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Papers by R. Peter

Diabetic Medicine, 2006

Aims To determine the relationship between HbA 1c and other indices of glycaemic status derived d... more Aims To determine the relationship between HbA 1c and other indices of glycaemic status derived during a standardized meal tolerance test (MTT) in newly diagnosed treatment-naive subjects with Type 2 diabetes (T2DM). Methods T2DM subjects (n = 262) consumed a standard MTT in the morning after a 10-h overnight fast. Frequent samples for plasma glucose (PG) were collected over the 4-h test period. The relationship between HbA 1c and other glycaemic indices derived from the MTT were explored. The postprandial glucose exposure was calculated as the area under the incremental plasma glucose curve above the fasting level for the test period (AUC 1). Excess hyperglycaemia was calculated as the AUC 0 − 4 h above the arbitrary PG concentrations of 6.0 mmol/l (AUC 2) and 5.5 mmol/l (AUC 3), respectively [upper limit of fasting normoglycaemia according to World Health Organization (WHO) and American Diabetes Association (ADA), respectively]. Fasting hyperglycaemia was also estimated, being the difference between each of the above and the postprandial excursion. The participants were divided into three subgroups according to HbA 1c (Group 1, ≤ 7.0%; Group 2, 7.1-9.0%; Group 3, > 9.0%) and the relative contribution calculated of the postprandial glucose and fasting hyperglycaemia to the excess hyperglycaemia above the designated international thresholds for fasting plasma glucose. Results HbA 1c was more strongly correlated with the fasting plasma glucose (r = 0.85, P < 0.001) than the overall postprandial glucose exposure (r = 0.539, P = 0.003). The contribution of fasting hyperglycaemia to excess hyperglycaemia using the WHO criteria for normal fasting plasma glucose for the three groups (Groups 1, 2 and 3) was 50.4%, 54.3% and 69.8%, respectively, and 57.8%, 58.8% and 71.4% using the ADA criteria. Conclusions The contribution of fasting hyperglycaemia to excess hyperglycaemia increases as glycaemic control deteriorates, becoming dominant with an HbA 1c in excess of 7.0%. These findings indicate which therapeutic approach needs to be adopted based on the HbA 1c of the person with T2DM.

QJM, 2011

Mrs LG a 60-year-old woman was referred to the medical outpatient department by her general pract... more Mrs LG a 60-year-old woman was referred to the medical outpatient department by her general practitioner with a 2-month history of increased tiredness, lethargy and weight loss having lost approximately 2 stones in the preceding 5 months. She had been diagnosed with hypothyroidism a few years previously and had been on thyroxine intermittently. She was not on thyroxine when seen in clinic. Blood tests carried out by her general practitioner indicated a free T4 6.7 pmol/l (12-22), thyroid stimulating hormone (TSH) 6.3 mU/l (0.5-4.5) and prolactin 1965 u/l (<650), sodium 139 mmol/l (135-145), potassium 5.1 mmol/l (3.5-5.1) and eGFR 57 ml/min. In the clinic she also complained of generalized myalgia, arthralgia and constipation. There was no history of cold intolerance or hair loss. She also did not give a history of headaches, visual disturbance or galactorrhoea. She was post menopausal with her periods having stopped 10 years earlier and had incidentally been diagnosed with primary biliary cirrhosis many years previously which had been stable and her medications included ursodeoxycholic acid and atenolol. She had a family history of thyrotoxicosis and her sister had died of a ruptured cerebral artery aneurysm 10 years earlier. On examination she had a pulse of 64 bpm and BP 120/70 mm of Hg. There was reduced visual acuity in her left eye, which had been longstanding with no abnormality on visual field testing on confrontation. Cardiovascular, respiratory and abdominal systems were normal. Her repeat

The Journal of Laryngology & Otology, 2011

Background:Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless... more Background:Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless, the treating physician should consider this condition within the differential diagnosis of a submandibular mass.Method:Case report of ectopic thyroid tissue presenting as a submandibular mass in a patient with hyperthyroidism, together with a review of the English-literature concerning ectopic thyroid tissue.Conclusion:To our knowledge, this is the first report of ectopic thyroid tissue presenting as a submandibular mass and causing hyperthyroidism. Removal of the submandibular mass resulted in normalisation of thyroid function, and subsequent reduction in the patient's antithyroid medication dosage. Ectopic thyroid tissue should be suspected in any patient with a submandibular mass. Prior to resection of such a lesion, it is essential to ensure that normal, functioning thyroid tissue is present elsewhere. Ectopic thyroid tissue can also present with pathology similar to that affec...

