Paris Roach - Academia.edu (original) (raw)

Papers by Paris Roach

The Journal of Clinical Endocrinology and Metabolism, Oct 1, 1995

Journal of Clinical Ultrasound, Jul 1, 1998

We studied the effects of octreotide and ursodiol on the gallbladders of patients with acromegaly... more We studied the effects of octreotide and ursodiol on the gallbladders of patients with acromegaly. We performed gallbladder sonography in patients with acromegaly at various intervals during treatment. Group I (18 patients) was treated with subcutaneous injections of the somatostatin analogue octreotide. Group II (10 patients) was treated with ursodiol while receiving octreotide therapy. Seventy-eight percent of patients receiving octreotide developed gallbladder abnormalities: sludge in 72% (13/18) and calculi in 39% (7/18). Ursodiol reversed the gallbladder abnormalities in 7 of 10 patients. A majority of patients receiving octreotide develop gallbladder abnormalities. Ursodiol appears to reverse the abnormalities in most cases.

Current Opinion in Endocrinology & Diabetes, 1994

Clinical Therapeutics, Apr 1, 2004

Diabetes Care, May 1, 1998

OBJECTIVE To study the pharmacodynamic properties of three premixed formulations of the rapid-act... more OBJECTIVE To study the pharmacodynamic properties of three premixed formulations of the rapid-acting insulin analog insulin lispro and its protamine-retarded preparation, neutral protamine lispro (NPL) insulin. RESEARCH DESIGN AND METHODS In this open, single-center, euglycemic glucose clamp study, 30 healthy volunteers (12 women, 18 men) aged 27 ± 2 years (mean ± SD), whose BM1 was 23.0 ± 2.3 kg/m2, received subcutaneous injections of 0.3 U/kg body wt of insulin mixture (high-mixture 75/25, mid-mixture 50/50, or low-mixture 25/75 insulin lispro/NPL insulin), insulin lispro, or NPL insulin on one of the five study days in randomized order. Glucose infusion rates were determined over a period of 24 h after administration. RESULTS Maximal metabolic activity decreased after subcutaneous injection of the mixtures with lower insulin lispro content; however, the time point of maximal and of early halfmaximal metabolic activity was comparable among the three mixtures. Higher proportions of insulin lispro resulted in higher values for area under the curve within the first 360 min after injection and a more rapid decline to late half-maximal activity. Serum insulin concentrations showed a similar pattern. CONCLUSIONS This study shows that the pharmacodynamic and pharmacokinetic properties of insulin lispro are preserved in stable mixtures with NPL insulin.

Journal of Biological Chemistry, 1994

Vascular Health and Risk Management, Apr 1, 2005

International Journal of Clinical Practice, Apr 1, 2001

A total of 166 patients (102 type 1, 64 type 2) were randomised to insulin lispro (LP) combined w... more A total of 166 patients (102 type 1, 64 type 2) were randomised to insulin lispro (LP) combined with insulin lispro protamine suspension (NPL), an intermediate-acting formulation of LP, or to regular human insulin (HR) combined with human NPH insulin (NPH) in this open-label, parallel study. Insulin doses were similar at endpoint. Blood glucose (BG) measurements (before and two hours after meals, bedtime, 3 a.m.)(mmol/l) were lower with LP/NPL two hours after breakfast (8.84 +/- 0.32 vs 10.29 +/- 0.41, p < 0.001), before lunch (6.21 +/- 0.20 vs 7.10 +/- 0.31, p = 0.016), two hours after the evening meal (10.18 +/- 0.36 vs 7.86 +/- 0.28, p < 0.0.001), and at bedtime (7.85 +/- 0.28 vs 9.43 +/- 0.40, p = 001). HbA1c was lower for LP/NPL at endpoint (7.54 +/- 0.11% vs 7.92 +/- 0.10%, p = 0.019). There was no difference in hypoglycaemia or insulin antibody levels. LP/NPL resulted in better glycaemic control than HR/NPH without increasing the risk of hypoglycaemia.

Health Literacy is believed to play an essential role in the ability of individuals to effectivel... more Health Literacy is believed to play an essential role in the ability of individuals to effectively manage their own health care. A report by the Institute of Medicine acknowledges that 90 million Americans with low literacy probably also have low health literacy, and that even individuals with adequate health literacy face challenges in the complex demands of health care contexts. This poster presents results of a 3-year study of an interdisciplinary project on health literacy and adherence at the Indiana Center for Intercultural Communication (ICIC) funded by the Eli Lilly & Co. Foundation. The purpose was to examine multiple dimensions of health literacy, based on patients’ perspectives (van Dulmen et al., 2008), with the goal of creating a new conceptualization and way of assessing health literacy in its broader sense that includes processing and acting on information in order to integrate those findings into interventions to improve health regimen adherence. Taking critical stud...

