Time-action profile of insulin detemir and NPH insulin in patients with type 2 diabetes from different ethnic groups.

AIM: To evaluate the time-action profiles and the dose-response relationship of the long-acting insulin analogues insulin detemir (IDet) and NPH insulin (NPH) in type 2 diabetic patients belonging to different ethnic groups. METHODS: Forty-eight type 2 diabetic patients belonging to different ethnic groups (three groups of 16 African Americans (AA), 16 Hispanics/Latinos (HL) and 16 Caucasians) participated in this double-blind crossover trial. Each patient took part in six 16-h isoglycaemic glucose clamps (clamp target 7.2 mmol/l) and was randomly allocated to three doses (0.3, 0.6 and 1.2 (I)U/kg) of IDet and NPH, respectively. RESULTS: IDet and NPH showed comparable pharmacodynamic effects [the area under the glucose infusion rate curve (AUC(GIR 0-16 h)) (mg/kg)] in the investigated dose range: IDet, 0.3 U/kg, 207 AA, 535 HL, 285 Caucasians; 0.6 U/kg, 1203 AA, 824 HL and 1126 Caucasians; 1.2 U/kg, 1502 AA, 1977 HL and 2269 Caucasians; NPH, 0.3 IU/kg, 733 AA, 1148 HL and 1148 Caucasians; 0.6 IU/kg, 1395 AA, 1976 HL and 1077 Caucasians; 1.2 IU/kg, 2452 AA, 3296 HL and 2455 Caucasians. Both IDet and NPH showed a linear dose-response relationship in all three groups (p = 0.31), without any significant differences in slope (p = 0.71) or intercept (p = 0.51). Comparable results were obtained for pharmacokinetics. CONCLUSIONS: These results confirm a linear dose-response relationship of IDet, without any relevant differences between ethnic groups. This suggests that similar dosing recommendation can be used for IDet in type 2 diabetic patients belonging to different ethnic group.

Changes in marketplace demand for physicians: a study of medical journal recruitment advertisements.

OBJECTIVE: To measure trends in marketplace demand for physicians in different specialties. METHODS: Retrospective review of physician recruitment advertisements appearing in the September issues of 7 medical journals in 1984, 1987, 1990, 1993, and 1995. MAIN OUTCOME MEASURE: Number of advertised positions in each of the studied specialties. RESULTS: Steep declines in the number of advertised positions for specialist physicians over the past 5 years were consistently observed with the exception of pediatric specialists. The most dramatic changes occurred in the number of internal medicine specialist positions, which declined by 75% since 1990. For physicians as a whole, there were 4 specialist positions for every generalist position advertised in 1990; by 1995, this ratio dropped to 1.8. Family medicine exhibited continuous growth in the number of advertised positions, more than doubling during the period studied. CONCLUSIONS: Our data suggest a recent decline in marketplace demand for physicians, particularly those in specialist fields. Among generalists, demand for internists and pediatricians is rising. Ongoing analysis of these advertisements will provide timely information about the demand for physicians in a rapidly changing health care system.