conserved between species and is the smallest form that retains the full range of biological activities. A variety of CCK molecular forms are secreted following ingestion of dietary fat and protein, from endocrine mucosal I cells that are mainly located in the duodenum and proximal jejunum. Once released CCK-8 exerts its biological action on various target tissues within the body in a neurocrine, paracrine or endocrine manner. These actions are mediated through two major receptor sub-populations CCK.sub.A (peripheral subtype) and CCK.sub.B (brain subtype). Specific receptor antagonists such as proglumide have aided our understanding of the action of CCK on food intake. Involvement of CCK in the control of food intake in
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rodents was recognised in the early 1970's, and since then this peptide hormone has been shown to reduce feeding in man and in several animal species. The induction of satiety is a common feature in different species but the mechanism by which this is achieved is poorly understood. However, many different tissues are known to possess specific receptors for CCK including the vagus nerve, pyloric sphincter and brain all of which may be implicated in this control mechanism. It has been proposed that CCK stimulates receptors in the intestine that activate the vagus nerve, which relays a message to the satiety centres in the hypothalamus. In support of this concept, it has been found that satiety effects of CCK are eliminated in vagotomized animals. Furthermore, rodent studies have indicated that CCK has a more potent satiating ability when administered by the intraperitoneal route rather than centrally. Intraperitoneal CCK-8 is thought to act locally rather than hormonally. In addition, it is known that CCK-8 does not cross the blood brain barrier. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Modulation of PTEN expression via oligomeric compounds Inventor(s): Baker, Brenda F.; (Carlsbad, CA), Bennett, C. Frank; (Carlsbad, CA), Monia, Brett P.; (Encinitas, CA), Vickers, Timothy; (Oceanside, CA) Correspondence: Cozen O'connor, P.C.; 1900 Market Street; Philadelphia; PA; 191033508; US Patent Application Number: 20040002153 Date filed: January 3, 2003 Abstract: Oligomeric compounds, compositions and methods are provided for modulating the expression of PTEN. The compositions comprise oligomeric compounds, particularly double stranded oligomeric compounds, targeted to nucleic acids encoding PTEN. Methods of using these compounds for modulation of PTEN expression and for treatment of diseases and conditions associated with expression of PTEN are provided. Such conditions include diabetes and hyperproliferative conditions. Methods for decreasing blood glucose levels, inhibiting PEPCK expression, decreasing blood insulin levels, decreasing insulin resistance, increasing insulin sensitivity, decreasing blood triglyceride levels or decreasing blood cholesterol levels in an animal, among others, using the compounds of the invention are also provided. The animal is preferably a human; also preferably the animal is a diabetic animal. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/878,582 filed Jun. 11, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/577,902 filed May 24, 2000, which is a continuation-in-part of PCT application PCT/US99/29594, filed Dec. 14, 1999, which is a continuation of U.S. patent application Ser. No. 09/358,381, filed Jul. 21, 1999, now issued as U.S. Pat. No. 6,020,199, the disclosures of which are hereby incorporated by reference in their entireties. This application also claims priority of U.S. application Ser. No. 60/411,780, filed Sep. 19, 2002, which is herein incorporated by reference in its entirety. The present invention provides compositions and methods for modulating the expression of PTEN. In particular, this invention relates to oligomeric compounds, particularly double stranded oligomeric compounds, hybridizable with nucleic acids encoding human PTEN. Such particularly double stranded oligomeric compounds have been shown to modulate the expression of PTEN. One of the principal mechanisms by which cellular regulation is effected is through the transduction of extracellular signals across the membrane that in turn modulate biochemical pathways within the cell. Protein phosphorylation
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represents one course by which intracellular signals are propagated from molecule to molecule resulting finally in a cellular response. These signal transduction cascades are tightly regulated and often overlap as evidenced by the existence of multiple protein kinase and phosphatase families and isoforms. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Multivariate analysis of green to ultraviolet spectra of cell and tissue samples Inventor(s): Freeman, Jenny; (Weston, MA), Mansfield, James; (Boston, MA) Correspondence: Mintz, Levin, Cohn, Ferris, Glovsky; And Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20040034292 Date filed: August 11, 2003 Abstract: This invention relates to methods for processing in vivo skin auto-fluorescence spectra for determining blood glucose levels. The invention also relates to methods of classifying cells or tissue samples or quantifying a component of a cell or tissue using a multivariate classification or quantification model. Excerpt(s): This invention relates to analysis methodology and multivariate classification of diagnostic spectra, and, in particular, to methods for processing in vivo skin auto-fluorescence spectra for determining blood glucose levels. The invention also relates to methods of classifying cells or tissue samples or quantifying a component of a cell or tissue using a multivariate classification or quantification model. Near-IR spectra taken from agricultural samples, such as grains, oil, seeds and feeds, etc., have been used to quantitate various bulk constituents, e.g., total protein, water content, or fat content. See, P. Williams et al., "Agricultural Applications of Near-IR Spectroscopy and PLS Processing," Canadian Grain Commission. The use of multivariate methods for the analysis of ex vivo tissue samples is well established. For spectra taken in vivo, some work has been done. Linear discriminant analysis has been used to classify visible/nearIR spectra of human finger joints into early and late rheumatoid arthritis classes. Multivariate methods have been used to classify fluorescence spectra taken in vivo from cervixes according to the presence or absence of cervical cancer or pre-cancerous tissues. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Non-invasive in vivo determination of body fluid parameter Inventor(s): Aberg, Peter; (Huddinge, SE), Ollmar, Stig; (Huddinge, SE), Perlmutter, Alan Lorne; (London, CA) Correspondence: Blake, Cassels & Graydon Llp; Box 25, Commerce Court West; 199 Bay Street, Suite 2800; Toronto; ON; M5l 1a9; CA Patent Application Number: 20030220581 Date filed: March 26, 2003 Abstract: A non-invasive method of monitoring a biological parameter concerning a bodily fluid of a subject, e.g., blood glucose of a human subject. The method includes: placing an electrode against a site of the skin of the subject; measuring impedance of the skin and determining the parameter therefrom; and using substantially the same site in another determination. Another non-invasive monitoring method includes: exposing a
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skin site to an aqueous salt solution for a pre-determined first period of time; removing excess of the solution from the site; measuring impedance at the site; exposing the site to the solution for a pre-determined second period of time and repeating the removing and measuring steps. It is determined whether the impedance measured falls within a predetermined range. The latter exposure and removal steps are repeated, if necessary, until two consecutive impedance measurements within the pre-determined range are obtained. Excerpt(s): This application claims priority from U.S. Provisional Patent Application Serial Nos. 60/367,196, filed Mar. 26, 2002, and No. 60/417,561, filed Oct. 11, 2002, the entire contents of which applications are incorporated herein by reference. This invention relates to a method of measuring impedance for the in vivo non-invasive determination of a biological parameter concerning a bodily fluid of a mammal. A particular aspect of the invention relates to measuring the impedance repetitively at the same site for determining a blood glucose level, to an apparatus for use in such measurements, etc. In another aspect, the invention involves a combination of multiple treatment steps of the skin site at which the impedance measurements are taken multiple impedance measurements in the determination. Non-invasive measurement of skin impedance is described in the patent literature, for example, in U.S. Pat. No. 5,890,489 which issued on Apr. 6, 1999, and international patent application No. PCT/US 98/02037 published initially on Aug. 12, 1999 under WO 99/39627, and again as U.S. Pat. No. 6,517,482 on Feb. 11, 2003. These documents describe the use of skin impedance measurements in determining the level of a subject's blood glucose. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Non-invasive measurement of analytes Inventor(s): Lambert, Christopher Robert; (Hudson, MA), Workman, Jerome James JR.; (Brookline, MA) Correspondence: Mintz, Levin, Cohn, Ferris, Glovsky; And Popeo, P.C.; One Financial Center; Boston; MA; 02111; US Patent Application Number: 20040106163 Date filed: July 10, 2003 Abstract: This invention provides devices, compositions and methods for determining the concentration of one or more metabolites or analytes in a biological sample, including cells, tissues, organs, organisms, and biological fluids. In particular, this invention provides materials, apparatus, and methods for several non-invasive techniques for the determination of in vivo blood glucose concentration levels based upon the in vivo measurement of one or more analytes or parameters found in skin. Excerpt(s): This invention is a continuation in part of U.S. Ser. No. 10/______, filed on Jul. 9, 2003 and claims priority to the U.S. provisional patent application serial No. 60/425,488, filed Nov. 12, 2002, and serial No. 60/438,837, filed Jan. 9, 2003, each of which is incorporated by reference in its entirety. This invention provides devices, compositions and methods for determining the concentration of one or more analytes in a biological sample, including cells, tissues, organs, organisms, and biological fluids. In particular, this invention provides materials, apparatus, and methods for several noninvasive techniques for the determination of in vivo blood glucose concentration levels based upon the in vivo measurement of one or more analytes or parameters found in
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skin. Identifying and understanding the risk factors associated with diabetes is invaluable for the development and evaluation of effective intervention strategies. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Non-invasive psychophysical measurement of glucose using photodynamics Inventor(s): Ou, Junli; (Lexington, KY), Rice, Mark J.; (Jacksonville, FL), Routt, Wilson; (Lexington, KY), Woods, Joe W.; (Lexington, KY) Correspondence: Foley & Lardner; 150 East Gilman Street; P.O. Box 1497; Madison; WI; 53701-1497; US Patent Application Number: 20040087843 Date filed: August 15, 2003 Abstract: Blood glucose concentrations are measured by non-invasive methods and apparatus using visual pigment bleaching in conjunction with psychophysical methodologies. Bleaching light of selected wavelengths is projected through the pupil of the eye of an observer onto the fundus to bleach visual pigments in the eye. The observer's psychophysical response to a visual stimulus is then measured to obtain information regarding the rate of regeneration of the visual pigments. From the rate of pigment regeneration, blood glucose concentrations are measured accurately. The psychophysical methodologies that may be used with the invention include visual acuity tests and color-matching tests. Excerpt(s): This application claims the benefit of provisional application No. 60/405,978, filed Aug. 26, 2002, the disclosure of which is incorporated by reference. This invention pertains to the field of non-invasive in vivo measurement of blood glucose. The measurement of blood glucose by diabetic patients has traditionally required the drawing of a blood sample for in vitro analysis. The blood sampling is usually drawn by the patient as a finger puncture. The need to draw blood for analysis is undesirable for a number of reasons, including discomfort to the patient, the time required for medical personal to draw and handle the samples, the high cost of testing supplies, and the potential risk of spread of disease through punctures of the skin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Novel compounds and therapeutic uses thereof Inventor(s): Sankaranarayanan, Alangudi; (Ahmedabad, IN) Correspondence: Sughrue Mion, Pllc; 2100 Pennsylvania Avenue, N.W.; Washington; DC; 20037; US Patent Application Number: 20030225102 Date filed: April 8, 2003 Abstract: The invention discloses a novel series of compound represented by general formula (I), 1its derivatives, analogs, tautomeric forms, stereoisomers, polymorphs, pharmaceutically acceptable salts, solvates wherein X, n, k, z, R1, R2, R3, R4, R5 and R6 are as defined in the specification that are useful in (i) normalizing elevated blood glucose levels in diabetes, (ii) treating disorders related to glucose intolerance and (iii) for scavenging free radicals of mammals.The invention also discloses pharmaceutically acceptable composition comprising these compounds, method for preparation of the
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compounds as defined above and method of treating mammals including human beings by administering an effective amount of said compounds to a subject in need thereof. The invention further discloses use of these compounds in the manufacture of a medicament useful for treatment of different disease conditions as stated above. Excerpt(s): This application claims benefit from U.S. provisional application No. 60/370,224 filed Apr. 08, 2002 which is incorporated herein by reference in its entirety. The present invention relates to novel heterocyclic compounds useful for normalizing elevated blood glucose levels in diabetics and in treating disorders related to glucose intolerance. These compounds inhibit the enzyme DPP-IV, that degrade the peptide GLP-1, providing for enhanced levels of active GLP-1, a peptide which normalizes elevated blood glucose levels. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Novel heteroaromatic inhibitors of fructose 1,6-bisphosphatase Inventor(s): Kasibhatla, Srinivas Rao; (San Diego, CA), Reddy, K. Raja; (San Diego, CA), Reddy, N. Rami; (San Diego, CA), Agarwal, Atul; (Hamdein, CT), Dang, Qun; (San Diego, CA), Erion, Mark D.; (Del Mar, CA) Correspondence: Diana L. Bush, PH.D., ESQ.; Brobeck, Phleger & Harrison, Llp; 12390 EL Camino Real; San Diego; CA; 92130-2081; US Patent Application Number: 20040058892 Date filed: August 6, 2003 Abstract: Novel FBPase inhibitors of the formula I and X 1are useful in the treatment of diabetes and other conditions associated with elevated blood glucose. Excerpt(s): This application is a continuation-in-part of Provisional Application Serial Nos. 60/135,504, filed Sep. 9, 1998 and 60/111,077, filed Dec. 7, 1998 and are incorporated by reference in its entirety. This invention relates to novel heteroaromatic compounds that possess a phosphonate group that are inhibitors of Fructose-1,6bisphosphatase. The invention also relates to the preparation and use of these compounds in the treatment of diabetes, and other diseases where the inhibition of gluconeogenesis, control of blood glucose levels, reduction in glycogen storage, or reduction in insulin levels is beneficial. The following description of the background of the invention is provided to aid in understanding the invention, but is not admitted to be, or to describe, prior art to the invention. All cited publications are incorporated by reference in their entirety. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Novel peptide agonists of GLP-1 activity Inventor(s): Larsen, Bjarne Due; (Bronshoj, DK), Mikkelsen, Jens Damsgaard; (Lyngby, DK), Neve, Soren; (Lyngby, DK) Correspondence: Edwards & Angell, Llp; P.O. Box 55874; Boston; MA; 02205; US Patent Application Number: 20040106547 Date filed: November 8, 2002
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Abstract: Novel peptide agonists of GLP-1 activity useful for lowering blood glucose levels. The novel peptides comprise variants of the GLP-1 or the exendin-4 polypeptide sequence and are pharmacologically active and stable. These peptides are useful in the treatment of diseases that benefit from regulation of excess levels of blood glucose and/or regulation of gastric emptying, such as diabetes and eating disorders. Excerpt(s): The present invention relates to novel peptide agonists of GLP-1 activity. More specifically the invention relates to novel peptides that lower blood glucose levels comprising variants of the exendin-4 polypeptide sequence and peptide conjugates comprising variants of the GLP-1 or the exendin-4 polypeptide sequences which are pharmacologically active and stable, and as agonists of GLP-1 activity are useful in the treament of diseases that benefit from regulation of excess levels of blood glucose and/or regulation of gastric emptying, such as diabetes and eating disorders. The present invention also relates to methods of preparing said novel peptides, a composition, e.g., a pharmaceutical composition, comprising a peptide of the invention and a physiologically acceptable carrier, to said peptide for use in therapy, a method of treating a disorder and to the use of said peptide for the manufacture of a pharmaceutical composition for use in therapy. A number of hormones that lower blood glucose levels are released from the gastrointestinal mucosa in response to the presence and absorption of nutrients in the gut. These include gastrin, secretin, glucosedependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). The most potent substance known is GLP-1 (.O slashed.rskov, 1992, Diabetologia 35:701711). Glucagon-like peptide 1 (GLP-1) is a product of proglucagon, a 180 amino acid peptide (Drucker, 1998, Diabetes 47:159-169). The overall sequence of proglucagon contains the 29-amino acid sequence of glucagon, the 36 or 37 amino acid sequence of GLP-1 and the 34 amino acid sequence of glucagon-like peptide-2 (GLP-2), an intestinotrophic peptide. GLP-1 has a number of functions. It is a physiological hormone that enhances the effect on insulin secretion in normal humans and is therefore an incretin hormone. In addition, GLP-1 also lowers glucagon concentrations, slows gastric emptying, stimulates (pro)insulin biosynthesis, and enhances insulin sensitivity (Nauck, 1997, Horm. Metab. Res. 47:1253-1258). The peptide also enhances the ability for the.beta.-cells to sense and respond to glucose in subjects with impaired glucose tolerance (Byrne, 1998, Eur. J. Clin. Invest. 28:72-78). The insulinotropic effect of GLP-1 in humans increases the rate of glucose disappearance partly because of increased insulin levels and partly because of enhanced insulin sensitivity (D'Alessio, 1994, Eur. J. Clin. Invest. 28:72-78). This has placed GLP-1 as a promising agent for treatment for type II diabetes. Active fragments of GLP-1 have been found to be GLP-1(7-36) (SEQ ID NO: 114) and GLP-1(7-37) (SEQ ID NO: 124). However, a major pharmacological problem with native GLP-1 is its short half-life. In humans and rats, GLP-1 is rapidly degraded by dipeptidyl peptidase-IV (DPP-IV) into GLP-1(9-36)amide (SEQ ID NO: 125), acting as an endogenous GLP-1 receptor antagonist (Deacon, 1998, Diabetologia 41:271-278). Several strategies circumventing this problem have been proposed, some using inhibitors of DPP-IV and others DPP-IV resistant analogues of GLP-1 (7-36)amide (SEQ ID NO: 114) (Deacon, 1998, Diabetologia 41:271-278; Deacon et al., 1998, Diabetes 47:764769; Ritzel, 1998, J. Endocrinol. 159:93-102; U.S. Pat. No. 5,545,618; Pederson, 1998, Diabetes 47:1253-1258). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Novel use of arylethene sulfonamide derivative Inventor(s): Fujimori, Akira; (Ibaraki, JP), Shibasaki, Kumiko; (Tsukuba-shi, JP), Sonoda, Rie; (Tsukuba-shi, JP), Tahara, Atsuo; (Tsukuba-shi, JP), Yuyama, Hironori; (Ibaraki, JP) Correspondence: Finnegan Henderson Farabow; Garrett & Dunner; 1300 I Street NW; Washington; DC; 20005-3315; US Patent Application Number: 20040097529 Date filed: September 26, 2003 Abstract: Novel use of N-[6-methoxy-5-(2-methoxyphenoxy)-2-(pyrimidin-2yl)pyrimidin- -4-yl]-2-phenylethenesulfonamide or a pharmaceutically acceptable salt thereof. Improvement of the following particular condition in a diabetic patient: (1) Elevation of blood glucose level; (2) Elevation of blood lipid level after the onset of early-stage nephropathy; (3) Renal dysfunction after the onset of early-stage nephropathy; (4) Increase of urinary albumin excretion after the onset of early-stage nephropathy; (5) Glomerular hyperfiltration after the onset of early-stage nephropathy; (6) Renal dysfunction after the progress toward chronic renal failure; (7) Increase of urinary protein excretion after the progress toward chronic renal failure. Excerpt(s): The present invention relates to novel use of N-[6-methoxy-5-(2methoxyphenoxy)-2-(pyrimidin-2-yl)pyrimidin-4-yl]-2 -phenylethenesulfonamide or salts thereof. Endothelin (hereinafter referred to as "ET") is an endogenous physiologically active peptide consisting of 21 amino acids, and known to exist as 3 types of iso-peptides, i.e., ET-1, ET-2 and ET-3, of which the amino acid sequences are slightly different each other. ET binds to the ET receptor on the target cellular membrane to exhibit a physiological activity. Up to now, as for the ET receptor, it is known that there are at least 2 sub-types, i.e., ET.sub.A and ET.sub.B. ET.sub.A receptor has higher affinity to ET-1 and ET-2 than to ET-3, and ETB receptor has the same degree of affinity to ET-1, ET-2 and ET-3. N-[6-Methoxy-5-(2 -methoxyphenoxy)-2-(pyrimidin-2yl)pyrimidin-4-yl- ]-2-phenylethenesulfonamide (hereinafter referred to as "Compound A") or salts thereof have been disclosed in International Patent Publication No. 97/22595, in which their effect of inhibiting the binding of ET-1 to the ET.sub.A receptor as well as the effect of inhibiting the ET-1-induced vasoconstriction and elevation of blood pressure have been disclosed specifically, but there is no disclosure on other particular effect. On the other hand, a number of diseases in which ET is possibly involved have been exemplified as follows: essential hypertension, pulmonary hypertension, erythropoietin-induced hypertension, cyclosporin A-induced hypertension, bronchial asthma, acute renal failure, chronic renal failure, glomerular nephritis, cyclosporin-induced renal failure, acute myocardial infarction, unstable angina pectoris, chronic heart failure, cerebrovascular spasm mainly caused by subarachnoid hemorrhage, cerebral ischemic disturbance, urinary incontinence, benign prostatic hypertrophy, arteriosclerosis, Raynaud's syndrome, diabetic peripheral circulatory disturbance, diabetic nephropathy, preeclampsia, premature labor, peptic ulcer, hepatic insufficiency, rheumatism, restenosis after PTCA, chronic respiratory failure, chronic obstructive pulmonary disease, cor pulmonale, acute respiratory failure, pulmonary edema, ischemic hepatopathy, adult respiratory distress syndrome, interstitial pneumonia, fibroid lung, glaucoma, osteoarthritis, chronic rheumatoid arthritis, liver cirrhosis, inflammatory enteropathy, cancer, and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Pharmaceutical compositions for lowering blood glucose and blood cholesterol levels Inventor(s): Bibbs, Jeffrey A.; (San Diego, CA), Rao, Srirama; (San Diego, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20040006128 Date filed: April 28, 2003 Abstract: Methods of treating a mammal with high blood-glucose, or high bloodcholesterol, levels with isovitexin, and pharmaceutical compositions comprising the same are disclosed. Excerpt(s): The present application is related to and claims priority to the U.S. Provisional Application Serial No. 60/378,716, filed May 6, 2002, by Bibbs et al., and entitled "PHARMACEUTICAL COMPOSITIONS FOR LOWERING BLOOD GLUCOSE AND BLOOD CHOLESTEROL LEVELS," the entire disclosure of which, including any drawings, is hereby incorporated by reference herein. The present invention relates to the field of lowering blood glucose or blood cholesterol levels by administering a bioflavanoid to a mammal in need thereof. Diabetes mellitus is a chronic condition characterized by the inability to regulate blood glucose levels. It is estimated that 1.5 to 2% of the entire population of the world suffers from diabetes mellitus of some type. Diabetes mellitus is a metabolic disorder of the human body primarily involving an inability of the body to properly store and utilize sugar and other chemical compounds in the metabolism of the body. It is characterized by an elevation in the concentration of sugar in the blood and also by the appearance of sugar in the urine. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Pituitary adenylate cyclase activating peptide (PACAP) receptor (VPAC2) agonists and their pharmacological methods of use Inventor(s): Dumas, Michael L.; (Richmond, CA), Froland, Wayne A.; (Alameda, CA), Kelner, Drew N.; (Newbury Park, CA), Pan, Clark; (Castro Valley, CA), Wang, Wei; (Alameda, CA), Wang, Yu-Chang John; (Burlingame, CA), Whelan, James; (Madison, CT) Correspondence: Jeffrey M. Greenman; Bayer Pharmaceuticals Corporation; 400 Morgan Lane; West Haven; CT; 06516; US Patent Application Number: 20040058870 Date filed: July 11, 2003 Abstract: This invention provides novel peptides that function in vivo as agonists of the VPAC2 receptor. These insulin secretagogue polypeptides are shown to lower blood glucose in vivo more than controls upon glucose challenge. The polypeptides of this invention are also stable in formulation and have long half-lives. The peptides of the present invention provide a new therapy for patients with decreased endogenous insulin secretion, in particular type 2 diabetics. In particular, the invention is a polypeptide selected from a specific group of VPAC2-related polypeptides, or functional equivalents thereof. The invention is also directed to a method of treating a metabolic disease in a mammal comprising administering a therapeutically effective amount of the insulin secretagogue peptides to said mammal. Also disclosed are methods of making the peptides, both recombinant and synthetic.
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Excerpt(s): This application claims benefit of U.S. Provisional Application Serial No. 60/395,738, filed Jul. 12, 2002, the contents of which are incorporated herein by reference in their entirety. This invention relates to newly identified polypeptides and the use of such polypeptides for therapeutic purposes. More particularly, the polypeptides of the present invention are useful in stimulating the release of insulin from pancreatic.beta.cells in a glucose-dependent manner, thereby providing a treatment option for those individuals afflicted with metabolic disorders such as diabetes or impaired glucose tolerance, a prediabetic state. Diabetes is characterized by impaired glucose metabolism manifesting itself, among other things, by an elevated blood glucose level in the diabetic patient. Underlying defects lead to a classification of diabetes into two major groups: type 1 diabetes, or insulin dependent diabetes mellitus (IDDM), which arises when patients lack.beta.-cells producing insulin in their pancreatic glands, and type 2 diabetes, or non-insulin dependent diabetes mellitus (NIDDM), which occurs in patients with an impaired.beta.-cell function and alterations in insulin action. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Placental alkaline phosphatase to control diabetes Inventor(s): Kiss, Zoltan; (Austin, MN) Correspondence: Faegre & Benson Llp; 2200 Wells Fargo Center; 90 South 7th Street; Minneapolis; MN; 55402; US Patent Application Number: 20040115185 Date filed: December 12, 2002 Abstract: The present invention provides methods for using human placental alkaline phosphatase or an active derivative to reduce blood glucose level in a mammal. Treatment regimens provided by the invention may be used to control Type I and Type II forms of diabetes in humans. The methods and treatment regimens may be effective to maintain the human's blood glucose level below about 10 mM, and preferably within the normal range of 4 mM to 7 mM. The methods and treatment regimens may be used in combination with administration of known anti-diabetic medicaments. The invention also provides a preparation for administration to a human, the preparation comprising homogeneous purified human placental alkaline phosphatase in a physiologically acceptable carrier. Excerpt(s): The present invention relates to methods for using human placental alkaline phosphatase, an enzyme produced by human placenta during pregnancy, to reduce blood glucose level in a mammal. Treatment regimens provided by the invention may be used to control Type I and Type II forms of diabetes in humans. Significant recent changes in human behavior and lifestyle as well as the human environment have resulted in the escalation of diabetes during the last decades. Diabetes is a disease characterized by elevated levels of blood plasma glucose, or hyperglycemia. Hyperglycemia, if uncontrolled, can lead to other complications, such as blindness, kidney disease, heart disease, stroke, nerve diseases, circulatory disorders, and impotence in males. Diabetes is a chronic disease with diverse pathologic manifestations, and is accompanied by lipid metabolism and cardiovascular disorders as well as glycometabolism disorders. Diabetes mellitus is a heterogeneous group of disorders characterized by high blood glucose (sugar) levels. There are two main types of diabetes. Type I, or insulin-independent diabetes, results from an absolute deficiency of insulin due to autoimmunological destruction of the insulin-producing pancreatic.beta.-cell islets [Bell, G. I. and Polonsky, K. S., "Diabetes mellitus and
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genetically programmed defects in.beta.-cell function." Nature 414, 788-791 (2001); Mathis, D., Vence, L. and Benoist, C., ".beta.-cell death during progression to diabetes." Nature 414, 792-798 (2001)]. People with Type I diabetes must take exogenous insulin for survival to prevent the development of ketoacidosis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Process for preparation of anti-diabetic compositions from banyan bark Inventor(s): Bassa, Babu V.; (Santee, CA), Murthy, Pothapragada Suryanarayana; (Noida, IN), Prabhu, Krishna Madhava; (Delhi, IN) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 92614; US Patent Application Number: 20040071803 Date filed: January 21, 2003 Abstract: The present invention is directed in part towards methods of preparing a blood glucose-lowering extract from banyan bark, method of treating a mammal with a high blood glucose level using a banyan bark extract, and pharmaceutical compositions comprising banyan bark extracts. Excerpt(s): There are two major types of diabetes mellitus--insulin dependent diabetes mellitus (IDDM) or type I and non-insulin dependent diabetes mellitus (NIDDM) or type II. Of these two, the incidence of NIDDM is much higher. Present view seems to be that IDDM is due to genetically destructive mechanisms with circulating antibodies to insulin which are aggravated by external factors such as infection (viruses etc.), toxic chemicals etc. It occurs mostly in young patients. For this reason it is also referred to as juvenile diabetes sometimes. As the name suggests insulin is essential for the treatment of IDDM. Oral diabetic drugs are of limited or no use to such patients. NIDDM occurs mostly in adults, either obese or non-obese. It is also referred to sometimes as maturity onset diabetes. In this condition there is deficiency of insulin secretion or action. This could be due to down regulation of insulin receptors or receptor mediated decreased sensitivity to insulin action or post receptor defect to insulin action. About 70% of the diabetics of the World are estimated to have NIDDM, who need oral antidiabetic drugs either alone or in some cases with insulin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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System and method for monitoring blood glucose levels using an implantable medical device Inventor(s): Kroll, Mark W.; (Simi Valley, CA) Correspondence: Pacesetter, INC.; 15900 Valley View Court; Sylmar; CA; 91392-9221; US Patent Application Number: 20040077962 Date filed: October 21, 2002 Abstract: T-wave amplitude and QT interval are derived from patient cardiac signals. Then blood glucose levels are determined based on a combination of the T-wave amplitude and the QT interval. By using a combination of both T-wave-based and QT interval-based signals, blood glucose levels can be reliably detected throughout a wide range of blood glucose levels. Once the blood glucose level has been detected, the
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implanted device compares the blood glucose level against upper and lower acceptable bounds and appropriate warning signals are generated if the level falls outside the bounds. In one example, wherein an implantable insulin pump is additionally provided, the pump is controlled based on the detected blood glucose level to maintain glucose levels within an acceptable range. A calibration technique is also provided for determining patient-specific parameters for use in the detection of blood glucose levels. Excerpt(s): This application is related to copending U.S. patent application Ser. No. ______, titled "System and Method for Monitoring Blood Glucose Levels Using an Implantable Medical Device," filed concurrently herewith, Atty. Docket A02P1067US01. The invention relates generally implantable medical devices, such as pacemakers or implantable cardioverter/defibrillators (ICDs), and in particular to implantable medical devices provided with the capability of monitoring blood glucose levels. Diabetic patients need to frequently monitor blood glucose levels to ensure that the levels remain within acceptable bounds and, for insulin dependent diabetics, to determine the amount of insulin that must be administered. Conventional techniques for monitoring blood glucose levels, however, leave much to be desired. One conventional technique, for example, requires that the patient draw blood, typically by pricking the finger. The drawn blood is then analyzed by a portable device to determine the blood glucose level. The technique can be painful and therefore can significantly discourage the patient from periodically checking blood glucose levels. Moreover, since an external device is required to analyze the blood, there is the risk that the patient will neglect to keep the device handy, preventing periodic blood glucose level monitoring. For insulindependent diabetics, failure to properly monitor blood glucose levels can result in improper dosages of insulin causing, in extreme cases, severe adverse health consequences such as a ketoacidotic diabetic coma, which can be fatal. Accordingly, there is a significant need to provide a reliable blood glucose monitoring technique, which does not rely on the patient to monitoring his or her own glucose levels and which does not require an external analysis device. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
System for providing blood glucose measurements to an infusion device Inventor(s): Estes, Mark C.; (Simi Valley, CA), Talbot, Cary D.; (Santa Clarita, CA), Tolle, Mike Charles Vallet; (Van Nuys, CA), Yonemoto, Jay A.; (Arcadia, CA) Correspondence: Medtronic Minimed, Inc; 18000 Devonshire Street; Northridge; CA; 91325-1219; US Patent Application Number: 20040068230 Date filed: July 22, 2003 Abstract: An infusion system includes a characteristic determining device and an infusion device. The characteristic determining device includes a receptacle for receiving and testing an analyte from the user to determine a concentration of the analyte in the user. The characteristic determining device also includes a communication system for transmitting a communication including data indicative of the determined concentration of the analyte in the user, and the infusion device includes a communication system for receiving the communication from the characteristic determining device. The infusion device further includes a bolus estimator for calculating an estimated amount of fluid to be infused into the body of the user based upon the received data indicative of the determined concentration of the analyte in the user and a target concentration of the
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analyte in the user, and an indicator to indicate when the estimated amount of fluid to be infused has been calculated. Excerpt(s): This application claims priority from U.S. Provisional Applications No. 60/398,199 filed Jul. 24, 2002 and No. 60/412,998 filed Sep. 23, 2002, which are herein incorporated by reference. This invention relates generally to infusion systems that are used for infusing a fluid into a user, and in particular, to apparatuses and methods for providing blood glucose measurements to an infusion device. Patients with Type 1 diabetes and some patients with Type 2 diabetes use insulin to control their blood glucose (BG) level. Typically, if a patient's BG level is too high, the patient can inject a "bolus" (dose) of insulin to lower his/her BG level from its present level to a desired target level. Furthermore, patients may inject a bolus of insulin in anticipation of ingesting carbohydrates, thus heading off a sharp rise in their BG level. Patients employ various calculations to determine the amount of insulin to inject. Bolus estimation software is available for calculating an insulin bolus. Patients may use these software programs on an electronic computing device, such as a computer, the Internet, a personal digital assistant (PDA), or an insulin delivery device. Insulin delivery devices include infusion pumps, injection pens, and IV meters. The best bolus estimation software takes into account the patient's present BG level. Presently, a patient must measure his/her blood glucose using a BG measurement device, such as a test strip meter, a continuous glucose measurement system, or a hospital hemacue. BG measurement devices use various methods to measure the BG level of a patient, such as a sample of the patient's blood, a sensor in contact with a bodily fluid, an optical sensor, an enzymatic sensor, or a fluorescent sensor. When the BG measurement device has generated a BG measurement, the measurement is displayed on the BG measurement device. Then the patient may visually read the BG measurement and physically enter the BG measurement into an electronic computing device to calculate a bolus estimate. Finally, once the bolus estimate is calculated, the patient must inject the insulin bolus or program an insulin delivery device to deliver the bolus into their body. Unfortunately, this process is cumbersome and is subject to transcribing errors--for example, the patient may inaccurately enter the BG measurement that is displayed on the BG measurement device into the electronic computing device. Thus, if the BG measurement is not entered correctly, the bolus estimate is not accurate, which may lead to the delivery of an inappropriate insulin dose. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Systems and methods for blood glucose sensing Inventor(s): Bell, Douglas E.; (Coral Springs, FL), Neel, Gary T.; (Weston, FL), Wong, T. Philip; (Coral Springs, FL) Correspondence: Mcdonnell Boehnen Hulbert & Berghoff Llp; 300 S. Wacker Drive; 32nd Floor; Chicago; IL; 60606; US Patent Application Number: 20040094432 Date filed: November 12, 2003 Abstract: A system for measuring a glucose level in a blood sample includes a test strip and a meter. The test strip includes a sample chamber, a working electrode, a counter electrode, fill-detect electrodes, and an auto-on conductor. A reagent layer is disposed in the sample chamber. The auto-on conductor causes the meter to wake up and perform a test strip sequence when the test strip is inserted in the meter. The meter uses the working and counter electrodes to initially detect the blood sample in the sample
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chamber and uses the fill-detect electrodes to check that the blood sample has mixed with the reagent layer. The meter applies an assay voltage between the working and counter electrodes and measures the resulting current. The meter calculates the glucose level based on the measured current and calibration data saved in memory from a removable data storage device associated with the test strip. Excerpt(s): This application is a divisional of U.S. patent application Ser. No. 10/286,648, filed Nov. 1, 2002, which claims priority on U.S. Provisional Patent Application Serial No. 60/375,017, filed Apr. 25, 2002, U.S. Provisional Patent Application Serial No. 60/375,019, filed Apr. 25, 2002, U.S. Provisional Patent Application Serial No. 60/375,020, filed Apr. 25, 2002, and U.S. Provisional Patent Application Serial No. 60/375,054, filed Apr. 25, 2002, all of which are fully incorporated herein by reference. The present invention relates to electrochemical sensors and, more particularly, to systems and methods for sensing blood glucose levels electrochemically. Many people, such as diabetics, have a need to monitor their blood glucose levels on a daily basis. A number of systems that allow people to conveniently monitor their blood glucose levels are available. Such systems typically include a test strip where the user applies a blood sample and a meter that "reads" the test strip to determine the glucose level in the blood sample. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Use Inventor(s): Gronberg, Alvar; (Knivsta, SE), Wikstrom, Per; (Upplands Vasby, SE) Correspondence: Fish & Richardson PC; 225 Franklin ST; Boston; MA; 02110; US Patent Application Number: 20030225117 Date filed: April 17, 2003 Abstract: The present invention relates to the use of NAD(P)H oxidase inhibitors to increase cellular uptake of glucose and in the treatment and/or prevention of diseases caused by insulin resistance or diseases related thereto, such as type II diabetes. Specifically, the invention relates to a method for identifying an agent useful for the treatment or prophylaxis of a medical condition associated with elevated levels of blood glucose, the method comprising (i) contacting a candidate agent with a mammalian NAD(P)H oxidase or NAD(P)H oxidase complex; and (ii) determining whether said candidate agent inhibits the biological activities of the NAD(P)H oxidase or NAD(P)H oxidase complex. Excerpt(s): This application claims priority from Swedish Patent Application No. 0201152-6, filed Apr. 17, 2002, and U.S. Provisional Patent Application Serial No. 60/410,626, filed Sep. 13, 2002. These applications are incorporated herein by reference in their entirety. The present invention relates to the use of NAD(P)H oxidase inhibitors to increase cellular uptake of glucose and in the treatment and/or prevention of diseases caused by insulin resistance or diseases related thereto, such as type II diabetes. A large number of people suffer, or are predisposed to suffer from disturbances in their metabolism. One such disturbance includes insulin resistance, which is characteristic of the metabolic syndrome (syndrome X), polycystic ovary syndrome, obesity and type II diabetes, diseases that are rapidly growing in number in the western world. These diseases are multi-factorial and their mechanism or physiology are, in the majority of cases, not well characterized or understood. Type II diabetes includes the most prevalent form of diabetes, which results from insulin resistance with an insulin
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secretory defect. Pharmacological treatments such as metformin and rosiglitazone have an ameliorating effect on insulin resistance and are believed to increase the effectiveness of endogenous insulin and thereby contribute to the lowering of elevated blood glucose levels in type II diabetes patients. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Use of carbohydrate source to limit weight gain in cats Inventor(s): Sunvold, Gregory D.; (Eaton, OH) Correspondence: Killworth, Gottman, Hagan & Schaeff, L.L.P.; Suite 500; One Dayton Centre; Dayton; OH; 45402-2023; US Patent Application Number: 20040022828 Date filed: July 30, 2003 Abstract: A process is provided for limiting weight gain in cats. The process includes feeding the cat a pet food composition that includes a source of protein, a source of fat, and a source of carbohydrates from a grain source that excludes rice. Use of the preferred low glycemic index grain sources that comprise a blend of corn and sorghum; a blend of corn, sorghum, and barley; or a blend of corn, sorghum, and oats, has the effect of decreasing the postprandial blood glucose and insulin response of the cat as compared to when feeding a rice-based diet. The result is that the animal becomes satiated and voluntarily decreases its intake of food, causing less weight gain. This effect is even more marked when the composition is fed to male cats. Excerpt(s): This application is a continuation-in-part of the following U.S. patent applications, the disclosures of which are incorporated herein by reference: Ser. No. 09/268,919, filed Mar. 16, 1999; Ser. No. 09/507,066, filed Feb. 18, 2000 and claiming priority to U.S. provisional application Serial No. 60/121,087, filed Feb. 23, 1999; and Ser. No. 09/609,622, filed Jul. 5, 2000 and claiming priority to U.S. provisional application Serial No. 60/143,032, filed Jul. 9, 1999. This invention relates to a process of administering a pet food composition to prevent obesity in companion animals, such as cats and dogs. More particularly, the invention relates to a process for limiting weight gain in cats. The invention is further directed to a process for decreasing the postprandial blood glucose and insulin response in cats to promote satiety and a voluntary decrease in food intake. Obesity is a significant health concern in companion animals. Veterinary care professionals have reported that approximately 20-40% of the pets in their care are overweight. These animals bear a greater risk for health problems associated with the respiratory, cardiovascular, and skeletal systems. More particularly, obese feline patients have demonstrated greater susceptibility to diseases such as diabetes mellitus, osteoarthritis, ligament injuries, perineal dermatitis, cardiomyopathy, and hepatic lipidosis. Accordingly, new technologies meeting the health needs of obese feline patients are in high demand by pet owners and veterinarians alike. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Use of exendins and agonists thereof for the treatment of gestational diabetes mellitus Inventor(s): Hiles, Richard A.; (San Diego, CA), Prickett, Kathryn S.; (San Diego, CA) Correspondence: Arnold & Porter; IP Docketing Department; RM 1126(b); 555 12th Street, N.W.; Washington; DC; 20004-1206; US Patent Application Number: 20040023871 Date filed: June 5, 2003 Abstract: Methods for treating gestational diabetes which comprise administration of an effective amount of an exendin or an exendin agonist, alone or in conjunction with other compounds or compositions that lower blood glucose levels. Excerpt(s): The present invention relates to methods for treating gestational diabetes mellitus comprising administration of an effective amount of an exendin or an exendin agonist alone or in conjunction with other compounds or compositions that affect blood glucose control, such as an insulin or an amylin agonist. Pharmaceutical compositions for use in the methods of the invention are also disclosed. The following description summarizes information relevant to the present invention. It is not an admission that any of the information provided herein is prior art to the presently claimed invention, nor that any of the publications specifically or implicitly referenced are prior art to that invention. Gestational Diabetes Mellitus Gestational diabetes mellitus ("GDM") is a disorder associated with elevated circulating plasma glucose. Although the diagnostic criteria for GDM have been the subject of controversy for decades, it was defined by the Third Workshop Conference on Gestational Diabetes Mellitus as carbohydrate intolerance of varying severity with onset or first recognition during pregnancy, irrespective of the glycemic status after delivery. Metzger (ed.) Proceedings of the Third International Workshop Conference on Gestational Diabetes Mellitus, Diabetes 40(Suppl. 2), 1991. Despite advances in clinical management of GDM, there are problems associated with GDM which persist, including elevated rate of perinatal morbidity and elevated rate of malformations in newborns. Persson et al., Diabetes and Pregnancy, In International Textbook of Diabetes Mellitus, Second Edition, John Wiley & Sons 1997 (Alberti et al. Eds.). For example, it has been reported that, when the mean blood glucose level is greater than 105 mg/dl, there is a greater risk for the P development of large-for-gestational age ("LGA") infants when compared with a control population. Id. Additional reported consequences of untreated GDM include an increased incidence of macrosomia, respiratory distress syndrome, and other abnormalities of fetal metabolism. Langer, Am. J. Obstet Gynecol. 176:S186, 1997; American Diabetes Association: Self-Monitoring of Blood-Glucose Consensus Statement, Diabetes Care 17:81-82, 1994("ABA Consensus Statement"); Coetzee & Jackson, S. Afr. Med. J. 56:467-475, 1979. It has been clearly established by those in the field that tight glycemic control can serve as the primary prevention of fetal disease relating to GDM. Drexel et al., Diabetes Care 11:761-768, 1988; Roversi et al., Diabetes Care 3:489494,.1980; Langer & Mazze, Am. J. Obstet Gynecol. 159:1478-1483, 1988; Langer et al., Am. J. Obstet Gynecol. 161:646-653, 1989). GDM results in a greater incidence of intrauterine death or neonatal mortality. Position Statement American Diabetes Association: Gestational Diabetes Mellitus, Diabetes Care 21 (Suppl. 1):S60-61, 1998. GDM pregnancies are at an increased risk for fetal macrosomia and neonatal morbidities including neural tube defects, hypoglycemia, hypocalcemiea, hypomagnsemia, polycythemia and hyperbilirubinemia and subsequent childhood and adolescent obesity. Siccardi, Gestational Diabetes. Other complications to the woman include
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increased rates of cesarean delivery, hypertensive disorders including preeclamsia and urinary tract infections. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with blood glucose, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “blood glucose” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on blood glucose. You can also use this procedure to view pending patent applications concerning blood glucose. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 6. BOOKS ON BLOOD GLUCOSE Overview This chapter provides bibliographic book references relating to blood glucose. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on blood glucose include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “blood glucose” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on blood glucose: •
Playing the Numbers: How to Make Sense of Your Blood Sugar Levels Source: Alexandria, VA: American Diabetes Association. 2003. 60 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. E-mail:
[email protected]. Fax: (770) 442-9742. Website: www.diabetes.org. PRICE: $7.95. ISBN: 580401813. Summary: A blood glucose meter is the best tool for taking care of diabetes. This booklet helps people with diabetes understand and use the numbers that the blood glucose meter provides from blood glucose testing (SMBG). The booklet discusses why blood glucose levels should be checked, how to do the SMBG checks, how to track and record numbers, the impact of food intake, medications (including insulin) and exercise on blood glucose levels, and strategies to improve the numbers (and, thus, one's diabetes management). The booklet provides most of the information in checklist or
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tabular format, for ease of understanding. Examples are provided to help readers understand how to interpret and utilize their own results for better self care. •
Advanced Carbohydrate Counting Source: Alexandria, VA: American Diabetes Association. 2003. 32 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. E-mail:
[email protected]. Fax: (770) 442-9742. Website: www.diabetes.org. PRICE: $20.00; sold in packages of 10; plus shipping and handling. Summary: A program of diabetes management must include an understanding of how food, medication, and physical activity work together to affect the blood glucose control. This booklet describes how counting carbohydrates can help increase the flexibility in food choices and timing of meals. The booklet reviews the importance of recordkeeping, pattern management (tracking and managing trends in blood glucose levels over time), related terminology, how to figure insulin-to-carbohydrate ratios, weight management, and the importance of good nutrition. The booklet has a section of answers to frequently asked questions, covering topics including how to handle a changing insulin-to-carbohydrate ratio, the basal requirements for insulin and how they can change over the day, insulin sensitivity factor (ISF) and how to calculate it, high fiber foods and meals, dietary fats, the use of insulin pumps for people using carbohydrate counting, and alcohol consumption. 5 figures. 7 references.
