Does hyperglycaemia cause symptoms in elderly people?

The aim of the present study was to describe the associations between glucose tolerance and symptoms in an unselected non-institutionalised elderly population aged 73 years or over (n = 259, of whom 93 were men). Diabetes was assessed on the basis of self-reports and 2-h oral glucose tolerance tests (1985 WHO criteria). Symptoms were measured with a modified diabetes symptom checklist (DSC-Type 2). The previously diagnosed diabetic patients reported to have more symptoms in all the six dimensions of the symptom checklist than the other study groups. According to the responses to twenty out of 34 items, more of the previously diagnosed diabetic women had symptoms than the other female study groups; the corresponding figure for the previously diagnosed diabetic men being 16/34. The following hyperglycaemic symptoms: "dry mouth", "increasing fatigue in the course of the day", "numbness in the hands", were either weakly or significantly associated with undiagnosed diabetes. Men with IGT reported to have "dry mouth" and "tingling or pricking in the legs or feet" more often than men with NGT. Symptoms of "moodiness" increased along with the deterioration of glucose tolerance, and it seems that depression is associated with type 2 diabetes in elderly people, too. Although the study covered a wide range of symptoms, it did not clearly reveal such symptoms that could be used as potential indicators of undiagnosed diabetes or especially IGT among elderly patients.

Hormone-induced aberrations in electromagnetic adhesion signaling as a developmental factor of androgenetic alopecia.

In androgenetic alopecia, overactivation of the androgen hormone cascade in genetically predisposed persons leads to miniaturization of the dermal papilla of the hair follicle and to reduction in the number of papilla cells in the scalp, but the mechanisms explaining this miniaturization have remained unclear. According to our hypothesis, the increase of dihydrotestosterone (DHT) production in the overactive androgen state inhibits cell mitosis in the dermal papilla and contributes to the induction of programmed cell death (apoptosis). Normally, DNA molecules have a negative charge, which doubles in every cell mitosis. In the catagen and telogen phases, the sulphur-rich hair moves upwards, dehydrates and develops an increasing positive charge. In a normal hair-growth cycle, the epithelial column shortens and the secondary germ is formed and it invaginates the dermal papilla by electromagnetic attraction. In the mitotic inhibition state induced by DHT, the negative charge decreases, leading to a weakening of the electromagnetic adhesion forces and weaker electrical attraction between the undifferentiated germ cells and the dermal papilla. Insulin resistance has an additional pathogenic role in the excessive miniaturization of the hair follicle. The vasoactive substances associated with endothelial dysfunction in insulin resistance induce microcirculatory disturbance, perifollicular vasoconstriction and stimulation of smooth muscle cell proliferation in the vascular wall. This leads to microvascular insufficiency and local tissue hypoxia and progressive miniaturization of hair follicles.

Early onset of androgenetic alopecia associated with early severe coronary heart disease: a population-based, case-control study.

CONTEXT: The relationship of ischaemic heart disease (IHD) with androgenic alopecia (AGA) has been demonstrated, but no differentiation between early and late onsets of alopecia with regard to the risk and severity of IHD has been made. OBJECTIVE: To test if the early onset of alopecia is a risk factor for early severe, coronary artery disease (CAD) requiring surgery and to test if the early onset of AGA differs in this respect from the late onset of AGA. DESIGN: Population-based case-control study. SETTING AND PARTICIPANTS: All the 85 male persons living on 31 December 1999 in a Finnish town with total population of 7200, who had had a coronary revascularization procedure between March 1987 and January 1999, were drawn from the discharge register. For each case, an individually selected age-matched control person living in the same town was drawn from the official census register. MAIN OUTCOME MEASURE: Alopecia defined as grade 3 vertex or more on the alopecia classification scale of Hamilton, modified by Norwood South Med J, 68:1359-1365, 1975. RESULTS: The unadjusted odds ratio (OR) for coronary revascularization under the age of 60 years was 3.57 (95% confidence interval (CI) 1.19-10.72) in men with an early onset of AGA compared with men with normal hair status or late AGA. After multivariate adjustment for the traditional CAD risk factors, the corresponding OR was 3.18 (95% CI, 1.01-10.03). The unadjusted OR for the coronary revascularization procedure at any age was 2.14 (95% CI, 1.08-4.23) in the subgroup of the men with early AGA compared to those with late AGA or normal hair status. After adjustment for traditional risk factors this OR was 1.84, being nearly significant (95% CI, 0.90-3.77). CONCLUSION: Our results support the hypothesis that the early onset of AGA is a risk factor for an early onset of severe coronary heart disease.