Diabetes Care, 1997

OBJECTIVE To determine insulin kinetics and overnight glycemic control after bedtime administrati... more OBJECTIVE To determine insulin kinetics and overnight glycemic control after bedtime administration of a new intermediate-acting insulin preparation called neutral protamine lispro (NPL). RESEARCH DESIGN AND METHODS We studied 12 patients with well-controlled type 1 diabetes. The study had a double-blind, randomized, crossover design. After a lead-in period of 10–14 days two experiments were carried out with an interval of 2–7 days. During these experiments overnight insulin kinetics and fasting blood glucose levels were studied after evening administration of NPH insulin and NPL. Blood glucose levels < 3.8 mmol/l were treated by means of a variable infusion of a 20% glucose solution. RESULTS A trend toward a shorter time to peak insulin concentration was observed after administration of NPL (P = 0.07). No differences between NPH and NPL were detected in the total area under the curve (AUC) for insulin, in insulin levels before breakfast, or in glucose levels before breakfast (P ...

Diabetes, 1994

The precise nature of the insulin-binding site of the insulin receptor (IR) has not been determin... more The precise nature of the insulin-binding site of the insulin receptor (IR) has not been determined, although the importance of several regions of the α-subunit in insulin binding has been demonstrated. A naturally occurring mutation in a patient with severe insulin resistance that changes the Ser323 codon in the α-subunit of the IR to a leucine codon is associated with markedly impaired insulin binding to cells from the patient and to transfected cells expressing the mutant receptor. However, unlike other IR α-subunit mutations associated with decreased insulin binding, this mutation does not lead to a defect in posttranslational processing or cell-surface expression of IRs. Thus, the defect in insulin binding associated with the Leu323 mutant IR is a direct result of an alteration in the insulin-binding site. No natural IR mutation described thus far is associated with both decreased insulin binding and normal cell-surface expression of the mutant receptor. This study demonstrates the critical role that Ser323 of the IR α-subunit plays in insulin binding, either by forming part of the binding site or by stabilizing its conformation.

Current Opinion in Endocrinology and Diabetes, 1994

BMJ, 2004

Reynolds and Strachan propose that routine home blood glucose monitoring (HBGM) not be used to mo... more Reynolds and Strachan propose that routine home blood glucose monitoring (HBGM) not be used to monitor non-insulin treated patients with type 2 diabetes due to lack of evidence of its benefit. Their underlying concerns are that unnecessary HBGM will result in unjustified costs and that it may adversely affect patients' quality of life. They also suggest that large randomized trials be performed to provide guidance on the optimal use of HBGM in this population. The effectiveness of any glucose monitoring program is highly dependent on the ability …

Objectives. Clinical experience with insulin lispro (Humalog) and insulin lispro fixed mixtures (... more Objectives. Clinical experience with insulin lispro (Humalog) and insulin lispro fixed mixtures (Humalog Mix25 and Humalog Mix50) is reviewed. Design. Multicentre and multinational clinical trials with insulin lispro and insulin lispro/neutral protamine lispro (NPL) mixtures. Setting. Inpatient and outpatient clinical settings. Subjects. Patients with type 1 and type 2 diabetes mellitus who were 15 to 75 years of age, and women with gestational diabetes mellitus who were at least 18 years of age. Outcome measures. Haemoglobin A 1c (HbA 1c ) fasting blood glucose (FBG), eight-point blood glucose profiles, patient preference and quality of life, hypoglycaemia rates, immunogenicity and adverse events. Results and conclusions. Treatment with insulin lispro has consistently resulted in lower postprandial blood glucose concentrations compared with regular human insulin. In patients with type 1 diabetes, treatment with insulin lispro has resulted in less hypoglycaemia (primarily nocturnal)...

Diabetes Research and Clinical Practice, 2000

Diabetes Care, 1999

OBJECTIVE: Humalog Mix25 is a manufactured premixed insulin formulation containing insulin lispro... more OBJECTIVE: Humalog Mix25 is a manufactured premixed insulin formulation containing insulin lispro and a novel insulin lispro-protamine formulation (NPL) in a ratio of 25:75%. The objective of this study was to compare Humalog Mix25 to human insulin 30/70 (30% regular insulin/70% NPH) with respect to glycemic control. RESEARCH DESIGN AND METHODS: Humalog Mix25 was compared with human insulin 30/70 in 89 individuals with type 2 diabetes during a 6-month randomized open-label two-period crossover study. Each insulin was administered twice daily, before the morning and evening meals. Information regarding self-monitored blood glucose (BG), hypoglycemic episodes (hypoglycemic signs or symptoms or BG < or = 3.0 mmol/l), insulin dose, and HbA1c was collected. RESULTS: Treatment with Humalog Mix25 resulted in better postprandial glycemic control after the morning and evening meals compared with treatment with human insulin 30/70. Overall glycemic control and the incidence of hypoglycemia...

