Brian Frier | University of Edinburgh (original) (raw)

Papers by Brian Frier

Clinical science. Supplement (1979), 1985

Diabetologia, Apr 1, 1980

The plasma concentration of C-peptide, insulin (IRI) and glucose was measured in 9 healthy subjec... more The plasma concentration of C-peptide, insulin (IRI) and glucose was measured in 9 healthy subjects during insulin-induced hypoglycaemia followed by a meal. Identical observations were made in the same subjects after an equivalent period of fasting without hypoglycaemia (control study). Endogenous secretion of insulin was suppressed following administration of exogenous insulin and this persisted long after the blood glucose concentration had returned to normal. After the meal the mean blood glucose rose to a peak of 8.4 + 0.3 mmol/1 (mean + SEM) at 60 min and was still raised at 7.5 + 0.3 mmol/1 at 120 min, compared with a peak value of only 5.1 + 0.2 mmol/1 at 30 rain after the meal in the control study. Following hypoglycaemia the mean plasma IRI rose from 8.3 + 1.3 mU/1 to a delayed peak of 81.6 + 12.7 mU/1 at 60 min and was 123.5 + 14 mU/1 at 120 min post-prandially, compared with a peak of 72.4 + 0.5 mU/1 at 30 min after the meal in the control study. Acute hypoglycaemia may thus induce an abnormal pattern of insulin secretion in response to a meal, with impaired carbohydrate tolerance in normal subjects.

Diabetes, Obesity and Metabolism, Jun 19, 2023

AimsTo determine the clinical characteristics, risk factors and mortality outcomes associated wit... more AimsTo determine the clinical characteristics, risk factors and mortality outcomes associated with severe hypoglycaemia (SH) treated at a hospital emergency department.Materials and MethodsAdult patients presenting with SH to the Northern General Hospital, Sheffield, UK over a 44‐month period were assessed for clinical characteristics, coexisting comorbidities and mortality outcomes, including cause of death, and analysed by age of diabetes onset, below and above age 40 years. Factors that predicted mortality were determined.ResultsA total of 619 episodes of SH occurred in 506 individuals. Most had type 1 (T1D; n = 172 [34.0%]) or type 2 diabetes (T2D; n = 216 [42.7%]), but several attendees did not have diabetes (non‐DM; n = 110 [21.7%]). Irrespective of age of diabetes onset, patients with T2D had more socioeconomic deprivation and comorbidities (P < 0.005). SH was uncommon in those with young‐onset T2D, who constituted 7.2% of all episodes in diabetes. Hospital admission was high (60%‐75%). The T2D cohort had the longest inpatient stay (median 5 days, vs. 2 and 3 days for the T1D and non‐DM cohorts, respectively). Survival after the index SH episode was lower and mortality was higher in the non‐DM (39.1%) and T2D (38.0%) cohorts than the T1D cohort (13.3%; all P < 0.05), with a median time to death of 13, 113 and 465 days, respectively. Most deaths (78%‐86%) were from non‐cardiovascular causes. Charlson index predicted mortality and poor survival in T1D and T2D (both P < 0.05).ConclusionsSevere hypoglycaemia requiring emergency hospital treatment is associated with non‐cardiovascular deaths and exerts a disproportionately greater impact on mortality in people with T2D and those without diabetes. Multimorbidity is an important risk factor for SH and increases mortality risk.

Clinical science. Supplement (1979), Dec 1, 1985

Clinical Science, Sep 1, 1980

Seasonal analysis of these data show that the fracture is most common in the winter months and le... more Seasonal analysis of these data show that the fracture is most common in the winter months and least common in late summer. The seasonal variation correlates closely with the prevalence of vitamin D deficiency in normal elderly women in Leeds. Most vitamin D deficiency in the elderly is due to lack of sunlight exposure. About 40% of all housebound women have low plasma 25-hydroxy-vitamin D (25-OHD) concentrations. A case-control study, on fracture patients and age/sex-matched controls. showed that subjects with low plasma 25-OHD concentrations had at least a 2.6-fold risk of fracture. Vitamin D status declines with age for many reasons. It is suggested that vitamin D deficiency is responsible, at least in part, for the increased incidence of femoral neck fracture in the elderly.