Glucose tolerance and cognitive impairment in an elderly population.

We investigated the associations between abnormal glucose tolerance and cognitive impairment in elderly subjects, taking into account some other known determinants of cognitive function. The study population consisted of community-living northern Finnish subjects aged 70 y or over (n=379, of whom were 141 men). Thirty-one percent of the men and women (n=43 for the men and n=75 for the women) scored 23 or less in the Mini Mental State Examination. A low level of basic education and high age were the most powerful predictors of impaired cognition. When adjusted for age, gender, educational level, presence of cardiovascular disease (or hypertension), use of alcohol, number of depressive symptoms and poor vision, abnormal glucose tolerance (including IGT) was also weakly associated with impaired cognitive function among these elderly subjects.

Self-esteem as a characteristic of adherence to diabetes and dental self-care regimens.

BACKGROUND, AIMS: There are biological associations between diabetes control and oral infections. We have also found psychological associations between diabetes self-care and oral health behavior. The aim of this study was to evaluate whether self-esteem can determine diabetes adherence and oral health behavior, both of with require daily, persistent self-care. METHOD: Cross-sectional data on 149 IDDM patients was collected by means of a quantitative self-completed questionnaire. RESULTS: High self-esteem was found to relate to good adherence with exercise regimens (p=0.005) and adjustment of insulin doses (p=0.040). These associations were also found when standardized for socio-demographic variables and HbA1c-level. In the dental sphere, logistic regression analysis showed an association between self-esteem and frequency of tooth brushing. CONCLUSIONS: It can be concluded that self-esteem may be a common psychological factor influencing diabetes and dental self-care. Strengthening patients' self-esteem could help patients to maintain daily self-care.

Blood pressure control in subjects with type 2 diabetes.

Blood pressure (BP) control of type 2 diabetic subjects aged under 65 years was assessed in a primary care setting. In addition, the usefulness of 24-h ambulatory BP measurement (ABPM) in the treatment of hypertension was assessed in subjects with diastolic BP (DBP) > or = 90 mm Hg. Of the total 381 diabetic subjects, 260 (68%) participated in the first phase, and 48 of the 110 subjects with DBP > or = 90 mm Hg were equipped with a Meditech ABPM-02 monitor in the second phase. The mean BP of the 260 participants was 156/91 (s.d. 22/11) mm Hg. According to the WHO criteria, 58% had hypertension, and 42% had a diagnosis of hypertension. Albuminuria > or = 20 micrograms/min was detected in 32% of the subjects. Ten percent of the subjects with diagnosed hypertension had a mean BP < 140/90 mm Hg and 50% had a mean BP > or = 160/95 mm Hg, as many as 38% of those not having a diagnosis of hypertension. Only long-term poor BP control in casual measurements was associated with albuminuria (42% vs 27%, P = 0.018). It is concluded that BP control was unsatisfactory and diagnosis of hypertension was delayed in most subjects with type 2 diabetes. Occurrence of microalbuminuria was associated with poor BP control and urinary albumin excretion rate may be useful in assessing the BP control. Further studies are needed to assess the position of 24-h ABPM in the treatment of hypertension of subjects with type 2 diabetes.

Effects of the WHO 1985 criteria and the proposed new diagnostic criteria on the prevalence of diabetes in an elderly population.

Population data suggest that a fasting blood glucose level of > or = 6.1 mmol/l corresponds best to a two-hour blood glucose level of > or = 11.1 mmol/l, which is associated with an increased risk of developing microvascular complications. The proposed new criteria, and the WHO 1985 criteria for diabetes, were applied in an elderly population, which underwent a two-hour oral glucose tolerance test. The prevalence of diabetes was higher when the proposed new criteria were used than when the old criteria were used. In calculating the prevalence of diabetes, the fasting blood glucose > or = 6.1 mmol/l corresponded better to the combination of fasting and/or two-hour values than did fasting blood glucose > or = 6.7 mmol/l. The prevalence obtained by using either of these fasting values alone or in combination with two-hour values corresponded poorly to that obtained by using mere two-hour blood glucose values.

Relative weight gain and obesity as a child predict metabolic syndrome as an adult.