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Helping the Student with Diabetes Succeed: A Guide for School Personnel Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2003. 77 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.ndep.nih.gov/. PRICE: Single copy free; Full-text available online at no charge. Order number: 03-5217. Summary: Advances in medical research and technology have produced an array of treatment and management tools that have made it easier for people with diabetes to check their blood glucose levels and to control them. Blood glucose levels that are well managed have the potential to help young people not only to stave off the long-term complications of diabetes but also to feel better and to be happier and more productive at school and at play. Accordingly, students with diabetes need a supportive environment to help them take care of their diabetes throughout the school day and at school-sponsored activities. The National Diabetes Education Program (NDEP) developed this guide to educate and inform school personnel about diabetes, how it is managed, and how each member of the school staff can help meet the needs of students with the disease. School principals, administrators, nurses, teachers, coaches, bus drivers, health care, and lunchroom staff all play a role in making the school experience safe and sound for students with diabetes. The booklet includes four sections: a diabetes primer for school personnel; actions for school personnel, parents, and students; tools for effective diabetes management in school; and school responsibilities under Federal laws. Appendices include a resource list, a glossary of terms, and the American Diabetes Association's position statement of 'Care of Children with Diabetes in the School and Day Care Setting.' The materials are illustrated with bright graphics and black and white photographs.
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Diabetes Management: Complications Risk Assessment, Diagnosis, and Therapeutic Options Source: Larchmont, NY: Mary Ann Liebert, Inc. 2000. 215 p. Contact: Available from Mary Ann Liebert, Inc. 2 Madison Avenue, Larchmont, NY 10538. (914) 834-3100 or (800) 654-3237. Fax: (914) 834-3688. Email:
[email protected]. Website: www.liebertpub.com. PRICE: $106.95. ISBN: 913113883. Summary: Diabetes is a severe disease, as determined by morbidity and mortality; however, these can be deferred by aggressively identifying and treating the risk factors driving cardiovascular death. This textbook focuses on risk assessment, diagnosis, and treatment options for cardiovascular disease in diabetes. The author emphasizes the practical clinical management of patients with diabetes. Nine chapters cover health care policy and diabetes in the United States, the global management plan, hypertension (high blood pressure), dyslipidemias, microalbuminuria (microscopic protein in the urine), menopause, hyperglycemia (high blood glucose levels), the advanced treatment of hyperglycemia, and diabetic emergencies. Each chapter concludes with references and a subject index concludes the textbook.
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Uncomplicated Guide to Diabetes Complications. 2nd ed Source: Alexandria, VA: American Diabetes Association. 2002. 294 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800)232-3472. E-mail:
[email protected]. Website: www.diabetes.org. PRICE: $16.95; plus shipping and handling. ISBN: 58040133. Summary: Diabetes mellitus can result in many complications, but many of them can be prevented. This book explains to patients how early testing, new medical treatments, and improvements in diabetes control can prevent or slow the development of complications. Each complication is discussed, including symptoms, medical treatments, and self care approaches, in nontechnical language. Twenty chapters cover acute complications (diabetic ketoacidosis or DKA, and hyperosmolar hyperglycemic state or HHS), hypoglycemia (low blood glucose levels), foot problems, eye disease (diabetic retinopathy), heart disease, cholesterol and other blood fats, stroke, hypertension (high blood pressure), nephropathy (kidney disease), peripheral vascular disease, peripheral neuropathy (nerve disease), autonomic neuropathies, gastrointestinal complications, infection and diabetes, diabetes and skin, psychosocial complications, men's sexual health, women's sexual health, oral health, and prevention strategies. This edition includes information on the discoveries and recommendations from the recently completed Diabetes Prevention Program, which linked improved diet and exercise with a slow-down in the development of diabetes and of its complications. One appendix lists medical tests, including recommended scheduling for those tests. A brief description of the activities and resources of the American Diabetes Association is included. A subject index concludes the book.
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Insulin Therapy Source: Monticello, NY: Marcel Dekker, Inc. 2002. 272 p. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (845) 796-1919 or (800) 228-1160. Fax (845) 796-1772. Email:
[email protected]. Website: www.dekker.com. PRICE: $99.75. ISBN: 824707117.
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Summary: Evaluating strategies for the management of type 1 and type 2 diabetes, this reference book explores the pharmacokinetics of insulin and insulin programs. The book focuses on the latest blood glucose self-monitoring equipment and assessment strategies that can achieve optimal glycemic control and thus reduce the occurrence of complications including retinopathy (eye disease), neuropathy (nerve disease), nephropathy (kidney disease) and cardiovascular disease. The book offers fifteen chapters in three sections: background, patient populations, and prevention and therapy. Topics include the rationale for and strategies to achieve glycemic control; goals of treatment; insulin syringes, pens, and glucose-monitoring equipment and techniques; nutrition assessment and therapy; the physiology of glucose homeostasis and insulin secretion; insulin pharmacokinetics; intensive insulin therapy in type 1 diabetes mellitus; insulin therapy in type 2 diabetes mellitus; insulin therapy in children; insulin therapy in pregnancy; insulin management of hospitalized diabetic patients; hyperglycemic emergencies, including diabetic ketoacidosis and nonketotic hyperosmolar syndrome; insulin therapy and hypoglycemia; the art and science of insulin pump therapy; and noninvasive insulin-delivery systems. Each chapter includes references and the text concludes with a subject index. •
Getting the Most Out of Diabetes Camp: A Guide for Parents and Kids Source: Alexandria, VA: American Diabetes Association. 2002. 106 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580401422. Summary: For many children, attending a diabetes camp is a life-changing experience. These camps provide a safe place where kids are surrounded by people with diabetes, where everyone else is doing the same things to manage their illness and have a good quality of life. This book helps youngsters with diabetes and their parents learn about diabetes camps, decide whether to go, and then to choose the right diabetes camp. The book offers nine chapters: why choose diabetes camp over other types of camps, how to determine if a child is ready for camp, selecting the most appropriate camp, the application process, packing tips, what to expect at camp, homesickness, traditional camps, and how to evaluate a camp experience after it is over. The authors include numerous quotes from children and parents, and practical suggestions in each chapter. The book includes four appendices: a list of diabetes camps, a sample application packet, a sample scholarship application, and the warning signs of hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose). A subject index concludes the book.
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Diabetes Snack, Munch, Nibble, and Nosh Book. 2nd ed Source: Alexandria, VA: American Diabetes Association. 2003. 208 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. E-mail:
[email protected]. Fax: (770) 442-9742. Website: www.diabetes.org. PRICE: $12.95. ISBN: 580401775. Summary: For people with diabetes, snacks may be an essential part of their daily meal plan. Snacks at midmorning and in the afternoon help provide energy and prevent low blood glucose. However, snacks must be considered in the context of the total meal plan. They should be nutritious and they need to be counted in the daily total of calories, fats, carbohydrates, and proteins. This cookbook provides recipes for snack
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foods, with the nutritional values for each food provided. After an introductory section describing how to best incorporate snacks into the meal plan, the book offers recipes in 11 sections: spread it on, sandwich board, just for fun, the bake shop, crowd pleasers, vegetable delights, salad days, just for kids, microwave wonders, delectable desserts, and more scrumptious snacks. Exchange list information is also provided for each recipe. A recipe title index and a subject index (including ingredients) conclude the cookbook. •
Challenging Cases in Endocrinology Source: Totowa, NJ: The Humana Press, Inc. 2002. 421 p. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail:
[email protected] PRICE: $145.00, plus shipping and handling. ISBN:0896039145. Summary: In medicine, the difficult cases can yield valuable insights because they force physicians to think a little harder when making a diagnosis and to be creative when treating the patient. In this textbook, distinguished clinician-scientists describe in concise studies their most difficult cases and reveal what they did, how they did it, and why. The cases cover a wide range of medical problems, including pituitary and thyroid tumors, hypopituitarism, hyper and hypo thyroidism, metabolic bone disease, Cushing's syndrome, adrenal insufficiency, cancer, diabetes, and hypoglycemia (low blood glucose). Other cases involve disorders of female reproduction, of water balance and lipoprotein metabolism, of puberty, and of growth and development. Each case study reviews how the patient was managed, details the reasons why various tests and treatments (many only recently available) were carried out, and provides references to ensure that these novel methodologies can be easily translated into the endocrine specialist's daily practice. Two chapters are particularly relevant for diabetes: Type 1 Diabetes Mellitus (Chapter 16) and Type 2 Diabetes Mellitus (Chapter 17). The volume concludes with a detailed subject index.
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Our Health, Our Lives: A Revolutionary Approach to Total Health Care for Women Source: New York, NY: Pocket Books. 1995. 448 p. Contact: Available from Pocket Books. 1230 Sixth Avenue, New York, NY 10020. (800) 223-2336. PRICE: $24. ISBN: 0671880853. Summary: In this book, the author demonstrates how medicine can function when it serves women's needs and shows women how to help start that process in their own lives. Eighteen chapters are presented in four sections: the woman-centered approach; total health in context; women's life cycles; and mind and body together. Topics include becoming one's own health advocation; how the female body works; risk factors for heart disease; women's cancer; diabetes; preventing osteoporosis; bladder conditions; fatigue and the immune system; the patterns in women's lives; pregnancy and beyond; the menopause years; the emotionally healthy woman; healthy sexuality; eating problems; and substance addictions. The chapter on diabetes, subtitled 'The Invisible Health Crisis,' discusses weight and dieting issues for women; risk factors; a definition of diabetes and its complications; diabetes screening; taking control of diabetes; general guidelines for diet control and weight management; the role of exercise; tracking blood glucose levels; managing stress; pregnancy; and the impact of one's menstrual cycle on diabetes management. A detailed subject index concludes the book.
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Managing Your Diabetes Without Insulin Source: Boston, MA: Joslin Diabetes Center. 1997. 18 p. Contact: Available from Joslin Diabetes Center. One Joslin Place, Boston, MA 02215. (800) 344-4501. Fax (617) 732-2562. Website: www.joslin.org. PRICE: $3.50; plus shipping and handling. Item number: JDC 260. Summary: Individuals with type 2 diabetes can make some insulin but do not use it properly; this type of diabetes often can be managed without insulin injections. This booklet offers diabetes management strategies for readers with type 2 diabetes who do not use insulin. The booklet covers the symptoms of uncontrolled diabetes, the causes of diabetes, the diabetes care team, why it is important to maintain blood glucose (sugar) at healthful levels, food and nutrition guidelines (the role of carbohydrates, dietary fiber, portion control, sugar intake), the role of exercise, target heart rate, weight management, blood glucose testing (SMBG), recordkeeping, medication, the complications of poorly managed diabetes, how to cope with low blood glucose (hypoglycemia) and high blood glucose (hypertension) episodes, foot care, sick days, traveling with diabetes, support groups, and behavior modification strategies. The booklet offers practical, everyday tips for patients. 2 figures. 6 tables.
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Diabetes Type II: Living A Long, Healthy Life Through Blood Sugar Normalization Source: Old Tappan, NJ: Simon and Schuster. 1990. 375 p. Contact: Available from Simon and Schuster. Mail Order Billing, Old Tappan, NJ 07675. (201) 767-5937. PRICE: $21.45 (Shipping $3). Summary: The author offers a step-by-step guide for people with diabetes to keep blood glucose in the normal range. The book includes information on medications, equipment and supplies. For those who use insulin, the author recommends measuring their blood glucose several times a day using one drop of blood and a blood glucose meter; a lowcarbohydrate, high-protein diet; and exercise. For milder cases, he recommends diet, exercise and sometimes oral medications, but in small doses to keep blood glucose normal. The author stresses that these techniques must be learned by individuals with diabetes, as they are the ultimate custodians of their own health. Topics include how insulin and other hormones regulate blood glucose levels; supplies for people with diabetes; tests at the doctor's office; how and when to measure blood glucose; an analysis of the effects of carbohydrates, proteins, fats, and alcohol on blood glucose; using exercise to enhance sensitivity to the body's insulin; and how to prevent and correct low blood glucose. Appendixes offer gourmet recipes for low-carbohydrate meals, new breakthroughs in medications for compulsive overeaters, and information on preventing extreme blood glucose swings during the menstrual cycle. A detailed subject index is included. 16 figures. 17 tables.
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Practical Insulin: A Handbook for Prescribers Source: Alexandria, VA: American Diabetes Association. 2002. 59 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $7.95 plus shipping and handling. ISBN: 1580401538. Summary: The medical practice of many physicians now includes handling everincreasing numbers of patients with diabetes. Insulin therapy is a medical necessity for
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all patients with type 1 diabetes and the many patients with type 2 diabetes who cannot reach their glycemic (levels of blood glucose) without insulin therapy. This handbook offers solutions to the many common challenges involved in prescribing insulin, from choosing insulin regimens, to dealing with patient reluctance to start insulin therapy, to minimize the weight gain that often accompanies improved glycemic control. Specific topics include patient selection, insulin choices, the different types of insulin and their character, mixing insulins, insulin regimens (for type 1 and for type 2 patients), troubleshooting, patient SMBG (self monitoring of blood glucose) records, and patient education. The handbook also includes numerous appendices: endogenous insulin action, insulin storage, insulin potency, additives, insulin delivery, insulin pump, and determining insulin-to-CHO (carbohydrates) ratio. The author notes that there are no standards for how to best use insulin therapy; individual patient strategies must be implemented. 11 figures. 11 tables. •
My Sister Rose Has Diabetes Source: Santa Fe, NM: Health Press. 1997. 32 p. Contact: Available from Health Press. P.O. Box 1388, Santa Fe, NM 87504. (800) 6432665. Fax (505) 983-1733. E-mail:
[email protected]. Website: www.healthpress.com. PRICE: $8.95 (paperback). ISBN: 09291732779. Summary: This book addresses many of the difficult issues facing children who have diabetes and their families. It demonstrates how manageable the disease can be and reduces the devastation of those concerned. The book is written from the perspectives of both Rose, a ten year old girl who has diabetes, and her twelve year old brother. Rose's parents were surprised that she was diagnosed with diabetes; in fact, the book notes that 90 percent of children with diabetes do not have a family history of the disease. Topics include coping, self-monitoring blood glucose, injecting insulin, meal planning, hypoglycemia and hyperglycemia symptoms, sick days, working with a patient care team, and recordkeeping. Rose points out that the three things that she needs to balance are food, insulin, and exercise. Drawings painted with watercolor are included on nearly every page. A glossary explains terms of anatomy, diabetes, and treatment in children's wording. (AA-M).
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Diabetes Burnout: What to Do When You Can't Take It Anymore Source: Alexandria, VA: American Diabetes Association. 1999. 348 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $18.95 plus shipping and handling. ISBN: 1580400337. Summary: This book addresses the issue of diabetes burnout to help people with diabetes overcome their frustrations associated with diabetes self care. This problem may contribute to poor self care, high blood glucose, and later complications. The book begins by presenting stories about people struggling with their diabetes. This is followed by a chapter that addresses the issue of motivation and diabetes care. Topics include recognizing and overcoming personal, interpersonal, and environmental barriers to diabetes self management. The next chapter helps readers determine whether they have burnout and prepare to deal with it. Other chapters present reasons why it is impossible to follow a healthy meal plan and ways to overcome the barriers to healthy eating and reasons to hate blood sugar monitoring and exercise and what to do about them. In addition, chapters discuss coping with the werewolf syndrome, using insulin
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and oral medications, developing goals and action plans, worrying about long term complications, coping with depression, understanding and overcoming denial, dealing with friends and family, and working with one's health care team. Final chapters examine the impact of life and diabetes stresses on diabetes and its management. The book also includes numerous worksheets and an index. •
101 Foot Care Tips for People with Diabetes Source: Alexandria, VA: American Diabetes Association. 2000. 120 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 158040040X. Summary: This book answers 101 of the most commonly asked questions about diabetes and foot care. Questions in chapter one provide general information about foot care, including the importance of foot care; the foot problems people with diabetes experience; the people at greatest risk for developing foot problems; the prevention of diabetic foot problems; the role of weight, blood glucose control, and meal planning in diabetic foot problems; and health care checkups. Chapter two offers tips on washing and soaking the feet; caring for dry skin; and dealing with athlete's foot fungus, foot odor, and foot swelling. The third chapter provides tips for nail care, including trimming toenails and caring for ingrown toenails. Questions in chapter four provide information on shoe and sock selection. Topics include selecting shoes that fit properly, using insoles and orthotic devices, and seeing a pedorthist. This is followed by a chapter that explains how to treat minor foot problems, including blisters, corns, calluses, warts, bunions, minor injuries, and deformities. Chapter six provides tips for exercising. Questions in the next chapter deal with the identification of major problems, including foot ulcers and infections. This is followed by chapters that answer questions about complications such as peripheral neuropathy and poor circulation. Topics include the symptoms, diagnosis, and treatment of these complications. The final chapter answers questions about other foot problems, including arthritis, gout, Charcot's joint, osteomyelitis, gangrene, and toe amputation. The book also includes a list of resources and an index.
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Reflections on Diabetes Source: Alexandria, VA: American Diabetes Association. 1996. 122 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. PRICE: $7.95 (members), $9.95 (nonmembers). ISBN: 0945448651. Summary: This book contains 39 short, personal essays that have appeared in the Reflections column of the American Diabetes Association's Diabetes Forecast magazine. The essays are written by and about people living with diabetes. The preface notes that living with diabetes involves much more than the clinical concepts, such as blood glucose levels, insulin dosage, and calorie intake, but that diabetes becomes part of one's life story. The editors note that the essayists are stronger and wiser, not just from having diabetes, but from allowing their experiences to teach them important lessons about themselves and their lives. The personal stories are divided into six categories: growing up; parenting; complications; travel, sports, and adventure; taking charge; and friends and lovers. The book is illustrated with line drawings. (AA-M).
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16 Myths of a Diabetic Diet Source: Alexandria, VA: American Diabetes Association. 1999. 238 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400310. Summary: This book dispels commonly held myths about the foods that people who have diabetes can and cannot eat. Myths are that people who have diabetes have to eat different foods from the rest of the family; can eat as much as they want as long as the food does not contain sugar; should not eat too many starchy foods; should eat a lot of protein to stay strong and healthy; do not have to worry about eating fat because it does not have much of an effect on blood glucose; should only eat foods sweetened with sugar substitutes instead of sugar; must use the exchange system for meal planning; and people who have diabetes need to focus only on sugar and calories when reading food labels. Other myths are that people who have diabetes must be at ideal body weight to be healthy; need special vitamin and mineral supplements; should always follow a lowsodium diet; should not eat snacks; must exercise every day to stay healthy; should not eat in restaurants; should never give in to food cravings; and people who have diabetes cannot use their favorite family recipes. The book explains the origins of these misconceptions and provides breakthrough methods for creating a healthy, enjoyable way of eating. Each chapter ends with a short quiz based on key points from the chapter. Appendices present quiz answers and provide information about dietitians and diabetes educators. 2 appendices.
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Diabetes Medical Nutrition Therapy: A Professional Guide to Management and Nutrition Education Resources Source: Alexandria, VA: American Diabetes Association. Chicago, IL: American Dietetic Association. 1997. 290 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. PRICE: $21.00 (members), $24.95 (nonmembers). ISBN: 0880911468. Order code PNDMNT. Also available from The American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606-6995. (800) 877-1600, ext. 5000. Fax (312) 899-4899. PRICE: $21.00 (members), $24.95 (nonmembers). Summary: This book emphasizes the importance of nutrition in diabetes mellitus management and incorporates components of two previously published resources: Maximizing the Role of Nutrition in Diabetes Management and Meal Planning Approaches for Diabetes Management. It is designed to help dietetics professionals and other members of the diabetes care team understand the current management of diabetes and help individuals take responsibility for their diabetes self care management. The authors write that diabetes medical nutrition therapy should be based on the four-step model of nutrition assessment, goal setting, intervention, and evaluation. The purpose of diabetes medical nutrition therapy is to assist clients in acquiring and maintaining the knowledge, skills, attitudes, behaviors, and commitment to meet the challenges of daily diabetes self management successfully. Twenty-three chapters are divided into five categories: diabetes management; diabetes nutrition education; basic nutrition intervention; indepth nutrition intervention; and case studies and conclusion. Specific topics include the classification, pathophysiology, and diagnosis of diabetes; exercise, medications, and self monitoring of blood glucose;
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intensive insulin therapy; life stages; complications; special topics in meal planning; the progression from philosophy to practice; nutrition intervention and guidelines; menus and exchanges; carbohydrate counting; and calorie and fat counting. Seven case studies demonstrate the use of various meal planning resources in individual situations. The book highlights the importance of individualizing the nutrition care plan and supports the registered dietitian as the nutrition expert and health care provider responsible for developing this plan. The nutrition care plan must be adapted to the individual's lifestyle; it should not require a lifestyle change to accommodate the regimen. The book's final chapter summarizes major messages and notes other diabetes nutrition education resources. Figures and tables are included throughout the book. Seven appendices and an index conclude the book. (AA-M). •
Diabetes Self-Care Method Source: Los Angeles, CA: Lowell House, and Chicago, IL: Contemporary Books. 1990. 154 p. Contact: Available from Contemporary Books. 2 Prudential Plaza, Suite 1200, Chicago, IL 60601. (800) 621-1918. PRICE: $12.95 (as of 1996). ISBN: 0929923294. Summary: This book for people with diabetes describes a self management program that the authors devised to help patients lead better, freer, more balanced lives. The program, based on research conducted in recent years, summarizes an approach to optimum diabetes control, explains why control is necessary, and presents tips and systems to achieve control. Topics include: diabetes and its complications; how to measure personal health status; diabetes medications; how blood glucose swings affect mood; food and meal planning; how to develop an effective personal exercise program; pregnancy and diabetes; travel; effective management of problem situations; and alcohol and diabetes. The book, intended as a easy-to-understand home program, stresses all major aspects of self care. A glossary and index are appended.
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I Hate to Exercise Book for People with Diabetes Source: Alexandria, VA: American Diabetes Association. 2000. 123 p. Contact: Available from American Diabetes Association (ADA). 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-23837 (DIABETES). Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400442. Summary: This book helps people who have diabetes stay active by making the most of the activities they do daily such as walking, performing household chores, or gardening. The book begins by identifying the benefits of exercise, including improving blood glucose control, preventing heart disease, and controlling weight, and explaining how to begin incorporating activity into a daily routine. This is followed by a chapter that focuses on setting activity goals, making a plan to achieve them, and staying committed to a plan. Other chapters offer guidelines on building an activity program; identify ways to be more active at home, at play, and on the job; and discuss setting goals for a lifetime of physical activity and using the FITT Principle to set out exercise goals. In addition, the book provides guidelines on monitoring the effect of activity on blood glucose levels and presents sample exercises in a sit, stretch, and strengthen routine. 1 appendix. 8 figures. 16 tables.
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Diabetes 101: A Pure and Simple Guide for People Who Use Insulin. 3rd ed Source: Minneapolis, MN: Chronimed Publishing. 1998. 202 p.
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Contact: Available from Chronimed Publishing. P.O. Box 59032, Minnetonka, MN 55459-9686. (800) 848-2793 or (612) 541-0239. Fax (800) 395-3344 or (612) 541-0210. PRICE: $12.95 plus shipping and handling. ISBN: 156561156x. Summary: This book is a brief and readable guide to important basic information needed every day by people who take insulin to control their diabetes. Written in story format, the book uses real life examples to explore topics including diabetes care and supplies, insurance coverage, and reimbursement; ways to prevent and cope with stress; avoiding insulin reactions; self monitoring of blood glucose; sick days; and current advances in diabetes research. A subject index concludes the volume. •
Hypo-Hyper: 101 Short Stories About Diabetes Source: Richmond, VA: Endocrine and Diabetes Management Center. 1996. 106 p. Contact: Available from Endocrine and Diabetes Management Center. 7231 Forest Avenue, Suite 103, Richmond, VA 23226. PRICE: $15.00. Summary: This book is a collection of short stories about the experiences of patients with diabetes. The book includes 24 topics related to hypoglycemia (low blood glucose), and 14 topics around ketoacidosis. Each of the stories briefly relates (in a paragraph or two) a patient's duration of diabetes, presenting problem, treatment, and outcome. The stories are prefaced by an index with which readers can find experiences that fit the circumstances they are interested in. The authors do not make any judgements about each of the stories, merely presenting the facts as they were reported to them. The stories are meant to be a reflection of the real world of diabetes. Topics addressed include brittle diabetes, patient-doctor interrelationships, the elderly, exercise, family issues, injury or death, blood glucose meters, driving motor vehicles, neuroglycopenia, problems at night, patient noncompliance, pregnancy, insulin pumps, severe hypoglycemic reactions, stress and emotional issues, IDDM, NIDDM, hypoglycemic unawareness, newly diagnosed diabetes, ketoacidosis in pregnancy, complications, diabetes and Addison's disease, medical mismanagement, pump user errors, and self advocacy.
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Living a Healthy Life With Chronic Conditions: Self-Management of Heart Disease, Arthritis, Stroke, Diabetes, Asthma, Bronchitis, Emphysema and Others Source: Palo Alto, CA: Bull Publishing Company. 1994. 296 p. Contact: Available from Bull Publishing Company. P.O. Box 208, Palo Alto, CA 943020208. (800) 676-2855 or (415) 322-2855. Fax (415) 327-3300. E-mail:
[email protected]. PRICE: $14.95. ISBN: 0923521283. Summary: This book is a complete self-management guide for people with chronic diseases. The authors focus on day-to-day living skills, in the context of the specific chronic diseases, including heart disease, arthritis, stroke, diabetes, asthma, bronchitis, and emphysema. General topics include the psychological aspects to self-management; finding resources; smoking and quitting; understanding common symptoms; using one's mind to manage symptoms; exercising for fun and fitness; exercising for flexibility and strength; exercising for endurance; exercising tips for people with specific chronic diseases; the importance of communication; durable powers of attorney for health care; eating well; and managing medications. The chapter on diabetes covers diabetes and its causes; maintaining an appropriate blood glucose level; symptoms of hyperglycemia and hypoglycemia; dietary management; exercise; insulin injections; oral medications; emotions; self-monitoring of blood glucose and urine; the complications of diabetes;
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and diabetes resources. Each chapter includes limited references and a subject index concludes the volume. •
Diabetes Problem Solver Source: Alexandria, VA: American Diabetes Association. 1999. 511 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This book is a reference guide that helps people who have diabetes identify and prevent the most common diabetes-related problems they encounter on a daily basis. The book is divided into two major sections. The first section consists of a series of flowcharts to help readers decide what they need to do about a particular condition or symptom. Flowcharts focus on arm and hand pain, back pain, blurry vision, chest pain, confusion, convulsions or seizures, difficulty breathing, dizziness, dry skin, eating disorders, emotional problems, emotional changes in women, feeling tired, fever, foot problems, headache, hyperglycemia, hypoglycemia, injection site problems, and intestinal problems. Other flowcharts deal with leg and foot pain, loss of consciousness, muscular weakness, nausea, numbness and tingling, pain or discomfort in women, palpitations, problems with the mouth, problems with blood glucose in women, sexual problems in men and women, skin discoloration, skin lesions, skin rashes and itchy skin, sleeping problems, stomach pain, sweating, swelling, thickening of the skin, urinary problems, vision problems, and vomiting. The second section provides more detailed information about many of the problems people who have diabetes face. Solutions are provided for monitoring and testing problems; hypoglycemia and hyperglycemia problems; insulin delivery and oral medication problems; circulation, neuropathy, kidney, vision, gastrointestinal, infection, foot, and skin problems; men's, women's, and children's problems; eating, exercise, and weight problems; lifestyle problems; coping problems; discrimination and insurance problems; and other medical problems. Each section provides the reader with information on the symptoms of the condition, who is at risk and what risk the particular condition poses for the reader, what the reader's immediate course of action should be, treatment in a medical setting, and how to prevent the condition from developing. The reader may use the book in two ways. If the reader knows he or she has a particular condition or wants more information, he or she can go straight to the second section and look up the condition. The reader may use the book as a guide to possible conditions that may be causing symptoms by referring to the flowcharts in the first section. The book also includes a glossary, resources, and an index. 6 figures. 5 tables.
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Diabetes Mellitus: A Practical Handbook Source: San Mateo, CA: Bull Publishing Company. 1990. 200 p. Contact: Available from Bull Publishing Company. 148 East Third Avenue, Suite 200, San Mateo, CA 94401. (415) 340-7288. PRICE: $10.95 plus shipping and handling. ISBN: 0923521089. Summary: This book is an easy-to-use, patient-oriented guide to managing the everyday concerns of living with diabetes mellitus. The authors, one a nurse and one a dietitian, provide specific suggestions and helpful hints on the following topics: meal planning, food shopping, utilizing the American Diabetic Association exchange lists, medications, exercise, self monitoring of blood glucose levels, and identifying and treating low blood
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sugar. Numerous illustrations, menus, lists, and charts help provide an accessible, survival-skills approach to managing diabetes. A brief subject index and numerous resources for additional information, including books, articles, and organizations are included. 33 references. •
Core Curriculum for Diabetes Education. 4th ed.: (Volume 1) Diabetes and Complications Source: Chicago, IL: American Association of Diabetes Educators (AADE). 2001. 245 p. Contact: Available from American Association of Diabetes Educators. AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 338-3633. Fax (312) 424-2427. Website: www.diabeteseducator.org. PRICE: Individual volume $45.00 for members and $60.00 for nonmembers; complete 4-volume set $149.95 for members and $199.95 for nonmembers; plus shipping and handling. ISBN: 1881876055 (Volume 1); 1881876098 (4-volume set). Summary: This book is one in a series of four texts that make up a Core Curriculum, designed primarily to help educators prepare for the Certified Diabetes Educator (CDE) exam. In addition, these books can be used as a diabetes educator's reference source for diabetes education and management. This first volume, on diabetes and its complications, covers the pathophysiology of the diabetes disease state, hyperglycemia (high blood glucose levels), an overview of chronic complications of diabetes, diabetes foot care and education, skin and dental care, macrovascular disease, eye disease and adaptive diabetes education for visually impaired persons, nephropathy (kidney disease) , and diabetic neuropathy (nerve disease). Each chapter lists the learning objectives for that chapter, presents information in outline and bulleted format, summarizes the key educational considerations, offers self review questions and questions for discussion, presents an illustrative case report, and concludes with a list of references. A post-test and the answers to the post-test questions are appended to each chapter. The volume concludes with a subject index.
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Core Curriculum for Diabetes Education. 4th ed.: (Volume 2) Diabetes Management Therapies Source: Chicago, IL: American Association of Diabetes Educators (AADE). 2001. 306 p. Contact: Available from American Association of Diabetes Educators. AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 338-3633. Fax (312) 424-2427. Website: www.diabeteseducator.org. PRICE: Individual volume $45.00 for members and $60.00 for nonmembers; complete 4-volume set $149.95 for members and $199.95 for nonmembers; plus shipping and handling. ISBN: 1881876063 (Volume 2); 1881876098 (4-volume set). Summary: This book is the second in a series of four texts that make up a Core Curriculum, designed primarily to help educators prepare for the Certified Diabetes Educator (CDE) exam. In addition, these books can be used as a diabetes educator's reference source for diabetes education and management. This second volume, on diabetes management therapies, covers medical nutrition therapy (MNT) for diabetes, exercise, pharmacologic (drug) therapies, monitoring, pattern management of blood glucose, insulin pump therapy and carbohydrate counting for pump therapy, hypoglycemia, and coping with illness and surgery. Each chapter lists the learning objectives for that chapter, presents information in outline and bulleted format, summarizes the key educational considerations, offers self review questions and questions for discussion, presents an illustrative case report, and concludes with a list of
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references. A post-test and the answers to the post-test questions are appended to each chapter. The volume concludes with a subject index. •
Tell Me What to Eat If I Have Diabetes Source: Franklin Lakes, NJ: Career Press, Inc. 1999. 157 p. Contact: Available from Career Press, Inc. 3 Tice Road, P.O. Box 687, Franklin Lakes, NJ 07417. (800) 227-3371. Website: www.careerpress.com or www.newpagebooks.com. PRICE: $10.99 plus shipping and handling. Summary: This book offers eating and nutrition guidelines for people who have been diagnosed with diabetes mellitus. The author focuses on type 2 diabetes, noting that diabetes can manifest differently in different patients and sometimes even changing throughout its course within one person. The author encourages readers to learn as much as they can about their disease and to utilize nutrition as an adjunct therapy and a vital component of their diabetes care. The author emphasizes the importance of following a personalized eating plan that helps keep blood glucose (sugar) levels normal, and helps protect against heart disease and weight gain without making the patient feel deprived. The book offers seven chapters that cover an overview of diabetes, the top 7 profiles of type 2 diabetes, working with a dietitian to manage diabetes, ten food steps to freedom, 20 recommended recipes, food shopping guidelines, and eating out at restaurants. Two of the ten recommended 'food' steps actually do not involve food: one involves monitoring the blood glucose (sugar) levels; the other the need for regular exercise. The eight remaining recommended food steps are: make dietary fiber a part of almost every meal; count carbohydrates; emphasize heart-protective fats; keep saturated fat and cholesterol low; count caloric intake; eat more fruits and vegetables; avoid eating large meals; and improve the diet with supplements as necessary. Recipes are provided for a light Denver omelet, egg muffin sandwich lite, sun dried tomato pesto spread, the Loxness monster spread, apple lover's oatmeal, honey wheat bread with flaxseed, flaxseed jam muffins, flaxseed focaccia, flaxseed maple scones, high legume fried rice, 3 minute burrito, pintos and cheese, quick fix chili and fries, lemon dijon salmon, simple salmon pasta salad, easy omega 3 fatty acid tuna sandwich, oat bran meat loaf, light club sandwich, monosaturated side salad, easy 3 bean salad, quick ranch dip with vegetables, spicy hummus with crudites and crackers, iced caf mocha, and oatmeal raisin bites. A brief subject index concludes the book.