Journal of Clinical Pathology, 2003

Aim: To compare amounts of salicyluric acid (SU) and salicylic acid (SA) excreted daily in the ur... more Aim: To compare amounts of salicyluric acid (SU) and salicylic acid (SA) excreted daily in the urine of non-vegetarians and vegetarians not taking salicylate drugs, and patients taking 75 or 150 mg aspirin/day. Methods: Urine excreted over 24 hours was collected from volunteers in the four groups. The volumes were recorded and the concentrations of SU and SA were determined electrochemically after separation by high performance liquid chromatography. Results: Significantly more SU was excreted daily by vegetarians (median, 11.01; range, 4.98-26.60 µmol/24 hours) than by non-vegetarians (median, 3.91; range, 0.87-12.23 µmol/24 hours), although amounts were significantly lower than those excreted by patients taking aspirin. Median amounts of SU excreted by patients taking 75 and 150 mg/day of low dose aspirin were 170.69 (range, 13.15-377.18) µmol/24 hours and 165.17 (range, 5.61-429.12) µmol/24 hours, respectively. The amount of SU excreted by patients taking either 75 or 150 mg of aspirin/day was not significantly different. Significantly more SA was excreted by vegetarians (median, 1.19; range, 0.02-3.55 µmol/24 hours) than by non-vegetarians (median, 0.31; range, 0.01-2.01 µmol/24 hours). The median amounts of SA excreted by vegetarians and the patients taking aspirin were not significantly different. Conclusions: More SU and SA is excreted in the urine of vegetarians than in non-vegetarians, consistent with the observation that fruits and vegetables are important sources of dietary salicylates. However, significantly less SU was excreted by vegetarians than patients taking aspirin, indicating that the daily intake of bioavailable salicylates by vegetarians is considerably lower than that supplied by a single 75 or 150 mg dose of aspirin.

International Journal of Clinical Practice, 2010

Diabetologia, 2008

Aims/hypothesis Estimation of GFR (eGFR) is recommended for the assessment of kidney function in ... more Aims/hypothesis Estimation of GFR (eGFR) is recommended for the assessment of kidney function in all patients with diabetes. We studied performance of the traditional '186' Modification of Diet in Renal Disease (MDRD) equation, and the 2005 revised '175' MDRD equation in patients with type 2 diabetes. Methods Two hundred and ninety-three mainly normoalbuminuric (267/293) patients were recruited. Patients were classified as having mild renal impairment (group 1, GFR <90 ml min -1 1.73 m -2 ) or normal renal function (group 2, GFR ≥90 ml min -1 1.73 m -2 ). eGFR was calculated by the traditional 186 MDRD equation using traditional creatinine values and the revised 175 MDRD equation using isotope dilution mass spectrometry-standardised creatinine values. Isotopic GFR was measured by the four-sample plasma clearance of 51 Cr-EDTA. Results For patients in group 1, mean±SD isotopic 51 Cr-EDTA GFR (iGFR) was 83.8±4.3 ml min -1 1.73 m -2 , and eGFR was 73.2±11.9 and 75.8±13.7 ml min -1 1.73 m -2 using the 186 and 175 MDRD equations, respectively. Method bias was -10.6 with the 186 MDRD and -7.9 ml min -1 1.73 m -2 (p<0.05) with the 175 MDRD equation. In group 2, iGFR was 119.4±20.2 ml min -1 1.73 m -2 , and eGFR was 92.3±18.6 and 97.5±21.6 ml min -1 1.73 m -2 using the 186 and 175 MDRD equations, respectively. Method bias was -27.1 with the 186 MDRD equation and -21.9 ml min -1 1.73 m -2 (p<0.05) with the 175 MDRD equation. In patients newly diagnosed with type 2 diabetes, the revised 175 MDRD equation was less biased than the traditional 186 MDRD equation. Despite a continued tendency to underestimate isotopically measured GFR, use of standardised creatinine values is a positive step towards improved estimation of GFR. Keywords eGFR . 175 MDRD equation . Standardised creatinine . Type 2 diabetes Abbreviations CKD chronic kidney disease 51 Cr-EDTA 51 Cr-labelled EDTA eGFR estimation of GFR IDMS isotope dilution mass spectrometry iGFR isotopic 51 Cr-labelled EDTA GFR MDRD Modification of Diet in Renal Disease

Therapy and clinical trials: glycaemia and prevention of macroangiopathy in type 2 diabetes

Current Opinion in Lipidology, 2008

Type 2 diabetes (T2DM) is a common disease affecting approximately 3–5% of people living in the w... more Type 2 diabetes (T2DM) is a common disease affecting approximately 3–5% of people living in the western world. Cardiovascular disease (CVD) is an important cause of morbidity and mortality among patients with T2DM. Compared with a normal glucose tolerant patient, a person with T2DM has a two to four fold increased risk of dying from a myocardial infarction (MI) [1,2]. It is now generally accepted that T2DM is a coronary artery disease (CAD) equivalent; that is, having diabetes confers a risk for a future cardiovascular event similar to that of established CVD [3,4]. The pathogenesis of CVD in patients with T2DM is multifactorial and typically results from clustering of risk factors such as hyperglycaemia, hypertension, dyslipidaemia and smoking. In the landmark Steno-2 trial, 160 people with T2DM and microalbuminuria were randomized to conventional treatment or intensive treatment with lifestyle modification and pharmacological interventions. Hyperglycaemia, hypertension, dyslipidaemia, microalbuminuria and prevention of CVD with aspirin were targeted in the intensive treatment arm. Over the 7.8 years of follow-up, it was found that patients receiving intensive therapy had a significantly lower risk of CVD (hazard ratio 0.47; 95% CI, 0.24–0.73; P1⁄4 0.008) compared with the conventionally treated group [5].