OBJECTIVE: To examine whether birth weight, weight gain from birth to the age of seven or body-mass index at the age of seven have any association with metabolic syndrome as an adult. DESIGN: A population study. SUBJECTS: 210 men and 218 women out of a total 712 subjects aged 36, 41 or 46 years in Pieksämäki town, Finland. MAIN OUTCOME MEASURES: Weight at birth and weight and height at the age of seven and metabolic syndrome defined as a clustering of hypertension, dyslipidemia (hypertriglyceridaemia or low high-density-lipoprotein cholesterol), and insulin resistance (inferred by abnormal glucose tolerance or hyperinsulinaemia). RESULTS: No association was found between birth weight and the metabolic syndrome as an adult. Among obese children at the age of seven (body-mass index in the highest quartile), the odds ratio (OR) for the metabolic syndrome in adulthood was 4.4 (95% CI 2.1-9.5) as compared to the other children (the three other quartiles combined). After adjustment for age, sex and current obesity, the risk of the syndrome still was 2.4 (95% CI 2.1-9.5). CONCLUSION: We could not replicate the close association between low birth weight and the metabolic syndrome in adulthood as has been shown in some earlier studies. Obesity at the age of seven predicts the metabolic syndrome in adulthood.

Hyperinsulinaemia in hypertensive subjects: validity of a test for the detection of insulin resistance in clinical practice.

OBJECTIVES: To determine the prevalence of hyperinsulinaemia in non-diabetic hypertensive subjects and to investigate the validity of a simple test for the detection of insulin resistance/hyperinsulinaemia. The test consisted of five markers: (1) obesity (body-mass index, BMI > or =30 kg/m2); (2) central adiposity (waist-to-hip ratio, WHR > or =1.00 in men and > or =0.88 in women); (3) hypertriglyceridaemia (> or =1.70 mmol/l); (4) low high-density lipoprotein (HDL) cholesterol (<1.00 mmol/l in men and <1.20 mmol/l in women); and (5) impaired glucose tolerance according to the WHO criteria. The test was defined to be positive for subjects who had simultaneously at least two of the five markers. DESIGN AND SETTING: A community-based screening programme for hypertension carried out at Pieksämäki District Health Centre, and the Community Health Centre of the City of Tampere, Finland. SUBJECTS: The 161 hypertensives who were detected by screening all subjects aged 36, 41, 46 and 51 years (n = 1148) in Pieksämäki town, and a randomly selected normotensive control group of 177 men and women aged 40 and 45 years in the City of Tampere. MAIN OUTCOME MEASURES: Hyperinsulinaemia defined by using two different cut-off points of the fasting plasma insulin (> or =13.0 mU/l and > or =18.0 mU/l). RESULTS: Hyperinsulinaemia > or =13.0 mU/l was present in 45% of hypertensive men and in 25% of hypertensive women. The sex difference was statistically significant (P < 0.01). The corresponding rates of hyperinsulinaemia > or =18.0 mU/l were 18% and 16%. The sensitivity of the test for hyperinsulinaemia > or =13.0 mU/l was 77% and specificity 73% in men, and 100% and 70% in women. The corresponding figures for hyperinsulinaemia > or =18.0 mU/l were 94% and 60% in men, and 100% and 63% in women. CONCLUSION: Our results suggest that hyperinsulinaemia/insulin resistance in hypertensives becomes identifiable by using simple measurements of BMI, WHR, serum triglycerides and HDL cholesterol as well as the oral glucose tolerance test as means.

Effect of smoking on the prevalence of insulin resistance-associated cardiovascular risk factors among Finnish men in military service.