Postgraduate Medical Journal, Nov 1, 1979

A patient is described who developed symptomatic hypopituitarism within 18 months of radiotherapy... more A patient is described who developed symptomatic hypopituitarism within 18 months of radiotherapy for nasopharyngeal carcinoma. Detailed investigation indicated a lesion at hypothalamic level. The effect of radiation on hypothalamic-pituitary function is discussed.

John Wiley & Sons, Ltd eBooks, Oct 25, 2013

Diabetic Medicine, Mar 1, 1985

In 34 patients suspected of having pancreatic cancer glucose homeostasis and insulin secretion in... more In 34 patients suspected of having pancreatic cancer glucose homeostasis and insulin secretion in response to intravenous glucagon (1 mg) were studied prospectively. Twelve patients had pancreatic cancer at laparotomy and the remainder were designated a control group. Responses were also measured in 12 healthy volunteers. There was no significant difference in the rise of blood glucose between the groups after glucagon. The mean plasma insulin concentrations rose rapidly in both groups after glucagon but were significantly lower in the pancreatic cancer group. In patients with obstructive jaundice the plasma insulin response was a better discriminator of pancreatic cancer. Abnormal pancreatic beta‐cell function is detectable in patients with pancreatic carcinoma before any change in glucose homeostasis, particularly in patients with obstructive jaundice. The glucagon stimulation test may be useful in the earlier diagnosis of pancreatic carcinoma before the development of clinically overt diabetes mellitus.

European Journal of Clinical Investigation, Feb 1, 1983

Peripheral white and red blood cell changes were studied in response to acute insulin-induced hyp... more Peripheral white and red blood cell changes were studied in response to acute insulin-induced hypoglycaemia in six normal, six splenectomized and five sympathectomized (tetraplegic) subjects. The normal subjects were restudied during beta (propranolol) and beta,-selective (metoprolol) adrenergic blockade. In the normal subjects a lymphocytosis immediately followed the acute hypoglycaemic reaction (R) with a neutrophilia 2 h later. The early lymphocytosis was absent in sympathectomized subjects (P < 0-001) and reduced under beta blockade (P c 0.02) in normal subjects, indicating mediation via an adrenergic mechanism. The later neutrophilia from R+60 min was not abolished by adrenergic blockade or preceding sympathectomy; the enhanced response with propranolol was associated with an elevated plasma cortisol. Haemoglobin, packed cell volume and total erythrocyte count rose maximally at R in all groups except the sympathectomized subjects in whom all parameters declined progressively from basal values. These peripheral erythrocyte changes appear to be mediated via an adrenergic mechanism which is unaffected by beta adrenergic blockade and which does not involve splenic contraction.,

Diabetic Medicine, Apr 1, 2008

Impaired awareness of hypoglycaemia (IAH) is thought to affect approximately 25% of people with t... more Impaired awareness of hypoglycaemia (IAH) is thought to affect approximately 25% of people with type 1 diabetes. While this estimate was based on retrospective information from patients in several small studies performed several years ago, validated methods of assessment have not been applied to a large hospital clinic-based population to ascertain the prevalence in the present era. Methods Five hundred and eighteen people with type 1 diabetes were recruited by random selection over a 2-year period. Participants completed a questionnaire documenting baseline characteristics and assessment of their awareness status using the method described by Gold et al. The number of episodes of SH they had experienced in the preceding year was recorded retrospectively. Results IAH was present in 19.5% of the cohort. Compared to those with normal awareness of hypoglycaemia, those with IAH were significantly older (39.3 (12.9) vs. 45.9 (13.5) years, p < 0.001), had a longer duration of diabetes (14 (8-22) vs. 23 (14-32) years, p < 0.001), and had a six-fold higher incidence in rates of severe hypoglycaemia in the previous year (0.38 (1.04) vs. 2.36 (4.81), p < 0.001). Discussion The present survey of a large hospital based clinic population has confirmed that a significant proportion of people with type 1 diabetes (19.5%) continue to have IAH. Despite improvements in insulin therapies, intensification of insulin regimens and innovative patient education, the prevalence of IAH remains high in type 1 diabetes.