Communication & Medicine, 2013

A great deal of research in health care has examined a wide range of variables to better understa... more A great deal of research in health care has examined a wide range of variables to better understand the degree to which patients follow the advice of medical professionals in managing their health, known as adherence. This paper explains the development of the linguistic systems to describe and evaluate two psychosocial constructs (i.e. control orientation and agency) that have been found to be related to adherence in previous research for subjects with diabetes (Trento et al. 2007; Wangberg 2007; O’Hea et al. 2009). The present data came from 43 semi-structured in-depth interviews of subjects with Type 2 diabetes. One-on-one interviews with open-ended questions elicited subjects’ ‘stories’ about living with diabetes, and the transcribed interviews were analyzed to develop the linguistic systems of control orientation and agency. The resultant systems were applied to the 43 interviews by raters with high inter-rater reliability. The results showed demarcations of clearly identified ...

Clinical Therapeutics, 2009

Background: Exenatide is an antidiabetic agent currently indicated as adjunctive therapy with ora... more Background: Exenatide is an antidiabetic agent currently indicated as adjunctive therapy with oral agents for the treatment of type 2 diabetes mellitus (T2DM). Limited published data exist on the off-label use of exenatide in conjunction with insulin in the treatment ofT2DM. Objective: The aim of this retrospective study was to examine the effects of exenatide on glycemic control, weight, and insulin dose in patients with T2DM treated with insulin. Methods: Patients with T2DM receiving insulin and adjuvant therapy with exenatide at an endocrinology clinic at a university hospital for up to 27 months were eligible for inclusion. Glycosylated hemoglobin (HbA1J, weight, insulin doses (total, prandial, and basal), concurrent oral antidiabetic medications, and adverse events were ascertained by retrospective review of medical records and were considered the clinical parameters of interest. The last observation in 4 specified time intervals (0-6, 6-12, 12-18, and 18-27 months) for each clinical parameter was used in the analysis. Results: Of the 3397 patients with a confirmed diagnosis of T2DM who were seen at the clinic during the study period, 268 patients met inclusion criteria and were enrolled in the study. Of the 268 patients enrolled, 38 discontinued therapy within the first 2 months, 30 were lost to follow-up, and 12 did not have evaluable data. These latter patients without sufficient data (n = 42) were not included in the primary analysis but were included in the adverse events analysis. Overall, data from 188 patients (mean [SD] age, 56 (9) years; 85 [45%] men; body mass index, 40.4 [8.4] kg/m 2 ; 160 [85%] white) were evaluated (mean duration of treatment, 350 [208] days) and included in all analyses. The mean baseline values for HbA 1c ' weight, and total daily insulin dose before exenatide therapy were July 2009 8.05% (1.47%), 117.8 (24.7) kg, and 99.9 (90.0) U, respectively. For the 4 time intervals, the mean chang-These data were presented as a poster at the 68th Annual Scientific Sessions of the American Diabetes Association,

Clinical Therapeutics, 2001

Background: Epidemiological and genetic studies indicate that ethnic/genetic background plays an ... more Background: Epidemiological and genetic studies indicate that ethnic/genetic background plays an important role in susceptibility to primary open angle glaucoma (POAG). POAG is more prevalent among the African-descent population compared to the Caucasian population. Damage in POAG occurs at the level of the optic nerve head (ONH) and is mediated by astrocytes. Here we investigated differences in gene expression in primary cultures of ONH astrocytes obtained from agematched normal and glaucomatous donors of Caucasian American (CA) and African American (AA) populations using oligonucleotide microarrays. Results: Gene expression data were obtained from cultured astrocytes representing 12 normal CA and 12 normal AA eyes, 6 AA eyes with POAG and 8 CA eyes with POAG. Data were normalized and significant differential gene expression levels detected by using empirical Bayesian shrinkage moderated t-statistics. Gene Ontology analysis and networks of interacting proteins were constructed using the BioGRID database. Network maps included regulation of myosin, actin, and protein trafficking. Real-time RT-PCR, western blots, ELISA, and functional assays validated genes in the networks. Conclusion: Cultured AA and CA glaucomatous astrocytes retain differential expression of genes that promote cell motility and migration, regulate cell adhesion, and are associated with structural tissue changes that collectively contribute to neural degeneration. Key upregulated genes include those encoding myosin light chain kinase (MYLK), transforming growth factor-β receptor 2 (TGFBR2), rho-family GTPase-2 (RAC2), and versican (VCAN). These genes along with other differentially expressed components of integrated networks may reflect functional susceptibility to chronic elevated intraocular pressure that is enhanced in the optic nerve head of African Americans.