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Beating the Blood Sugar Blues Source: Alexandria, VA: American Diabetes Association. 2001. 159 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 plus shipping and handling. ISBN: 1580400485. Summary: This book offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the day-to-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. The book includes 20 chapters that cover an overview of hypoglycemia (low blood glucose levels), the risks associated with high and low blood glucose levels, monitoring blood glucose levels (SMBG), monitoring blood levels over time (glycosylated hemoglobin levels), treating low blood glucose at home, adjusting insulin to avoid hypoglycemia, using a meal plan to control blood glucose, the impact of exercise on blood glucose, handling low blood glucose at
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school, teenagers and the blood sugar blues, sex and pregnancy and their impact on hypoglycemia, sleep, driving or flying safely, traveling and hypoglycemia, alcohol and hypoglycemia, prescription drugs and hypoglycemia, the effects of hypoglycemia on nerves and vision, psychological insights, losing awareness of hypoglycemia, and managing one's own diabetes. The book concludes with a subject index. •
Diabetes Travel Guide Source: Alexandria, VA: American Diabetes Association. 2000. 172 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400418. Summary: This book organizes the process of traveling for people who have diabetes. Chapter one focuses on preparing for a trip. Topics include researching one's destination; seeing one's health care provider prior to departure, carrying a letter from one's doctor; locating medical facilities at one's destination; taking one's medications along; and obtaining health insurance, passports, and visas. Chapter two explains how to pack clothing, diabetes supplies, snacks, and items for an emergency and offers tips for preventing foot infections and other complications from happening. Chapter three provides detailed guidelines for packing and using insulin, syringes, a blood glucose meter, test strips, ketone strips, and a glucagon kit. Other topics include adjusting insulin and an insulin pump for various time zone changes. Chapter four provides tips for packing and taking oral medications, handling time zone changes, dealing with meals and physical activity, and creating a diabetes survival kit. Chapter five provides guidelines for traveling by auto, airplane, or boat. Chapter six addresses the issue of eating well and exercising while away from home. Topics include dealing with time zone changes, deciding where and when to eat, following a meal plan, eating fast foods, and adjusting insulin or diabetes pill doses according to physical activity level. Chapter seven uses a question and answer format to provide tips for coping with illness while traveling. Topics include receiving immunizations prior to traveling if necessary; checking blood glucose and ketones during an illness; dealing with vomiting, diarrhea, colds, jet lag, and urinary tract or vaginal infections; avoiding constipation; preventing insulin pump site infections; and preparing for health care prior to traveling. Chapter eight explains how to plan for situations that may occur during overseas travel, outdoor trips, and scuba diving. 22 appendices. 6 tables.
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101 Tips for Improving Your Blood Sugar. 2nd ed Source: Alexandria, VA: American Diabetes Association. 1999. 129 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400264. Summary: This book presents a collection of tips, ideas, strategies, and common sense approaches to the daily challenge of maintaining normal blood glucose levels for people who have diabetes. One question appears on each page, with the answer immediately below. Questions in chapter one provide general information about blood glucose levels and self management of blood glucose. Chapter two focuses on high blood glucose, and chapter three answers questions about low blood glucose. Questions in chapter four provide general information about the use of insulin. This is followed by a chapter
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that explains how to get the most out of oral medications. Chapter six offers tips for coping with sick days. Questions in the next two chapters deal with nutrition and physical activity issues. This is followed by chapters that offer educational and miscellaneous tips. The final chapter lists the name, address, and telephone number of helpful organizations. The book also includes an index. •
American Diabetes Association Guide to Raising a Child with Diabetes. 2nd ed Source: Alexandria, VA: American Diabetes Association. 2000. 165 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $16.95 plus shipping and handling. ISBN: 1580400272. Summary: This book presents up to date information on diabetes to help parents and other family members care for a child who has diabetes. The book begins with a chapter that explains the causes of type 1 diabetes, identifies the signs and symptoms of diabetes, and discusses the management of blood glucose levels. The next chapter focuses on caring for the child who has diabetes. Topics include new thinking about treating children with diabetes, the role of health care providers, and ways to keep a child's best interests a top priority. Chapter three discusses the use of insulin to manage diabetes, focusing on insulin types, insulin dosages, insulin administration, site rotation, insulin delivery devices, needle disposal, insulin adjustment, and self injection. This is followed by a chapter that explains blood glucose testing. Topics include determining the number of times per day to test blood glucose, recording blood glucose test results, making sure a blood glucose meter is accurate, testing urine for glucose and ketones, helping a child test regularly, and understanding the glycated hemoglobin test. The fifth chapter deals with meal planning, focusing on planning balanced meals; using exchanges and carbohydrate counting to plan meals; helping a child accept meal planning; coping with schedule changes, holidays, and parties; and eating out. The next chapter offers guidelines for playing games and sports safely. This is followed by a chapter that explains how to prevent and treat hypoglycemia, hyperglycemia, and ketoacidosis and how to handle sick days and infections. Chapter eight deals with diabetes care during various stages of development, focusing on care of infants, preschoolers, school age children, and adolescents. The final chapter offers advice for living with diabetes, focusing on budgeting, traveling, solving the day to day challenges of diabetes, coping with diabetes, and asking for help. The book provides problem solving examples and easy to read tables throughout. In addition, the book includes a glossary, a list of resources, and an index. 44 figures. 2 tables.
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Handbook of Diabetes Medical Nutrition Therapy Source: Gaithersburg, MD: Aspen Publishers, Inc. 1996. 711 p. Contact: Available from Aspen Publishers. P.O. Box 990, Frederick, MD 21705-9727. (800) 638-8437. Fax (301) 695-7931. PRICE: $89.00. ISBN: 0834206315. Summary: This book provides dietitians and other health care professionals with information they need to provide comprehensive diabetes care and self-management training in the area of diabetes medical nutrition therapy. Thirty-six chapters are presented in seven sections: understanding diabetes, setting and achieving management goals, selecting a nutrition education approach, the influence of macronutrients on blood glucose and health, making food choices, life stages, nutrition and specific clinical conditions, and making it all work. Topics include nutritional assessment, exercise
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benefits, blood glucose monitoring, counseling skills for improved behavioral change, meal-planning, the exchange system, carbohydrate counting, weight loss, cultural considerations, protein needs, lipid metabolism, caloric intake, dietary fiber, food selection, pregnancy, caring for older persons with diabetes, renal disease, hypertension, eating disorders, diabetes during surgery, gastrointestinal issues, dental care, HIV and diabetes, and reimbursement issues. Each chapter includes numerous references, and a subject index concludes the volume. •
Diabetes Sourcebook. 3rd ed Source: Detroit, MI: Omnigraphics. 2003. 621 p. Contact: Available from Omnigraphics. 615 Griswold Street, Detroit, MI 48226. (800) 234-1340. Fax (800) 875-1340. Website: www.omnigraphics.com. ISBN: 780806298. Summary: This book provides information for people seeking to understand the risk factors, complications, and management of type 1 diabetes, type 2 diabetes, and gestational diabetes. The book offers 67 chapters in seven sections: diabetes types and diagnosis; lifestyle and related diabetes management concerns; exercise and nutrition for diabetes management; medication management of diabetes; complications of diabetes; treatment of end stage renal disease (ESRD); and diabetes-related research and statistics. Specific topics include risk factors, impaired glucose tolerance (IGT), insulin resistance, HbA1c (glycosylated hemoglobin) testing, blood glucose testing, urine testing, SMBG (self monitoring of blood glucose), non-invasive blood glucose monitors, preventing complications, how stress affect diabetes, alternative therapies for diabetes, exercise, exchange lists, carbohydrate counting, eating at restaurants, insulin administration and dosage, oral medications, amputation, kidney disease (diabetic nephropathy), diabetic retinopathy (eye disease), diabetic neuropathy (nerve disease), gastroparesis (reduced motility of stomach contents), hypoglycemia (low blood glucose levels), hyperglycemia (high blood glucose levels), erectile dysfunction (ED formerly called impotence), research advances in diabetes, and diabetes in ethnic and racial groups. The book includes a glossary of related terms, information about locating financial help for diabetes care, and a list of resources, including organizations, recipes and cookbooks.
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Alternative and Complementary Diabetes Care: How to Combine Natural and Traditional Therapies Source: New York, NY: John Wiley and Sons, Inc. 2000. 244 p. Contact: Available from John Wiley and Sons, Inc. Distribution Center, 1 Wiley Drive, Somerset, NJ 08875-1272. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail:
[email protected]. Website: www.wiley.com. PRICE: $14.95 plus shipping and handling. ISBN: 0471347841. Summary: This book provides people who have diabetes with information on alternative and complementary healing regimens for diabetes. The book is organized in a way to help readers remember what a full, balanced health program should include. This is done by using the acronym PARENT, which stands for positive thinking, assertiveness, relaxation, exercise, nutrition, and touch. Chapter one provides an overview of the field of alternative and complimentary care. Topics include the activities of the Office of Alternative Medicine to assist professionals and lay people in recognizing the most helpful treatments, the steps some medical schools are taking to teach future physicians about alternative treatment approaches, and models of practice. Chapter two focuses on positive thinking. Readers learn how positive thinking affects
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the body from the standpoint of laughter, prayer, reframing, meditation, thought stopping, problem solving, and other choices. Considerations related to blood sugar control address logical thinking versus various other approaches to management. Chapter three deals with assertiveness, focusing on how to use assertiveness in daily life, how to handle conflict, how to develop a win-win approach, how to handle anger, and how using assertiveness relates to blood glucose control. Chapter four explains the physiology of stress and examines the effect of relaxation on blood glucose levels. Relaxation methods include biofeedback, progressive relaxation, autogenic therapy, deep breathing, imagery, visualization, aroma therapy, and meditation. Chapter five provides guidelines for evaluating one's present physical condition in relation to safe exercise choices. Types of exercise include aerobics, muscle strengthening, tension relievers, tai chi, qigong, other martial arts, and hatha yoga. Chapter six focuses on nutrition and diets. Topics include diet programs, obesity, weight loss, and types of foods. Chapter seven discusses the use of herbs in terms of general considerations, the availability and safety of herbs, regulation problems, and the usefulness of herbs. In addition, the chapter reviews products that people with diabetes might read or hear about and identifies specialty practices that use herbs. Chapter eight provides information on therapies that have something to do, directly or indirectly, with various energy responses of the mind or body, including art therapy, aroma therapy, colon therapy, chiropractic therapy, osteopathic therapy, homeopathic therapy, hypnotherapy, imagery therapy, journaling therapy, music therapy, magnet therapy, thought field therapy, and pain management therapy. Chapter nine introduces touch and nontouch remedies and various therapies that have the potential to lead to improved circulation, improved balance, and an improved sense of well being. Chapter 10 offers general reminders about the use of alternative remedies and provides some suggestions to improve quality of life. 7 appendices. 1 figure. 45 references. •
Mayo Clinic on Managing Diabetes Source: Rochester, MN: Mayo Clinic. 2001. 194 p. Contact: Available from Mayo Clinic Health Information. 200 First Street, S.W., Fifth Floor Centerplace Building, Rochester, MN 55905. (800) 430-9699. Website: www.mayoclinic.com. PRICE: $14.95 plus shipping and handling. ISBN: 1893005062. Summary: This book provides practical and easy to understand information on controlling diabetes and preventing complications of the disease. Part one provides facts about diabetes. Topics include types of diabetes, the signs and symptoms of diabetes, the risk factors for diabetes, and the criteria and tests for diagnosing diabetes. In addition, the issue of diabetic complications is addressed, focusing on hypoglycemia, diabetic hyperosmolar syndrome, diabetic ketoacidosis, neuropathy, nephropathy, retinopathy, heart and blood vessel disease, and increased risk of infection. Part two deals with the components involved in controlling the disease. Chapters discuss monitoring blood glucose, eating a healthy diet, getting daily exercise, and maintaining a healthy weight. Part three examines medical therapies for managing diabetes. Chapters provide information on the use of insulin to manage type 1 and type 2 diabetes; the use of sulfonylureas, meglinitides, biguanides, alpha glucosidase inhibitors, thiazolidinediones, and drug combinations to manage type 2 diabetes; and pancreas and islet cell transplantation as possible cures for diabetes. Part four addresses issues related to living well with diabetes. One chapter focuses on important tests every person who has diabetes should be getting, including the glycosylated hemoglobin test, lipid tests, the serum creatinine test, and the urine microalbumin test. Another chapter discusses self care issues, including having annual physical examinations, visiting a
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dentist regularly, caring for feet, avoiding smoking, monitoring blood pressure, and managing stress. A third chapter explores sexual health issues for both men and women. Topics include the affect of the menstrual cycle and menopause on blood glucose, hormone replacement therapy, pregnancy, and impotence. Each chapter concludes with a question and answer section. The book also includes a list of additional resources. 17 figures. 1 table. •
Managing Your Gestational Diabetes: A Guide for You and Your Baby's Good Health Source: Minneapolis, MN: Chronimed Publishing. 1994. 132 p. Contact: Available from Chronimed Publishing. P.O. Box 59032, Minnetonka, MN 55459-0032. (800) 848-2793. PRICE: $9.95. ISBN: 1565610520. Summary: This book provides pregnant women with information about gestational diabetes. Women diagnosed with gestational diabetes should follow a special meal plan and self-monitor blood glucose. They also may need to follow a regular exercise program and inject insulin each day. Fourteen chapters address an introduction to diabetes, emotions, gestational diabetes treatment, meal planning, exercise, insulin and insulin reactions, self monitoring of blood glucose and urine ketone testing, stress management, delivery, breastfeeding, and planning for the future. The author notes that meal planning is central to controlling gestational diabetes and ensuring delivery of a healthy baby. All other parts of the treatment program hinge on successfully following an appropriate meal plan. A list of meal planning publications, a glossary, biographical information, sample record pages, a comparison of American and Canadian food group exchanges, and a subject index conclude the book. (AA-M).
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Diabetes: Questions You Have, Answers You Need. Revised ed Source: Allentown, PA: People's Medical Society. 1997. 191 p. Contact: Available from Independent Publishers Group. Order Department, 814 N. Franklin Street, Chicago, IL 60610. (800) 888-4741 or (312) 337-0747. Fax (312) 337-5985. E-mail:
[email protected]. PRICE: $12.95. ISBN: 1882606531. Summary: This book provides readers with a 'consumer's guide' to managing diabetes. The author emphasizes that, while diabetes is incurable, with proper medical treatment and a great deal of self management, most people with diabetes can live normal length lives with little or no restrictions on their lifestyles. The author hopes that the information in the book can help empower people with diabetes and encourage them to become and remain active participants in their own health care. The first chapter introduces the basics of Type I and Type II diabetes (insulin-dependent and noninsulindependent, respectively), including risk factors for diabetes, impaired glucose tolerance, secondary diabetes, and gestational diabetes. The next chapter focuses on the use of insulin in Type I diabetes, including insulin pumps, jet injectors, and insulin pens. The chapter on Type II diabetes covers insulin resistance, heredity, obesity, diet, oral therapy, insulin therapy, combination therapy, and new treatment options. Chapter Four covers the short term complications of diabetes, including hypoglycemia, ketoacidosis, and hyperosmolar or nonketotic coma; and the longterm complications, including eye problems, nephropathy (kidney disease), cardiovascular complications, neuropathy, and foot problems. The final chapter emphasizes self management, discussing issues including the self monitoring of blood glucose (SMBG), nutrition, exercise, foot care, dental care, smoking, children and diabetes, pregnancy and diabetes, and aging. The book concludes with a glossary, a selected bibliography, and a subject index. 47 references.
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Insulin Pump Therapy Book: Insights from the Experts Source: Sylmar, CA: MiniMed Technologies. 1995. 162 p. Contact: Available from MiniMed Technologies. 12744 San Fernando Road, Sylmar, CA 91342. (800) 933-3322 or (818) 362-5958. Fax (818) 364-2246. PRICE: $19. ISBN: 0964783703. Summary: This book provides readers with a comprehensive overview of the insulin pump. The authors hope to help establish insulin pump therapy as a cost-effective mode of intensive diabetes management that not only facilitates normalized blood glucose, but also makes it feasible for people living with diabetes to experience the most normal lifestyle possible. Thirteen chapters the benefits of insulin pump therapy; candidate selection; initiating pump therapy; establishing and verifying basal rates; bolus and supplemental insulin; counting carbohydrates; pattern analysis and recordkeeping; everyday management; exercise and the pump; preventing diabetic ketoacidosis (DKA); hypoglycemia and its prevention; and pump therapy in preconception and pregnancy. A subject index concludes the volume.
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Core Curriculum for Diabetes Education. 3rd ed Source: Chicago, IL: American Association of Diabetes Educators. 1998. 901 p. Contact: Available from American Association of Diabetes Educators. 100 West Monroe Street, 4th Floor, Chicago, IL 60603-1901. (800) 338-3633 or (312) 424-2426. Fax (312) 4242427. PRICE: $95.00 for AADE members; $135.00 for nonmembers. ISBN: 1881876047. Summary: This book provides the most up-to-date information for diabetes educators so that they can help people with diabetes to become effective decision makers for their own diabetes care. The first section addresses the issue of education, focusing on the program design and educational methods used to help patients learn about diabetes. The next section examines psychosocial issues, including psychological assessment, behavior changes, and psychological disorders. The third section explains the pathophysiology of the diabetes disease state. The following section describes therapies that will help people with diabetes make self directed behavior changes to improve their overall diabetes management or nutritional status. Topics include nutrition, exercise, pharmacologic therapies, self-monitoring of blood glucose, and monitoring of metabolic control by the health care team. The fifth section examines blood glucose management, focusing on pattern management; hyperglycemia; hypoglycemia; illness and surgery; and skin, foot, and dental care. The sixth section discusses the impact of diabetes during each stage of the life cycle, focusing on diabetes in children, adolescents, pregnant women, and the elderly. This is followed by a section on the complications of diabetes, including eye disease, neuropathy, nephropathy, and macrovascular disease. The final section discusses the importance of research and outcomes. Chapters include case studies, self-review questions, and lists of suggested readings. The book concludes with continuing education post-test questions for each chapter and an index. 41 figures. Numerous tables. Numerous references.
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Clinical Management of the Child and Teenager with Diabetes Source: Baltimore, MD: The Johns Hopkins University Press. 1998. 268 p. Contact: Johns Hopkins University Press. 2715 North Charles Street, Baltimore, MD 21218-4363. (410) 516-6900. Fax (410) 516-6998. Website: www.press.jhu.edu. PRICE: $24.95 for paperback; $55.00 for hardcover; plus shipping and handling. ISBN: 0801859093.
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Summary: This book serves as a comprehensive clinical guide to the management of type 1 diabetes and stresses the importance of helping children who have diabetes to live as normally as possible. Chapter one reviews the pathophysiology, diagnostic criteria, etiology, genetics, natural history, epidemiology, and clinical course of type 1 diabetes. Chapter two presents several case studies to illustrate the variety of ways type 1 diabetes can be manifested and observed. The chapter also addresses initial management issues, discusses the honeymoon period, and examines psychological issues. Chapter three explains the survival skills of preparing for and giving insulin injections, monitoring blood glucose and urine ketones, keeping records, planning meals, managing exercise, and handling complications. Chapter four discusses general health care for children and adolescents who have diabetes and the implications of the Diabetes Control and Complications Trial for the medical management of diabetes. Chapter five focuses on patient education. Chapter six discusses insulin in terms of its sources, timing and duration of action, dosage, regimens, and rate of absorption. Chapter seven presents various meal planning approaches, discusses exchange lists and carbohydrate counting, and addresses age related food issues. Chapter eight offers guidelines on making adjustments to a diabetes regimen and provides tips on handling sick days. Chapter nine addresses age specific management issues. Chapter 10 describes the acute, intermediate, and chronic complications of diabetes. Chapter 11 examines psychological issues. Chapter 12 presents a near verbatim transcription of a lengthy conversation with several children, adolescents, and adults who have diabetes. Chapter 13 highlights research on diabetes. 9 appendices. 9 figures. 13 tables. •
Parenting a Child with Diabetes: A Practical, Empathetic Guide to Help You and Your Child Live with Diabetes. 2nd ed Source: Los Angeles, CA: Lowell House. 1999. 205 p. Contact: Available from NTC/Contemporary Publishing Group. 4255 West Touhy Avenue, Lincolnwood, IL 60712-1975. (800) 323-4900. (800) 998-3103. E-mail:
[email protected]. PRICE: $14.95 plus shipping and handling. ISBN: 073730301. Summary: This book serves as a guide for parents who have a child with diabetes. The first chapter serves as an introduction to the book. Chapter two is a primer on diabetes and how its affects a child's body. Topics include how insulin works, the tools parents will need to control their child's blood sugar, and the obstacles parents will encounter in trying to achieve good control. Chapter three focuses on the practical elements of life with diabetes. Topics include the role of each professional comprising a diabetes care team; home blood glucose testing tips and equipment; insulin, injections, and attendant gadgets; the use of insulin, food, and exercise to overcome the obstacles to good control; and the essential supplies to have at home and at school. Chapter four presents the dietary aspects of treatment. This chapter provides information on good nutrition, the exchange diet, and the glycemic index. In addition, the chapter offers tips for supporting a child's diet plan while eating away from home or on special occasions. Chapter five presents a child's view of diabetes and the ways the child's views affect his or her emotions. The chapter also offers an overview of some techniques of good parenting and identifies some special problems for adolescents. Chapter six offers suggestions to help parents deal with the stress of having a child who has diabetes, provides tips for developing a solid support system, and encourages parents to become advocates for their child. The final chapter reviews the history of diabetes research and its present state. The book also includes an index and a resources section that lists may sources of information and support.
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Diabetes for Dummies Source: Foster City, CA: IDG Books Worldwide, Inc. 1999. 371 p. Contact: Available from IDG Books Worldwide, Inc. 919 E. Hillsdale Blvd., Suite 400, Foster City, CA 94404-2112. (800) 762-2974 or (416) 293-8464. Website: www.idgbooks.com. PRICE: $19.99 plus shipping and handling. ISBN: 076455154X. Summary: This book serves as a state of the art guide to diabetes management. Part one focuses on dealing with the onset of diabetes. Topics include the emotional and psychological consequences of the diagnosis of diabetes; the diagnosis itself; and the symptoms, causes, and prevention of type 1 and type 2 diabetes. Part two explains how diabetes affects the body, focusing on acute and chronic complications. Topics include the symptoms, causes, and treatment of hypoglycemia, ketoacidosis, and hyperosmolar syndrome; the prevention of diabetic nephropathy, retinopathy, and neuropathy; and the prevention of heart disease, peripheral and cerebrovascular disease, diabetic foot disease, and skin diseases. In addition, readers are given information about some sexual problems related to diabetes and the problems of a diabetic pregnancy. Part three presents information on all the tools available to treat diabetes. Readers are told about the kinds of tests they and their doctor should be doing to maintain health, the dietary changes and physical activity that are needed to control blood glucose, and the way to get the most from oral hypoglycemic agents and insulin. Other topics include the role of various professionals in diabetes care and the use of knowledge to improve quality of life. Part four addresses special diabetes related considerations for infants, children, adolescents, young adults, and the elderly. Other topics include occupational and insurance problems, new diabetes care devices and medications, and treatments that do not work. Part five presents 10 ways to prevent or reverse the effects of diabetes, dispels 10 myths about diabetes, and identifies 10 ways to obtain help from others. Part six consists of appendices that present recipes, exchange lists, websites, and a glossary. 8 figures. 10 tables.
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What to Eat When You Get Diabetes: Easy and Appetizing Ways to Make Healthful Changes in Your Diet Source: New York, NY: John Wiley and Sons, Inc. 2000. 240 p. Contact: Available from John Wiley and Sons, Inc. Distribution Center, 1 Wiley Drive, Somerset, NJ 08875-1272. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail:
[email protected]. Website: www.wiley.com. PRICE: $14.95 plus shipping and handling. ISBN: 047138139X. Summary: This book serves as a step by step guide to making informed nutrition choices for people newly diagnosed with type 2 diabetes. The book begins with a chapter that discusses the basics of eating with diabetes. This is followed by a chapter that addresses the issue of weight loss, focusing on increasing physical activity and modifying eating behaviors. The chapter stresses the importance of determining goal weight by blood glucose numbers rather than numbers on a scale. Subsequent chapters deal with understanding the food pyramid plan, learning that calories count, watching out for portion sizes, consuming sugar and carbohydrates, determining which fats to consume, and understanding food labels. Topics of remaining chapters include continuing to enjoy favorite foods, eating out healthfully, consuming adequate amounts of vitamins and other helpful substances, balancing food and medication such as insulin and oral diabetes medications, finding a dietitian, and living with diabetes. The book also includes sample meal plans and recipes and a list of diabetes cookbooks, helpful organizations, and useful web sites. 1 appendix.
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Pumping Insulin: Everything in a Book for Successful Use of an Insulin Pump. 2nd ed Source: San Diego, CA: Torrey Pines Press. 1994. 156 p. Contact: Available from Torrey Pines Press. 1030 West Upas Street, San Diego, CA 92103-3821. (619) 497-0900. Fax (619) 497-0900. PRICE: $19.95; discounts available for larger quantities. ISBN: 1884804772. Summary: This book serves as an instructional manual for people who use insulin pumps to help manage their diabetes. Designed to be used as an addition to a physician's guidance, the book offers a comprehensive approach to obtaining the best results from an insulin pump and presents detailed suggestions for dealing with problem areas in blood glucose control. Twenty one chapters discuss the education and preparation necessary before obtaining an insulin pump; learning to use the pump; and troubleshooting. Each chapter includes an outline of the points presented and numerous charts and worksheets to illustrate the main concepts. An appendix presents a guide to carbohydrate factors and carbohydrate countin g.
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Family and Friends' Guide to Diabetes: Everything You Need to Know Source: New York, NY: John Wiley and Sons, Inc. 2000. 282 p. Contact: Available from John Wiley and Sons, Inc. Distribution Center, 1 Wiley Drive, Somerset, NJ 08875-1272. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail:
[email protected]. Website: www.wiley.com. PRICE: $14.95 plus shipping and handling. ISBN 0471348015. Summary: This book uses a question and answer format to provide the family and friends of people who have diabetes with information on the disease so that they can be understanding and supportive to those who have diabetes. Chapter one presents facts about diabetes. The chapter explains what diabetes is and what a normal blood glucose level is; describes type 1, type 2, and gestational diabetes; and discusses the causes of these types of diabetes. Other topics include diagnosing and treating diabetes, monitoring blood glucose levels, and understanding complications. In addition, the chapter dispels common myths about diabetes. The second chapter focuses on the management of low blood glucose. Topics include the causes, symptoms, and treatment of hypoglycemia. The next chapter deals with meal planning. The chapter teaches readers what people who have diabetes are advised to eat, what exchanges and carbohydrate counting are, and how to modify meals to make them lower in fat and sodium. In addition, readers learn how to plan menus and identify the different types of sugar found naturally in foods. Chapter four reviews the effect illness has on diabetes. The chapter describes the causes, symptoms, and treatment of hyperglycemia and diabetic ketoacidosis and offers tips on how to help people who have diabetes during an illness. This is followed by a chapter that focuses on planning special occasions. The chapter provides tips and ideas on how to make holidays and celebrations fun and healthy for everyone. Other topics include simple courtesies to keep in mind to make special times less stressful for those who have diabetes or others who are watching what they eat. Chapter six offers guidelines for creating a work environment that supports healthy lifestyle habits and is diabetes friendly. The chapter helps readers assess their workplace and organizational culture to identify any barriers that could create diabetes self care challenges and discusses the creation of an emergency plan for hypoglycemia. In addition, the chapter explains why diabetes is a legal disability and how current laws prevent workplace discrimination. This is followed by a chapter that helps readers assess the impact of diabetes on their lives, teaches them positive coping skills, and
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suggests ways to create a supportive environment for them and the person who has diabetes. Chapter eight focuses on promoting healthy habits at home. The chapter helps readers learn how change occurs and to plan for it, assess readiness to change an unhealthy behavior, and help someone trying to change or break an unhealthy habit. The final chapter offers guidelines for building positive relationships and friendships. 4 appendices. Numerous references. •
Dear Diabetes Advisor: Plain and Simple Answers to Your Questions About Diabetes Source: Alexandria, VA: American Diabetes Association. September 1997. 90 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $10.95 plus shipping and handling. ISBN: 094544883. Summary: This book uses a simple question and answer format to provide straightforward information about diabetes. The book was compiled using actual questions published in 'The Diabetes Advisor,' a publication of the American Diabetes Association (ADA). Questions and answers are organized into chapters that address issues concerning treatment, exercise, psychological adjustment, healthy cooking and eating, weight loss, insurance, and consumer issues. The book helps readers determine their body mass index, choose the best health plan, and calculate tax deductible medical expenses. It also includes boxes and sidebars that list foods that may be used to treat low blood glucose and identify types of vegetarians. The book concludes with an index and a list of self-care publications available from the ADA.
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Take Charge of Your Diabetes. 3rd ed Source: Silver Spring, MD: Centers for Disease Control and Prevention, Department of Health and Human Services. 2002. 134 p. Contact: Available from Centers for Disease Control and Prevention. CDC Division of Diabetes Translation, P.O. Box 8728, Silver Spring, MD 20910. (877) 232-3422. Fax: (301) 562-1050. E-mail:
[email protected]. Website: www.cdc.gov/diabetes. PRICE: Full-text available online at no charge; contact organization for print copies. Summary: This book was written to help people with diabetes take important steps to prevent the problems that can be caused by diabetes. The book discusses the complications of diabetes, how to work with a health care team to prevent those complications, the importance of getting blood glucose and blood pressure as close to normal as possible, and how to find out about resources in one's community that may help with diabetes care management and prevention of complications. The book includes twelve chapters: controlling diabetes, keeping track of blood glucose levels, feelings about having diabetes, eye problems, kidney problems, heart and blood vessel problems, nerve damage, foot problems, dental disease, vaccinations, and pregnancy and women's health. Words printed in bold typeface are defined in the glossary of terms at the end of the book. There are blank forms included that can help readers and their health care providers keep records of health care; forms include: records for sick days, tests and goals for each visit, tests and goals for each year, glucose log sheets, and the health care team. A list of resource organizations concludes the book. The book is spiral bound and illustrated with line drawings.
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Take-Charge Guide to Type I Diabetes Source: Alexandria, VA: American Diabetes Association. 1994. 282 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-6733. PRICE: $19.95 for ADA members; $24.95 for nonmembers (as of 1995). ISBN: 094544835X. Order Number CSMT1. Summary: This book, from the American Diabetes Association, is designed to help people with diabetes take a more active approach to their diabetes care and to life in general. Written for people with insulin-dependent diabetes (IDDM), the book presents thirteen chapters: the biology of IDDM; insulin; balancing blood glucose levels; intensive diabetes treatment; equipment and supplies, including blood glucose meters and record keeping supplies; diabetes complications and their prevention; working with a health care team; healthy food choices, including dining out and considerations regarding alcohol; how fitness fits in with diabetes care; family planning and pregnancy; work and employment issues; health insurance and diabetes; and reflections on life with diabetes. The appendix lists guides to the basics of diabetes care, including monitoring blood glucose, preparing an insulin syringe, giving an injection, and reusing syringes. The book concludes with a detailed list of resources and a subject index.
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How to Get Great Diabetes Care: What You and Your Doctor Can Do to Improve Your Medical Care and Your Life Source: Alexandria, VA: American Diabetes Association. 1996. 180 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. PRICE: $9.95 (members), $11.95 (nonmembers). ISBN: 094544866X. Summary: This book, which is based on American Diabetes Association (ADA) clinical practice guidelines, is designed to help readers get the best possible health care for their diabetes. The author points out that in order for a person with diabetes to prevent or postpone complications, he or she must work with a health care team. In the introductory chapter, the author discusses standards of care, self-monitoring of blood glucose, advances in diabetes treatment, and diseases linked to diabetes. The next ten chapters provide information on diabetes risk factors, blood glucose control, the first doctor visit, continuing care, pregnancy and diabetes, diabetic eye disease, diabetic nephropathy, hypertension, lipids and exercise, and diabetic neuropathy. A final chapter addresses flowcharts, doctors, and insurance. The author notes that the three major risk factors for diabetes include having a family member with diabetes, being overweight, and belonging to an ethnic group that has an above average risk. The book is written in nontechnical language and includes numerous tables. Sidebars provide information on the history of diabetes treatment, the Diabetes Control and Complications Trial (DCCT), safe exercise, and foot ulcer prevention. In several chapters, sidebars include both questions to ask the doctor and questions that may be asked by the doctor. The book also includes information about insulin, oral medication, and diabetes-related World Wide Web sites. A glossary and an index conclude the book. (AA-M).
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Diabetes in Color: No More Black and White. 2nd ed Source: Saco, ME: Faith Thibodeau. 2000. 55 p. Contact: Available from Faith Thibodeau. 7 Simpson Road, Saco, ME 04072. (207) 2844537. E-mail:
[email protected]. PRICE: $13.60 plus shipping and handling.
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Summary: This book, which is based on the American Diabetes Association 'Clinical Practice Recommendations 2000,' serves as a resource for both health professionals and people who have diabetes. The book provides a clear explanation of the mechanism of diabetes, emphasizes the value of glucose self monitoring, and discusses ways to minimize risk for heart disease, hypertension, and foot disease. A chart lists and explains the advantages and disadvantages of blood glucose monitors. A table lists the different nutritional approaches to diabetes management and highlights their pros and cons. The book also compares oral hypoglycemic agents, discusses herbs and supplements, and presents the benefits of exercise. Other topics include fats and carbohydrates, fast foods, label reading, smoking, sick days, alcohol consumption, pregnancy, health insurance, and weight loss. In addition, the book lists useful resources. •
Medical Management of Pregnancy Complicated by Diabetes. 3rd ed Source: Alexandria, VA: American Diabetes Association. 2000. 176 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $39.95 plus shipping and handling. ISBN: 1580400132. Summary: This book, which is part of the American Diabetes Association's Clinical Education Series, provides health professionals with protocols that have resulted in healthy infants in pregnancies complicated by type 1, type 2, or gestational diabetes. The first section focuses on prepregnancy counseling and management of women with preexisting diabetes or previous gestational diabetes. The next section discusses contraceptive methods, including oral contraceptives, the norplant system, barrier methods, intrauterine devices, the rhythm method, and permanent sterilization. This is followed by a section that examines the psychological impact of diabetes and pregnancy. Topics include the response to pregnancy in women with preexisting diabetes, the response to a diagnosis of gestational diabetes, long term adaptation, personality types and individualizing treatment, pregnancy crises, and the importance of a team approach and a support system. The fourth section focuses on blood glucose monitoring. Topics include glycosylated hemoglobin measurements in pregnancy for women with preexisting or gestational diabetes, self monitoring of blood glucose and urine ketones, and medical tests to evaluate maternal status in women with preexisting or gestational diabetes. The next section offers guidelines for managing morning sickness with dietary remedies, insulin adjustments, and medical management. The sixth section discusses nutritional management during pregnancy in women with preexisting diabetes. Topics include patient responsibility; the nutrient needs of pregnancy; diet and eating habits; vitamin and mineral supplementation; calorie level; weight gain; meal planning; recordkeeping; use of sodium, caffeine, and artificial sweeteners; the management of hypoglycemia; and postpartum nutritional management. Section seven focuses on the use of insulin during pregnancy in women with preexisting diabetes. Topics include metabolic alterations during normal gestation, therapeutic insulin use, dosage adjustment, insulin during labor and delivery, postpartum insulin requirements, and oral hypoglycemic agents. The next section describes diagnostic tests and methods of fetal surveillance, including ultrasonography, alpha fetoprotein testing, genetic testing, fetal monitoring, and amniocentesis. The ninth section discusses gestational diabetes, focusing on epidemiology, screening, diagnosis, nutritional management, insulin therapy, exercise, and obstetric management. Section ten addresses the issue of neonatal care of infants of women with diabetes. Topics
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include perinatal mortality and morbidity, resuscitation, nursery care, and long term followup. The final section discusses postpartum followup of women with gestational diabetes. The book includes an index and resources for health care professionals. 3 figures. 39 tables. Numerous references. •
My Doctor Says I Have a Little Diabetes Source: Garden City Park, NY: Avery Publishing Group. 1997. 138 p. Contact: Available from Avery Publishing Group. 120 Old Broadway, Garden City Park, NY 11040. (800) 548-5757 or (516) 741-2155. Fax (516) 742-1892. E-mail:
[email protected]. Website: www.averypublishing.com. PRICE: $9.95 plus shipping and handling. ISBN: 0895298600. Summary: This book, which is written in easy to understand language, serves as a guide to understanding and controlling type 2 diabetes. The book begins with a chapter that provides basic information on diabetes and diabetes care. Topics include the symptoms of diabetes, the types of diabetes, risk factors for diabetes, diagnostic tests for diabetes, common misconceptions about diabetes, and the management of the emotional aspects of diabetes. Each of the remaining chapters examines a specific aspect of diabetes care, including monitoring blood levels, following an appropriate diet, exercising, using medications, managing high and low blood glucose levels, preventing complications, and handling special situations. The chapter on glucose monitoring offers guidelines for selecting a monitor and checking blood glucose levels. The chapter on diet presents the latest goals and guidelines for the nutritional management of type 2 diabetes; explains how protein, carbohydrates, fats, and other nutrients affect diabetes; provides meal planning options that will make eating an enjoyable experience; and offers tips for handling special situations. The chapter on exercise discusses some of the advantages of following a program of regular exercise, helps readers choose a program suited to their needs, and offers advice about how to begin an exercise program. The chapter on medication discusses the different diabetes medications, medication interactions and precautions, and the effects that many prescription and over the counter medications have on diabetes. The chapter also presents information about mixing and injecting various types of insulin. The chapter on dealing with high and low blood glucose levels presents the causes, symptoms, and associated problems of hyperglycemia and hypoglycemia. Guidelines for treating these problems are also provided. The chapter on the prevention of complications reviews symptoms and prevention of the complications associated with diabetes, including high blood pressure; atherosclerosis; eye disorders; kidney disease; and foot and lower leg, autonomic nervous system, skin, and sexual problems. The final chapter on special situations covers the special care needed on sick days and when traveling. The book also includes a list of resources and provides tables for converting glucose, cholesterol, and triglyceride levels from milligram per deciliter to millimoles per liter. 3 figures. 8 tables. 28 references.