Diabetic Medicine, Jul 23, 2023

Springer eBooks, 2013

The use of general descriptive names, registered names, trademarks, service marks, etc. in this p... more The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

British Journal of Haematology, Feb 1, 1980

Coagulation factor VIII activity has been assayed in nine normal volunteers before and after acut... more Coagulation factor VIII activity has been assayed in nine normal volunteers before and after acute hypoglycaemia. In all subjects there was a rise in activity with a mean increment of 96%. Control studies using saline failed to demonstrate any change. In four subjects with pre-ganglionic sympathectomy n o increase in activity was observed. In the normal subjects the increase was blocked by proprano-lo1 but not by metoprolol, indicating mediation via beta? receptors.

Annals of Clinical Biochemistry, May 1, 1981

Pancreatic beta-cell function is usually assessed by the measurement of plasma insulin concentrat... more Pancreatic beta-cell function is usually assessed by the measurement of plasma insulin concentration in various clinical situations. However, the advent of an assay for the measurement of connecting-peptide (C-peptide) concentration in plasma has provided a further method for the assessment of the secretory capacity of the pancreatic beta cell in clinical disorders, particularly in the investigation of hypoglycaemia. The metabolism and immunoassay methodology of C-peptide are reviewed, and its application in clinical practice is outlined.

The Journal of Clinical Endocrinology and Metabolism, Jun 1, 1992

The adrenergic control of intact PTH secretion was investigated by measuring its plasma concentra... more The adrenergic control of intact PTH secretion was investigated by measuring its plasma concentration during insulin-induced hypoglycemia in normal human subjects under control conditions (n = 12) and after alpha (n = 5)- or beta (n = 6)-adrenoceptor blockade. Blood samples were taken at baseline, at the time of the acute hypoglycemic reaction, and at regular intervals for 60 min thereafter. Plasma concentrations of intact PTH, catecholamines, total calcium, magnesium, albumin, phosphate, and glucose were measured in all subjects, and plasma ionized calcium was also assayed in three subjects during acute hypoglycemia without pharmacological blockade. At the time of the acute hypoglycemic reaction, the plasma concentration of intact PTH in the control subjects fell to 60.8% of baseline values and was accompanied by a small but significant increase in plasma total calcium. Intact PTH concentrations remained suppressed after the plasma calcium concentration had returned to normal. The two groups of subjects who were exposed to adrenoceptor blockade exhibited a reduced fall in plasma intact PTH and showed no significant increase in plasma total calcium. Therefore, insulin-induced acute hypoglycemia was associated with a fall in plasma intact PTH. Adrenoceptor blockade reduced, but did not abolish, the response, suggesting that other factors are involved.

Diabetes Care, Oct 26, 2007

Diabetes Care, 2003

OBJECTIVE—To determine the incidence, predisposing factors, and costs of emergency treatment of s... more OBJECTIVE—To determine the incidence, predisposing factors, and costs of emergency treatment of severe hypoglycemia in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS—Over a 12-month period, routinely collected datasets were analyzed in a population of 367,051 people, including 8,655 people with diabetes, to measure the incidence of severe hypoglycemia that required emergency assistance from Ninewells Hospital and Medical School (NHS) personnel including those in primary care, ambulance services, hospital accident and emergency departments, and inpatient care. Associated costs with these episodes were calculated. RESULTS—A total of 244 episodes of severe hypoglycemia were recorded in 160 patients, comprising 69 (7.1%) people with type 1 diabetes, 66 (7.3%) with type 2 diabetes treated with insulin, and 23 (0.8%) with type 2 diabetes treated with sulfonylurea tablets. Incidence rates were 11.5 and 11.8 events per 100 patient-years for type 1 and type 2 patients tr...

Journal of Clinical Psychopharmacology, Apr 1, 2006