A comparison of acarbose versus metformin as an adjuvant therapy in sulfonylurea-treated NIDDM patients.

OBJECTIVE: To compare the effects of acarbose or metformin treatment used as an adjunct with a sulfonylurea agent in the treatment of NIDDM not adequately controlled with the use of a sulfonylurea agent alone. RESEARCH DESIGN AND METHODS: Of the poorly controlled female NIDDM patients on sulfonylurea treatment, 18 were randomly selected from the outpatient diabetic clinic for study. For 8 weeks, they received either acarbose (300 mg/daily) or metformin (1,500 mg/daily) in addition to sulfonylurea in a crossover design using a 3-week washout period between treatments. The efficacy of each drug regimen was assessed by measuring the levels of glycosylated hemoglobin, fasting and 2-h postprandial blood glucose (PPBG) levels, cholesterol, triglyceride, and fibrinogen levels before and after 8 weeks of therapy. RESULTS: The metabolic parameters measured before initiation of either treatment regimen were similar. Mean fasting and 2-h postprandial glucose levels were reduced moderately at the end of 8 weeks of both combination treatments (P < 0.05). Although the fasting and 2-h postprandial plasma insulin and C-peptide and fibrinogen levels at the end of the 8-week treatment periods were lower than those obtained at the beginning of the study, the differences between these values were not statistically significant. Cholesterol levels remained unchanged. Only the 2-h PPBG level in the group using acarbose plus a sulfonylurea was lower than the level achieved by the group using metformin plus a sulfonylurea (8.1 +/- 0.8 vs. 9.8 +/- 1.0 mmol/l, respectively, P < 0.05). The difference between pre- and posttreatment levels of the 2-h PPBG level in both arms of the study were statistically significant (delta-acarbose, 5.3 +/- 0.4 vs. delta-metformin, 2.9 +/- 0.3) (P < 0.05). Specific drug-associated side effects were observed in 12 patients on acarbose and 3 patients on metformin. CONCLUSIONS: Acarbose or metformin can be used as effective adjuvant therapies with a sulfonylurea agent in NIDDM patients who are poorly controlled with the sulfonylurea agent alone.

The effect of radioactive iodine treatment on thyroid C cells.

To determine the effect of radioiodine treatment on thyroid C cells, calcitonin (CT) levels were measured by RIA before and after intravenous calcium stimulation (2 mg/kg body-weight elemental calcium) in 22 women treated with 131I for hyperthyroidism. The results were compared with sex, age and weight-matched normal controls. There was a slight but statistically significant decrease in basal CT levels of the patients compared to the control group (mean +/- SE; 0.009 +/- 0.001 vs 0.011 +/- 0.001 pmol/l, P less than 0.05). The mean stimulated CT level of the patient group was significantly lower than that of the controls (0.010 +/- 0.001 vs. 0.018 +/- 0.003 pmol/l, P less than 0.001). The absence or presence of 131I-induced hypothyroidism at the time of the study did not influence basal or stimulated CT levels. Basal and stimulated CT levels were significantly lower in the patients with Graves' disease than in the patients with toxic nodular goitre. We conclude that 131I used to correct hyperthyroidism may cause marked CT deficiency.

Failure of cyproheptadine to affect calcium homoeostasis and PTH levels in primary hyperparathyroidism.

In this study we evaluated the influence of cyproheptadine treatment on serum PTH values, as well as serum Ca, Mg and P levels in patients with primary hyperparathyroidism. For this purpose, cyproheptadine was given in a dose of 4 mg orally every 4 hours during 10 consecutive days to six patients with primary hyperparathyroidism. Control fasting blood samples for PTH, Ca, Mg and P were obtained every other day for a week. Afterwards cyproheptadine treatment was applied as mentioned above. Then blood samples were taken on the 4th, 6th, and 10th day of treatment to determine serum PTH, Ca, Mg and P. Before treatment the mean PTH (+/- SE) values were 22.95 +/- 1.4 mlU/ml and during cyproheptadine treatment were 23.06 +/- 0.9, 22.95 +/- 0.8, 22.32 +/- 0.8 mlU/ml, respectively. There were no significant changes in serum PTH levels before and during treatment (P greater than 0.05). Also serum Ca, Mg and P levels remained unchanged. Our data suggest that cyproheptadine treatment does not affect calcium homoeostasis and serum PTH levels in primary hyperparathyroidism.

Urinary hydroxyproline levels in patients with prostatic carcinoma.

In this study daily urinary hydroxyproline (HOP) levels were evaluated in 26 patients with advanced prostatic cancer and 15 patients with BPH. In patients with prostatic cancer--the ones with bone metastases proved by bone scanning--urinary HOP levels were found to be 69.58 mg/l/day and in those without metastases the levels amounted to 22.55 mg/l/day. In patients with BPH, serving as controls, urinary HOP was 12.80 mg/l/day. Urinary HOP Levels in cancer patients were statistically higher than in the control group. This difference was even more significant in patients with bone metastases. The method detects small metastatic foci of low activity, therefore it may be used also in smaller centres and for effective monitoring of therapy.