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Understanding Gestational Diabetes: A Practical Guide to a Healthy Pregnancy. Revised ed Source: Bethesda, MD: National Institute of Child Health and Human Development. 1993. 46 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. E-mail:
[email protected]. PRICE: Single copy free. Bulk copies available from National
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Institute of Child Health and Human Development. 31 Center Drive, MSC 2425, Building 31, Room 2A32, Bethesda, MD 20892. (301) 496-5133. Summary: This booklet for pregnant women and their families explains gestational diabetes and its impact on the health of mother and baby. It addresses many questions about diet, exercise, measurement of blood glucose levels, and general medical and obstetric care of women with gestational diabetes. Screening methods for gestational diabetes are discussed. The primary focus of this health guide is on diet and weight gain. Several tables are included to assist the pregnant woman in following a nutritionally sound diet that fosters an appropriate weight gain and that keeps blood glucose levels as normal as possible. Footnotes cite 4 bibliographic citations and a brief glossary is included. Blank Self Blood Glucose Monitoring Diary and Food and Exercise Record Sheet charts are appended. •
Do Your Level Best: Start Controlling Your Blood Sugar Today Source: Bethesda, MD: National Diabetes Outreach Program (NDOP), National Diabetes Information Clearinghouse (NDIC). September 1995. 60 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Single copy free; bulk orders available to health professionals; contact NDIC for current availability status. Also available at http://www.niddk.nih.gov/. Summary: This booklet helps people with newly diagnosed diabetes learn how to take care of their diabetes and how to prevent complications of the disease. Topics include an introduction to how diabetes affects the body and the types of diabetes; regular diabetes care, including proper food, nutrition, medications, monitoring (blood glucose testing), and recordkeeping; what to do when blood glucose levels are high (hyperglycemia) or low (hypoglycemia); the impact diabetes can have on the heart and blood vessels, the eyes, the kidneys, the nervous system, the gums and teeth, and the feet; taking care of diabetes in special circumstances, including sick days, travel, and during pregnancy; and where to get additional information and help. The booklet features a back pocket with various brochures, including those on diabetes and periodontal disease, diabetic eye disease, and diabetes research, and a recordkeeping form for readers to keep track of their diabetes management activities.
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Eating Healthy with Diabetes: Easy Reading Guide Source: Alexandria, VA: American Diabetes Association. 2003. 18 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. E-mail:
[email protected]. Fax: (770) 4429742. Website: www.diabetes.org. PRICE: $4.00, plus shipping and handling. Summary: This booklet is a teaching tool for use with persons with diabetes. Written in nontechnical language, with illustrations for each concept presented, the brochure introduces healthy eating and why it is important for good diabetes control. The booklet begins with a discussion of the importance of normal blood glucose (sugar) levels, how to eat less fats, and which foods should be included on a regular basis. The booklet then outlines each of the three meals of the day, plus snacks, with food choices in each food group: starch, fruit, milk, nonstarchy vegetable, meat and meat substitutes, fat, and free foods. There is space for the reader and his or her dietitian to individualize the
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recommendations. Additional sections discuss how to include sweets into one's meal plan, how to count mixed foods, and how to measure foods. The brochure is illustrated with brightly colored graphics and full-color photographs of food items. •
Living with Type 2 Diabetes Source: Hamilton, Ontario, Canada: Hamilton Civic Hospitals. 1997. 43 p. Contact: Available from Robert Panchyson, Education Department, 3LN, Hamilton Health Sciences Corp. General Site, 237 Barton Street East, Hamilton, Ontario, Canada, L8L 2X2. (905) 527-4322, ext. 6615. Fax (905) 527-1941. PRICE: Contact directly for current price. Summary: This booklet is written primarily for elderly patients with diabetes. It is written at a grade 4 to 6 reading level. The booklet defines diabetes and blood glucose and covers the impact of foods on blood glucose levels, insulin, how insulin works, type 2 diabetes, weight and meal plans, exercise and activity levels, low blood glucose (hypoglycemia) and its treatment, prevention of hypoglycemia, high blood glucose (hyperglycemia), diabetes medications, alcohol and diabetes medications, and diabetes complications. The booklet presents clear practical suggestions for managing various aspects of diabetes self care, and is illustrated with simple line drawings to help readers comprehend the topics. The 1997 revision of the English-language version (other language versions have not yet been revised) includes additional information about cholesterol, blood pressure and oral medications. The booklet is available in English, Spanish, French, Italian, Polish, or Portuguese. A Hindi version is expected.
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7 Principles for Controlling Your Diabetes for Life Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC). 2003. [20 p.]. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.ndep.nih.gov/. PRICE: Single copy free; $5.00 for each additional package of 25; Limit 2 packages. Order number: NDEP-17. Summary: This brochure describes the seven essential components of quality diabetes care in a checklist form. These principles, or steps, can help patients manage their diabetes and live a long and active life. The author emphasizes that diabetes affects almost every part of the body and good diabetes care requires a team of health care providers. The seven principles outlined are: learn as much as possible about diabetes; get regular care for diabetes; learn how to manage diabetes; control the ABCs of diabetes (A1C, blood glucose, cholesterol); monitor one's diabetes; prevent long term diabetes complications; and get tested for complications and treat any problems as they arise. The brochure also focuses on the importance of good recordkeeping. The brochure concludes with the contact information for a group of related resource organizations. The booklet is illustrated with colorful line drawings and black-and-white photographs.
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Taking Diabetes to School. 2nd ed Source: Valley Park, MO: JayJo Books, LLC. 1998. 26 p. Contact: Available from JayJo Books, LLC. P.O. Box 213, Valley Park, MO 63088-0213. (800) 801-0159 or (314) 861-1331. PRICE: $11.95. ISBN: 1891383000.
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Summary: This children's book presents basic information about diabetes from the perspective of a young boy with the disease. The book, designed to be read aloud in the classroom, focuses on the school experiences of a child with diabetes. The book discusses adherence to scheduled meal plans, especially during class; testing for blood glucose levels; the problem of hypoglycemia; emergency identification tags; and sports and exercise. The book concludes with 10 tips for teachers who have students with diabetes in the classroom. The book is illustrated in full color with drawings of the child's various activities. •
Trick-or-Treat for Diabetes: A Halloween Story for Kids Living With Diabetes Source: Plainview, NY: JayJo Books. 1999. 31 p. Contact: Available from JayJo Books. 135 Dupont Street, P.O. Box 760, Plainview, NY 11803-0760. (800) 999-6884. Fax (800) 262-1886. E-mail:
[email protected]. Website: www.JayJo.com. PRICE: $11.95 plus shipping and handling. Order number: BK190H170025. ISBN: 891383078. Summary: This children's book was written for children living with type 1 diabetes whose families may not realize that there are creative ways to allow these children to take part in the imaginative traditional holiday of Halloween. The author notes that Halloween is a tradition inspiring creativity, fun, socialization, and make-believe. The book follows the story of Sarah, a young adolescent with type 1 diabetes, as she learns ways to enjoy a Halloween party at school and trick-or-treating with her friends. The book depicts Sarah doing her own diabetes care, monitoring her blood glucose, taking insulin shots, and making food choices. The story also demonstrates the importance of an adult support person (in this case, Sarah's mother) for supervision and creative ideas for handling special situations like holidays. The book is filled with colorful illustrations.
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Periodontal Complications of Diabetes Source: Torrance, CA: Homestead Schools, Inc. 2000. 87 p. Contact: Available from Homestead Schools, Inc. 23844 Hawthorne Boulevard, Suite 200, Torrance, CA 90505. (310) 791-9975. Fax (310) 791-0135. E-mail:
[email protected]. Website: www.homesteadschools.com. PRICE: $48.00 plus shipping and handling. Course No. 6575. Summary: This continuing education program for dentists focuses on the periodontal complications of diabetes. Topics include the epidemiology of diabetes mellitus in the United States, particularly in minority populations; the morbidity and mortality of diabetes; the importance of glycemic control in a patient with diabetes; the etiology and pathogenesis of type 1 and type 2 diabetes; the long term complications of diabetes; the genetics of diabetes; the interrelationship between glycemic control and periodontitis; the genetic connection between the increased risk for periodontitis and diabetes; the pathophysiological mechanism involved in the destruction of collagen, accelerated alveolar bone loss and diabetes; diabetes as a risk factor for periodontal health; the effect of mechanical periodontal treatment and systemic antibiotics therapy in improving periodontal status as well as glycemic control; the connection between diabetes and oral health in older adults; patient education; the connection between bacterial infections and diabetes; risk factors for periodontitis; the natural history of oral infections in diabetes; the etiology and pathogenesis of pulpal and periapical infections in diabetes patients; the effect of diabetes treatments on the oral microflora; the immune response to oral pathogens; how immune responses are related to glycemic control; the nature of the microflora and host mediators in healthy individuals and people with diabetes who do
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or do not have periodontitis; the genetic relationships between diabetes and periodontitis; behavior modification strategies; the effects of periodontal therapy on diabetes; the role of strict control of blood glucose; the effect of early intervention on the development and rate of progression of oral complications of diabetes; appropriate treatment therapies for periodontal diseases in the patient with diabetes; the periodontal manifestations of diabetes and the signs and symptoms that may help a dentist detect and monitor the presence of this disease; and patient education principles and strategies. The document includes a reproduction of a 50-item slide presentation that is a guide for health care providers on the detection and prevention of periodontal complications of diabetes mellitus (compiled by the National Institute of Dental and Craniofacial Research). The document concludes with a posttest with which readers can qualify for continuing education credit. The document is illustrated with numerous black and white photographs. 51 figures. •
Diabetes Cookbook for Dummies Source: Foster City, CA: IDG Books Worldwide, Inc. 2000. 375 p. Contact: Available from IDG Books Worldwide, Inc. 919 E. Hillsdale Blvd., Suite 400, Foster City, CA 94404-2112. (800) 762-2974 or (416) 293-8464. Website: www.idgbooks.com. PRICE: $19.99 plus shipping and handling. ISBN: 0764552309. Summary: This cookbook helps people who have diabetes understand their disease and learn how to best manage their condition while enjoying delicious food. Part one explains the many factors involved in living healthy for a person who has diabetes, including exercising, staying informed about the disease, controlling blood glucose, and maintaining safe blood pressure. Other topics include the effects of good relationships and a sense of humor on one's health and the importance of what, when, and how much the person who has diabetes eats. In addition, this part explains how to plan a nutritional program, shop for groceries, and cook healthy meals. Part two presents more than 150 recipes for breakfast foods, appetizers, soups, salads, main courses, grains and vegetables, snacks, and desserts. Each recipe includes a nutritional analysis that notes the serving size; the diabetes exchanges; the number of calories; the number of grams of fat, carbohydrate, protein, and fiber; and the number of milligrams of cholesterol and sodium. Information on preparation and cooking are also included. Part three teaches readers how to select healthy food while on the go and provides a breakdown of the nutritional content of popular fast food items. Part four presents 10 simple ways to improve one's diet, 10 easy substitutions in one's eating plan, 10 strategies to normalize one's blood glucose, and 10 tactics for teaching children with diabetes healthy eating habits. Part five consists of appendices that provide more information on restaurants; exchange lists for people who have diabetes; a glossary of basic cooking terms for the cooking novice; conversions of weights, measures, and sugar substitutes; and other recipe sources for people who have diabetes.
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Managing Type II Diabetes: Your Invitation to a Healthier Lifestyle. Revised ed Source: Minneapolis , MN: International Diabetes Center. 1996. 184 p. Contact: Available from HealthSource. 3800 Park Nicollet Boulevard, Minneapolis, MN 55416-9963. (800) 372-7776. PRICE: $11.95 plus $3.50 shipping and handling or 7 percent of total order (as of 1996). ISBN: 1885115261. Summary: This easy-to-read manual has been updated to include the latest advances in diabetes management including the DCCT, and new nutrition guidelines and medications. Written by a team of diabetes specialists, the book is intended to serve as a
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guide for people with noninsulin-dependent diabetes (NIDDM) who want to gain more control of their lives. The book discusses what NIDDM is; targeting your care; the social and emotional stresses of NIDDM; diet, nutrients, the food guide pyramid, and weight loss; exercise and the activity pyramid; handling stress; medication; monitoring blood glucose; carbohydrate counting and developing a food plan; developing an activity plan; goal-setting; and the complications of diabetes. The book lists many resources for more information, and includes an index. •
Best for You and Your Baby: Answers About Gestational Diabetes Source: Indianapolis, IN: Boehringer Mannheim Corporation. 1993. 40 p. Contact: Available from Boehringer Mannheim Corporation. Medical Services Department. 9115 Hague Road, Indianapolis, IN 46250. (800) 428-5076. PRICE: Single copy free. Summary: This easy-to-read patient education booklet offers general information about gestational diabetes. Topics include the patient care team and the patient's role in it; a definition of gestational diabetes; the causes of high blood glucose levels; complications to the fetus and the mother caused by hyperglycemia; monitoring fetal health; selfmonitoring of blood glucose (SMBG); meal planning; the use of insulin; the role of exercise; emotional support; labor and delivery; postpartum problems with diabetes; and breastfeeding. Written in clear, basic language, the booklet features charcoal drawing illustrations and sidebars that highlight the important points on each page. The booklet concludes with a glossary of relevant terms. It is also available in Spanish (Lo Mejor para Usted y su Bebe: Respuestas Sobre la Diabetes del Embarazo).
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Meal Planning for Diabetes in Pregnancy: Practical Applications Source: Mendham, NJ: Infinity Impressions, Ltd. 1990. 63 p. Contact: Available from Infinity Impressions, Ltd. 88 East Main Street, Suite 500, Mendham, NJ 07945. (201) 543-9231. PRICE: $29.95 plus $3 for shipping and handling. ISBN: 1879339137. Summary: This guide for Registered Dietitians, nutrition experts, or diabetes educators working with pregnant women with diabetes interprets nutrient breakdowns and diabetic exchanges for meal compliance. Three sections cover gestational diabetes (GDM); nutrient breakdowns and menus with carbohydrate distribution in tenths; and nutrient breakdowns and menus with carbohydrate distribution in sevenths. Topics addressed in the appendices include the metabolism of food into glucose and glucose absorption; glucose goals for pregnancy; daily record of blood glucose levels; worksheet for meal plan nutrient breakdown; sources of simple sugars; and food label ingredients that contain sugar or added starch. 8 references.
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Renal Lifestyles Manual. 3rd ed Source: Marina del Rey, CA: R and D Laboratories. 1999. 338 p. Contact: Available from R and D Laboratories, Inc. 4640 Admiralty Way, Suite 710, Marina del Rey, CA 90292. (800) 338-9066 ext. 264 or (310) 305-8053. Fax (310) 305-8103. E-mail:
[email protected]. Website: www.rndlabs.com. PRICE: $29.95 plus shipping and handling. ISBN: 0967043905. Summary: This guide is designed to help patients understand and follow special renal (kidney) diets. The primary goal for diet therapy is to decrease the work load on the
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kidneys (by eating less protein). The manual also explains the critical issues related to living with kidney disease and provides lists of food choices and detailed diets for predialysis, hemodialysis, and peritoneal dialysis patients. The manual includes sections on the anatomy and physiology of the renal system, phosphorus and how to control phosphorus levels, guidelines for the renal patient with diabetes, high and low blood glucose (sugar) symptoms, renal vitamins and phosphate binders, blood chemistry tests and values, gaining and losing weight, and understanding fluid allowances. The manual can be used by patients, dietitians, or both in tandem, and medical concepts are explained in nontechnical language. The bulk of the material is presented in charts, tables, and lists to ease understanding and accessibility. The handbook includes fifty pages of recipes, with the nutritional information (calories, protein, sodium, potassium, phosphorus) noted for each. The manual concludes with a sodium, potassium, and phosphorus counter; a protein and calorie counter; and a fast food protein and calorie counter. A glossary of terms concludes the handbook. The handbook is spiral bound. •
What You Need to Know About Diabetes: A Short Guide Source: Boston, MA: Joslin Diabetes Center. 1999. 60 p. Contact: Available from Joslin Diabetes Center. One Joslin Place, Boston, MA 02215. (800) 344-4501 or (508) 583-3240. Fax (617) 732-2562. Website: www.joslin.harvard.edu. PRICE: $11.50 each; plus shipping and handling. Order number JDC210. Summary: This guide provides people who have diabetes with information on the basics of diabetes self care. The guide begins with a chapter that explains normal metabolism and the impact of diabetes on body functioning, identifies the short-and long-term risks of high blood sugar, defines low blood sugar, and offers self care tips. This is followed by a chapter that explains how to use good nutrition practices to care for diabetes. Topics include eating the right amount and kind of food at the right time; developing a meal plan; and making healthy food choices by limiting fatty foods, consuming high fiber food, using less salt, replacing sugar with artificial sweeteners, and limiting alcohol consumption. The chapter also offers tips for eating out and developing healthy eating habits and provides examples of food choices from various food groups. Chapter three provides guidelines for using exercise to care for diabetes, focusing on starting an exercise plan and preventing a low blood sugar reaction. This is followed by a chapter that focuses on the use of medications to care for diabetes. The chapter provides information on insulin, offers tips for drawing up and injecting a single or mixed dose of insulin, and presents suggestions for taking care of insulin and syringes. In addition, the chapter explains how oral diabetes medications work, presents guidelines for taking oral diabetes medications, and summarizes tips for using oral medications that are currently available. Chapter five focuses on the monitoring of blood glucose. Topics include the steps involved in checking blood for sugar and urine for ketones. The sixth chapter discusses special problems, including hyperglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic state, and hypoglycemia. Remaining chapters outline sick day rules; offer foot care tips; present guidelines for avoiding eye, kidney, nerve, heart and blood vessel, and foot damage; and provide suggestions for living with diabetes.
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Stop the Rollercoaster: How to Take Charge of Your Blood Sugars in Diabetes Source: San Diego, CA: Torrey Pines Press. 1996. 230 p. Contact: Available from Torrey Pines Press. 1030 West Upas Street, San Diego, CA 92103-3821. (800) 988-4772 or (619) 497-0900. PRICE: $21.95. ISBN: 1884804829.
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Summary: This guidebook helps readers with diabetes who are interested in implementing intensive diabetes management and control their blood glucose levels. The book is organized into seven sections: learning about diabetes, taking control, the types of insulin, setting insulin doses, daily challenges and how to meet them, blood glucose patterns and solutions, and research insights. The book also has a glossary, an index, checklists for improving control, many step by step directions, and specific examples of management strategies. Included are three blood glucose charting methods, comprehensive approaches to exercise and pregnancy, and information on the latest research and therapies for complications. 166 references. •
Core Curriculum for Diabetes Education. 5th ed.: (Volume 2) Diabetes Management Therapies Source: Chicago, IL: American Association of Diabetes Educators (AADE). 2003. 341 p. Contact: Available from American Association of Diabetes Educators (AADE). AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 3383633 or (312) 424-2426. Fax (312) 424-2427. Email:
[email protected]. Website: www.aadenet.org. PRICE: Individual volume $55.00 for members and $75.00 for nonmembers: complete 4-volume set $159.95 for members and $229.95 for nonmembers; plus shipping and handling. ISBN: 881876128 (Volume 2); 881876152 (4-volume set). Summary: This guidebook is the second in a series of four handbooks in the CORE Curriculum, a project originally planned to help educators prepare for the Certified Diabetes Educators (CDE) exam. However, the use and scope of the CORE Curriculum has expanded; it is both a key reference for the Advanced Diabetes Management credential exam and an authoritative source of information for diabetes education, training, and management. This first volume covers diabetes management therapies. Topics include medical nutrition therapy for diabetes; physical activity and exercise; pharmacologic (drug) therapies for glucose management; pharmacologic therapies for hypertension (high blood pressure) and dyslipidemia (altered levels of blood fats, including cholesterol); monitoring; pattern management of blood glucose; insulin pump therapy and carbohydrate counting for pump therapy, including the use of insulin-tocarbohydrate ratios; hypoglycemia (low blood glucose levels); and coping with illness and surgery. Each chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). The handbook concludes with a subject index.
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Diabetes A to Z: What You Need to Know About Diabetes, Simply Put. 4th ed Source: Alexandria, VA: American Diabetes Association. 2000. 195 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 for members; $14.95 for nonmembers; plus shipping and handling. ISBN: 1580400353. Summary: This guidebook provides people who have diabetes with all the information they need about diabetes in clear, simple terms. Special features that make the book easy to use include the presentation of thorough, up to date information in an encyclopedia style format, easy to read charts and tables, and alphabetized listings to provide quick access to information. Topics include activity, alcohol use, blood fats, blood glucose, blood vessel damage, complications, coping, dental care, diabetes pills, diet, exercise, foot care, gestational diabetes, health care professionals, heart disease, high blood pressure, insulin, insulin injections and pumps, insurance, kidney disease, meal
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planning, nerve damage, pregnancy, sex, sick days, skin care, smoking, stress, stroke, type 1 and type 2 diabetes, vegetarian diets, vitamins and minerals, and weight loss. 27 figures. •
Handbook of Diabetes, Second Edition Source: Malden, MA: Blackwell Science, Inc. 1999. 220 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail:
[email protected]. Website: www.blackwell-science.com. PRICE: $60.95. ISBN: 0632055049. Summary: This handbook covers a wide spectrum of information on diabetes mellitus. The handbook includes an introduction and 31 topical chapters: the history of diabetes, diagnosis of diabetes, classification, public health aspects, normal physiology of insulin secretion and action, the epidemiology and etiology of type 1 diabetes, the epidemiology and etiology of type 2 diabetes, other types of diabetes, assessing control in diabetes, the management of type 1 diabetes, the management of type 2 diabetes, diabetic ketoacidosis and hyperosmolar non-ketotic coma, hypoglycemia (low blood glucose levels), control and complications, diabetic eye disease (retinopathy), diabetic nephropathy (kidney disease), diabetic neuropathy (nerve disease), hyperlipidemia (high levels of blood fats) in diabetes, hypertension (high blood pressure) in diabetes, macrovascular disease in diabetes, the diabetic foot, sexual problems in diabetes, gastrointestinal problems in diabetes, the skin in diabetes, psychological and psychiatric problems in diabetes, some intercurrent problems (exercise, drugs, infection, surgery), pregnancy and diabetes, diabetes in children, diabetes in the elderly, lifestyle considerations (driving, employment, smoking, travel), and the organization of diabetes care. The handbook design includes information presented in small chunks, with numerous color illustrations, charts, and photographs to make the information more accessible. A detailed subject index concludes the book.
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Diabetes Mellitus: A Practical Handbook. 6th ed Source: Palo Alto, CA: Bull Publishing. 1995. 200 p. Contact: Available from Bull Publishing. P.O. Box 208, Palo Alto, CA 94302-0208. (415) 322-2855. Fax (415) 327-3300. PRICE: $12.95 plus shipping and handling. ISBN: 0923521313. Summary: This handbook explains diabetes in simple language and diagrams. Topics include the etiology of diabetes mellitus; hyperglycemia and hypoglycemia; blood sugar levels; diet and nutrition; self monitoring of blood glucose; urine testing; ketones and ketoacidosis; insulin and insulin storage; injection techniques; oral diabetes medications; laboratory tests; exercise; sick days; personal hygiene, including skin care and foot care; stress and emotions; traveling with diabetes; complications; and research. Additional sections discuss resources and organizations where peole can seek more information; a bibliography; meal planning forms; and a time schedule.
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Therapy for Diabetes Mellitus and Related Disorders. 3rd ed Source: Alexandria, VA: American Diabetes Association. 1998. 487 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 442-
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9742. Website: www.diabetes.org. PRICE: $39.95 plus shipping and handling. ISBN: 0945448945. Summary: This handbook focuses on the treatment of problems that are of importance in the management of people with diabetes mellitus. The book attempts to help health professionals apply major advances in health care to their patients. Topics include the diagnosis and classification of diabetes mellitus, genetic counseling for type 1 diabetes, gestational diabetes mellitus, the management of pregnant women who have diabetes, antepartum and intrapartum obstetric care, neonatal problems and their management, type 1 diabetes and diabetic ketoacidosis in children, psychosocial adjustment in children who have type 1 diabetes, psychosocial aspects in adults, diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome in adults, and lactic acidosis. Other topics include the role of diabetes education in patient management; self monitoring of blood glucose; the rationale for management of hyperglycemia; medical nutrition therapy; pharmacological treatment of obesity; exercise; oral hypoglycemic agents such as sulfonylureas, repaglinide, metformin, alpha glucosidase inhibitors, and thiazolidinediones; insulin treatment; insulin pump therapy; combination therapy for hyperglycemia; and diabetes complications. In addition, the book discusses surgery and anesthesia in people with diabetes, geriatric patient care, hypoglycemia in patients who have type 1 diabetes, insulin allergy and insulin resistance, drugs and hormones that increase blood glucose levels, diabetic dyslipidemia, antihypertensive therapy, cutaneous disorders associated with diabetes mellitus, infections, visual loss, ocular complications, drug induced renal dysfunction, diabetic nephropathy, chronic kidney disease, painful or insensitive lower extremity, mononeuropathy and amyoradiculopathy, gastrointestinal disturbances, and bladder dysfunction. Final topics include erectile dysfunction, female sexual disorders, postural hypotension, sudomotor dysfunction and dark vision, cardiac denervation syndrome, noninvasive cardiac testing, angina and congestive heart failure, myocardial infarction, peripheral vascular disease, and foot ulcers and infections. The book includes an index. Numerous figures. Numerous tables. Numerous references. •
Diabetes Meal Planning: Self Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 31 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $2.73 each; plus shipping and handling; quantity discounts available. Order number 97841. Summary: This handbook helps people who have diabetes begin a meal plan. Diabetes affects the body by increasing blood sugar levels and causing problems with blood vessels and the heart, the kidneys, the eyes, the nerves, and the feet. Maintaining a regular routine for meals and snacks can help keep blood sugar levels as normal as possible throughout the day. People who have diabetes need to know that there is no one diabetes diet, every person who has diabetes needs a personal meal plan, a meal plan will involve making some changes, and a meal plan works in balance with other measures. Working as a partner with a health care team will help a person manage his or her diabetes. The food pyramid, diabetes exchange lists, and carbohydrate counting are tools to help people who have diabetes eat a variety of healthy foods. Nutrition labels on packaged foods may also be used to help. The handbook explains how to use these tools and offers tips for making healthy choices when shopping, cooking, eating at home, and dining out. Guidelines for dealing with sick days and other emergencies are presented. In addition, the handbook includes worksheets to help readers map a course to successful diabetes management; plan meals; and monitor food consumption,
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exercise, blood glucose levels, and medications. The handbook includes a list of organizations that provide information on diabetes and its management. •
You Can Control Diabetes and High Blood Pressure: Self Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 31 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $2.73 each; plus shipping and handling; quantity discounts available. Summary: This handbook provides people who have diabetes with self care advice for managing high blood pressure. The handbook begins with an explanation of diabetes and high blood pressure and the complications they can cause. Having both conditions puts a person at greater risk of stroke, coronary artery disease, heart failure, kidney disease, blindness, reduced circulation to the feet and legs, and nerve damage. The handbook then provides guidelines for monitoring blood glucose and blood pressure, setting weight and exercise goals, making other lifestyle changes to improve health, eating balanced meals and snacks, and managing their medications. The handbook includes charts and worksheets that help readers with managing their diabetes and high blood pressure. The handbook also stresses the importance of undergoing regular screenings, caring for one's emotional health, and seeking outside assistance when needed. The handbook includes a list of organizations that can answer questions about diabetes and high blood pressure.
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Your Child Has Diabetes: A Parents Guide for Managing Diabetes in Children Source: Atlanta, GA: Pritchett and Hull Associates, Inc. 2002. 40 p. Contact: Available from Pritchett and Hull Associates, Inc. 3440 Oakcliff Road, N.E., Suite 110, Atlanta, GA 30340. (800) 241-4925. Website: www.p-h.com. PRICE: $3.25; plus shipping and handling. Summary: This handbook was written to teach parents of children newly diagnosed with diabetes the basics about diabetes and its management. The booklet begins by reminding parents that it may take some time to learn about diabetes and its management, so not to be too discouraged at first. Topics covered include glucose and how the body uses glucose for energy; the two most common types of diabetes; diabetes from the child's perspective; the multi-pronged approach to diabetes care, including food, exercise, insulin, oral medicines, and checking blood glucose levels; the members of the typical patient care team; eating healthy meals and snacks; meal planning, diabetes exchanges, and carbohydrate counting; the food pyramid (slightly modified for diabetes); insulin, including injections, insulin pumps, and self monitoring of blood glucose, or SMBG; coping with blood glucose problems, including hyperglycemia (high blood glucose levels) and hypoglycemia (low blood glucose levels); complications of diabetes; and coping with diabetes in school. The booklet is illustrated with colorful, cartoon drawings and includes spaces for parents to individualize the information with their child's goals, the health care providers' telephone numbers, and management strategies. The booklet concludes with a list of resource organizations through which parents can obtain additional information.
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Healing Handbook for Persons with Diabetes Source: Worcester, MA: University of Massachusetts Medical School. 1998. [141 p.].
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Contact: Available from University of Massachusetts Medical School Bookstore. 55 Lake Avenue, Worcester, MA 01655. (508) 856-3213. Website: http://www.umassmed.edu/diabeteshandbook/. PRICE: $14.95 plus $5.00 for shipping and handling. Summary: This handbook, available in both English and Spanish, provides people who have diabetes with an overview of the disease. Chapter one defines diabetes and provides information on the causes and history of the disease, as well as an overview of insulin, the pancreas, and kidney functioning. Chapter two offers practical advice for accepting diabetes and living with it day to day. Topics include psychological and social aspects, coping skills, life and health insurance, diabetes identification, legal rights, treatment plans, regular assessments, and continuing education. Chapters three and four describe type 1 and type 2 diabetes, respectively. Topics include goals and management. Chapter five focuses on blood glucose monitoring. Topics include self monitoring of blood glucose (SMBG), equipment for SMBG, glycosylated hemoglobin, and urine tests for ketones and glucose. Chapter six deals with diet, focusing on basic nutrition, meal planning at home or when dining out, and exchange lists. Chapter seven offers advice on exercise programs for people who have diabetes. Topics include aerobic exercise options, exercise for the overweight person with type 2 diabetes, exercise for the person with type 1 diabetes, food exchanges for exercise, easy exercises for beginners, and blood glucose monitoring during exercise. Chapter eight provides an overview of insulin, focusing on types of insulin, how to buy and store insulin, how to inject insulin, and how to avoid and treat insulin reactions. Chapter nine describes oral medications that are used to treat type 2 diabetes, including sulfonylurea compounds, biguanides, thiazolidinediones, and alpha glucosidase inhibitors. Chapter 10 serves as a guide to diabetes management during an illness. Chapter 11 offers tips for preventing some common skin and foot problems experienced by people who have diabetes. Chapter 12 describes complications associated with diabetes and provides advice on how to avoid them. Complications discussed include those affecting the eyes, kidneys, nerves, blood vessels, feet, and teeth. Chapter 13 addresses special concerns of families coping with diabetes. Sections discuss the special needs of women with diabetes during pregnancy, provide advice for parents of children with diabetes, and offer information for school personnel who have contact with students who have diabetes. Chapter 14 offers tips that help ensure safe, healthy travel for people who have diabetes. Chapter 15 highlights current research activities into the causes and prevention of and potential treatments for diabetes. Some chapters end with a series of questions and answers that may help clarify information about the chapter. Several chapters list products for people with diabetes or refer to other publications on diabetes. A glossary of diabetes related terms is included at the end of the handbook. •
Insulin-Dependent Diabetes in Children, Adolescents and Adults: How to Become an Expert on Your Own Diabetes Source: Uddevalla, Sweden: Becton Dickinson and Company. 1998. 268 p. Contact: Available from Becton Dickinson and Company. Becton Dickinson Division, 1 Becton Drive, Franklin Lakes, NJ 07417-1884. (201) 847-6800. Fax (201) 847-6692. PRICE: $29.00; plus shipping and handling. ISBN: 9163062615. Also available from www.amazon.com and Piara Publishing. Turkosv 12, S-451 62 Uddevalla, Sweden. +46 522 66 93 66. E-mail:
[email protected]. Summary: This illustrated book provides people with the practical information they need to take good care of their diabetes. The book begins by describing the anatomy of the digestive system and explaining how the healthy body works. This is followed by
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sections that focus on self care; the symptoms and treatment of hypoglycemia and hyperglycemia; insulin treatment; insulin requirements; injection technique; injection aids such as indwelling catheters, automatic injectors, and jet injectors; the insulin pump; the side effects of insulin treatment; the adjustment of insulin doses; temporary and permanent changes to insulin doses; and urine and blood testing. Other sections focus on diet, the use of dietary sweeteners, the consumption of candy and ice cream, weight control, eating disorders, physical exercise, stress, sick days, active and passive smoking, alcohol consumption, pregnancy, social issues, travel, associated diseases, and complications. Several sections focus on research efforts, including research addressing the issue of whether better blood glucose control can lessen the risk of complications and research concerning equipment improvements, the cause of diabetes, and alternative modes of insulin administration. Remaining sections deal with psychological issues, needle phobia, and well known persons who have diabetes. The book includes a glossary, an index, and a reading list. 433 references. •
My Own Type 1 Diabetes Book Source: West Vancouver, BC: Grandma Sandy. 1999. 37 p. Contact: Available from Grandma Sandy. 5742 Westport Court, West Vancouver, BC V7W 2X9. Also available from Amazon.com. PRICE: $10.00 plus shipping and handling. ISBN: 0968667201. Summary: This illustrated book serves as a tool and a reference for children who have type 1 diabetes and their families and caregivers. The book uses simple text and visual imagery to demystify type 1 diabetes. The book begins by explaining how people get diabetes and what diabetes is. This is followed by a discussion of the need for people who have diabetes to balance their diet, exercise, and insulin level. Other topics include doing blood glucose checks, eating appropriate foods, injecting insulin, using an insulin pump, exercising, and dealing with hyperglycemia and hypoglycemia. The book includes blank pages for recording notes and reminders, lists reference books for further reading and websites that give additional information, and identifies items for a type 1 diabetes kit.
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Taming the Diabetes Dragon Source: Valley Park, MO: JayJo Books, LLC. 1998. 24 p. Contact: Available from JayJo Books, LLC. P.O. Box 213, Valley Park, MO 63088-0213. (636) 861-1331. Fax (636) 861-2411. E-mail:
[email protected]. Website: www.jayjo.com. PRICE: $14.95. ISBN: 1891383035. Summary: This illustrated book tells the story of the villagers of Pancreas who are being attacked by a dragon known as Diabetes to help children who have diabetes better understand their disease. Once the dragon attacks the village, it does not leave. Many of the villagers are becoming sick from the dragon's fire. A young girl named Samantha leaves the village to find help. She meets a boy named Preston and brings him back to Pancreas. Preston has the knowledge to deal with the dragon. He teaches the people how to use the tools of insulin, syringes, blood glucose meters, and appropriate snacks to tame the dragon and live in peace with it.
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Managing Your Diabetes: Basic Facts About Diabetes. Revised ed Source: Indianapolis, IN: Eli Lilly and Company. 1998. 29 p.
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Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN 46285. (800) 545-5979 or (317) 276-2000. PRICE: Single copy free. Summary: This illustrated booklet for people with diabetes explains the main principles and techniques of diabetes management. A step-by-step guide to drawing and injecting insulin is included, and activity charts are given for Lilly insulins and for oral hypoglycemic agents. Additional topics include diet, exercise, blood sugar testing, self blood glucose monitoring, complications, and care of the skin, feet, and teeth. The signs, symptoms, and treatment of diabetic emergencies are discussed. The booklet is also available in Spanish. •
Even Little Kids Get Diabetes Source: Morton Grove, IL: Albert Whitman and Company. 1991. 25 p. Contact: Available from Albert Whitman and Company. 6340 Oakton Street, Morton Grove, IL 60053. (800) 255-7675 or (847) 581-0033. Fax (847) 581-0039. PRICE: $12.95 (hardback) or $4.95 (paperback). ISBN: 0807521582 (hardback); 0807521590 (paperback). Summary: This illustrated children's book tells the story of a two-year-old girl who is diagnosed with insulin-dependent diabetes mellitus (IDDM). Told in the simple language of a child, the story briefly describes the effects of the disease; the importance of eating well, testing blood glucose levels, and taking insulin shots; and the psychological impact of diabetes on the child and on her family members. A short note from the author to parents of children who have diabetes is appended.
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Teenagers with Type 1 Diabetes: A Curriculum for Adolescents and Families Source: Alexandria, VA: American Diabetes Association. 2000. [31 p.]. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $39.95 plus shipping and handling. ISBN: 158040054X. Summary: This illustrated guide presents a curriculum, based on materials developed for use in the Adolescent Clinic Project, that provides adolescents who have diabetes with a model for making decisions that affect both their lives and their diabetes and teaches adolescents to use problem solving skills to make adjustments to their treatment program based on the results of their blood glucose monitoring. The book is organized into five modules. The first module provides some information about making choices. The second module introduces all of the basic ideas and tools involved in diabetes care. The remaining three modules focus on special issues of decision making and adjusting diabetes treatment plans, including adjusting insulin dosage, planning meals, and exercising. Each module has five sections for health care professionals and two sections for adolescents. The professional sections present learning objectives, guidelines for teen and parent groups, a prequiz, and a postquiz. The adolescent sections provide an overview of the module and its goals and present module information. A final section provides guidelines that can be used with each of the modules. Each guideline offers ideas on special situations such as handling sick days, treating hypoglycemia, using glucagon, getting better results using blood sugar testing, keeping track of blood sugar and insulin, making permanent insulin dose changes, counting carbohydrates, choosing fast foods, determining a target heart rate, selecting exercise snacks, and decreasing insulin dose for extended exercise.
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Diabetes and Your Heart: Self Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 31 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $2.73 each; plus shipping and handling; quantity discounts available. Order number 97964. Summary: This illustrated handbook provides people who have type 2 diabetes with information on the relationship between diabetes and heart disease. Higher than normal levels of blood glucose may lead to unhealthy blood lipid levels and increase the risk of blood clots. Cardiovascular disease puts people at increased risk for angina, heart attacks, stroke, and poor blood flow to the extremities. People who have diabetes should focus on their blood glucose level, blood pressure, blood lipids, and body weight. A diabetes health care team can help a person who has diabetes to set goals, learn important skills, and become more informed about diabetes and its management. The handbook includes interactive worksheets that show readers how to prevent or control heart disease by encouraging them to monitor their blood glucose and blood pressure, establish and track their lipid profile, develop exercise and healthy eating plans, quit smoking, and monitor their medications. In addition, the handbook offers suggestions for coping with the psychological aspects of living with a chronic illness. The handbook includes a list of organizations that can provide additional information about diabetes and heart disease.
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Wizdom: A Kit of Wit and Wisdom for Kids with Diabetes Source: Alexandria, VA: American Diabetes Association. 2000. 100 p. Contact: Available from American Diabetes Association (ADA). 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-23837 (DIABETES). Website: www.diabetes.org/wizdom. PRICE: Free to patients; $19.95 plus shipping and handling for non-patients. Also available for free on the internet at www.diabetes.org/wizdom/download.asp. Summary: This information kit, which consists of two handbooks, serves as a resource for children with diabetes and parents whose child has been diagnosed with diabetes. The handbook for parents provides an overview of diabetes care. Chapters define type 1 and type 2 diabetes, describe the various forms of insulin, provide a step by step guide to giving insulin injections, offer guidelines on healthy eating and safe exercise, explain blood glucose monitoring and recordkeeping, and discuss the psychological aspects of a diabetes diagnosis. Other topics include informing family members and friends about the diagnosis, developing a plan for diabetes care at school, dealing with discrimination against children with diabetes, handling sick days, and planning for special occasions. The handbook concludes with chapters on coping with the challenges posed by issues that arise among adolescents who have diabetes, obtaining good diabetes care, and learning more about diabetes from the American Diabetes Association and other sources. The handbook for children with diabetes provides them with materials they can use to help them live a healthy and happy life. Chapters explain the difference between type 1 and type 2 diabetes; discuss the importance of using insulin, eating well, and exercising; offer strategies for maintaining good blood glucose control; and provide suggestions for coping with emotional lows. Other topics include telling friends about one's diabetes; making a school packet; handling discrimination, special occasions, and sick days; and learning more about diabetes. 2 appendices.