BACKGROUND: Obesity, central obesity, hypertension, dyslipidemia and hyperinsulinemia tend to cluster in the same individuals as a metabolic syndrome; smoking has an adverse effect on insulin resistance. The aim of our study was to examine the occurrence of clusters of insulin-resistance-associated abnormalities and the effect of smoking on this clustering in young men. METHODS: In 1995 we invited all the 1268 servicemen attending military service in the Ostrobothnian Brigade, Finland, for screening of the metabolic syndrome. The first phase consisted of an interview concerning smoking and measurements of blood pressure, weight, height, waist and hip circumferences. If diastolic pressure was > 85 mmHg, body mass index > 27 or waist-to-hip ratio > 0.98, these participants were invited to blood samples for the measurements of fasting serum lipids, plasma glucose and insulin. These results were obtained from 144 screening-positive men (120%) and from their 79(7%) randomly selected controls. RESULTS: The metabolic syndrome, defined as plasma insulin > or = 13.0 mU/l and serum triglycerides > or = 1.70 mmol/l and/or total cholesterol/high-density lipoprotein cholesterol > 5.0, was present in 10% (n = 1 4) of the screening-positive participants. None of the randomly selected controls had the metabolic syndrome. The metabolic syndrome was present in 12% (n = 11) of 93 smokers and in 2% (n = 3) of 1 28 non-smokers (P= 0.004). CONCLUSIONS: We conclude that clusters of metabolic abnormalities associated with insulin resistance are already present in young men, and that the prevalence of these clusters in smokers is sixfold compared with non-smokers.

Does folk medicine work? A randomized clinical trial on patients with prolonged back pain.

OBJECTIVE: To determine whether traditional bone-setting or continuous light exercise therapy could case back pain and improve function better than ordinary physiotherapy. DESIGN: Observer-blinded, randomized clinical trial with a 6-month follow-up. SETTING: An outpatient institution for folk medicine research. PATIENTS: Of 147 back pain patients recruited from local health centers and by newspaper announcements, 132 were found eligible (non-retired-no contraindications to manipulation) and entered. A final 114 (one dropout) with back pain for longer than 7 weeks were included in this intent to treat analysis. INTERVENTIONS: Bone-setting, guidance for continuous light back movements or physiotherapy for up to ten 1-hour sessions during 6 weeks. MAIN OUTCOME MEASURES: Spinal mobility and muscular performance. Back pain assessed by visual analog scales (VAS). RESULTS: The physical measures changed only modestly, from one tenth to half of standard deviation, while the VAS was halved. The thoracolumbar side-bending, the modified Schober, and the VAS were significantly better improved by bone-setting than by exercise but not better than by physiotherapy. CONCLUSION: Neither bone-setting nor exercise differed significantly from physiotherapy, but bone-setting improved lateral and forward bending of the spine and back pain more than did exercise.

Neck and shoulder symptoms of high school students and associated psychosocial factors.

PURPOSE: The aim of this study was to describe the prevalence of neck and shoulder symptoms among high school students and associated psychosocial factors. METHODS: High school students (718) completed a questionnaire concerning neck and shoulder pain and psychosocial factors such as stress symptoms, depressive symptoms, and self-efficacy. A participant was classified into the "no disturbing symptoms" group or into the "disturbing symptoms" group according to the frequency of the neck and shoulder symptoms. The sum of mean scores of stress symptoms, depressive symptoms, and self-efficacy were compared between these groups. RESULTS: Twenty-one percent of the girls and 10% of the boys suffered from disturbing neck and shoulder symptoms. Stress symptoms and depressive symptoms were more common among the girls than the boys. For both sexes, the sum of stress scores and those of depressive symptom scores were significantly higher in the "disturbing symptoms" group than the "no disturbing symptoms" group. Among the girls, the sum of the self-efficacy scores was lower in the "disturbing symptoms" group than in the "no disturbing symptoms" group. CONCLUSIONS: Neck and shoulder symptoms are common among adolescents and psychosocial factors such as stress and depressive symptoms seem to be associated with these symptoms, especially among girls. More knowledge about the etiologic factors associated with neck and shoulder symptoms in adolescents may result in preventive programs with the potential for reducing morbidity of neck and shoulder symptoms in adulthood.

Long-term effects of guar gum and microcrystalline cellulose on glycaemic control and serum lipids in type 2 diabetes.

The effects of guar gum (GG) and microcrystalline cellulose (MC) on metabolic control and serum lipids were compared in a double-blind, cross-over trial in 18 poorly controlled Type 2 diabetic patients. There were two 12 week treatment periods separated by a 4 week wash-out period. A significant reduction in fasting BG was found after 6 weeks treatment with GG, but the initial level was regained after further 6 weeks, at the end of the treatment period. No statistically significant change in fasting BG was observed with MC. Serum cholesterol was lowered by 10% during GG treatment. Microcrystalline cellulose had no effect on serum lipids. The results suggest, that during 12 weeks supplementation with guar gum, the improvement in glycemic control was not sustained, but that it might reduce the risk of macrovascular disease in diabetic patients.