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My Log Book Source: Chicago, IL: The Diet and Diabetes Shop. 1992. 21 p. Contact: Diet and Diabetes Shop. 10725 S. Western Avenue, Chicago, IL 60643. PRICE: $2.50 plus $0.60 postage (orders of 25 books or more are postage-free); 1 year's supply (3 books) $7. Summary: This log book designed for children with diabetes includes boxes for logging daily insulin dosage and blood glucose results, a daily diary, and jokes, games and puzzles. The log book allows extra space for children to record items such as after school blood glucose results and their activities. Printed on brightly colored paper, there is a riddle for each week. Each log book includes pages for 20 weeks (3 books for one year).
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Caring for Young Children Living With Diabetes: Professional Manual Source: Boston, MA: Joslin Diabetes Center. 1996. 125 p. Contact: Available from Joslin Publications. One Joslin Place, Boston, MA 02215. (800) 344-4501. Fax (617) 732-2562. PRICE: $5.95. ISBN: 1879091151. Summary: This manual for health care providers reviews the basics of multidisciplinary diabetes care for young children (age 8 and under) who have insulin-dependent diabetes (IDDM). Sections include current theories in the etiology and pathogenesis of IDDM; the 'team concept' of diabetes management; management strategies to balance insulin, meals, and physical activity, and to provide realistic goals for blood glucose monitoring to achieve safe glycemic control in this population; normal growth and development issues of young children, and how normal developmental tasks and temperaments may make diabetes management difficult; strategies for diabetes crisis management, including sick days, diabetic ketoacidosis (DKA) and severe hypoglycemia; current diabetes research; and the Joslin Diabetes Center's Young Children's Program, a model of comprehensive diabetes care for the family of the young child with IDDM. The manual concludes with appendices and a subject index. (AA-M).
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Caring for Young Children Living With Diabetes: Parent Manual Source: Boston, MA: Joslin Diabetes Center. 1996. 108 p. Contact: Available from Joslin Publications. One Joslin Place, Boston, MA 02215. (800) 344-4501. Fax (617) 732-2562. PRICE: $5.95. ISBN: 1879091143. Summary: This manual provides useful information to parents about the daily management of insulin-dependent diabetes (IDDM) in the young child. Section One of this manual reviews the basic definition and description of IDDM. Section Two describes the child's health care team and provides guidelines for frequency of reevaluation and medical assessment. Section Three reviews all aspects of the diabetes treatment plan, including insulin, meal planning, physical activity, home blood glucose monitoring, and the need for family education. Additional sections review normal development in young children and show how and when diabetes treatment may be in conflict with normal development; review the definitions, causes, symptoms, and treatments of low and high blood glucose levels, sick days, and diabetic ketoacidosis; and describe recent directions in diabetes research. The final section closes with an overview of the diabetes treatment plan, for distribution to the child's nonparental caregivers. The manual concludes with a glossary of terms and a subject index.
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Children with Diabetes: A Resource Guide for Schools Source: Rensselaer, NY: New York State Health Department. 1999. 100 p. Contact: Available from New York State Health Department. Distribution Center, 11 4th Ave., Rensselaer, NY 12144. Fax (518) 465-0432. E-mail:
[email protected]. Website: www.health.state.ny.us. PRICE: Single copy free, also can be found at www.health.state.ny.us/nysdoh/consumer/diabetes/resource/families.htm. Summary: This manual serves as a diabetes resource guide for New York State school personnel. The manual presents an overview of the governor's initiative for people with diabetes. This is followed by an American Diabetes Association (ADA) position statement on the care of children with diabetes in school and day care settings and ADA recommendations for diabetes classification, testing, and diagnosis. The next section provides general information about diabetes. Topics include the symptoms and types of diabetes, nutrition, physical activity, blood glucose monitoring, the symptoms and treatment of hyperglycemia and hypoglycemia, insulin and insulin delivery systems, the care of children with diabetes, and diabetes identification cards and care information. This is followed by sections that present tools and information for parents and school nurses. The section for parents focuses on general information about diabetes, the responsibilities of parents who have a child with diabetes, appropriate accommodations for a special needs child under the law, care planning, the age related responsibilities of children, psychosocial aspects of the child with diabetes, factors causing emotional distress for the child, sick day and travel guidelines, and medical identification products. The section for school nurses deals with care planning, training, staff training, appropriate accommodations for a special needs child under the law, sick day guidelines, and answers to questions about roles and responsibilities in relation to nursing procedures. Another section presents tools and information for teachers, administrators, school staff, and bus drivers. In addition, the manual includes an appendix that provides sample forms and letters and identifies numerous resources. 1 appendix.
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Living Well With Diabetes Source: Puyallup, WA: Good Samaritan Hospital. 1992. 63 p. Contact: Available from Good Samaritan Hospital. Diabetes Education Center, 407 14th Avenue SE, Puyallup, WA 98372. (206) 848-6661, ext. 1633. PRICE: $24.94 each, 10 or more $19.95 each; matching overheads $10 per set, plus $4.50 shipping and handling for over 5 manuals. Summary: This manual, intended for use in class instruction, is designed to help people newly-diagnosed with diabetes understand the disease and their role in diabetes management. Topics include a brief definition of diabetes, blood glucose testing, hypoglycemia, hyperglycemia, meal planning, exchange lists, sweeteners, fiber, fat and cholesterol, food labels, dining out, alcohol, cooking tips and cookbooks, exercise, insulin and oral hypoglycemic agents, long-term complications, care during illness (sick days), the psychosocial issues of living with diabetes, and support services. The topics are categorized into five class sessions and a 1-month follow-up meeting. Throughout the manual, charts and diagrams illustrate the material being presented.
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Manual for Management of Diabetes Mellitus: A Hong Kong Chinese Perspective Source: Hong Kong: Chinese University Press. 1998. 144 p.
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Contact: Available from Chinese University Press. Chinese University of Hong Kong, Sha Tin, N.T., Hong Kong. (852) 2609 6508. Fax (852) 2603 6692. E-mail: cup @cuhk.hk. PRICE: $19.00 plus shipping and handling. ISBN: 9622017576. Summary: This manual, which combines the latest international and Chinese information on diabetes, serves as a quick reference to all health care personnel involved in the management of diabetes. The manual begins with a chapter on the classification and pathogenesis of diabetes, focusing on intermediary metabolism, insulin, and counterregulatory hormones; the classification, presentation, and pathogenesis of diabetes; the overlap between type 1 and type 2 diabetes; and diabetes in Chinese people. This is followed by a chapter on the diagnosis of diabetes. Topics include the American Diabetes Association and World Health Organization diagnostic criteria and the oral glucose tolerance test. The third chapter recommends standards of medical care for patients who have diabetes, focusing on the initial visit, continuing care, the annual assessment, target values, hospital admission criteria, and referral for specialist assessment. The next chapter addresses the issue of patient education. Topics include health beliefs and affective responses, knowledge and skills, patient rights and roles, obstacles to glycemic control, self monitoring of blood glucose, insulin administration, sick day management, hypoglycemia, diabetic complications, treatment noncompliance, psychosociological problems, and finances. The fifth chapter focuses on the dietary management of diabetes and exercise in diabetes. Diet-related topics include the goals of dietary management, diet composition, healthy eating and dining out guidelines, food choices, weight control, and sweeteners. This is followed by a chapter on oral drugs for treating diabetes, including sulfonylureas, biguanides, antiabsorptive drugs, antiobesity drugs, and insulin and oral agent combinations. The next chapter discusses insulin use in terms of indications for use, actions and duration, types, regimen, dosage, adjustment of dosage, and use while travelling. The eighth chapter describes diabetic complications, including ophthalmic complications, diabetic foot, diabetic neuropathy, and microalbuminuria and renal involvement. This is followed by chapters on the treatment of hypertension and dyslipidemia. Perioperative management of people who have poorly and well controlled type 1 or type 2 diabetes is the topic of the next chapter. This is followed by a chapter on diabetic emergencies such as diabetic ketoacidosis, hyperosmolar nonketotic coma, and lactic acidosis. Remaining chapters discusses the diagnosis and management of gestational diabetes and the primary, secondary, and tertiary prevention of diabetes. 2 appendices. 9 figures. 1 table. •
Meeting the Challenge: Children Living With Diabetes Source: Milwaukee, WI: Gareth Stevens Publishing. 1992. 48 p. Contact: Available from Gareth Stevens Publishing. RiverCenter Building, Suite 201, 1555 North RiverCenter Drive, Milwaukee, WI 53212. (800) 542-2595 or (414)225-0333. Fax (414) 225-0377. ISBN: 0836807383. PRICE: May not be currently available from publisher; contact directly for details. Summary: This nonfiction children's book introduces readers to Jonny, a ten-year old Swedish boy who has had diabetes since he was seventeen months old. Readers learn about Jonny's daily successes and frustration with diabetes as he is at home, visiting the doctor, and attending a three-week summer camp for children with diabetes. The author addresses urine and blood glucose tests, injections, the short term effects of low blood glucose levels, and record keeping. Black and white photographs depict Jonny as he experiences various aspects of diabetes care in his everyday life. The book includes answers to questions which children may have about diabetes, as well as relevant projects for them to try. The book concludes with lists of organizations and books that
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will provide readers with more information about diabetes, a glossary, and an index. (AA-M). •
Putting Your Diabetes on the Pump Source: Alexandria, VA: American Diabetes Association. 2001. 59 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $7.95 plus shipping and handling. ISBN: 1580401414. Summary: This pocket sized handbook familiarizes readers with how people with diabetes can use an insulin pump to keep blood glucose (sugar) levels within target ranges. The author notes that by using an insulin pump, the patient can match their insulin needs to their lifestyle, rather than take an insulin injection and match their activities to how the insulin is working. Pumps deliver rapid or short-acting insulin 24 hours a day through a catheter placed under the skin. Insulin doses are separated into basal rates, bolus doses to cover the carbohydrate in meals, and correction or supplemental doses. Basal insulin is delivered continuously over 24 hours and keeps the blood glucose levels in range between meals and at night. When the pump user eats, he or she uses buttons on the pump to give additional insulin called a bolus. The booklet describes the positive and negatives aspects of using an insulin pump, what to know before using the pump, good habits, the practicalities of wearing an insulin pump, infusion sets, equipment and supplies, blood glucose targets, exercise and sports, days off the pump, dealing with hyperglycemia (high levels of blood glucose) and hypoglycemia (low levels of blood glucose), coping with sick days, and skin care. The booklet concludes with some suggestions from others who already use the insulin pump for part of their diabetes management, a blank form for recordkeeping, and basic information about the American Diabetes Association. The booklet is illustrated with simple line drawings. 1 figure. 4 tables.
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Nutrition Management and Restorative Dining for Older Adults: Practical Interventions for Caregivers Source: Chicago, IL: American Dietetic Association. 2001. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606-6995. (800) 877-1600. Website: www.eatright.org/catalog/. Summary: This practical guide serves as an easy to use concise reference with tips, interventions, and tools to ensure improved management of nutrition care for older adults. The first three chapters explore the role of nutrition as it relates to the needs of the older adult, nutrition assessment, and the eating environment. The third chapter includes a section on dietary modifications for people with specific conditions such as type 2 diabetes. People with this form of diabetes need adequate nutrition and consistent amounts of carbohydrate at the same times each day. People who have diabetes are likely to have better quality of life and nutritional status if specific foods are not restricted in their diet. The next four chapters focus on eating skills and rehabilitation, the effects of impaired swallowing and mobility, and cognitive and perceptual deficits that impact nutrition status. Remaining chapters discuss the most recent approaches to nutrition management of acute and chronic conditions and offer guidelines on enteral and parenteral nutrition support. A section on diabetes discusses this disease in terms of types, diagnosis, long term complications, and medical nutrition therapy. Other diabetes related topics include the importance of blood glucose control,
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acute complications, the management of diabetes through medications, special problems in older adults with diabetes, diabetes care in health care institutions, exercise considerations for older adults with diabetes, and alternative therapies for diabetes. Numerous figures. Numerous tables. Numerous references. •
Maximizing the Role of Nutrition in Diabetes Management Source: Alexandria, VA: American Diabetes Association. 1994. 64 p. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-6733. PRICE: $17.50 for ADA members; $21.95 for nonmembers (as of 1995). ISBN: 0945448422. Order Number PMNDMB. Summary: This publication contains the highlights of a one-day clinical education program presented around the U.S. in Spring 1994. The program, Maximizing the Role of Nutrition in Diabetes Management, was developed as a continuing education program for registered dietitians. Eight sections cover topics including the results of the Diabetes Control and Complications Trial (DCCT) and their impact on medical nutrition therapy (MNT) for diabetes; the medical aspects of diabetes management; the use of medications and exercise to manage diabetes; the use of MNT and blood glucose monitoring to manage diabetes; diabetes management in special medical situations, including hypertension, renal disease, gastrointestinal neuropathy, and surgery; diabetes management in different life stages, including pregnancy, childhood and adolescence, and older age; and nutrition self-management versus diet prescription. Objectives, key points, and clinical implications are stated at the beginning of each chapter. The book also includes a glossary of acronyms and a continuing education registration form.
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Selected Diabetes and Nutrition Education Resources: For the Diabetes Professional Source: Chicago, IL: American Dietetic Association (ADA). 1999. 83 p. Contact: Available from American Dietetic Association. P.O. Box 97215, Chicago, IL 60678-7215. (800) 877-1600 ext. 5000. Fax (312) 899-4899. Website: www.eatright.org. PRICE: $12.00 for members; $14.50 for nonmembers. Summary: This publication is a directory of selected diabetes and nutrition education resources for the diabetes professional to use in teaching people who have diabetes and their families. Print and audiovisual resources are included for various subject areas related to diabetes nutrition management and other aspects of diabetes care. Specifically, resource topics include comprehensive diabetes information, fundamental diabetes self management skills, general facts about diabetes, blood and urine self monitoring techniques, the management of blood glucose levels during an illness, foot care techniques, the action and use of oral agents and insulin, hypoglycemia, meal planning, advanced diabetes self management skills, intensive insulin therapy and pump therapy regimens, food exchange lists, carbohydrate counting, gestational diabetes, physical activity, complications, weight loss or maintenance, psychosocial concerns, comprehensive education programs, and diabetes prevention. Other resources include various types of cookbooks; material written for children, adolescents, men, women, and parents; magazines and newsletters; and diabetes-related agencies and associations. Each resource is listed alphabetically by title in each subject category. Resource entries may include the author or publisher, copyright date, ISBN number, address or telephone number for ordering, cost, number of pages, format, and a summary. In addition, each entry includes symbols that designate the target audience
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age, group or type of diabetes, educational use, and reading level for which the resource is appropriate. An index is also included. 3 appendices. •
Management of Diabetes Mellitus. 2nd ed Source: Durant, OK: Essential Medical Information Systems, Inc. 1991. 267 p. Contact: Available from Essential Medical Information Systems, Inc. P.O. Box 1607 Durant, OK 74702. (800) 225-0694. FAX (405) 924-9414. PRICE: $12.95 plus $1.95 shipping and handling. Bulk prices available. ISBN: 0929240316. Summary: This reference guide for the management of diabetes mellitus consists of 34 chapters on the following topics: fuel-hormonal dynamics; the cellular effects of insulin; diagnosis; insulin-dependent diabetes mellitus; noninsulin-dependent diabetes mellitus; secondary causes; effects of glucose normalization; laboratory methods; self blood glucose monitoring; diet therapy; methods of exercise; oral agents; insulin; dealing with the difficult patient; hypoglycemia; diabetic ketoacidosis; hyperglycemic hyperosmolar nonketotic coma; diabetes and the eyes; nephropathy; hypertension; neuropathy; sexuality; foot disease; lipids; macrovascular disease; digestive disease; prepartum planning and genetic counseling; glucose control during pregnancy; obstetrical considerations; surgery; outpatient sick day therapy; pump therapy; pancreatic transplantation; and enhancing adherence. Most chapters include references, charts, and figures where necessary.
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Diabetes Ready-Reference Guide for Health Care Professionals Source: Alexandria, VA: American Diabetes Association. 2000. 56 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $29.95 plus shipping and handling. ISBN: 1580400116. Summary: This reference guide provides health professionals with clear, concise guidelines for effective direct or indirect care of patients who have diabetes. The guide is tabbed for quick access to the various topics. Sections focus on the causes, characteristics, and treatment of type 1, type 2, and gestational diabetes; the diagnosis of diabetes; monitoring blood glucose through the use of self monitoring and the glycated hemoglobin and fructosamine test; the dietary management of diabetes and the meal planning approaches for obtaining optimal glucose and weight management; and the benefits of exercise and ways to start an exercise program. Other sections deal with the dosage, duration of action, and side effects of oral agent medications; types of insulin and the dosing and administration of insulin; the effects of nonprescription and prescription medications on diabetes control; acute complications such as hypoglycemia, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic syndrome; chronic complications such as cardiovascular disease, diabetic retinopathy, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, and autonomic dysfunction; foot care; sick day rules; and travel guidelines. The guide also includes a glossary and a bibliography.
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Serving Individuals with Diabetes who are Blind or Visually Impaired: A Resource Guide for Vocational Rehabilitation Counselors Source: Mississippi State, MS: Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. 1997. 227 p.
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Contact: Available from Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. Publications Manager, P.O. Drawer 6189, Mississippi State, MS 39762. (601) 325-2001 or (601) 325-8693. Fax (601) 325-8989. TDD (601) 325-8693. PRICE: $25.00 in any format. Summary: This resource guide is designed to help counselors better serve individuals with diabetes who are blind or visually impaired. The guide refers readers to a large collection of resources on various diabetes publications, medications, and appliances. Five sections cover an introduction to diabetes; self management; current medical issues; employment issues; and emotional aspects of diabetes. Topics include myths about diabetes; diabetic eye disease; new nutrition guidelines for diabetes management; oral diabetes medications; diabetes and medications; insulin and measurement devices and systems; maintaining the proper temperature of insulin; blood glucose control; 'talking' blood glucose monitoring systems; and noninvasive glucose monitors. The authors also discuss diabetes and the feet; kidney failure, dialysis, and transplantation; pancreas transplantation; arthritis and diabetes; diabetes and yeast infections; hypoglycemia; diabetic peripheral neuropathy; diabetes and men's sexual health; cardiovascular health; diabetic ketoacidosis; diabetic dermopathy; diabetes and the Individualized Written Rehabilitation Program (IWRP); the use of Braille; health insurance; and scleral shells. The book's appendix includes lists of diabetes-related organizations, publications, listservs, and World Wide Web sites; sources of low-sugar products and products for the blind; and diabetes equipment and supplies, including insulin syringe magnifiers. The resource guide is available in large print, Braille, audiocassette, and computer diskette. •
Balance PC Source: Concord, MA: Medilife, Inc. 199x. (CD-ROM). Contact: Available from Medilife, Inc. 30 Monument Square, Concord, MA 01742. (508) 371-3170. Fax (508) 371-4906. PRICE: $59.95. Summary: This software program provides people with diabetes with tools to monitor and understand the factors that affect blood glucose levels (diet, medications, stress, exercise, etc.). The program begins with a Personal Interview in which users answer indepth questions about diet, medications, testing, weight, lifestyle, and most recent HbA1c test results. This section also helps users understand their own individual health risks and to plan their daily schedules. The Smart Health Calendar enables users to plan and track meals, food intake, medications, blood testing, exercise, and other activities. The program also automatically accepts blood glucose meter readings. Reporting functions organize the information into easy to read reports and graphs. The Daily Analyzer shows the factors affecting blood glucose levels. A comprehensive Quarterly Report can be printed out for review with the health care provider. The program also includes the Food and Health Books section. This includes dozens of recipes; a listing of over 16,000 foods and their nutrients; and health and diabetes references, with information on 4,000 medications, and 1,000 symptoms and conditions. (AA-M).
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American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Diabetes Reference. 2nd ed Source: Alexandria, VA: American Diabetes Association. 1999. 514 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $23.95 plus shipping and handling. ISBN: 1580400388.
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Summary: This sourcebook provides people who have diabetes with expert advice, written in clear, easy to understand language, on every aspect of type 1, type 2, and gestational diabetes. The book begins with a chapter that provides an overview of type 1, type 2, and gestational diabetes. This is followed by a chapter that offers guidelines for designing a diabetes plan and describes options for treating diabetes, including insulin therapy, pancreas and islet transplantation, diet therapy, and oral diabetes medications. The third chapter provides suggestions for selecting a diabetes care team and answers questions about the glycated hemoglobin test. The next chapter describes types of insulin; explains how to buy, store, and administer insulin; and discusses various insulin plans. This is followed by a chapter that focuses on achieving glucose control. Topics include the impact of food, insulin, exercise, stress, and illness on blood glucose; self monitoring of blood glucose; and the causes and treatment of hypoglycemia and hyperglycemia. Chapter six provides information on diabetes tools, including blood glucose meters, test strips, lancets, and miscellaneous supplies. The focus of chapter seven is on intensive diabetes management. Topics include standard diabetes control versus tight control, goals for type 1 and type 2 diabetes, and intensive management techniques. Chapter eight discusses healthy eating in terms of creating a healthy meal plan using the food pyramid and using medical nutrition therapy. The next chapter offers suggestions for beginning an exercise program, exercising safely, and finding a desirable exercise. Other topics include the impact of exercise on blood glucose levels and exercise during pregnancy. Chapter 10 examines diabetes complications and their prevention and treatment. Complications include cardiovascular disease, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, and infections. Other chapters discuss the impact of diabetes on sexual health and pregnancy, the psychological impact of diabetes, and the effect of diabetes on other family members. Remaining chapters examine diabetes in the workplace, in the military, and at school and offer advice for working with the health care system. The book includes a glossary, an index, and lists of resources and helpful websites. 1 appendix. 9 figures. •
Type II Diabetes Sourcebook Source: Los Angeles, CA: Lowell House, and Chicago, IL: Contemporary Books. 1997. 336 p. Contact: Available from Contemporary Books, Inc. 2 Prudential Plaza, Suite 1200, Chicago, IL 60601. Also available from Lowell House, 2020 Avenue of the Stars, Suite 300, Los Angeles, CA 90067. (310) 552-7555. Fax (310) 552-7573. PRICE: $25.00 (cloth). ISBN: 1565656466. Summary: This sourcebook provides people with diabetes a comprehensive manual of self care for noninsulin-dependent diabetes mellitus (NIDDM, or Type II). The authors stress the importance of active patient participation and self management in caring for diabetes and in preventing complications. Sixteen chapters cover an introduction to diabetes, self empowerment, the patient care team and elements of a good treatment plan, the biology of diabetes and the role of insulin, stress management, blood glucose and its monitoring, food and nutrition, exercise, medications, laboratory tests and why each is important, daily hygiene and self care steps to prevent complications, pregnancy, the social and psychological aspects of diabetes, financial considerations, complications, and research being undertaken in this area. The chapter on laboratory tests covers blood pressure, hemoglobin A1C testing, lipid profile, urine tests, oral glucose tolerance test (OGTT), and the fructosamine assay. The chapter on mental health covers family problems, social support, communication skills, professional counseling, support
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groups, and diabetes burnout. The book includes two appendices: a listing of resources and a glossary of common terms. A subject index concludes the volume. •
Rufus Comes Home Source: Plainview, NY: JayJo Books. 1998. 34 p. Contact: Available from JayJo Books. 135 Dupont Street, P.O. Box 760, Plainview, NY 11803-0760. (800) 999-6884. Fax (800) 262-1886. E-mail:
[email protected]. Website: www.JayJo.com. PRICE: $11.95 plus shipping and handling. Order number: BK190H170024. ISBN: 891383027. Summary: This story book was written for children who have recently been diagnosed with type 1 diabetes. The book follows the story of a young boy, Brian, and his parents, as they go through the process of diabetes diagnosis and learning how to manage the disease. Topics include the symptoms of diabetes, testing for blood glucose, complications of diabetes, the physiology of insulin and blood glucose levels, the use of insulin injections, the role of meal planning and nutrition, hyperglycemia (high blood glucose levels) and hypoglycemia (low blood glucose levels), and the emotions of being diagnosed with diabetes. The story tells the tale of a stuffed bear, Rufus, being used to help the child with diabetes not feel so alone; the bear has diabetes too, and special patches where blood glucose testing and insulin shots could be pretended. The book ends with information telling readers how they can purchase a Rufus bear. The book is filled with colorful illustrations.
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It's Time to Learn About Diabetes: A Workbook on Diabetes for Children Source: Minneapolis, MN: Chronimed Publishing, Inc. 1991. 113 p. Contact: Available from Chronimed Publishing. P.O. Box 59032, Minnetonka, MN 55459-9686. (800) 848-2793 or (612) 541-0239. Fax (800) 395-3344 or (612) 541-0210. PRICE: $9.95 plus shipping and handling. ISBN: 1565610806. Summary: This workbook is a basic management guide for school-age children with diabetes. With the help of cartoon hosts Cindy and Mike, the author covers the basics of diabetes, what happens without insulin, the importance of balance and avoiding low blood glucose, taking insulin, testing blood and urine, healthy eating, exercise, sick days, party and holiday times, diabetes in school, self care, and friends and feelings. Appendixes include a certificate of completion, answers to the workbook questions, and a bibliography. 10 references.
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Managing Your Diabetes: A Comprehensive Study Guide for Patients and Their Health Care Professionals Source: Indianapolis, IN: Eli Lilly and Company. 1994. 107 p. Contact: Available from Eli Lilly and Company. Lilly Corporate Center, Indianapolis, IN 46285. (800) 545-5979 or (317) 276-2000. PRICE: Single copy free. Summary: This workbook provides an overview of diabetes and information on ways to control it. Designed primarily for people newly diagnosed, the workbook has 14 chapters. Topics include a definition of diabetes, its symptoms, and causes; the importance of the team approach to diabetes care; meal planning; exercise; insulin; oral hypoglycemic agents; blood glucose testing; ketone testing; pattern management; hypoglycemia; hyperglycemia; ketoacidosis; long-term complications; and general health care tips, including skin and foot care, sick days, and travel. Many of these
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sections have blanks to be filled in with the help of a doctor, nurse, pharmacist, or diabetes educator. Full-color photographs and colorful charts illustrate the material presented. The book concludes with a glossary of terms. The booklet is also available in Chinese, Spanish, Turkish, and Italian. •
Learning to Live Well with Diabetes. Revised ed Source: Minneapolis, MN: DCI Publishing, Chronimed Inc. 1991. 511 p. Contact: Available from Chronimed Publishing. P.O. Box 59032, Minnetonka, MN 55459-9686. (800) 848-2793 or (612) 541-0239. Fax (800) 395-3344 or (612) 541-0210. PRICE: $24.95 (paperback) plus shipping and handling. ISBN: 0937721794. Summary: Written by health professionals for people with either insulin-dependent or noninsulin-dependent diabetes, this book offers readable information to meet a variety of needs. Thirty-six chapters grouped into seven major sections address topics that include: the basics of diabetes, including emotional adjustment; controlling diabetes with insulin; managing diabetes with meal planning, exercise and oral medications; preventing long-term problems; advanced management and special concerns, including stress management, the effects of medications on diabetes, and fine-tuning blood glucose control; diabetes and youth; and diabetes research. Illustrations, photographs, and charts highlight the text. The book includes three appendices: exchange lists for meal planning; a blood glucose monitoring equipment guide, and an exchange list for infant foods. A subject index and a resource list are also provided.
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Touch of Diabetes: A Straightforward Guide for People Who Have Type II, Noninsulin-Dependent Diabetes. Revised ed Source: Minneapolis, MN: Chronimed Publishing, Inc. 1995. 144 p. Contact: Available from Chronimed Publishing. P.O. Box 59032, Minnetonka, MN 55459-9686. (800) 848-2793 or (612) 541-0239. Fax (800) 395-3344 or (612) 541-0210. PRICE: $10.95 (paperback) plus shipping and handling. ISBN: 1565610792. Summary: Written by two diabetes researchers and authors and the former editor of 'Diabetes in the News' magazine, this book presents information on a wide range of issues and topics of concern to people with noninsulin-dependent diabetes mellitus (NIDDM). Fourteen chapters present medical advice, with supporting experience and research, on topics ranging from curbing complications to counting calories. Topics include what diabetes is, diabetes self-care, the effect of diabetes on one's sex life, complications, emotions, stress, and coping strategies. The authors offer practical advice about changing eating habits, beginning to exercise, finding the best balance of medication, monitoring blood glucose levels, and utilizing all available resources. Charts and lists help to summarize and illustrate the text. A glossary and subject index are appended.
Chapters on Blood Glucose In order to find chapters that specifically relate to blood glucose, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and blood glucose using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates
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and language you prefer, and the format option “Book Chapter.” Type “blood glucose” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on blood glucose: •
Pattern Management of Blood Glucose Source: in Franz, M.J., et al., eds. Core Curriculum for Diabetes Education. 5th ed. (Volume 2) Diabetes Management Therapies. Chicago, IL: American Association of Diabetes Educators (AADE). 2003. p. 213-246. Contact: Available from American Association of Diabetes Educators (AADE). AADE Member Service Center, 100 W. Monroe Street, Suite 400, Chicago, IL 60603. (800) 3383633 or (312) 424-2426. Fax (312) 424-2427. Email:
[email protected]. Website: www.aadenet.org. PRICE: Individual volume $55.00 for members and $75.00 for nonmembers: complete 4-volume set $159.95 for members and $229.95 for nonmembers; plus shipping and handling. ISBN: 881876128 (Volume 2); 881876152 (4-volume set). Summary: Pattern management is the application of a systematic analysis of data by both persons with diabetes and health care providers in the daily, weekly, and long term management of blood glucose levels. This chapter on pattern management of blood glucose is from a handbook of the CORE Curriculum, a publication that helps educators prepare for the Certified Diabetes Educators (CDE) exam, serves as a key reference for the Advanced Diabetes Management credential exam, and provides an authoritative source of information for diabetes education, training, and management. This chapter covers concepts of pattern management; strategies used in pattern management; algorithms for making insulin adjustments; changes in insulin regimens to accommodate special situations, such as travel or shift work; and the use of pattern management in people with type 2 diabetes (regardless of whether they are on oral agents or insulin). The chapter includes an introduction, a list of learning objectives, key definitions (glossary), key educational considerations, self review questions, references, and a post-test (including an answer key). 6 tables. 42 references.
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Caring During Illness and High Blood Glucose Source: in Gehling, E. Family and Friends' Guide to Diabetes: Everything You Need to Know. New York, NY: Wiley and Sons, Inc. 2000. p. 114-134. Contact: Available from John Wiley and Sons, Inc. Distribution Center, 1 Wiley Drive, Somerset, NJ 08875-1272. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail:
[email protected]. Website: www.wiley.com. PRICE: $14.95 plus shipping and handling. ISBN 0471348015. Summary: This book chapter reviews the effect illness has on diabetes, focusing on the causes, symptoms, and treatment of hyperglycemia and diabetic ketoacidosis. Hyperglycemia occurs when blood glucose levels stay above normal. Causes include eating meals larger than usual, eating more carbohydrate-rich foods than usual, being less active than usual, failing to take insulin or diabetes pills, being under severe stress, having an illness or infection, and taking a new medication for a condition other than diabetes. Hyperglycemia can cause both long-and short-term problems. Diabetic ketoacidosis (DKA) occurs when ketones build up in the body to a point where blood and tissues become acidic. DKA can develop quickly, so it requires prompt emergency medical treatment. People who have type 1 diabetes are more susceptible to DKA than people who have type 2 diabetes. People who have type 2 diabetes can tolerate higher glucose levels without developing acidosis, so they are at risk for developing a condition
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called hyperglycemia hyperosmolar nonketotic syndrome. The chapter also offers tips on how to help people who have diabetes during an illness. •
Managing Low Blood Glucose Source: in Gehling, E. Family and Friends' Guide to Diabetes: Everything You Need to Know. New York, NY: Wiley and Sons, Inc. 2000. p. 46-71. Contact: Available from John Wiley and Sons, Inc. Distribution Center, 1 Wiley Drive, Somerset, NJ 08875-1272. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail:
[email protected]. Website: www.wiley.com. PRICE: $14.95 plus shipping and handling. ISBN 0471348015. Summary: This book chapter uses a question and answer format to provide the family and friends of people who have diabetes with information on the disease so that they can be understanding and supportive to those who have diabetes. The chapter focuses on the management of low blood glucose. Topics include the causes, symptoms, and treatment of hypoglycemia. Hypoglycemia, which means low blood glucose, is used to describe a condition where a person's blood glucose level is below normal. This condition is more likely to affect people who use insulin to treat their diabetes. Hypoglycemia is caused by having too much insulin and too little glucose in the bloodstream at the same time. A range of physical, mental, or emotional symptoms warn people when they are experiencing a drop in glucose levels. Generally, treating hypoglycemia involves testing blood glucose levels, eating or drinking 10 to 15 grams of a fast-acting carbohydrate, and retesting blood glucose levels. A glucagon injection may be needed if a person is unable to self treat for hypoglycemia. The chapter provides guidelines for helping a person who is experiencing a hypoglycemic episode.
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Why Is Managing Your Blood Glucose So Important? Source: in Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 21-32. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400612. Summary: This chapter focuses on the importance of self management of blood glucose and the implications of the Diabetes Control and Complications Trial (DCCT) for diabetes self care. The DCCT found that intensive treatment for people who had type 1 diabetes resulted in fewer cases of eye and kidney disease. The major drawback of intensive therapy was severe hypoglycemia. The United Kingdom Prospective Diabetes Study examined the effects of diabetes control in people with type 2 diabetes. This study found that people who were less than 120 percent of their ideal body weight slowed the progression of retinopathy by 21 percent and the progression of microalbuminuria by 34 percent. They also reduced their risk of having a heart attack by 16 percent. For overweight participants, metformin was used with one of the treatment groups. The use of this drug improved outcomes. Although these studies underscore the benefits of intensive diabetes management, intensive blood glucose control will not work for everyone, including people who do not know when they are hypoglycemic; people who have advanced complications, another serious disease, advanced heart disease, and history of stroke; and children under 13. The chapter presents guidelines so that readers can determine whether intensive therapy may be beneficial for them. The chapter
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includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 1 table. •
Blood Glucose Source: in American Diabetes Association. Diabetes A to Z: What You Need to Know About Diabetes, Simply Put. 4th ed. Alexandria, VA: American Diabetes Association. 2000. p. 9-11. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 for members; $14.95 for nonmembers; plus shipping and handling. ISBN: 1580400353. Summary: This chapter provides people who have diabetes with information on blood glucose. Food is broken down into glucose by the body, and cells use glucose for energy. Glucose needs the help of insulin to get inside cells, but when insulin is not able to do its job, glucose cannot get into cells. Instead, glucose collects in the blood, and the amount of glucose in the blood is called the blood glucose level. Too much glucose in the blood is called hyperglycemia, and too little glucose in the blood is called hypoglycemia. People with diabetes need to keep their blood glucose between the highs and lows. The chapter offers tips for keeping blood glucose within normal ranges by balancing food, activity, and diabetes pills or insulin.
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Food and Blood Glucose Source: in Michigan Diabetes Research and Training Center; Funnell, M.M., et al. Life with Diabetes: A Series of Teaching Outlines by the Michigan Diabetes Research and Training Center. 2nd ed. Alexandria, VA: American Diabetes Association. 2000. p. 55-79. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $75.00 plus shipping and handling. ISBN: 1580400566. Summary: This teaching outline, part of a series of teaching outlines on living with diabetes, provides information about the impact of different foods on blood glucose levels and overall health. The outline includes a statement of purpose; prerequisites that participants should know before attending a particular session; objectives; materials needed for teaching a session; a recommended teaching method; a content outline that includes the general concepts to be covered, specific details, and instructor's notes or teaching tips; an evaluation and documentation plan; and suggested readings. Concepts covered in the outline include examining food diaries for relationships between food intake and blood glucose levels; understanding the basic food groups and the general effects of carbohydrates, protein, and fat on blood glucose; finding a dietary balance; and planning for change. Visuals and handouts are also provided.
Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to blood glucose have been published that consolidate information
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across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:10 •
American Diabetes Association 1999 Resource Guide Source: Diabetes Forecast. 1999 Resource Guide: 1-104. January 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This guide provides complete and up-to-date information on managing diabetes and begins with an article on ways that people can better manage their diabetes to prevent complications. This is followed by an extensive product listing designed to help readers identify diabetes products that are right for them. Products include new devices for home monitoring of blood glucose, aids for people who are visually impaired, new lancets and lancing devices, new insulin administration products, new prescription drugs for diabetes-related conditions, and miscellaneous products. In addition, the guide offers a complete analysis of all drugs available to treat type 2 diabetes and a description of how each drug works, a listing of diabetes education programs recognized for their quality and excellence by the American Diabetes Association, a listing of recognized health care providers, and a one-page guide to the programs and services available through the American Diabetes Association.
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You will need to limit your search to “Directory” and “blood glucose” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “blood glucose” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.
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CHAPTER 7. MULTIMEDIA ON BLOOD GLUCOSE Overview In this chapter, we show you how to keep current on multimedia sources of information on blood glucose. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on blood glucose is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “blood glucose” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “blood glucose” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on blood glucose: •
Pen 2 Companion 2: Blood Glucose Testing System Source: Waltham, MA: Medisense, Inc. 1992. Contact: Available from Medisense, Inc. 266 Second Avenue, Waltham, MA 02154. (617) 895-6000, fax (617) 890-1711. PRICE: $14.99. Summary: This videotape demonstrates the use of the Companion 2 and Pen 2 blood glucose monitors. The video includes personal experience testimonials from people of all ages who use the Pen or Companion sensors. Also included is a step-by-step demonstration of the Companion 2 Sensor. Features covered in the videotape include testing procedures, timing, calibration, care, memory, 4-year warranty, and size and portability. (AA-M).
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Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “blood glucose” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on blood glucose: •
Carbohydrate Counting Source: Van Nuys, CA: Prana Publications. 1995. (audiocassette). Contact: Available from Prana Publications. 5623 Matilija Avenue, Van Nuys, CA 91401. (800) 735-7726 of (818) 780-1308. Fax (818) 786-7359. PRICE: $11.95 plus $3 shipping and handling (as of 1995). Item Number A15. Summary: In this audiocassette, narrated by diabetes educator Betty Brackenridge, listeners learn about carbohydrate counting as a method of diabetes management and meal planning. Ms. Brackenridge stresses that carbohydrate counting can give people with diabetes more food choice, more mealtime freedom, and better control. The rationale is that carbohydrate (CHO) foods have a much greater effect on blood glucose than protein and fat. Counting CHOs will show listeners who are using numerous insulin injections how to adjust insulin dosage to the CHOs eaten. The system also works for people with noninsulin-dependent diabetes (NIDDM) by helping them match their food to their bodies' ability to produce insulin. The program covers food labels; portion measurement; carbohydrate counting books and information resources; and adapting the Exchange System to carbohydrate counting. (AA-M).
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Bernstein Plan: Type I Source: Van Nuys, CA: Prana Publications. 1995. (audiocassettes). Contact: Available from Prana Publications. 5623 Matilija Avenue, Van Nuys, CA 91401. (800) 735-7726 or (818) 780-1308. Fax (818) 786-7359. E-Mail
[email protected]. PRICE: $22.95 plus $3.25 shipping and handling (as of 1995). Order Number A04. Summary: These audiocassette tapes familiarize listeners with Dr. R.K. Bernstein's method of diabetes control. Dr. Bernstein, who has had insulin-dependent diabetes for 49 years, believes high blood sugar causes diabetes complications and that complications can be prevented and at times reversed by normalizing blood sugar. He keeps his patients' blood glucose levels between 85 and 105 by severely limiting carbohydrates in the diet. Topics on the tapes include the low carbohydrate diet; muscle building; multiple blood glucose tests; multiple small doses of insulin; preventing hypoglycemia; managing sick days; and gastroparesis. (AA-M).
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Happy, Healthy Babies: Type I Mothers Source: Van Nuys, CA: Prana Publications. 1995. (audiocassette). Contact: Available from Prana Publications. 5623 Matilija Avenue, Van Nuys, CA 91401. (800) 735-7726 or (818) 780-1308. Fax (818) 786-7359. E-Mail
[email protected]. PRICE: $11.95 plus $3.25 shipping and handling (as of 1995). Order Number A10. Summary: This audiocassette program features Dr. Lois Jovanovic-Peterson discussing pregnancy in women with diabetes. Topics include medical tests, blood glucose levels,
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insulin doses, matching insulin with food, tests during pregnancy, labor and delivery, and breast feeding. Dr. Jovanovic-Peterson, a wife and mother, also has diabetes. (AAM). •
Changing Nature of Diabetes Therapy: Challenges in Patient Education Source: Princeton, NJ: Novo Nordisk Pharmaceuticals Inc. 199x. (audiotape). Contact: Available from Novo Nordisk Pharmaceuticals Inc. 100 Overlook Center, Suite 200, Princeton, NJ 08540-7810. (800) 727-6500. PRICE: Single copy free. Order number 000-87C. Summary: This audiotape is from a series of accredited continuing education audio programs and corresponding monographs designed to help the primary care physician manage patients with diabetes more effectively. In this program, moderator Steven Fox and guests discuss the latest innovations in insulin delivery and how they translate into better patient care. Topics include the importance of a team approach in the care and education of patients with diabetes; the influence of a positive self-concept on adherence to a treatment plan; adjunctive educational resources available to clinician and patient; the critical role of self-monitoring of blood glucose (SMBG); special strategies for the care and education of elderly patients and children with diabetes; and strategies for modifying behavior patterns. The study guide includes a post-test quiz for earning Continuing Medical Education (CME) credit. 9 references. (AA-M).
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Serving Individuals with Diabetes who are Blind or Visually Impaired: A Resource Guide for Vocational Rehabilitation Counselors Source: Mississippi State, MS: Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. 1997. 227 p. Contact: Available from Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University. Publications Manager, P.O. Drawer 6189, Mississippi State, MS 39762. (601) 325-2001 or (601) 325-8693. Fax (601) 325-8989. TDD (601) 325-8693. PRICE: $25.00 in any format. Summary: This resource guide is designed to help counselors better serve individuals with diabetes who are blind or visually impaired. The guide refers readers to a large collection of resources on various diabetes publications, medications, and appliances. Five sections cover an introduction to diabetes; self management; current medical issues; employment issues; and emotional aspects of diabetes. Topics include myths about diabetes; diabetic eye disease; new nutrition guidelines for diabetes management; oral diabetes medications; diabetes and medications; insulin and measurement devices and systems; maintaining the proper temperature of insulin; blood glucose control; 'talking' blood glucose monitoring systems; and noninvasive glucose monitors. The authors also discuss diabetes and the feet; kidney failure, dialysis, and transplantation; pancreas transplantation; arthritis and diabetes; diabetes and yeast infections; hypoglycemia; diabetic peripheral neuropathy; diabetes and men's sexual health; cardiovascular health; diabetic ketoacidosis; diabetic dermopathy; diabetes and the Individualized Written Rehabilitation Program (IWRP); the use of Braille; health insurance; and scleral shells. The book's appendix includes lists of diabetes-related organizations, publications, listservs, and World Wide Web sites; sources of low-sugar products and products for the blind; and diabetes equipment and supplies, including insulin syringe magnifiers. The resource guide is available in large print, Braille, audiocassette, and computer diskette.
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Diabetes and How You Can Manage It Easily Source: San Diego, CA: H L Enterprises. 1993. (audiocassettes). Contact: Available from H L Enterprises. 12730 Carmel Country Road, Number 120, San Diego, CA 92130. (619) 792-8837. PRICE: $33.00. Summary: This set of four audiocassettes is designed to provide an overview of diabetes mellitus and its care. Topics include the importance of attitude; meal planning and food habits; medicines and exercise; and blood glucose, including monitoring and understanding hypoglycemia and hyperglycemia. The accompanying outline includes information on resources for further information.
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CHAPTER 8. PERIODICALS AND NEWS ON BLOOD GLUCOSE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover blood glucose.
News Services and Press Releases One of the simplest ways of tracking press releases on blood glucose is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “blood glucose” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to blood glucose. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “blood glucose” (or synonyms). The following was recently listed in this archive for blood glucose: •
Adipocyte hormone may regulate blood glucose levels, linking obesity to diabetes Source: Reuters Industry Breifing Date: February 20, 2004
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Exenatide reduces blood glucose in diabetics Source: Reuters Medical News Date: June 07, 2004
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Post-MI blood glucose predicts long-term mortality Source: Reuters Medical News Date: May 21, 2004 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “blood glucose” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “blood glucose” (or synonyms). If you know the name of a company that is relevant to blood glucose, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.
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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “blood glucose” (or synonyms).
Newsletters on Blood Glucose Find newsletters on blood glucose using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “blood glucose.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “blood glucose” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •
Diabetes: Nutrition Guidelines Emphasize Personal Touch Source: Mayo Clinic Health Letter. 12(8): 4-5. August 1994. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037. Summary: This brief newsletter article reports on the new set of nutrition guidelines for people with diabetes. The guidelines, recently released by the American Diabetes Association (ADA), underscore the important role of diet in keeping blood glucose levels under control. The new recommendations stress the need for individualizing the diet and developing a meal plan based on the individual's food preferences, health concerns such as weight or blood cholesterol level, and insulin therapy. The article concludes by urging readers to work closely with a registered dietitian and other members of the diabetes care team in planning the diet.
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “blood glucose” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on blood glucose: •
Effect of Different Foods on Postprandial Blood Glucose Excursions Source: On the Cutting Edge: Diabetes Care and Education. 17(4): 11-12. Summer 1996. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606-6995. (312) 899-0040. Summary: This newsletter article addresses the effect of different foods on blood glucose levels after meals. The author notes that there are many factors that mask the
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effect a specific food may have on blood glucose response. Topics include established beliefs, portion sizes, individual differences, timing of meals, the time of day or meal at which food is consumed, other foods eaten at a meal, meal variability versus the benefits of consistency, and meal planning methods. According to the author, many clients underestimate obvious causes of higher glucose levels, such as portion sizes and caloric density. Each person is likely to have his or her own unique blood glucose response to foods, and this may be due to individual differences in digestion, absorption, and metabolism of foods, different cooking methods, or different combinations of foods. The article suggests that, while more research is necessary, health professionals should keep an open mind, stay abreast of current research, review blood-glucose monitoring records, and listen carefully to what people with diabetes are saying. 4 references. •
Pattern Management: A Tool for Improving Blood Glucose Control With Exercise Source: On the Cutting Edge: Diabetes Care and Education. 17(4): 4-7. Summer 1996. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606-6995. (312) 899-0040. Summary: This newsletter article outlines the benefits of exercise pattern management in improving blood glucose control. Health benefits of exercise include a reduction in cardiovascular risk factors, lowered body weight, reduced body fat, and a heightened sense of well being. Exercise also significantly affects blood glucose control. The author notes that pattern management, when applied to exercise, can be used to achieve different desired outcomes depending not only on an individual's history and activity but also on the type of diabetes. Metabolic changes associated with exercise improve glycemic control for individuals with noninsulin-dependent diabetes mellitus (NIDDM, or Type II), yet the same adaptations can lead to significant blood glucose fluctuations and a management challenge for individuals with insulin-dependent diabetes mellitus (IDDM, or Type I). Variables that influence the effect of exercise on blood glucose levels in IDDM include the level of training and fitness, metabolic control, nutritional status and glycogen stores, circulating insulin levels, and the intensity, duration, and time of exercise. For people with NIDDM, exercise is considered adjunct therapy to meal planning. The author discusses exercise pattern management in NIDDM, exercise pattern management in IDDM, insulin adjustment, carbohydrate supplementation, and monitoring and blood glucose pattern management. The author reminds readers that the provided guidelines are general; pattern management allows modifications in diabetes management programs to be individualized based on unique need. Two case studies are included. 2 figures. 4 tables. 14 references. (AA-M).
Academic Periodicals covering Blood Glucose Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to blood glucose. In addition to these sources, you can search for articles covering blood glucose that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles.
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At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for blood glucose. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with blood glucose. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to blood glucose: Insulin •
Systemic - U.S. Brands: Humulin 50/50; Humulin 70/30; Humulin 70/30 Pen; Humulin L; Humulin N; Humulin N Pen; Humulin R; Humulin R, Regular U500 (Concentrated); Humulin U; Lente; Lente Iletin II; Novolin 70/30; Novolin 70/30 PenFill; Novolin 70/30 Prefilled; Novolin L; Novolin N; Novolin N PenFill; Novolin N Prefilled; Novolin R; Novolin R PenFill; Novolin R Prefilled; NPH Iletin II; NPH Purified Insulin; Regular (Concentrated) Iletin II, U-500; Regular Iletin II; Regular Insulin; Velosulin BR http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203298.html
Insulin Glargine •
Systemic - U.S. Brands: Lantus http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500147.html
Metformin •
Systemic - U.S. Brands: Glucophage; Glucophage XR http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202756.html
Nateglinide •
Systemic - U.S. Brands: Starlix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500277.html
Rosiglitazone and Metformin •
Systemic - U.S. Brands: Avandamet http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500433.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by
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brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
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These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
12
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “blood glucose” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 88932 376 998 86 489 90881
HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “blood glucose” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
14
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
15
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
19 Adapted 20
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on blood glucose can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to blood glucose. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to blood glucose. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “blood glucose”:
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Diabetes http://www.nlm.nih.gov/medlineplus/diabetes.html Diabetes and Pregnancy http://www.nlm.nih.gov/medlineplus/diabetesandpregnancy.html Diabetic Diet http://www.nlm.nih.gov/medlineplus/diabeticdiet.html Hypoglycemia http://www.nlm.nih.gov/medlineplus/hypoglycemia.html Juvenile Diabetes http://www.nlm.nih.gov/medlineplus/juvenilediabetes.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on blood glucose. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
Diabetes: Thinking About Controlling Your Blood Glucose Source: Midland, MI: Health Enhancement Systems. 1999. [2 p.]. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317 or (517) 839-0852. Fax (517) 839-0025. E-mail:
[email protected]. Website: www.hesonline.com. PRICE: $.68 each; discounts available in bulk orders; Item number: HESBG-1. Summary: High blood glucose levels (hyperglycemia) can damage blood vessels in the eyes, kidneys, nerves, and other parts of the body. For people with diabetes, blood glucose control means taking care of one's body to keep blood glucose levels at the healthiest place possible. This simple brochure asks readers to consider their current blood glucose levels and to think about making blood glucose control part of an overall plan for better health. The brochure outlines the benefits of better blood glucose control. The brochure also has blank space for readers to record their thoughts about blood glucose control and how to overcome the typical obstacles to making changes in one's habits. The brochure concludes with a brief list of resources for readers wanting additional information.
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Self-Testing of Blood Glucose Source: Cleveland, OH: Diabetes Association of Greater Cleveland. 2001. 2 p. Contact: Available from Diabetes Association of Greater Cleveland. 3601 South Green Road Suite 100, Cleveland, Ohio 44122. (216) 591-0800 Fax (216) 591-0320. E-mail:
[email protected]. Website: www.dagc.org. PRICE: Single copy free. Summary: Self monitoring of blood glucose levels (SMBG) is a simple test that can be performed any time and any where to find out one's blood glucose level. Blood glucose levels can tell the patient and the physician how food, physical activity, medications, and stress affect the blood glucose level. In fact, successful management of diabetes depends on accurate and regular testing of the blood glucose levels. This fact sheet describes SMBG and the recordkeeping that accompanies it. Readers are reminded that by keeping their blood glucose level near to normal, they can reduce their chances of developing diabetes-related complications such as eye, kidney, blood vessel, and nerve damage. The fact sheet then discusses normal blood glucose values, how often to check blood glucose levels, when to perform SMBG, and where to learn more. The fact sheet concludes with the contact information for the Diabetes Association of Greater Cleveland (www.dagc.org). 2 references.
•
Thinking About Controlling Your Blood Glucose Source: Midland, MI: Health Enhancement Systems. 1999. 2 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.68 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBG1. Summary: This brochure guides people who have diabetes through the process of thinking about controlling their blood glucose. The brochure begins by explaining that diabetes occurs when there is too much glucose circulating in the blood. This is followed by a discussion of the importance of controlling blood glucose. In addition, the brochure asks a series of questions that helps readers think about blood glucose control. The brochure includes a list of helpful organizations.
•
Testing Your Blood Glucose: Putting Yourself in Control Source: San Bruno, CA: Krames Communications. 1993. 2 p. Contact: Available from Krames Communications. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (415) 244-4512. PRICE: $0.40 per copy; bulk discounts available. Order Number 1466. Summary: This brochure provides a step-by-step guide to blood glucose monitoring. Written in easily understandable language, with illustrations depicting each step, the brochure shows readers how to prepare for blood glucose testing, draw a drop of blood, place the drop on a test strip, read the test strip, and record the results. Other sections discuss the equipment and supplies needed; how the results are used; the use of ketone testing; and the benefits of regular blood glucose monitoring. The brochure includes a blank checklist to individualize the instructions for each reader.
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Benefits of Controlling Your Blood Glucose Source: Midland, MI: Health Enhancement Systems. 1999. 6 p.
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Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBG2. Summary: This brochure provides people who have diabetes with information on the benefits of controlling their blood glucose. The brochure begins by identifying the risk factors for diabetes that people can and cannot control. Controllable risk factors include weight, physical activity, smoking habit, and alcohol consumption. Risk factors that people cannot control include heredity, race, and age. This is followed by information on the advantages of controlling blood glucose and the benefits of keeping a blood glucose record. In addition, the brochure presents several scenes that readers can reflect upon to help them control their blood glucose, provides sample questions that readers can answer to learn about their blood glucose and how to control it, and explains the importance of finding support. The brochure includes a list of helpful organizations. •
Ready, Set, Start Counting: How to Use Carbohydrate Counting to Keep Your Blood Glucose Healthy Source: Chicago, IL: American Dietetic Association. 2003. 2 p. Contact: Available from American Dietetic Association. 120 South Riverside Plaza, Chicago, IL 60606-6695. (800) 877-1600, ext. 5000. Fax (312) 899-4899. E-mail:
[email protected]. Website: www.eatright.org or www.dce.org. PRICE: Full-text available online at no charge. Summary: This educational fact sheet helps readers with diabetes understand how to use carbohydrate counting as a method of diet therapy. Carbohydrate counting is used to plan the amount of carbohydrate in the diet and thus better manage the diabetes. Carbohydrate counting is described as a meal planning tool that helps patients understand how their food choices affect their blood glucose level. Topics include the interplay between carbohydrates and blood glucose, different approaches to carbohydrate counting (consistency, maximums, and matching), and the components of carbohydrate counting (food choices, portion sizes, how to read a food label). The second page of the fact sheet includes specific food suggestions for each food group and a table for readers to individualize their carbohydrate goals. The fact sheet concludes with a recommendation to eat a variety of foods for good health. 4 figures.
•
Hyperglycemia (High Blood Glucose) Source: Cleveland, OH: Diabetes Association of Greater Cleveland. 2001. 2 p. Contact: Available from Diabetes Association of Greater Cleveland. 3601 South Green Road Suite 100, Cleveland, Ohio 44122. (216) 591-0800 Fax (216) 591-0320. E-mail:
[email protected]. Website: www.dagc.org. PRICE: Single copy free. Summary: This fact sheet describes hyperglycemia, high blood glucose levels, a common problem associated with diabetes. The fact sheet defines hyperglycemia, then notes the symptoms of the problem. The fact sheet then discusses blood glucose testing, recordkeeping, determining how blood glucose levels may have gotten high, and management strategies. Readers are advised to adjust their food intake, increase the amount of physical activity they do, lose any extra weight, treat illness and infections quickly, reduce stress, and work in close tandem with a health care provider for adjusting diabetes medications. The fact sheet concludes with the contact information
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for the Diabetes Association of Greater Cleveland (www.dagc.org). 1 figure. 2 references. •
Hypoglycemia (Low Blood Glucose) Source: Cleveland, OH: Diabetes Association of Greater Cleveland. 2002. 2 p. Contact: Available from Diabetes Association of Greater Cleveland. 3601 South Green Road Suite 100, Cleveland, Ohio 44122. (216) 591-0800 Fax (216) 591-0320. E-mail:
[email protected]. Website: www.dagc.org. PRICE: Single copy free. Summary: This fact sheet describes hypoglycemia, low blood glucose levels, a common problem associated with diabetes. The fact sheet defines hypoglycemia, then notes mild, moderate, and severe symptoms of the problem. The fact sheet stresses that it is important to treat hypoglycemia when symptoms are mild to moderate. Simple treatment options are outlined. The fact sheet then discusses the causes of hypoglycemia, how it can be prevented, and what people with diabetes can do to prepare for coping with hypoglycemia. The fact sheet concludes with the contact information for the Diabetes Association of Greater Cleveland (www.dagc.org). 2 tables.
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Living with Diabetes: Balance Your Blood Glucose with Good Nutrition, Exercise, and Medication Source: Washington, DC: Egg Nutrition Center. 1997. 2 p. Contact: Available from Egg Nutrition Center. 1819 H Street, NW, Suite 520, Washington, DC 20006. (202) 833-8850. E-mail:
[email protected]. Website: www.enconline.org. Summary: This fact sheet focuses on the use of diet, exercise, and medication to effectively treat diabetes. It explains that diabetes is a disease in which the body cannot control blood glucose either because it does not produce any or enough insulin or because it does not properly use the insulin it does produce. The fact sheet discusses the type of diet a person with diabetes should follow. This diet consists of a variety of foods found in the Food Guide Pyramid, with a heavy emphasis on whole grain products, fruits, and vegetables. Foods from meat and diary groups should also be included, and moderate amounts of alcohol and sweets can occasionally be incorporated into a person's dietary plan. Snacks or meals made with eggs can satisfy hunger without adversely increasing blood glucose levels. The fact sheet also examines the importance of exercise and medication in controlling diabetes, identifies its long-term complications, and lists the signs of high and low blood glucose.
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Blood Glucose Monitors: Choosing The Meter That's Right For You Source: Columbus, OH: Central Ohio Diabetes Association. 199x. 2 p. Contact: Available from Central Ohio Diabetes Association. Janet Gorman, 1803 West Fifth Avenue, Columbus, OH 43212. (614) 486-7124. PRICE: Single copy free. Summary: This fact sheet reviews the factors people with diabetes should consider before purchasing a blood glucose monitor. After a general introduction, the fact sheet lists some of the monitors now available on the market. For each monitor listed, the fact sheet notes the procedure used for testing, time required for testing, calibration, memory capacity, and test strips are required. Monitors listed are: Accu-Check III; Diascan-S; Glucometer 3; Tracer II; Accu Check EZ; Checkmate; Exactech; One Touch II; One Touch Basic; and Ultra.
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Blood Glucose Self-Monitoring Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 2 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $14.90 each; plus shipping and handling; quantity discounts available. Order number 97326A-07-99. Summary: This illustrated fact sheet focuses on blood glucose self monitoring. Performed regularly, self monitoring of blood glucose (SMBG) is one of the best ways to help control diabetes and avoid serious health complications. The steps involved in SMBG include gathering the necessary equipment, following the glucose monitor manufacturer's instructions, washing one's hands with mild soap and warm water, pricking the side of the fingertip, determining the results, recording the results in a logbook, and disposing of the used lancet safely. The fact sheet provides several self monitoring tips.
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Operator's Manual: Tracer II Blood Glucose Monitor Source: Indianapolis, IN: Boehringer Mannheim Corporation. 1991. 44 p. Contact: Available from Boehringer Mannheim Corporation. 9115 Hague Road, P.O. Box 50110, Indianapolis, IN 46250-0100. (800) 858-8072. Summary: This manual provides a comprehensive overview of the use of the Tracer II blood glucose monitor. Toics covered include performing a blood test, hints for a good sample, guide for best results, blood application and wiping, care and maintenance of the monitor, product specifications, performance characteristics, limitations of the procedure, supplies, assistance available from the manufacturer, a routine display glossary, a troubleshooting guide, and a copy of the manufacturer's warranty. The manual is fully illustrated.
•
Answers to Frequently Asked Questions About Low Blood Glucose Source: Diabetes Spectrum. 10(1): 71-72. 1997. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This patient education fact sheet provides information about low blood glucose levels (hypoglycemia). Although hypoglycemia happens most often in people with diabetes who use insulin, it can also be a problem for people who take medication for noninsulin-dependent diabetes mellitus (NIDDM). The fact sheet notes the symptoms of hypoglycemia, including shakiness, sweating, irritability, rapid heartbeat, light headedness, nervousness, impatience, chills, anxiety, and hunger; as the hypoglycemia worsens, symptoms can include sleepiness, anger, blurred vision, lack of coordination, headaches, personality change, confusion, and unconsciousness. However, the author notes that the only sure way to know if hypoglycemia is present is to test blood glucose levels. The author outlines the common causes of hypoglycemia, then describes hypoglycemia unawareness, or the situation where the person with diabetes cannot feel the early symptoms of low blood glucose. The author notes that avoiding even mild hypoglycemia can help restore awareness of symptoms. The author also addresses concerns that hypoglycemia will be present more often if tight control of blood glucose is attempted (through intensive diabetes management). The fact sheet continues with a discussion of treating hypoglycemia and what happens when the hypoglycemic reaction has gone too far for the person to treat themselves. The fact sheet
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concludes with a set of suggestions for preventing low blood glucose levels. One sidebar lists a variety of foods containing 15 grams of easily absorbed carbohydrate. 2 references. (AA-M). The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “blood glucose” (or synonyms). The following was recently posted: •
Benefits and risks of controlling blood glucose levels in patients with type 2 diabetes mellitus Source: American Academy of Family Physicians - Medical Specialty Society; 1999 April; 39 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2377&nbr=1603&a mp;string=blood+AND+glucose Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
Your Guide to Diabetes: Type 1 and Type 2 Summary: This guide explains what diabetes is, daily care of diabetes, blood glucose levels, and where to get more help. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6550 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to blood glucose. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to blood glucose. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with blood glucose. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about blood glucose. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “blood glucose” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received
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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “blood glucose”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “blood glucose” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “blood glucose” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
22
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
23
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on blood glucose: •
Basic Guidelines for Blood Glucose Blood glucose monitoring Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003438.htm
•
Diagnostics and Tests for Blood Glucose Blood glucose levels Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Fasting blood glucose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm Glucose tolerance test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm
•
Background Topics for Blood Glucose Adolescent test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002054.htm
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Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Infant test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002055.htm Physical activity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Preschooler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002057.htm Schoolage test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002058.htm Toddler test or procedure preparation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002056.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
291
BLOOD GLUCOSE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Ablation: The removal of an organ by surgery. [NIH] Acanthosis Nigricans: A circumscribed melanosis consisting of a brown-pigmented, velvety verrucosity or fine papillomatosis appearing in the axillae and other body folds. It occurs in association with endocrine disorders, underlying malignancy, administration of certain drugs, or as in inherited disorder. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetone: A colorless liquid used as a solvent and an antiseptic. It is one of the ketone bodies produced during ketoacidosis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU]
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Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal insufficiency: The reduced secretion of adrenal glands. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adult-Onset Diabetes: Former term for noninsulin-dependent or type II diabetes. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH] Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH]
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Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Albuminuria: More than normal amounts of a protein called albumin in the urine. Albuminuria may be a sign of kidney disease. [NIH] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH]
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Allogeneic: Taken from different individuals of the same species. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alpha-fetoprotein: AFP. A protein normally produced by a developing fetus. AFP levels are usually undetectable in the blood of healthy nonpregnant adults. An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Bone Loss: The resorption of bone in the supporting structures of the maxilla or mandible as a result of periodontal disease. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acid Substitution: The naturally occurring or experimentally induced replacement of one or more amino acids in a protein with another. If a functionally equivalent amino acid is substituted, the protein may retain wild-type activity. Substitution may also diminish or eliminate protein function. Experimentally induced substitution is often used to study enzyme activities and binding site properties. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amniocentesis: Percutaneous transabdominal puncture of the uterus during pregnancy to obtain amniotic fluid. It is commonly used for fetal karyotype determination in order to diagnose abnormal fetal conditions. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]
Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger
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cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]
Amylase: An enzyme that helps the body digest starches. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]
Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiopathy: Disease of the blood vessels (arteries, veins, and capillaries) that occurs when someone has diabetes for a long time. There are two types of angiopathy: macroangiopathy and microangiopathy. In macroangiopathy, fat and blood clots build up in the large blood
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vessels, stick to the vessel walls, and block the flow of blood. In microangiopathy, the walls of the smaller blood vessels become so thick and weak that they bleed, leak protein, and slow the flow of blood through the body. Then the cells, for example, the ones in the center of the eye, do not get enough blood and may be damaged. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antecedent: Existing or occurring before in time or order often with consequential effects. [EU]
Anthropometric measurements: Measurements of human body height, weight, and size of component parts, including skinfold measurement. Used to study and compare the relative proportions under normal and abnormal conditions. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidiabetic: An agent that prevents or alleviates diabetes. [EU] Antidiabetic Agent: A substance that helps a person with diabetes control the level of glucose (sugar) in the blood so that the body works as it should. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue
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cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antineoplastic Agents: Substances that inhibit or prevent the proliferation of neoplasms. [NIH]
Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipruritic: Relieving or preventing itching. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Aqueous fluid: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Aqueous humor: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Art Therapy: The use of art as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU]
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Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autogenic: A type of succession when the developing vegetation itself is the cause for the succession. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the
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internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]
Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Adhesion: Physicochemical property of fimbriated and non-fimbriated bacteria of attaching to cells, tissue, and nonbiological surfaces. It is a factor in bacterial colonization and pathogenicity. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH]
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Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Bioassays: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Glucose Self-Monitoring: Self evaluation of whole blood glucose levels outside the clinical laboratory. A digital or battery-operated reflectance meter may be used. It has wide application in controlling unstable insulin-dependent diabetes. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH]
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Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bolus injection: The injection of a drug (or drugs) in a high quantity (called a bolus) at once, the opposite of gradual administration (as in intravenous infusion). [EU] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Breast Feeding: The nursing of an infant at the mother's breast. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the
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trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency, or other output. [NIH] Caloric intake: Refers to the number of calories (energy content) consumed. [NIH] Calpain: Cysteine proteinase found in many tissues. Hydrolyzes a variety of endogenous proteins including neuropeptides, cytoskeletal proteins, proteins from smooth muscle, cardiac muscle, liver, platelets and erythrocytes. Two subclasses having high and low calcium sensitivity are known. Removes Z-discs and M-lines from myofibrils. Activates phosphorylase kinase and cyclic nucleotide-independent protein kinase. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH]
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Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Celiac Artery: The arterial trunk that arises from the abdominal aorta and after a short course divides into the left gastric, common hepatic and splenic arteries. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH]
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Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Physiology: Characteristics and physiological processes of cells from cell division to cell death. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH]
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Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholestyramine: Strongly basic anion exchange resin whose main constituent is polystyrene trimethylbenzylammonium as Cl(-) anion. It exchanges chloride ions with bile salts, thus decreasing their concentration and that of cholesterol. It is used as a hypocholesteremic in diarrhea and biliary obstruction and as an antipruritic. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromic: Catgut sterilized and impregnated with chromium trioxide. [NIH] Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Body: A ring of tissue extending from the scleral spur to the ora serrata of the retina. It consists of the uveal portion and the epithelial portion. The ciliary muscle is in the uveal portion and the ciliary processes are in the epithelial portion. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH]
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Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clomiphene: A stilbene derivative that functions both as a partial estrogen agonist and complete estrogen antagonist depending on the target tissue. It antagonizes the estrogen receptor thereby initiating or augmenting ovulation in anovulatory women. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational
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beliefs with more realistic and functional ones.
[NIH]
Colestipol: Highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic. It may also may reduce triglyceride levels. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Community Health Nursing: General and comprehensive nursing practice directed to individuals, families, or groups as it relates to and contributes to the health of a population. This is not an official program of a Public Health Department. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements,
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megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or
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treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cor pulmonale: Heart disease that results from resistance to the passage of blood through the lungs; it often leads to right heart failure. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]
Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a
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myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corpuscle: A small mass or body; a sensory nerve end bulb; a cell, especially that of the blood or the lymph. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Craniotomy: An operation in which an opening is made in the skull. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU] Critical Illness: A disease or state in which death is possible or imminent. [NIH] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH]
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Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeletal Proteins: Major constituent of the cytoskeleton found in the cytoplasm of eukaryotic cells. They form a flexible framework for the cell, provide attachment points for organelles and formed bodies, and make communication between parts of the cell possible. [NIH]
Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three
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layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermatitis: Any inflammation of the skin. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Desmin: An intermediate filament protein found predominantly in smooth, skeletal, and cardiac muscle cells. Localized at the Z line. MW 50,000 to 55,000 is species dependent. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] DEXA: A method (dual energy X-ray absortiometry) used to estimate total body fat and percent of body fat. Potential disadvantages include whole body radiation and the long time required for scanning while the subject lies on a hard table. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetes, Gestational: Either symptomatic diabetes or impaired glucose tolerance induced by pregnancy but resolved at the end of pregnancy. It does not include previously diagnosed diabetics who become pregnant (pregnancy in diabetics). [NIH] Diabetic Foot: Ulcers of the foot as a complication of diabetes. Diabetic foot, often with infection, is a common serious complication of diabetes and may require hospitalization and disfiguring surgery. The foot ulcers are probably secondary to neuropathies and vascular problems. [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic
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acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]
Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietetics: The study and regulation of the diet. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]
Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH]
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Discriminant Analysis: A statistical analytic technique used with discrete dependent variables, concerned with separating sets of observed values and allocating new values. It is sometimes used instead of regression analysis. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diving: An activity in which the organism plunges into water. It includes scuba and bell diving. Diving as natural behavior of animals goes here, as well as diving in decompression experiments with humans or animals. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Combinations: Single preparations containing two or more active agents, for the purpose of their concurrent administration as a fixed dose mixture. It is differentiated from
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combination drug therapy in which two or more drugs are administered separately for a combined effect. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elastomers: A generic term for all substances having the properties of natural, reclaimed, vulcanized, or synthetic rubber, in that they stretch under tension, have a high tensile strength, retract rapidly, and recover their original dimensions fully. [NIH] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the
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latter being a high-energy biproduct of nuclear decay. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]
Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]
Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH]
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Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH]
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Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocyte Membrane: The semipermeable outer portion of the red corpuscle. It is known as a 'ghost' after hemolysis. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Esterification: The process of converting an acid into an alkyl or aryl derivative. Most frequently the process consists of the reaction of an acid with an alcohol in the presence of a trace of mineral acid as catalyst or the reaction of an acyl chloride with an alcohol. Esterification can also be accomplished by enzymatic processes. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]
Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH]
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Excrete: To get rid of waste from the body. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Factor V: Heat- and storage-labile plasma glycoprotein which accelerates the conversion of prothrombin to thrombin in blood coagulation. Factor V accomplishes this by forming a complex with factor Xa, phospholipid, and calcium (prothrombinase complex). Deficiency of factor V leads to Owren's disease. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Feeding Behavior: Behavioral responses or sequences associated with eating including modes of feeding, rhythmic patterns of eating, and time intervals. [NIH] Fenfluramine: A centrally active drug that apparently both blocks serotonin uptake and provokes transport-mediated serotonin release. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally
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fertilized in the body. [NIH] Fetal Macrosomia: A complication of several conditions including diabetes mellitus and prolonged pregnancy. A macrosomic fetus is defined as weighing more than 4000 grams. [NIH]
Fetal Monitoring: Physiologic or biochemical monitoring of the fetus. It is usually done during labor and may be performed in conjunction with the monitoring of uterine activity. It may also be performed prenatally as when the mother is undergoing surgery. [NIH] Fetal Movement: Motion of the fetus perceived by the mother and felt by palpation of the abdomen. [NIH] Fetoprotein: Transabdominal aspiration of fluid from the amniotic sac with a view to detecting increases of alpha-fetoprotein in maternal blood during pregnancy, as this is an important indicator of open neural tube defects in the fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Foam Cells: Lipid-laden macrophages originating from monocytes or from smooth muscle cells. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Food Exchange: See: Exchange lists. [NIH] Food Preferences: The selection of one food over another. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have
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less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radical Scavengers: Substances that influence the course of a chemical reaction by ready combination with free radicals. Among other effects, this combining activity protects pancreatic islets against damage by cytokines and prevents myocardial and pulmonary perfusion injuries. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Fructosamine: An amino sugar formed when glucose non-enzymatically reacts with the Nterminal amino group of proteins. The fructose moiety is dervied from glucose by the "classical" Amadori rearrangement. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH]
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Gastric Inhibitory Polypeptide: A gastrointestinal hormone consisting of a 43-amino acid polypeptide (molecular weight 5105). It inhibits gastric secretion and motility and stimulates release of insulin. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]
Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH]
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Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glipizide: An oral hypoglycemic agent which is rapidly absorbed and completely metabolized. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glomeruli: Plural of glomerulus. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucokinase: A group of enzymes that catalyzes the conversion of ATP and D-glucose to ADP and D-glucose 6-phosphate. They are found in invertebrates and microorganisms and are highly specific for glucose. (Enzyme Nomenclature, 1992) EC 2.7.1.2. [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]
Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Clamp Technique: Maintenance of a constant blood glucose level by perfusion or infusion with glucose or insulin. It is used for the study of metabolic rates (e.g., in glucose, lipid, amino acid metabolism) at constant glucose concentration. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose Oxidase: An enzyme of the oxidoreductase class that catalyzes the conversion of beta-D-glucose and oxygen to D-glucono-1,5-lactone and peroxide. It is a flavoprotein, highly specific for beta-D-glucose. The enzyme is produced by Penicillium notatum and other fungi and has antibacterial activity in the presence of glucose and oxygen. It is used to estimate glucose concentration in blood or urine samples through the formation of colored dyes by the hydrogen peroxide produced in the reaction. (From Enzyme Nomenclature, 1992) EC 1.1.3.4. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH]
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Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycogen Synthase: An enzyme that catalyzes the transfer of D-glucose from UDPglucose into 1,4-alpha-D-glucosyl chains. EC 2.4.1.11. [NIH] Glycolysis: The pathway by which glucose is catabolized into two molecules of pyruvic acid with the generation of ATP. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Glycosuria: The presence of glucose in the urine; especially the excretion of an abnormally large amount of sugar (glucose) in the urine, i.e., more than 1 gm. in 24 hours. [EU] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granule: A small pill made from sucrose. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH]
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Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Hate: An enduring attitude or sentiment toward persons or objects manifested by anger, aversion and desire for the misfortune of others. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematopoietic Stem Cells: Progenitor cells from which all blood cells derive. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have
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failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemoglobin M: A group of abnormal hemoglobins in which amino acid substitutions take place in either the alpha or beta chains but near the heme iron. This results in facilitated oxidation of the hemoglobin to yield excess methemoglobin which leads to cyanosis. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Hexokinase: An enzyme that catalyzes the conversion of ATP and a D-hexose to ADP and a D-hexose 6-phosphate. D-Glucose, D-mannose, D-fructose, sorbitol, and D-glucosamine can act as acceptors; ITP and dATP can act as donors. The liver isoenzyme has sometimes been called glucokinase. (From Enzyme Nomenclature, 1992) EC 2.7.1.1. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH]
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Histology: The study of tissues and cells under a microscope. [NIH] Holidays: Days commemorating events. Holidays also include vacation periods. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Human growth hormone: A protein hormone, secreted by the anterior lobe of the pituitary, which promotes growth of the whole body by stimulating protein synthesis. The human gene has already been cloned and successfully expressed in bacteria. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydra: A genus of freshwater cnidarians, of interest because of their complex organization and because their adult organization corresponds roughly to the gastrula of higher animals. [NIH]
Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH]
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Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycaemia: Abnormally increased content of sugar in the blood. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperglycemic Hyperosmolar Nonketotic Coma: A syndrome consisting of extreme hyperglycemia, serum hyperosmolarity and dehydration in the absence of ketosis and acidosis. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertension, Pulmonary: Increased pressure within the pulmonary circulation, usually secondary to cardiac or pulmonary disease. [NIH] Hypertension, Renal: Hypertension due to renal diseases, especially chronic parenchymal disease. Hypertension as a result of compression or obstruction of the renal artery or its branches is hypertension, renovascular. [NIH] Hypertension, Renovascular: Hypertension due to compression or obstruction of the renal artery or its branches. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hypnotherapy: Sleeping-cure. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]
Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypopituitarism: Diminution or cessation of secretion of one or more hormones from the anterior pituitary gland (including LH; FSH; somatotropin; and corticotropin). This may result from surgical or radiation ablation, non-secretory pituitary neoplasms, metastatic tumors, infarction, pituitary apoplexy, infiltrative or granulomatous processes, and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU]
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Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Ice Cream: A frozen dairy food made from cream or butterfat, milk, sugar, and flavorings. Frozen custard and French-type ice creams also contain eggs. [NIH] Ileum: The lower end of the small intestine. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU]
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In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant Food: Food processed and manufactured for the nutritional health of children in their first year of life. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Infusion Pumps: Fluid propulsion systems driven mechanically, electrically, or osmotically that are used to inject (or infuse) over time agents into a patient or experimental animal; used routinely in hospitals to maintain a patent intravenous line, to administer antineoplastic agents and other drugs in thromboembolism, heart disease, diabetes mellitus (insulin infusion systems is also available), and other disorders. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own
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psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin Infusion Systems: Portable or implantable devices for infusion of insulin. Includes open-loop systems which may be patient-operated or controlled by a pre-set program and are designed for constant delivery of small quantities of insulin, increased during food ingestion, and closed-loop systems which deliver quantities of insulin automatically based on an electronic glucose sensor. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Invertebrates: Animals that have no spinal column. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a
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positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]
Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] Jellyfish: Free swimming marine cnidarians. Most of the large jellyfish are in the class Scyphozoa; the small jellyfish are in the class Hydrozoa (hydra). [NIH] Karyotype: The characteristic chromosome complement of an individual, race, or species as defined by their number, size, shape, etc. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU]
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Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labor Onset: The establishment of regular uterine contractions together with beginning dilatation of the cervix. [NIH] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no
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troublesome effect. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]
Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Life Change Events: Those occurrences, including social, psychological, and environmental, which require an adjustment or effect a change in an individual's pattern of living. [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH]
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Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipid Peroxides: Peroxides produced in the presence of a free radical by the oxidation of unsaturated fatty acids in the cell in the presence of molecular oxygen. The formation of lipid peroxides results in the destruction of the original lipid leading to the loss of integrity of the membranes. They therefore cause a variety of toxic effects in vivo and their formation is considered a pathological process in biological systems. Their formation can be inhibited by antioxidants, such as vitamin E, structural separation or low oxygen tension. [NIH] Lipolysis: The hydrolysis of lipids. [NIH] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH]
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Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Macronutrients: Nutrients in the diet that are the key sources of energy, namely protein, fat, and carbohydrates. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mammary: Pertaining to the mamma, or breast. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mannans: Polysaccharides consisting of mannose units. [NIH] Mazindol: Tricyclic anorexigenic agent unrelated to and less toxic than amphetamine, but with some similar side effects. It inhibits uptake of catecholamines and blocks the binding of cocaine to the dopamine uptake transporter. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]
Meat Products: Articles of food which are derived by a process of manufacture from any portion of carcasses of any animal used for food (e.g., head cheese, sausage, scrapple). [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH]
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Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Melanosis: Disorders of increased melanin pigmentation that develop without preceding inflammatory disease. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU]
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Metabolic acidosis: (met-ah-BOL-ik as-id-O-sis): A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream). [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methacrylate: A vinyl monomer. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Middle Cerebral Artery: The largest and most complex of the cerebral arteries. Branches of the middle cerebral artery supply the insular region, motor and premotor areas, and large regions of the association cortex. [NIH] Milligram: A measure of weight. A milligram is approximately 450,000-times smaller than a pound and 28,000-times smaller than an ounce. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region.
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[EU]
Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Monounsaturated fat: An unsaturated fat that is found primarily in plant foods, including olive and canola oils. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucolytic: Destroying or dissolving mucin; an agent that so acts : a mucopolysaccharide or glycoprotein, the chief constituent of mucus. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Music Therapy: The use of music as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH]
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Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myofibrils: Highly organized bundles of actin, myosin, and other proteins in the cytoplasm of skeletal and cardiac muscle cells that contract by a sliding filament mechanism. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephritis: Inflammation of the kidney; a focal or diffuse proliferative or destructive process which may involve the glomerulus, tubule, or interstitial renal tissue. [EU] Nephropathy: Disease of the kidneys. [EU] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH]
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Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nutrition Assessment: Evaluation and measurement of nutritional variables in order to assess the level of nutrition or the nutritional status of the individual. Nutrition surveys may be used in making the assessment. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of
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nutrients. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ophthalmic: Pertaining to the eye. [EU] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]
Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]
Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organizational Culture: Beliefs and values shared by all members of the organization. These shared values are reflected in the day to day operations of the organization. [NIH]
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Orthotic Devices: Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overexpress: An excess of a particular protein on the surface of a cell. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU]
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Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreas Transplant: A surgical procedure that involves replacing the pancreas of a person who has diabetes with a healthy pancreas that can make insulin. The healthy pancreas comes from a donor who has just died or from a living relative. A person can donate half a pancreas and still live normally. [NIH] Pancreas Transplantation: The transference of a pancreas from one human or animal to another. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paralysis: Loss of ability to move all or part of the body. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Team: Care of patients by a multidisciplinary team usually organized under
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the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Participation: Patient involvement in the decision-making process in matters pertaining to health. [NIH] Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perennial: Lasting through the year of for several years. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]
Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral
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sensory receptors. [NIH] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor
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of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylase: An enzyme of the transferase class that catalyzes the phosphorylysis of a terminal alpha-1,4-glycosidic bond at the non-reducing end of a glycogen molecule, releasing a glucose 1-phosphate residue. Phosphorylase should be qualified by the natural substance acted upon. EC 2.4.1.1. [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Photoreceptor: Receptor capable of being activated by light stimuli, as a rod or cone cell of the eye. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physicochemical: Pertaining to physics and chemistry. [EU] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Piloerection: Involuntary erection or bristling of hairs. [NIH]
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Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Apoplexy: Sudden hemorrhage or ischemic necrosis involving the pituitary gland which may be associated with acute visual loss, severe headache, meningeal signs, cranial nerve palsies, panhypopituitarism, and rarely coma. The most common cause is hemorrhage (intracranial hemorrhages) related to a pituitary adenoma. Ischemia, meningitis, intracranial hypertension, and other disorders may be associated with this condition. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Pituitary Neoplasms: Neoplasms which arise from or metastasize to the pituitary gland. The majority of pituitary neoplasms are adenomas, which are divided into non-secreting and secreting forms. Hormone producing forms are further classified by the type of hormone they secrete. Pituitary adenomas may also be characterized by their staining properties (adenoma, basophil; adenoma, acidophil; and adenoma, chromophobe). Pituitary tumors may compress adjacent structures, including the hypothalamus, several cranial nerves, and the optic chiasm. Chiasmal compression may result in bitemporal hemianopsia. [NIH]
Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plana: The radiographic term applied to a vertebral body crushed to a thin plate. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen Activator Inhibitor 1: A member of the serpin family of proteins. It inhibits both the tissue-type and urokinase-type plasminogen activators. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH]
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Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Ovary Syndrome: Clinical symptom complex characterized by oligomenorrhea or amenorrhea, anovulation, and regularly associated with bilateral polycystic ovaries. [NIH] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]
Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyphagia: Great hunger; a sign of diabetes. People with this great hunger often lose weight. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyurethanes: A group of thermoplastic or thermosetting polymers containing polyisocyanate. They are used as elastomers, as coatings, as fibers and as foams. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU]
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Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postprandial Blood Glucose: Blood taken 1-2 hours after eating to see the amount of glucose (sugar) in the blood. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Prefrontal Cortex: The rostral part of the frontal lobe, bounded by the inferior precentral fissure in humans, which receives projection fibers from the mediodorsal nucleus of the thalamus. The prefrontal cortex receives afferent fibers from numerous structures of the diencephalon, mesencephalon, and limbic system as well as cortical afferents of visual, auditory, and somatic origin. [NIH] Pregnancy in Diabetics: Previously diagnosed diabetics that become pregnant. This does not include either symptomatic diabetes or impaired glucose tolerance induced by pregnancy but resolved at the end of pregnancy (diabetes, gestational). [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH]
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Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progeny: The offspring produced in any generation. [NIH] Proglumide: 4-Benzamido-N,N-dipropylglutaramic acid. A drug that exerts an inhibitory effect on gastric secretion and reduces gastrointestinal motility. It is used clinically in the drug therapy of gastrointestinal ulcers. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proinsulin: The substance made first in the pancreas that is then made into insulin. When insulin is purified from the pancreas of pork or beef, all the proinsulin is not fully removed. When some people use these insulins, the proinsulin can cause the body to react with a rash, to resist the insulin, or even to make dents or lumps in the skin at the place where the insulin is injected. The purified insulins have less proinsulin and other impurities than the other types of insulins. [NIH] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proliferative Retinopathy: A disease of the small blood vessels of the retina of the eye. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH]
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Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional Hazards Models: Statistical models used in survival analysis that assert that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Propylene Glycol: A clear, colorless, viscous organic solvent and diluent used in pharmaceutical preparations. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the
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secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]
Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotomimetic: Psychosis miming. [NIH] Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of
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literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]
Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Circulation: The circulation of blood through the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purified Insulins: Insulins with much less of the impure proinsulin. It is thought that the use of purified insulins may help avoid or reduce some of the problems of people with diabetes such as allergic reactions. [NIH] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Pyloric Sphincter: The muscle between the stomach and the small intestine. [NIH] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radial Artery: The direct continuation of the brachial trunk, originating at the bifurcation of the brachial artery opposite the neck of the radius. Its branches may be divided into three groups corresponding to the three regions in which the vessel is situated, the forearm, wrist, and hand. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH]
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Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]
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Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration
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(= cell respiration). [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]
Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Retrovirus: A member of a group of RNA viruses, the RNA of which is copied during viral replication into DNA by reverse transcriptase. The viral DNA is then able to be integrated into the host chromosomal DNA. [NIH] Reversion: A return to the original condition, e. g. the reappearance of the normal or wild type in previously mutated cells, tissues, or organisms. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH]
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Rhythm Method: A contraceptive method whereby abstinence is practiced a few days before and after the estimated day of ovulation. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rosiglitazone: A drug taken to help reduce the amount of sugar in the blood. Rosiglitazone helps make insulin more effective and improves regulation of blood sugar. It belongs to the family of drugs called thiazolidinediones. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Ryanodine: Insecticidal alkaloid isolated from Ryania speciosa; proposed as a myocardial depressant. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Sarcoplasmic Reticulum: A network of tubules and sacs in the cytoplasm of skeletal muscles that assist with muscle contraction and relaxation by releasing and storing calcium ions. [NIH] Satiation: Full gratification of a need or desire followed by a state of relative insensitivity to that particular need or desire. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH]
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Secretin: A hormone made in the duodenum. Causes the stomach to make pepsin, the liver to make bile, and the pancreas to make a digestive juice. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Sella Turcica: A bony prominence situated on the upper surface of the body of the sphenoid bone. It houses the pituitary gland. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serrata: The serrated anterior border of the retina located approximately 8.5 mm from the limbus and adjacent to the pars plana of the ciliary body. [NIH] Serrated: Having notches or teeth on the edge as a saw has. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH]
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Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Smooth Muscle Tumor: A tumor composed of smooth muscle tissue, as opposed to leiomyoma, a tumor derived from smooth muscle. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals
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with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Socialization: The training or molding of an individual through various relationships, educational agencies, and social controls, which enables him to become a member of a particular society. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatotropin: A small peptide hormone released by the anterior pituitary under hypothalamic control. Somatotropin, or growth hormone, stimulates mitosis, cell growth, and, for some cell types, differentiation in many tissues of the body. It has profound effects on many aspects of gene expression and metabolism. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and
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types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Spectrophotometry: The art or process of comparing photometrically the relative intensities of the light in different parts of the spectrum. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Steady state: Dynamic equilibrium. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU]
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Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Striatum: A higher brain's domain thus called because of its stripes. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH]
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Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic blood pressure: The maximum pressure in the artery produced as the heart contracts and blood begins to flow. [NIH] Telecommunications: Transmission of information over distances via electronic means. [NIH]
Telomere: A terminal section of a chromosome which has a specialized structure and which is involved in chromosomal replication and stability. Its length is believed to be a few hundred base pairs. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Testimonials: Information provided by individuals who claim to have been helped or cured
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by a particular product. The information provided lacks the necessary elements to be evaluated in a rigorous and scientific manner and is not used in the scientific literature. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]
Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thiourea: A photographic fixative used also in the manufacture of resins. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), this substance may reasonably be anticipated to be a carcinogen (Merck Index, 9th ed). Many of its derivatives are antithryoid agents and/or free radical scavengers. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thought Field Therapy: Radiotherapy in which a lesion is subjected to radiation entering the body through several portals. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thromboplastin: Constituent composed of protein and phospholipid that is widely distributed in many tissues. It serves as a cofactor with factor VIIa to activate factor X in the extrinsic pathway of blood coagulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
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Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [NIH] Tolazamide: A sulphonylurea hypoglycemic agent with actions and uses similar to those of chlorpropamide. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transcutaneous: Transdermal. [EU]
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Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transposase: An enzyme that binds to single-stranded DNA. It is thought to recognize the repetitive ends of a transposon and to participate in the cleavage of the recipient site into which the new transposon copy inserts. EC 2.7.7.-. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Troglitazone: A drug used in diabetes treatment that is being studied for its effect on reducing the risk of cancer cell growth in fat tissue. [NIH] Trophic: Of or pertaining to nutrition. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities.
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[NIH]
Tympanic membrane: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]
Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urine Testing: Checking urine to see if it contains glucose (sugar) and ketones. Special strips of paper or tablets (called reagents) are put into a small amount of urine or urine plus water. Changes in the color of the strip show the amount of glucose or ketones in the urine. Urine testing is the only way to check for the presence of ketones, a sign of serious illness. However, urine testing is less desirable then blood testing for monitoring the level of glucose in the body. [NIH]
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Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Vagotomy: The interruption or removal of any part of the vagus (10th cranial) nerve. Vagotomy may be performed for research or for therapeutic purposes. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venom: That produced by the poison glands of the mouth and injected by the fangs of poisonous snakes. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venter: Belly. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH]
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Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinarians: Individuals with a degree in veterinary medicine that provides them with training and qualifications to treat diseases and injuries of animals. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vimentin: An intermediate filament protein found in most differentiating cells, in cells grown in tissue culture, and in certain fully differentiated cells. Its insolubility suggests that it serves a structural function in the cytoplasm. MW 52,000. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Visually Impaired Persons: Persons with loss of vision such that there is an impact on activities of daily living. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Voltage-gated: It is opened by the altered charge distribution across the cell membrane. [NIH]
Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border
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of the fifth thoracic vertebra. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xanthomatosis: A condition of morphologic change in which there is accumulation of lipids in the large foam cells of tissues. It is the cutaneous manifestation of lipidosis in which plasma fatty acids and lipoproteins are quantitatively changed. The xanthomatous eruptions have several different distinct morphologies dependent upon the specific form taken by the disease. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
373
INDEX A Abdomen, 69, 291, 300, 301, 317, 320, 329, 331, 335, 342, 344, 345, 346, 363, 369 Abdominal, 47, 72, 291, 292, 303, 304, 331, 344, 346, 356 Abdominal fat, 47, 291 Ablation, 15, 162, 291, 328 Acanthosis Nigricans, 49, 291 Acceptor, 291, 335, 343, 367 Acetone, 291, 333 Acetylcholine, 291, 341 Acidosis, 72, 230, 238, 246, 291, 328, 332 Acoustic, 174, 291 Actin, 25, 171, 291, 339, 340 Activities of Daily Living, 291, 370 Acute renal, 185, 291 Acyl, 45, 167, 291, 318 Adaptability, 291, 303, 304 Adaptation, 9, 54, 220, 291, 348 Adenine, 292 Adenosine, 7, 292, 302, 347 Adenovirus, 35, 42, 45, 154, 292 Adenylate Cyclase, 186, 292 Adipocytes, 292, 334 Adipose Tissue, 26, 40, 51, 75, 135, 291, 292 Adjunctive Therapy, 292, 297, 339 Adjustment, 4, 33, 210, 218, 220, 230, 233, 238, 245, 258, 291, 292, 334 Adolescence, 38, 240, 292 Adrenal Cortex, 292, 293, 310, 356 Adrenal Glands, 292, 356 Adrenal insufficiency, 199, 292 Adrenal Medulla, 6, 292, 317, 341 Adrenergic, 27, 169, 292, 298, 314, 317, 352, 364 Adult-Onset Diabetes, 176, 292 Adverse Effect, 31, 292, 360 Aerobic, 232, 292, 319, 338, 343 Aerobic Exercise, 232, 292 Aerobic Metabolism, 292, 343 Aerobic Respiration, 292, 343 Afferent, 292, 334, 350 Affinity, 185, 293, 361 Age Groups, 32, 293 Age of Onset, 293, 368 Aged, 80 and Over, 293 Agonist, 177, 193, 293, 306, 314
Agoraphobia, 293, 347 Albumin, 8, 27, 46, 56, 58, 62, 80, 185, 293, 348 Albuminuria, 53, 293 Aldosterone, 27, 293 Alertness, 293, 302 Algorithms, 43, 146, 147, 246, 293, 300 Alimentary, 293, 313, 344 Alkaline, 187, 291, 293, 294, 302 Alkaline Phosphatase, 187, 293 Alkaloid, 293, 306, 358 Alleles, 26, 27, 293 Allogeneic, 294, 324 Alpha Particles, 294, 354 Alpha-1, 294, 347 Alpha-fetoprotein, 294, 320 Alternative medicine, 256, 294 Alveolar Bone Loss, 224, 294 Ameliorating, 167, 192, 294 Amenorrhea, 45, 294, 349 Amino Acid Sequence, 152, 184, 185, 294, 296, 322 Amino Acid Substitution, 51, 294, 326 Amino Acids, 178, 185, 294, 296, 306, 322, 340, 345, 349, 353, 358, 359, 366, 367, 368 Ammonia, 294, 364, 368 Amniocentesis, 220, 294 Amnion, 89, 294 Amniotic Fluid, 294, 322 Amphetamine, 169, 294, 312, 336 Amputation, 7, 16, 145, 173, 202, 211, 295 Amygdala, 10, 295, 334 Amylase, 152, 295 Amyloid, 41, 173, 177, 295 Anaerobic, 295, 369 Anaesthesia, 74, 77, 295, 330 Anal, 38, 295, 314 Analog, 37, 142, 295 Analogous, 39, 142, 295, 367 Analytes, 22, 130, 133, 136, 138, 141, 145, 147, 150, 158, 164, 174, 175, 181, 295 Anaphylatoxins, 295, 307 Anastomosis, 295, 321 Anatomical, 295, 298, 305, 308, 329, 358 Anesthesia, 91, 230, 295, 315 Anesthetics, 295, 317 Angina, 185, 230, 235, 295, 352 Angina Pectoris, 185, 295, 352
374
Blood Glucose
Angiopathy, 160, 295 Angiotensinogen, 27, 296, 356 Animal model, 15, 20, 28, 44, 52, 167, 296 Anions, 293, 296, 332 Ankle, 46, 296 Anorexia, 34, 296, 368 Anovulation, 45, 296, 349 Antagonism, 98, 296, 302, 313 Antecedent, 10, 36, 296 Anthropometric measurements, 14, 296 Antibacterial, 296, 323, 362 Antibiotic, 296, 345, 362 Antibodies, 188, 296, 325, 326, 327, 329, 348 Antibody, 293, 296, 297, 307, 325, 327, 329, 330, 332, 337, 339, 354, 355, 361, 371 Anticoagulant, 296, 352, 353 Antidiabetic, 117, 135, 160, 161, 188, 296, 324 Antidiabetic Agent, 160, 296 Antigen, 21, 293, 296, 297, 307, 327, 328, 329, 330, 337 Antigen-Antibody Complex, 297, 307 Antihypertensive, 65, 91, 230, 297 Anti-infective, 297, 327, 360 Anti-inflammatory, 32, 297, 312, 323 Antineoplastic, 297, 310, 330 Antineoplastic Agents, 297, 310, 330 Antioxidant, 31, 118, 297, 343 Antipruritic, 297, 305 Anuria, 297, 333 Anus, 295, 297, 301, 307, 345, 355 Anxiety, 64, 69, 278, 297, 347, 352 Aorta, 297, 303, 309, 356, 369 Apolipoproteins, 26, 297, 335 Apoptosis, 19, 51, 297 Aqueous, 7, 117, 120, 130, 172, 173, 181, 297, 299, 305, 311, 327, 334, 335 Aqueous fluid, 130, 297 Aqueous humor, 172, 173, 297, 305 Arachidonic Acid, 171, 297, 334, 352 Arginine, 295, 297, 341 Art Therapy, 212, 297 Arterial, 176, 297, 298, 303, 305, 309, 328, 353, 364 Arteries, 24, 295, 297, 298, 300, 301, 303, 304, 309, 310, 332, 335, 339, 340, 354, 365 Arteriolar, 298, 301, 356 Arterioles, 298, 301, 302, 338, 340 Arteriolosclerosis, 298 Arteriosclerosis, 165, 185, 298, 328, 340
Artery, 24, 42, 54, 55, 60, 231, 297, 298, 299, 309, 316, 332, 336, 338, 354, 364 Articular, 298, 343 Artifacts, 156, 298 Aspiration, 298, 320 Assay, 25, 29, 98, 130, 155, 191, 243, 298 Asymptomatic, 16, 64, 298, 344 Atenolol, 94, 298 Atrial, 298, 309, 367 Atrioventricular, 298, 309 Atrium, 298, 309, 367, 369 Attenuated, 298, 313 Auditory, 298, 336, 350, 368, 369 Autodigestion, 298, 344 Autogenic, 212, 298 Autoimmune disease, 167, 298 Autoimmunity, 15, 298 Autologous, 15, 298 Autonomic Nervous System, 30, 36, 131, 221, 298, 345, 361, 364 Autosuggestion, 299, 329 Axillary, 299, 301 Axillary Artery, 299, 301 Axons, 299, 312, 340, 342 B Back Pain, 206, 299 Bacterial Adhesion, 46, 299 Bacterial Infections, 224, 299, 304 Bacterial Physiology, 291, 299 Bactericidal, 299, 318 Base, 24, 52, 54, 118, 292, 299, 322, 332, 333, 364, 368 Basement Membrane, 52, 299, 333 Benign, 185, 298, 299, 320, 325, 334, 355, 370 Beta-pleated, 295, 299 Bewilderment, 299, 308 Bilateral, 299, 349 Bile, 165, 299, 300, 305, 321, 332, 335, 359, 362 Bile Acids, 299, 362 Bile Acids and Salts, 299 Biliary, 299, 300, 302, 305, 344 Biliary Tract, 300, 302, 344 Bilirubin, 151, 293, 300, 328 Bioassays, 7, 300 Bioavailability, 135, 300 Biochemical, 18, 91, 130, 179, 293, 300, 320, 324, 333, 343, 359 Biological therapy, 300, 324 Biological Transport, 300, 313 Biomarkers, 52, 300
375
Biopsy, 52, 300 Biosynthesis, 45, 133, 152, 184, 297, 300, 359 Biotechnology, 7, 15, 65, 66, 256, 269, 300 Biphasic, 152, 300 Bladder, 178, 199, 230, 300, 308, 321, 330, 340, 352, 368, 370 Blastocyst, 300, 308, 316, 348 Bloating, 300, 322 Blood Coagulation, 300, 302, 319, 365 Blood Glucose Self-Monitoring, 81, 114, 198, 278, 300 Blood-Brain Barrier, 20, 301 Body Composition, 60, 301 Body Fluids, 138, 300, 301, 361, 367 Body Image, 47, 301 Body Mass Index, 51, 57, 61, 90, 218, 301, 343 Bolus, 142, 189, 190, 214, 239, 301 Bolus infusion, 301 Bolus injection, 142, 301 Bone Density, 61, 301 Bone Marrow, 15, 301, 318, 322, 329, 336, 339 Bone scan, 301, 358 Bowel, 178, 295, 301, 313, 331, 340, 346, 363 Bowel Movement, 301, 313, 363 Brachial, 24, 34, 301, 354 Brachial Artery, 34, 301, 354 Brachytherapy, 301, 331, 332, 354, 371 Bradykinin, 301, 341, 348 Breast Feeding, 253, 301 Bronchi, 301, 302, 317, 366 Bronchial, 185, 302 Bronchitis, 205, 302, 305 C Caffeine, 220, 302 Calcification, 298, 302 Calcium, 9, 27, 41, 302, 307, 313, 319, 353, 358, 360 Calculi, 302, 324 Calibration, 22, 39, 141, 146, 147, 155, 168, 189, 191, 251, 277, 302 Caloric intake, 208, 211, 302 Calpain, 109, 302 Capillary, 4, 20, 72, 73, 74, 80, 87, 88, 108, 164, 301, 302, 369 Capsules, 25, 302 Carbon Dioxide, 137, 302, 321, 348, 356, 369 Carcinogen, 303, 365
Carcinogenic, 303, 330, 351, 362 Cardiac, 24, 156, 188, 230, 302, 303, 309, 312, 315, 317, 318, 328, 340, 344, 357, 362 Cardiomyopathy, 144, 192, 303 Cardiorespiratory, 60, 292, 303 Cardioselective, 298, 303, 352 Carotene, 303, 357 Case report, 207, 303, 306 Case series, 303, 306 Cataract, 77, 160, 303 Catecholamines, 292, 303, 314, 336 Catheter, 239, 303 Caudal, 303, 329, 349 Causal, 36, 52, 165, 303, 326 Cause of Death, 18, 140, 143, 303 Celiac Artery, 303, 326 Cell Death, 188, 297, 303, 304, 340 Cell Differentiation, 303, 360 Cell Division, 299, 304, 324, 338, 348, 359 Cell membrane, 28, 171, 300, 304, 312, 347, 370 Cell Physiology, 19, 304 Cell proliferation, 10, 51, 298, 304, 360 Cell Respiration, 292, 304, 338, 343, 356 Cell Survival, 304, 324 Cell Transplantation, 89, 212, 304 Central Nervous System Infections, 304, 325 Cerebral, 9, 20, 28, 41, 185, 301, 304, 309, 316, 317, 318, 320, 321, 338, 364, 365 Cerebral Arteries, 304, 338 Cerebrospinal, 41, 71, 304, 335, 362 Cerebrospinal fluid, 41, 71, 304, 335, 362 Cerebrovascular, 185, 216, 303, 304 Cerebrum, 304 Cervical, 180, 304 Cervix, 304, 333 Cesarean Section, 5, 304 Character, 201, 295, 304, 311 Chemotactic Factors, 304, 307 Chest Pain, 206, 304 Chin, 8, 114, 119, 305, 337 Chiropractic, 212, 305 Chlorophyll, 305, 321 Cholesterol Esters, 305, 335 Cholestyramine, 165, 305 Choroid, 305, 357 Chromatin, 297, 305, 336 Chromic, 133, 305 Chromium, 115, 133, 305 Chromosomal, 27, 52, 305, 348, 357, 364
376
Blood Glucose
Chromosome, 26, 27, 305, 325, 332, 334, 359, 364 Chronic Disease, 13, 22, 140, 143, 165, 172, 187, 205, 305 Chronic Obstructive Pulmonary Disease, 185, 305 Chronic renal, 185, 305, 349, 368 Chylomicrons, 305, 335 Ciliary, 297, 305, 359 Ciliary Body, 305, 359 Ciliary processes, 297, 305 Circulatory system, 165, 176, 306, 316 CIS, 306, 357 Clamp, 7, 34, 38, 42, 51, 306 Clinical Medicine, 306, 350 Clinical study, 60, 306, 309 Clinical trial, 6, 7, 13, 17, 46, 57, 60, 64, 269, 306, 309, 345, 353, 355 Clomiphene, 56, 306 Cloning, 300, 306 Coagulation, 162, 168, 300, 306, 348 Coca, 306 Cocaine, 54, 306, 336 Codon, 178, 306, 322 Cofactor, 306, 353, 365 Cognition, 41, 306 Cognitive restructuring, 306, 363 Colestipol, 165, 307 Collagen, 27, 151, 224, 299, 307, 320, 349, 351 Colloidal, 293, 307 Colon, 51, 212, 307, 333 Combination Therapy, 85, 213, 230, 307 Community Health Nursing, 60, 307 Complement, 10, 295, 307, 332, 348 Complementary and alternative medicine, 117, 124, 307 Complementary medicine, 117, 307 Compliance, 5, 22, 24, 34, 93, 226, 308 Computational Biology, 269, 308 Computed tomography, 301, 308, 358 Computerized axial tomography, 308, 358 Conception, 308, 320, 350, 362 Concomitant, 9, 29, 149, 308 Cones, 308, 357 Confounding, 54, 308 Confusion, 206, 278, 308, 314, 328, 368 Congestive heart failure, 230, 308 Connective Tissue, 301, 307, 308, 312, 320, 321, 336, 337 Consciousness, 206, 308, 314, 357 Constipation, 209, 308
Constriction, 308, 332, 369 Constriction, Pathologic, 308, 369 Consultation, 58, 79, 308 Continuous infusion, 134, 308 Contraception, 12, 308 Contraceptive, 220, 308, 358 Contraindications, ii, 308 Control group, 5, 18, 23, 41, 43, 47, 55, 309, 351, 355 Controlled clinical trial, 50, 100, 309 Convulsions, 206, 309, 315, 328, 350 Coordination, 278, 309 Cor, 185, 309, 328 Cor pulmonale, 185, 309 Cornea, 297, 309 Coronary, 8, 14, 24, 42, 55, 60, 75, 109, 131, 165, 176, 231, 295, 303, 309, 310, 339, 340 Coronary Artery Bypass, 109, 309 Coronary Circulation, 295, 309 Coronary Disease, 165, 309 Coronary heart disease, 8, 14, 55, 75, 131, 165, 303, 309 Coronary Thrombosis, 309, 339, 340 Coronary Vessels, 309, 310 Corpuscle, 310, 318 Cortex, 304, 310, 317, 318, 320, 338, 343, 350 Cortical, 310, 318, 350, 359 Corticosteroids, 310, 323 Cortisol, 37, 53, 61, 293, 310 Cortisone, 310, 312 Cost Savings, 17, 22, 103, 310 Coumarins, 310, 353 Cranial, 310, 325, 342, 345, 348, 369 Craniocerebral Trauma, 310, 325 Craniotomy, 79, 310 Creatinine, 8, 27, 137, 212, 310, 333, 368 Criterion, 96, 310 Critical Illness, 71, 310 Crossing-over, 310, 355 Cross-Sectional Studies, 64, 310 Cues, 47, 310 Cultured cells, 167, 310 Curative, 310, 365 Cutaneous, 96, 230, 310, 371 Cyanosis, 310, 326 Cyclic, 83, 292, 302, 311, 325, 341, 347, 352 Cytokine, 76, 167, 311 Cytoplasm, 297, 304, 311, 317, 324, 336, 339, 340, 358, 370 Cytoskeletal Proteins, 302, 311 Cytotoxic, 311, 355, 360
377
D Data Collection, 23, 33, 58, 311, 320 Deamination, 311, 368 Decidua, 311, 348 Decompression, 311, 314 Decubitus, 311, 360 Decubitus Ulcer, 311, 360 Defense Mechanisms, 20, 311 Degenerative, 154, 311, 343, 357 Dehydration, 311, 328 Deletion, 297, 311 Delivery of Health Care, 311, 325 Denaturation, 27, 311 Dendrites, 311, 312, 340 Dental Care, 207, 211, 213, 214, 228, 311 Dentate Gyrus, 311, 326 Dentists, 224, 312 Depolarization, 156, 312, 360 Deprivation, 20, 312 Dermatitis, 144, 192, 312 Dermis, 312, 367 Desmin, 25, 312 Detergents, 312, 360 Deuterium, 312, 327 DEXA, 34, 39, 49, 61, 312 Dexamethasone, 79, 312 Dextroamphetamine, 295, 312 Diabetes Insipidus, 312, 349 Diabetes, Gestational, 230, 312, 350 Diabetic Foot, 202, 216, 229, 238, 312 Diabetic Ketoacidosis, 197, 198, 212, 214, 217, 227, 229, 230, 236, 238, 241, 242, 246, 253, 312 Diabetic Retinopathy, 35, 197, 211, 241, 243, 313, 347 Diagnostic Imaging, 313, 354 Diagnostic procedure, 129, 256, 313 Dialyzer, 313, 326 Diarrhea, 139, 209, 305, 313 Diastolic, 313, 328 Dietary Fats, 196, 313 Dietary Fiber, 120, 200, 208, 211, 313 Dietetics, 203, 313 Dietitian, 204, 206, 208, 216, 222, 257, 313 Diffusion, 46, 300, 313, 330 Digestion, 258, 293, 299, 301, 313, 322, 331, 335, 345, 363 Digestive system, 232, 313 Digestive tract, 313, 360 Dilation, 34, 301, 313 Diltiazem, 94, 313 Dilution, 61, 313
Diploid, 313, 348 Direct, iii, 12, 20, 43, 53, 77, 160, 241, 261, 306, 313, 314, 354, 356, 364 Discrete, 39, 313, 314 Discriminant Analysis, 180, 314 Discrimination, 206, 217, 235, 314 Disease Progression, 42, 53, 314 Disinfectant, 314, 318 Disorientation, 308, 314 Disparity, 110, 314 Dissociation, 88, 293, 314 Dissociative Disorders, 314 Distal, 42, 130, 140, 163, 309, 314, 315, 346, 353 Diuresis, 302, 314 Diving, 209, 314 Dizziness, 206, 314 Dopamine, 294, 306, 312, 314, 336, 339, 341, 347 Dose-dependent, 9, 314 Drug Combinations, 212, 314 Drug Interactions, 262, 263, 315 Drug Tolerance, 315, 366 Duodenum, 178, 299, 315, 321, 326, 332, 345, 359, 363 Dyes, 295, 315, 323 Dyslipidemia, 24, 38, 54, 228, 230, 238, 315 E Eating Disorders, 45, 152, 184, 206, 211, 233, 315 Eclampsia, 315, 350 Edema, 313, 315, 350, 368 Effector, 291, 307, 315, 347 Efficacy, 5, 7, 37, 43, 50, 51, 52, 57, 69, 80, 91, 315 Elasticity, 298, 315 Elastin, 307, 315 Elastomers, 315, 349 Electroacupuncture, 114, 119, 315 Electrocoagulation, 306, 315 Electrode, 8, 46, 155, 180, 190, 315 Electrolyte, 293, 315, 333, 350, 361, 368 Electrons, 297, 299, 315, 331, 336, 343, 354, 355 Elementary Particles, 315, 316, 336, 341, 353 Embolus, 316, 330 Embryo, 294, 300, 303, 316, 330, 350, 362 Embryo Transfer, 316, 350 Emphysema, 205, 305, 316 Empirical, 50, 316 Encapsulated, 37, 48, 141, 316
378
Blood Glucose
Encephalocele, 316, 340 Endemic, 316, 362 Endocrine System, 316, 340 Endogenous, 6, 20, 28, 41, 45, 142, 152, 184, 185, 186, 192, 201, 302, 314, 316, 317, 366 Endometrium, 311, 316, 337 Endorphins, 316, 341 Endothelial cell, 20, 61, 301, 316, 365 Endothelium, 20, 34, 316, 317, 341, 348 Endothelium, Lymphatic, 316 Endothelium, Vascular, 316, 317 Endothelium-derived, 317, 341 Endotoxic, 317, 335 Endotoxins, 307, 317 End-stage renal, 72, 131, 140, 143, 305, 317, 349 Energy balance, 52, 317, 334 Energy Intake, 47, 56, 317 Enhancer, 171, 317, 357 Enkephalins, 317, 341 Entorhinal Cortex, 317, 326 Environmental Health, 268, 270, 317 Enzymatic, 146, 169, 173, 190, 302, 303, 307, 317, 318, 357 Epidemic, 60, 317, 362 Epidemiological, 38, 58, 100, 165, 317 Epidermal, 317, 332, 337, 370 Epidermis, 312, 317, 332 Epigastric, 317, 344 Epinephrine, 6, 292, 314, 317, 341, 368 Epithelial, 27, 300, 305, 311, 317, 318, 326, 333 Epithelial Cells, 318, 326, 333 Epithelium, 299, 316, 318, 332 Equipment and Supplies, 200, 219, 239, 242, 253, 275, 318 Erectile, 211, 230, 318 Erection, 318, 347 Erythrocyte Membrane, 61, 318 Erythrocytes, 301, 302, 318, 326, 356 Erythropoietin, 185, 318 Escalation, 187, 318 Esophagus, 313, 318, 345, 346, 363 Esterification, 45, 318 Estrogen, 306, 318 Estrogen receptor, 306, 318 Ethanol, 21, 118, 318 Ether, 8, 318 Eukaryotic Cells, 153, 311, 318 Evacuation, 308, 318, 321 Evoke, 318, 363
Excitability, 318, 340 Excitation, 318, 341 Excitatory, 28, 318, 324 Excrete, 297, 319, 333 Exercise Test, 72, 319 Exhaustion, 45, 296, 319 Exocrine, 319, 344 Exogenous, 48, 142, 188, 316, 319, 368 Expiration, 319, 356 Expiratory, 92, 319 External-beam radiation, 319, 332, 354, 371 Extracellular, 6, 30, 61, 62, 153, 179, 295, 308, 319, 320, 338, 361 Extracellular Space, 319, 338 Extremity, 131, 230, 319 Eye Infections, 292, 319 F Factor V, 8, 24, 319 Family Planning, 219, 269, 319 Fatigue, 106, 199, 319, 325 Fatty acids, 45, 80, 96, 133, 293, 313, 319, 335, 352, 360, 365, 371 Feces, 308, 319, 363 Feeding Behavior, 34, 44, 319 Fenfluramine, 169, 319 Ferritin, 76, 319 Fertilization in Vitro, 319, 350 Fetal Macrosomia, 193, 320 Fetal Monitoring, 220, 320 Fetal Movement, 43, 320 Fetoprotein, 54, 220, 320 Fetus, 226, 294, 304, 318, 320, 348, 351, 362, 363, 369 Fibrin, 300, 320, 348, 365, 366 Fibrinogen, 8, 24, 26, 320, 348, 353, 365 Fibroblasts, 320, 331 Fibroid, 185, 320, 334 Fibrosis, 8, 31, 88, 320, 358 Filtration, 157, 320, 333 Fissure, 312, 320, 350 Fluorescence, 13, 25, 180, 320 Foam Cells, 320, 371 Focus Groups, 18, 320 Fold, 16, 320, 337, 342, 343 Food Exchange, 232, 240, 320 Food Preferences, 257, 320 Foot Care, 200, 202, 207, 213, 227, 228, 229, 240, 241, 244, 320 Foot Ulcer, 202, 219, 230, 312, 321 Forearm, 67, 68, 83, 102, 108, 137, 173, 300, 321, 354
379
Free Radical Scavengers, 321, 365 Free Radicals, 117, 182, 297, 314, 321 Frontal Lobe, 321, 350 Fructosamine, 67, 241, 243, 321 Fructose, 29, 66, 183, 321, 326 Fundus, 58, 182, 321, 342 Fungus, 202, 321 G Gallbladder, 291, 299, 300, 313, 321, 326 Ganglia, 291, 321, 334, 340, 345, 364 Gangrene, 145, 173, 202, 321 Gas, 294, 302, 313, 321, 327, 341, 357, 363, 369 Gas exchange, 321, 357, 369 Gastric, 60, 84, 85, 152, 172, 177, 178, 184, 298, 303, 321, 322, 345, 351 Gastric Bypass, 60, 321 Gastric Emptying, 85, 152, 177, 178, 184, 321, 322 Gastric Inhibitory Polypeptide, 172, 322 Gastric Juices, 322, 345 Gastrin, 152, 184, 322, 327 Gastrointestinal tract, 9, 318, 320, 322, 334, 359, 367 Gastroparesis, 211, 252, 322 Gene Expression, 13, 29, 31, 45, 59, 66, 322, 361 Gene Therapy, 118, 153, 154, 292, 322 General practitioner, 101, 322 Generator, 151, 156, 322 Genetic Code, 322, 341 Genetic testing, 220, 322 Genetics, 26, 38, 139, 141, 167, 215, 224, 322 Genotype, 322, 346 Geriatric, 38, 108, 230, 322 Gestation, 5, 54, 220, 322, 345, 348, 362 Gestational, 5, 12, 42, 58, 70, 71, 79, 85, 98, 103, 104, 105, 193, 211, 213, 217, 220, 221, 222, 226, 228, 238, 240, 241, 243, 322 Gestational Age, 5, 70, 193, 322 Ginseng, 119, 124, 323 Gland, 292, 310, 323, 336, 344, 348, 352, 359, 363, 365 Glipizide, 85, 122, 134, 323 Glomerular, 52, 86, 185, 323, 333, 356 Glomeruli, 10, 52, 323 Glomerulus, 323, 340 Glucocorticoid, 37, 165, 166, 312, 323 Glucokinase, 13, 323, 326 Gluconeogenesis, 29, 183, 323 Glucose Clamp Technique, 134, 323
Glucose Intolerance, 16, 40, 57, 74, 182, 183, 312, 323 Glucose Oxidase, 155, 323 Glucose Tolerance Test, 52, 58, 134, 238, 243, 323 Glutamate, 62, 324 Glutamic Acid, 324, 326, 341, 351 Glyburide, 134, 324 Glycine, 299, 324, 341, 359 Glycogen, 28, 40, 65, 78, 151, 153, 183, 258, 324, 347 Glycogen Synthase, 40, 153, 324 Glycolysis, 62, 324 Glycoprotein, 318, 319, 320, 324, 333, 339, 365 Glycosidic, 324, 347 Glycosuria, 95, 133, 324 Glycosylation, 61, 88, 324 Gonadotropin, 56, 324 Gout, 202, 324 Governing Board, 324, 350 Grade, 97, 169, 223, 324 Graft, 11, 48, 324 Graft Rejection, 48, 324 Grafting, 109, 309, 324, 329 Granule, 146, 312, 324, 358 Granulocytes, 324, 360, 370 Growth factors, 8, 10, 324 Guanylate Cyclase, 325, 341 H Habitual, 304, 325 Half-Life, 152, 184, 325 Haploid, 325, 348 Haptens, 293, 325 Hate, 201, 204, 325 Headache, 206, 302, 325, 328, 348 Headache Disorders, 325 Health Behavior, 18, 325 Health Care Costs, 17, 42, 155, 325 Health Education, 53, 325 Health Expenditures, 325 Health Status, 43, 204, 325 Heart attack, 235, 247, 303, 325 Heart failure, 145, 149, 185, 231, 309, 325 Heartbeat, 278, 325 Hematopoietic Stem Cells, 15, 325 Hemodialysis, 227, 313, 325, 333 Hemoglobin A, 61, 241, 326 Hemoglobin C, 151, 326 Hemoglobin M, 220, 310, 326 Hemoglobinopathies, 322, 326 Hemolysis, 318, 326
380
Blood Glucose
Hemorrhage, 185, 310, 313, 315, 325, 326, 348, 363 Hepatic, 13, 34, 66, 117, 142, 144, 153, 171, 185, 192, 293, 303, 323, 326, 335 Hepatic Artery, 35, 326 Hepatocytes, 29, 35, 326 Hereditary, 147, 154, 324, 326 Heredity, 52, 213, 276, 322, 326 Heritability, 39, 326 Heterogeneity, 38, 293, 326 Hexokinase, 13, 326 Hippocampus, 6, 40, 312, 326, 334, 363 Histology, 25, 52, 62, 327 Holidays, 210, 217, 224, 327 Homeostasis, 22, 29, 59, 66, 98, 125, 153, 198, 327, 361 Homogeneous, 82, 187, 298, 327 Homologous, 27, 41, 293, 310, 322, 327, 359, 364 Hormonal, 12, 17, 29, 40, 144, 241, 327 Hormone Replacement Therapy, 213, 327 Human growth hormone, 9, 327 Humoral, 324, 327 Hybridomas, 327, 331 Hydra, 327, 332 Hydrogel, 32, 327 Hydrogen, 19, 165, 291, 299, 302, 311, 312, 323, 327, 335, 339, 341, 343, 346, 353 Hydrogen Peroxide, 19, 323, 327, 335 Hydrolysis, 29, 146, 169, 327, 335, 347, 349, 353 Hydrophilic, 135, 159, 169, 312, 327 Hydrophobic, 159, 312, 327, 335 Hydroxylysine, 307, 327 Hydroxyproline, 307, 327 Hygienic, 328, 360 Hyperbilirubinemia, 193, 328, 332 Hypercholesterolemia, 133, 164, 165, 169, 315, 328 Hyperglycaemia, 91, 95, 110, 153, 328 Hyperglycemic Hyperosmolar Nonketotic Coma, 241, 328 Hyperlipidemia, 167, 229, 315, 328 Hypersensitivity, 328, 334, 357 Hypertension, Pulmonary, 185, 328 Hypertension, Renal, 240, 328 Hypertension, Renovascular, 328 Hypertriglyceridemia, 315, 328 Hypertrophy, 185, 309, 328, 367 Hyperuricemia, 324, 328 Hypnotherapy, 212, 328 Hypoglycaemia, 68, 72, 102, 105, 328
Hypoglycemic Agents, 216, 220, 230, 234, 237, 244, 328 Hypopituitarism, 199, 328 Hypotension, 230, 309, 328 Hypothalamic, 40, 328, 361 Hypothalamus, 10, 17, 30, 131, 179, 299, 328, 329, 334, 348, 365 Hypothermia, 328, 329 Hypoxia, 35, 329 Hysterotomy, 304, 329 I Iatrogenic, 36, 329 Ice Cream, 233, 329 Ileum, 329, 332 Illusion, 98, 329 Immune response, 159, 224, 296, 298, 310, 324, 325, 329, 363, 370 Immune system, 199, 298, 300, 329, 334, 369, 370 Immunization, 329, 351 Immunogenic, 329, 335 Immunohistochemistry, 8, 329 Immunologic, 304, 322, 329, 355 Immunology, 293, 329 Immunosuppressant, 37, 329 Immunosuppressive, 48, 323, 329 Impairment, 41, 45, 106, 299, 319, 329, 337 Implant radiation, 329, 331, 332, 354, 371 Implantation, 15, 31, 133, 159, 308, 329 Impotence, 187, 211, 213, 318, 329 In situ, 46, 329 In vitro, 13, 15, 20, 21, 25, 31, 32, 39, 51, 61, 132, 150, 171, 177, 182, 316, 322, 330, 366 Incision, 329, 330, 331, 354 Incontinence, 185, 330 Incubated, 30, 330 Induction, 56, 72, 179, 330 Infant Food, 245, 330 Infant, Newborn, 293, 330 Infarction, 20, 76, 328, 330 Infertility, 45, 330 Infiltration, 171, 330 Infuse, 330 Infusion, 62, 99, 163, 189, 190, 239, 301, 323, 330, 331 Infusion Pumps, 190, 330 Ingestion, 17, 22, 73, 125, 143, 144, 178, 323, 330, 331, 349 Initiation, 71, 171, 330, 351, 366 Inotropic, 298, 314, 330 Insight, 62, 330 Insulin Infusion Systems, 330, 331
381
Insulin-dependent diabetes mellitus, 9, 17, 48, 84, 96, 135, 153, 154, 156, 167, 234, 241, 258, 331 Insulin-like, 22, 64, 331 Intensive Care, 43, 74, 75, 77, 331 Interleukin-6, 60, 331 Intermittent, 138, 331, 346 Internal radiation, 331, 332, 354, 371 Interstitial, 30, 37, 74, 100, 106, 136, 147, 185, 301, 319, 331, 332, 340, 356, 371 Intestinal, 21, 119, 171, 206, 303, 323, 331 Intestine, 178, 299, 301, 331, 333 Intracellular, 31, 41, 62, 180, 302, 330, 331, 341, 350, 352, 360 Intramuscular, 331, 344 Intraperitoneal, 48, 179, 331 Intravenous, 30, 52, 92, 301, 330, 331, 344 Intrinsic, 24, 30, 293, 299, 331 Invertebrates, 323, 331 Involuntary, 331, 340, 347, 361 Ion Exchange, 331 Ions, 299, 305, 314, 315, 327, 331, 353, 358 Iris, 309, 332, 354 Irradiation, 107, 332, 371 Ischemia, 20, 35, 126, 311, 332, 348 Ischemic stroke, 20, 332 Isoenzyme, 326, 332 J Jaundice, 328, 332 Jejunum, 178, 321, 332 Jellyfish, 13, 332 K Karyotype, 294, 332 Kb, 268, 332 Keratin, 332 Keratinocytes, 154, 332 Ketoacidosis, 33, 133, 188, 205, 210, 213, 216, 229, 230, 244, 246, 291, 332, 333 Ketone Bodies, 133, 291, 313, 332, 333 Ketosis, 138, 313, 328, 332, 333 Kidney Failure, 7, 42, 138, 145, 158, 242, 253, 317, 333 Kidney Failure, Acute, 333 Kidney Failure, Chronic, 333 Kidney stone, 333, 368 Kinetics, 62, 86, 135, 333 L Labile, 307, 319, 333 Labor Onset, 155, 333 Lag, 42, 209, 333 Laminin, 299, 333 Large Intestine, 313, 331, 333, 355, 360
Larynx, 333, 366, 369 Latent, 76, 333, 350 Leiomyoma, 320, 334, 360 Length of Stay, 109, 334 Lens, 73, 173, 297, 303, 334, 370 Leprosy, 321, 334 Leptin, 26, 27, 30, 44, 47, 61, 64, 334 Lesion, 309, 321, 334, 335, 365 Leukemia, 322, 334 Leukotrienes, 171, 297, 334 Life Change Events, 24, 334 Life cycle, 199, 214, 300, 334 Ligament, 144, 192, 334, 352 Ligation, 29, 334 Limbic, 295, 334, 350 Limbic System, 295, 334, 350 Linear Models, 12, 334, 356 Linkage, 26, 27, 52, 334 Lipid A, 133, 335 Lipid Peroxidation, 335, 343 Lipid Peroxides, 24, 335 Lipolysis, 51, 335 Lipopolysaccharides, 335 Lipoprotein, 8, 14, 47, 51, 54, 109, 199, 315, 335 Liposome, 154, 335 Liver Cirrhosis, 185, 335 Liver scan, 335, 358 Lobe, 327, 335 Localization, 25, 329, 335 Localized, 37, 96, 312, 316, 330, 333, 335, 343, 348 Locomotion, 335, 348 Longitudinal Studies, 310, 335 Loop, 41, 43, 74, 131, 178, 321, 331, 335 Low-density lipoprotein, 315, 335 Lumbar, 41, 299, 335, 362 Lumbar puncture, 41, 335, 362 Lymph, 299, 304, 306, 310, 316, 336 Lymph node, 299, 304, 336 Lymphatic, 316, 330, 336, 337 Lymphocytes, 118, 296, 327, 329, 336, 370 Lymphoid, 296, 310, 336 Lysine, 326, 327, 336 M Macronutrients, 55, 57, 210, 336 Magnetic Resonance Imaging, 10, 61, 62, 336, 358 Magnetic Resonance Spectroscopy, 62, 336 Malignancy, 291, 336 Malnutrition, 45, 293, 336
382
Blood Glucose
Mammary, 309, 336 Mandible, 294, 305, 336, 356 Manifest, 16, 208, 336 Mannans, 321, 336 Mazindol, 169, 336 Meat, 208, 222, 277, 313, 336 Meat Products, 313, 336 Meatus, 336, 368, 369 Medial, 40, 298, 337, 342 Mediate, 35, 41, 314, 337 Mediator, 155, 337, 359 Medical Records, 58, 337 Medical Staff, 42, 337 Medicament, 178, 183, 337 MEDLINE, 269, 337 Melanin, 147, 151, 332, 337, 347, 368 Melanocytes, 337 Melanoma, 62, 337 Melanosis, 291, 337 Memory, 4, 5, 6, 40, 155, 168, 191, 251, 277, 296, 337 Meninges, 304, 310, 337 Menopause, 197, 199, 213, 337, 350, 352 Menstrual Cycle, 199, 200, 213, 337 Menstruation, 294, 311, 337, 342 Mental Disorders, 337, 351, 353 Mental Health, iv, 6, 243, 268, 270, 337, 351, 353 Mental Processes, 314, 337, 353 Mesenchymal, 15, 337 Mesenteric, 337, 349 Metabolic acidosis, 313, 338 Metabolic disorder, 134, 135, 139, 167, 186, 187, 312, 324, 338 Metastatic, 328, 338 Methacrylate, 159, 338 Microbe, 338, 366 Microbiology, 291, 338 Microcirculation, 335, 338, 348 Microdialysis, 30, 51, 75, 338 Microorganism, 306, 338, 370 Microscopy, 25, 42, 63, 299, 338 Middle Cerebral Artery, 20, 338 Milligram, 221, 338 Milliliter, 301, 338 Mitochondria, 151, 338 Mitosis, 297, 338, 361 Mobility, 137, 239, 338 Mobilization, 28, 338 Modeling, 11, 17, 38, 149, 174, 338 Modification, 9, 34, 47, 59, 178, 200, 225, 338, 354
Modulator, 17, 29, 338 Monitor, 22, 28, 30, 42, 43, 47, 59, 67, 77, 86, 87, 104, 108, 131, 132, 133, 149, 151, 155, 157, 158, 163, 172, 189, 191, 213, 221, 223, 225, 230, 235, 242, 277, 278, 310, 339, 341 Monoamine, 294, 312, 339 Monoclonal, 327, 332, 339, 354, 371 Monocytes, 320, 331, 339 Monounsaturated fat, 56, 339 Morphological, 316, 321, 337, 339 Morphology, 9, 20, 303, 339 Motility, 177, 178, 211, 322, 339, 351, 359 Motion Sickness, 339, 340 Motor Activity, 83, 309, 339 Mucins, 339, 358 Mucolytic, 133, 339 Mucosa, 90, 152, 184, 339 Mucus, 339 Muscle Contraction, 339, 358 Music Therapy, 212, 339 Mutagenesis, 10, 339 Mutagens, 339 Mydriatic, 313, 339 Myocardial infarction, 65, 68, 91, 96, 106, 185, 230, 310, 339, 340, 352 Myocardial Ischemia, 295, 309, 340 Myocardium, 295, 339, 340 Myofibrils, 302, 340 N Nausea, 206, 322, 333, 340, 368 Necrosis, 297, 330, 339, 340, 348 Neonatal, 5, 43, 71, 76, 97, 99, 100, 104, 105, 193, 220, 230, 340 Nephritis, 185, 340 Nephropathy, 10, 52, 58, 61, 103, 160, 176, 185, 197, 198, 207, 211, 212, 213, 214, 216, 219, 229, 230, 241, 243, 333, 340 Nerve Fibers, 131, 340 Nervous System, 30, 41, 131, 222, 291, 292, 294, 298, 302, 304, 306, 312, 321, 324, 334, 337, 340, 341, 342, 345, 359, 364 Nervousness, 278, 340 Networks, 159, 174, 340 Neural, 17, 28, 34, 193, 292, 295, 316, 320, 327, 340 Neural tube defects, 193, 320, 340 Neuroendocrine, 30, 37, 41, 340 Neuronal, 10, 17, 28, 340 Neurons, 10, 20, 28, 30, 34, 306, 311, 312, 318, 321, 340, 364 Neuropeptide, 178, 340
383
Neurophysiology, 312, 341 Neurosis, 97, 341, 347 Neurosurgery, 20, 79, 341 Neurotransmitter, 71, 291, 292, 301, 314, 324, 341, 360, 363 Neutrons, 294, 332, 341, 354 Nitric Oxide, 27, 46, 167, 341 Nitrogen, 29, 293, 333, 341, 367 Norepinephrine, 126, 292, 314, 341 Nuclear, 19, 25, 51, 54, 316, 318, 334, 340, 341, 365 Nuclei, 294, 295, 315, 322, 334, 336, 338, 341, 342, 353 Nucleic acid, 172, 179, 322, 339, 341 Nucleus, 297, 305, 311, 312, 316, 318, 336, 339, 341, 350, 353, 361 Nutrition Assessment, 198, 203, 239, 341 Nutritional Status, 214, 239, 258, 341 O Observational study, 14, 44, 65, 84, 342 Ocular, 160, 166, 230, 342 Ointments, 342, 360 Oligomenorrhea, 342, 349 Oliguria, 333, 342 Omentum, 326, 342 On-line, 19, 98, 289, 342 Opacity, 303, 342 Operon, 342, 351, 356 Ophthalmic, 77, 238, 342 Opsin, 342, 357 Optic Chiasm, 329, 342, 348 Optic Disk, 313, 342 Optic Nerve, 342, 357 Oral Health, 197, 224, 342 Organ Culture, 342, 366 Organizational Culture, 217, 342 Orthotic Devices, 202, 343 Osmotic, 293, 343 Osteoarthritis, 144, 170, 171, 185, 192, 343 Osteomyelitis, 202, 343 Osteoporosis, 199, 343 Outpatient, 58, 241, 343 Ovaries, 343, 349, 359 Overexpress, 31, 343 Overweight, 48, 57, 60, 114, 144, 169, 192, 219, 232, 247, 343 Ovulation, 56, 296, 306, 343, 358 Ovum, 311, 322, 334, 343 Oxidation, 31, 51, 291, 297, 313, 326, 335, 343 Oxidative metabolism, 62, 292, 334, 343 Oxidative Stress, 19, 31, 343
Oximetry, 151, 343 Oxygen Consumption, 319, 343, 356 Oxygenation, 151, 343 P Pacemaker, 344 Palliative, 344, 365 Palpation, 320, 344 Pancreas, 13, 15, 21, 37, 48, 53, 111, 134, 145, 147, 149, 154, 156, 162, 176, 177, 212, 232, 233, 242, 243, 253, 291, 300, 313, 326, 331, 344, 351, 359, 362, 367 Pancreas Transplant, 242, 253, 344 Pancreas Transplantation, 242, 253, 344 Pancreatic cancer, 16, 344 Pancreatitis, 87, 344 Paralysis, 132, 344 Parenteral, 9, 96, 142, 239, 317, 344 Parenteral Nutrition, 239, 344 Paroxysmal, 295, 325, 344 Particle, 9, 335, 344, 361, 367 Patch, 42, 344, 367 Pathologic, 187, 291, 297, 300, 309, 328, 344, 356 Pathologic Processes, 297, 344 Pathologist, 54, 344 Pathophysiology, 26, 45, 203, 207, 214, 215, 344 Patient Care Team, 201, 226, 231, 243, 344 Patient Compliance, 25, 345 Patient Education, 5, 58, 201, 215, 224, 226, 238, 253, 274, 278, 284, 286, 290, 345 Patient Participation, 243, 345 Patient Satisfaction, 79, 345 Patient Selection, 201, 345 Pedigree, 26, 52, 345 Pelvis, 291, 333, 335, 343, 345, 369 Penicillin, 296, 345 Pepsin, 345, 359 Peptic, 185, 345 Peptic Ulcer, 185, 345 Perennial, 345, 367 Perfusion, 321, 323, 329, 345 Perinatal, 42, 54, 193, 221, 345 Perineal, 144, 192, 345 Perineum, 345 Periodontal disease, 106, 222, 225, 294, 345 Periodontitis, 224, 345 Peripheral blood, 15, 345 Peripheral Nervous System, 317, 341, 345, 363 Peripheral Neuropathy, 106, 145, 173, 197, 202, 242, 253, 346
384
Blood Glucose
Peripheral Vascular Disease, 42, 58, 154, 197, 230, 346 Peritoneal, 72, 109, 227, 331, 346 Peritoneal Cavity, 331, 346 Peritoneal Dialysis, 72, 109, 227, 346 Peritoneum, 342, 346 Peroxide, 323, 346 PH, 151, 301, 346 Phagocytosis, 46, 346 Pharmaceutical Preparations, 178, 318, 346, 352 Pharmacist, 245, 346 Pharmacodynamic, 7, 346 Pharmacokinetic, 7, 346 Pharmacologic, 29, 44, 207, 214, 228, 295, 325, 346, 366 Pharynx, 346, 369 Phenotype, 8, 25, 40, 52, 346 Phenylalanine, 158, 175, 346, 368 Phobia, 233, 347 Phobic Disorders, 347 Phosphodiesterase, 167, 347 Phospholipases, 347, 360 Phospholipids, 319, 335, 347 Phosphorus, 227, 302, 347 Phosphorylase, 65, 78, 153, 302, 347 Phosphorylated, 40, 347 Phosphorylation, 25, 40, 179, 347 Photocoagulation, 306, 347 Photoreceptor, 347, 357 Physical Examination, 16, 212, 322, 347 Physicochemical, 9, 299, 347 Physiologic, 27, 33, 37, 43, 44, 47, 293, 300, 313, 320, 325, 337, 347, 352, 355, 356 Physiology, 13, 37, 60, 66, 67, 72, 79, 98, 191, 198, 212, 227, 229, 244, 341, 347 Pigment, 182, 300, 337, 347 Piloerection, 328, 347 Pilot study, 8, 50, 52, 63, 74, 98, 105, 106, 348 Pituitary Apoplexy, 328, 348 Pituitary Gland, 144, 328, 348, 359 Pituitary Neoplasms, 328, 348 Placenta, 54, 187, 348 Plana, 348, 359 Plants, 13, 293, 302, 306, 323, 339, 341, 348, 366, 367 Plasma cells, 296, 348 Plasma protein, 293, 316, 348, 353 Plasmid, 171, 348, 369 Plasmin, 348, 366 Plasminogen Activator Inhibitor 1, 24, 348
Plasminogen Activators, 348 Plasticity, 326, 348 Platelet Activation, 349, 360 Platelet Aggregation, 295, 341, 349, 365 Platelets, 302, 341, 349, 359 Pneumonia, 185, 309, 349 Poisoning, 340, 349 Polycystic, 56, 167, 191, 349 Polycystic Ovary Syndrome, 56, 167, 191, 349 Polydipsia, 131, 349 Polyethylene, 9, 349 Polymerase, 349, 351, 356 Polymers, 135, 349, 353, 363 Polymorphic, 26, 312, 349 Polyp, 52, 349 Polypeptide, 152, 177, 184, 186, 294, 307, 320, 322, 348, 349, 353, 371 Polyphagia, 131, 349 Polysaccharide, 148, 297, 349, 353 Polyurethanes, 8, 349 Polyuria, 131, 349 Portal Vein, 35, 349 Posterior, 295, 299, 305, 332, 344, 349 Postmenopausal, 51, 56, 343, 350 Postnatal, 70, 350, 362 Postoperative, 61, 109, 350 Postprandial, 34, 77, 88, 94, 100, 102, 105, 110, 119, 120, 144, 164, 165, 192, 257, 350 Postprandial Blood Glucose, 34, 77, 88, 94, 100, 102, 119, 120, 144, 164, 165, 192, 257, 350 Postsynaptic, 350, 360 Post-translational, 178, 350 Postural, 230, 350 Potassium, 27, 137, 227, 293, 350, 360 Potentiation, 350, 360 Practice Guidelines, 219, 270, 279, 350 Preclinical, 13, 350 Precursor, 152, 296, 297, 314, 315, 316, 317, 341, 346, 350, 351, 353, 367, 368 Predisposition, 36, 144, 350 Preeclampsia, 185, 350 Prefrontal Cortex, 7, 350 Pregnancy in Diabetics, 312, 350 Pregnancy Outcome, 5, 43, 95, 350 Pregnancy Tests, 322, 350 Premenopausal, 56, 61, 350 Prenatal, 5, 43, 316, 351 Preoperative, 77, 351 Presynaptic, 341, 351
385
Prevalence, 34, 53, 57, 67, 82, 96, 134, 160, 351 Primary endpoint, 34, 46, 351 Primary Prevention, 46, 57, 193, 351 Probe, 17, 338, 351 Problem Solving, 210, 212, 234, 351 Prodrug, 351 Progeny, 27, 351 Proglumide, 178, 351 Prognostic factor, 351, 364 Progression, 3, 17, 24, 31, 36, 42, 52, 70, 103, 165, 171, 188, 204, 225, 247, 296, 351 Progressive, 15, 16, 61, 212, 298, 303, 305, 315, 318, 333, 340, 343, 349, 351, 356 Proinsulin, 45, 142, 351, 354 Projection, 311, 341, 342, 350, 351 Proliferative Retinopathy, 35, 351 Proline, 307, 327, 351 Promoter, 29, 45, 59, 154, 171, 351 Promotor, 351, 357 Prone, 32, 352 Prophylaxis, 191, 352, 357 Proportional Hazards Models, 59, 352 Propranolol, 298, 352 Propylene Glycol, 146, 169, 352 Prospective study, 81, 352 Prostaglandin, 24, 51, 352, 365 Prostaglandins A, 352 Prostate, 300, 352, 367 Protease, 307, 352, 366 Protein C, 173, 293, 294, 297, 306, 319, 332, 335, 352, 368 Protein Conformation, 294, 332, 352 Protein S, 19, 61, 142, 145, 153, 300, 322, 327, 353, 358 Proteinuria, 52, 350, 353 Proteoglycans, 299, 353 Proteolytic, 178, 294, 307, 320, 348, 353, 366 Prothrombin, 168, 319, 353, 365 Prothrombin Time, 168, 353 Protocol, 5, 17, 23, 46, 56, 58, 353 Protons, 294, 327, 336, 353, 354 Proximal, 178, 314, 321, 351, 353 Psychiatric, 35, 50, 63, 229, 337, 353 Psychiatry, 17, 28, 40, 95, 353, 363 Psychic, 337, 341, 353, 359 Psychology, 6, 19, 71, 96, 314, 353 Psychotomimetic, 294, 312, 353 Psyllium, 124, 353 Puberty, 44, 199, 353 Public Health, 34, 50, 229, 270, 307, 353
Public Policy, 269, 353 Publishing, 3, 65, 77, 204, 205, 206, 213, 215, 221, 229, 232, 238, 244, 245, 353 Pulmonary, 185, 300, 309, 319, 321, 328, 333, 334, 354, 369 Pulmonary Artery, 300, 354, 369 Pulmonary Circulation, 328, 354 Pulmonary Edema, 185, 333, 354 Pulmonary hypertension, 309, 354 Pulse, 53, 56, 62, 142, 151, 156, 339, 343, 354 Punctures, 150, 182, 354 Pupil, 182, 309, 313, 339, 354 Purified Insulins, 351, 354 Purifying, 40, 312, 354 Putrefaction, 321, 354 Pyloric Sphincter, 179, 354 Pyogenic, 343, 354 Q Quality of Life, 22, 23, 33, 38, 60, 114, 198, 212, 216, 239, 354 R Race, 24, 58, 61, 276, 332, 354 Radial Artery, 24, 354 Radiation, 162, 295, 312, 316, 319, 320, 321, 328, 331, 332, 354, 355, 358, 365, 371 Radiation therapy, 319, 331, 332, 354, 371 Radioactive, 301, 325, 327, 329, 331, 332, 335, 341, 354, 355, 358, 371 Radiography, 322, 355 Radiolabeled, 332, 354, 355, 371 Radiopharmaceutical, 322, 355 Radiotherapy, 301, 332, 354, 355, 365, 371 Random Allocation, 355 Randomization, 58, 355 Randomized, 11, 14, 15, 18, 23, 33, 34, 41, 43, 48, 49, 52, 53, 55, 57, 58, 60, 64, 100, 315, 355 Randomized clinical trial, 15, 23, 355 Reactive Oxygen Species, 19, 31, 355 Reagent, 81, 139, 140, 155, 157, 164, 175, 190, 355 Recombinant, 27, 45, 153, 154, 177, 186, 355, 369 Recombination, 27, 154, 322, 355 Rectal, 52, 355 Rectum, 297, 301, 307, 313, 321, 330, 333, 352, 355 Recurrence, 63, 355 Red blood cells, 157, 318, 356 Refer, 1, 232, 307, 314, 316, 335, 341, 356, 366, 370
386
Blood Glucose
Reflective, 154, 356 Refraction, 356, 362 Refractory, 56, 170, 315, 356 Regeneration, 149, 182, 356 Regimen, 4, 59, 102, 163, 165, 204, 215, 238, 315, 345, 356 Regression Analysis, 314, 356 Reliability, 63, 356 Remission, 355, 356 Renal Artery, 328, 356 Renal failure, 16, 185, 356 Renin, 27, 53, 296, 356 Renin-Angiotensin System, 53, 356 Repressor, 59, 342, 356 Resorption, 294, 356 Respiration, 156, 302, 339, 356, 357 Respiratory distress syndrome, 185, 193, 357 Respiratory failure, 185, 357 Response Elements, 29, 357 Resuscitation, 221, 357 Retina, 35, 150, 305, 308, 313, 334, 342, 351, 357, 358, 359, 370 Retinal, 35, 80, 105, 313, 314, 342, 357, 370 Retinoids, 357, 370 Retinol, 357 Retinopathy, 35, 46, 58, 61, 87, 160, 176, 198, 212, 216, 229, 241, 247, 313, 357 Retrospective, 19, 35, 357 Retroviral vector, 322, 357 Retrovirus, 154, 357 Reversion, 31, 357 Rheumatoid, 170, 171, 180, 185, 357 Rheumatoid arthritis, 170, 171, 180, 185, 357 Rhodopsin, 150, 342, 357 Rhythm Method, 220, 358 Ribose, 292, 358 Ribosome, 358, 367 Rigidity, 348, 358 Risk factor, 8, 16, 24, 25, 26, 28, 33, 34, 39, 54, 55, 58, 60, 70, 82, 86, 100, 106, 131, 165, 182, 197, 199, 211, 212, 213, 219, 221, 224, 258, 276, 352, 358 Risk patient, 58, 358 Rod, 306, 347, 358 Rosiglitazone, 41, 51, 166, 192, 262, 358 Rubber, 315, 358 Ryanodine, 25, 358 S Saline, 8, 358 Saliva, 130, 154, 155, 158, 175, 358
Salivary, 313, 344, 358 Salivary glands, 313, 358 Saphenous, 309, 358 Saphenous Vein, 309, 358 Sarcoplasmic Reticulum, 24, 358 Satiation, 18, 57, 358 Scans, 149, 358 Sclerosis, 298, 358 Screening, 16, 46, 52, 58, 85, 93, 98, 103, 199, 220, 222, 306, 358 Secretin, 152, 184, 359 Secretion, 22, 28, 31, 37, 40, 41, 44, 45, 66, 131, 135, 139, 142, 152, 167, 171, 176, 178, 184, 186, 188, 198, 229, 292, 322, 328, 331, 339, 351, 359 Secretory, 56, 151, 192, 328, 359 Sedentary, 48, 61, 144, 359 Segregation, 355, 359 Seizures, 135, 206, 344, 359 Sella, 348, 359 Sella Turcica, 348, 359 Senile, 343, 359 Sensor, 7, 13, 25, 31, 37, 44, 46, 63, 77, 81, 83, 106, 132, 138, 141, 163, 164, 173, 177, 190, 251, 331, 359 Sepsis, 29, 95, 338, 359 Sequencing, 40, 359 Serine, 359, 366 Serotonin, 319, 341, 359, 367 Serous, 316, 359 Serrata, 122, 305, 359 Serrated, 359 Sex Characteristics, 292, 353, 359 Sharpness, 360, 370 Shock, 29, 360, 367 Side effect, 137, 148, 162, 165, 233, 241, 261, 292, 300, 328, 336, 360, 366 Signal Transduction, 19, 180, 360 Signs and Symptoms, 210, 212, 225, 356, 360, 368 Skeletal, 40, 61, 144, 192, 306, 312, 340, 358, 360, 361 Skeleton, 291, 352, 360 Skin Care, 229, 239, 360 Skull, 310, 316, 340, 360, 364 Small intestine, 21, 305, 315, 327, 329, 331, 332, 354, 360 Smooth muscle, 19, 24, 295, 302, 320, 334, 356, 360, 361, 363 Smooth Muscle Tumor, 320, 360 Soaps, 360 Social Environment, 354, 360
387
Social Support, 52, 243, 360, 363 Socialization, 224, 361 Sodium, 27, 61, 137, 203, 217, 220, 225, 227, 293, 324, 360, 361, 364 Soft tissue, 165, 301, 360, 361 Solitary Nucleus, 299, 361 Solvent, 291, 318, 343, 352, 361 Somatic, 292, 327, 334, 338, 345, 346, 350, 361, 369 Somatotropin, 328, 361 Sorbitol, 326, 361 Sound wave, 356, 361 Spasm, 185, 361 Spatial disorientation, 314, 361 Specialist, 199, 238, 280, 313, 361 Species, 31, 178, 294, 304, 312, 317, 332, 338, 339, 354, 355, 361, 363, 367, 370, 371 Specificity, 13, 29, 41, 45, 105, 154, 293, 361 Spectrometer, 39, 137, 138, 151, 362 Spectrophotometry, 146, 362 Spectroscopic, 37, 146, 147, 151, 336, 362 Spectrum, 151, 154, 229, 278, 362 Sperm, 305, 362 Spina bifida, 340, 362 Spinal cord, 301, 304, 305, 337, 340, 341, 345, 362, 364 Spinal tap, 335, 362 Spinous, 317, 332, 362 Splenic Vein, 349, 362 Spontaneous Abortion, 350, 362 Sporadic, 16, 362 Staging, 358, 362 Steady state, 62, 146, 169, 362 Steel, 109, 306, 362 Stem Cells, 15, 21, 318, 362 Sterility, 330, 362 Sterilization, 220, 362 Steroid, 299, 310, 362 Stillbirth, 350, 363 Stimulant, 294, 302, 312, 363 Stimulus, 156, 182, 314, 315, 318, 333, 347, 363, 365 Stool, 307, 330, 333, 363 Stress, 19, 28, 31, 44, 53, 99, 126, 199, 205, 211, 212, 213, 215, 226, 229, 233, 242, 243, 245, 246, 257, 275, 276, 299, 310, 340, 343, 350, 357, 358, 363 Stress management, 213, 243, 245, 363 Striatum, 7, 363 Stupor, 36, 363 Styrene, 358, 363 Subacute, 330, 363
Subarachnoid, 185, 325, 363 Subclinical, 24, 330, 359, 363 Subcutaneous, 9, 33, 46, 75, 80, 81, 106, 132, 163, 177, 292, 315, 334, 344, 363 Subiculum, 326, 363 Subspecies, 361, 363 Substance P, 359, 363 Substrate, 34, 157, 363 Suction, 136, 320, 363 Supplementation, 61, 95, 119, 220, 258, 363 Support group, 200, 244, 363 Suppression, 22, 44, 364 Survival Analysis, 11, 352, 364 Sweat, 312, 328, 364 Sympathetic Nervous System, 298, 341, 364 Sympathomimetic, 294, 312, 314, 317, 341, 364 Symptomatic, 312, 344, 350, 364 Synapse, 292, 351, 364, 367 Synaptic, 341, 360, 364 Systemic, 76, 86, 224, 262, 297, 300, 317, 330, 332, 354, 364, 367, 371 Systolic, 135, 328, 364 Systolic blood pressure, 135, 364 T Telecommunications, 131, 364 Telomere, 27, 364 Temporal, 17, 40, 150, 295, 325, 326, 336, 364 Temporal Lobe, 295, 364 Teratogenic, 313, 364 Terminator, 306, 364 Testimonials, 251, 364 Thalamus, 334, 350, 365 Therapeutics, 7, 68, 69, 70, 74, 75, 76, 79, 83, 93, 96, 97, 98, 103, 106, 108, 135, 139, 263, 365 Thermal, 22, 137, 314, 341, 365 Thigh, 102, 365 Thiourea, 167, 365 Third Ventricle, 329, 365 Thoracic, 299, 365, 371 Thought Field Therapy, 212, 365 Threonine, 153, 359, 365 Threshold, 16, 30, 36, 72, 318, 328, 365 Thrombin, 319, 320, 349, 352, 353, 365 Thromboembolism, 330, 365 Thrombomodulin, 352, 365 Thromboplastin, 353, 365 Thrombosis, 10, 46, 54, 353, 363, 365 Thromboxanes, 297, 365
388
Blood Glucose
Thyroid, 70, 144, 199, 365, 368 Thyroxine, 293, 347, 365 Tissue Culture, 172, 366, 370 Tissue Plasminogen Activator, 20, 366 Tolazamide, 134, 366 Tolerance, 11, 28, 41, 46, 58, 131, 135, 139, 146, 147, 152, 160, 170, 184, 187, 211, 213, 289, 291, 312, 323, 350, 366 Tomography, 41, 98, 105, 308, 336, 366 Tooth Preparation, 291, 366 Topical, 229, 318, 327, 360, 366 Torsion, 330, 366 Toxaemia, 350, 366 Toxic, iv, 12, 141, 188, 335, 336, 340, 363, 366 Toxicity, 31, 45, 315, 366 Toxicology, 270, 366 Toxin, 317, 366 Trace element, 133, 305, 366 Trachea, 302, 333, 346, 365, 366 Traction, 306, 366 Transcriptase, 357, 366 Transcription Factors, 19, 357, 366 Transcutaneous, 163, 366 Transdermal, 136, 366, 367 Transduction, 179, 360, 367 Transfection, 19, 300, 322, 367 Transferases, 324, 367 Translating, 18, 367 Translation, 50, 218, 367 Translational, 45, 56, 367 Transmitter, 291, 314, 337, 341, 367 Transplantation, 37, 103, 111, 241, 242, 243, 253, 305, 316, 329, 333, 367 Transposase, 154, 367 Trauma, 5, 7, 31, 96, 340, 344, 367 Trees, 174, 358, 367 Tricuspid Atresia, 309, 367 Triglyceride, 64, 135, 137, 139, 179, 221, 307, 328, 367 Troglitazone, 166, 367 Trophic, 131, 367 Tryptophan, 307, 359, 367 Tumor marker, 300, 367 Tunica, 339, 367 Tympanic membrane, 22, 368 Tyrosine, 24, 303, 314, 368 U Ulceration, 311, 345, 368 Ultrasonography, 220, 322, 368 Uraemia, 344, 368 Urea, 167, 333, 364, 368
Uremia, 333, 356, 368 Ureters, 333, 356, 368 Urethra, 352, 368 Uric, 137, 324, 328, 368 Urinary, 8, 46, 56, 98, 139, 185, 194, 206, 209, 302, 330, 342, 349, 366, 368 Urinary tract, 194, 209, 368 Urinary tract infection, 194, 368 Urinate, 368, 370 Urine Testing, 211, 229, 368 Urokinase, 348, 369 Uterine Contraction, 333, 369 Uterus, 294, 304, 311, 316, 320, 321, 329, 334, 337, 343, 369 V Vaccine, 353, 369 Vagal, 131, 369 Vagina, 304, 329, 337, 369 Vaginal, 54, 209, 369 Vaginosis, 54, 369 Vagotomy, 131, 369 Vagus Nerve, 35, 131, 179, 361, 369 Vascular, 10, 19, 24, 54, 62, 117, 305, 312, 316, 317, 325, 330, 335, 338, 341, 348, 369 Vasculitis, 344, 369 Vasoactive, 171, 369 Vasoconstriction, 185, 317, 369 Vasodilators, 341, 369 VE, 80, 92, 369 Vector, 132, 153, 154, 367, 369 Vein, 10, 35, 331, 341, 349, 358, 362, 369 Venom, 152, 369 Venous, 33, 63, 72, 74, 80, 106, 353, 367, 369 Venous blood, 74, 80, 106, 369 Venter, 369 Ventral, 30, 329, 369 Ventricle, 295, 298, 309, 326, 354, 364, 365, 367, 369 Ventricular, 309, 367, 369 Venules, 301, 302, 316, 338, 369 Vestibular, 170, 370 Vestibule, 370 Veterinarians, 144, 192, 370 Veterinary Medicine, 269, 370 Vimentin, 25, 370 Viral, 141, 154, 357, 367, 370 Virulence, 298, 366, 370 Virus, 154, 304, 317, 357, 367, 370 Visceral, 299, 334, 346, 369, 370 Visceral Afferents, 299, 369, 370 Viscosity, 88, 141, 148, 370
389
Visual Acuity, 182, 370 Visually Impaired Persons, 207, 370 Vitamin A, 203, 220, 357, 370 Vitreous, 313, 334, 357, 370 Vitreous Body, 357, 370 Vitro, 15, 20, 21, 171, 370 Vivo, 10, 15, 17, 19, 20, 21, 25, 31, 39, 46, 59, 65, 66, 78, 80, 95, 132, 141, 150, 171, 180, 181, 182, 186, 322, 330, 335, 338, 365, 370 Void, 26, 370 Voltage-gated, 37, 370 W Warts, 202, 370
White blood cell, 296, 330, 336, 339, 348, 370 Windpipe, 346, 365, 370 Wound Healing, 27, 46, 61, 371 X Xanthomatosis, 165, 371 Xenograft, 48, 296, 371 X-ray, 47, 301, 308, 312, 320, 332, 341, 354, 355, 358, 371 X-ray therapy, 332, 371 Y Yeasts, 321, 346, 371 Z Zymogen, 352, 371
390
Blood Glucose
391
392
Blood Glucose