Diabetes

Current Opinion in Lipidology, 2012

Clinical Endocrinology, 2004

BACKGROUND Adult GH deficiency (AGHD) is associated with osteoporosis and reduced bone turnover; ... more BACKGROUND Adult GH deficiency (AGHD) is associated with osteoporosis and reduced bone turnover; factors improved by GH replacement (GHR), with men gaining greater benefit than women. Reduction in sensitivity of bone and kidney to the effects of PTH may underlie AGHD changes in bone turnover. We determined the gender difference in PTH target-organ sensitivity following GHR in AGHD patients. DESIGN , PATIENTS AND MEASUREMENTS Twenty AGHD patients (10 men) were admitted to hospital before and after GHR initiation. Half-hourly blood samples were collected for PTH, calcium, nephrogenous cyclic AMP (NcAMP, marker of PTH activity), type-I collagen C-telopeptide (CTX, bone resorption marker) and procollagen type-I amino-terminal propeptide (PINP, bone formation marker). The 24-h mean PTH concentration decreased in both genders ( P < 0•001), with maximal changes seen 6 and 12 months following GHR in men and women, respectively. Increases in 24-h mean NcAMP ( P < 0•05), calcium ( P < 0•001) and bone turnover markers ( P < 0•001) occurred in both genders following GHR, with maximal changes at 1 month in men, but at 3 months for NcAMP, calcium and CTX and 12 months for PINP in women. Maximal NcAMP increase was higher in men ( P = 0•009). CONCLUSIONS Following GHR, PTH target-organ sensitivity increased in both genders, demonstrated by simultaneous reduction in PTH concentration and increase in NcAMP, calcium and bone turnover. In women, improvement in renal PTH sensitivity was delayed and reduced, and changes in bone turnover were delayed, with increase in bone resorption preceding bone formation. Both factors may contribute to the reduced bone mineral density (BMD) response to GHR observed in women.

Diabetes Care, 2005

OBJECTIVE—To study the effects of exercise on the absorption of the basal long-acting insulin ana... more OBJECTIVE—To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine (Lantus), administered subcutaneously in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS—A total of 13 patients (12 men, 1 woman) with type 1 diabetes on a basal-bolus insulin regimen were studied. 125I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening (2100) before the study day on two occasions 1 week apart. Patients were randomly assigned to 30 min intense exercise (65% peak oxygen uptake [Vo2peak]) on one of these visits. The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter. Blood samples were collected at regular intervals on the study days to assess plasma glucose and insulin profiles. RESULTS—No significant difference was found in the 125I-labeled insulin glargine decay rate on the two occasions (exercise vs. no exe...

Diabetic Medicine, 2006

To determine the relationship between HbA 1c and other indices of glycaemic status derived during... more To determine the relationship between HbA 1c and other indices of glycaemic status derived during a standardized meal tolerance test (MTT) in newly diagnosed treatment-naive subjects with Type 2 diabetes (T2DM).

Diabetic Medicine, 2006

Aims To determine the relationship between HbA 1c and other indices of glycaemic status derived d... more Aims To determine the relationship between HbA 1c and other indices of glycaemic status derived during a standardized meal tolerance test (MTT) in newly diagnosed treatment-naive subjects with Type 2 diabetes (T2DM). Methods T2DM subjects (n = 262) consumed a standard MTT in the morning after a 10-h overnight fast. Frequent samples for plasma glucose (PG) were collected over the 4-h test period. The relationship between HbA 1c and other glycaemic indices derived from the MTT were explored. The postprandial glucose exposure was calculated as the area under the incremental plasma glucose curve above the fasting level for the test period (AUC 1). Excess hyperglycaemia was calculated as the AUC 0 − 4 h above the arbitrary PG concentrations of 6.0 mmol/l (AUC 2) and 5.5 mmol/l (AUC 3), respectively [upper limit of fasting normoglycaemia according to World Health Organization (WHO) and American Diabetes Association (ADA), respectively]. Fasting hyperglycaemia was also estimated, being the difference between each of the above and the postprandial excursion. The participants were divided into three subgroups according to HbA 1c (Group 1, ≤ 7.0%; Group 2, 7.1-9.0%; Group 3, > 9.0%) and the relative contribution calculated of the postprandial glucose and fasting hyperglycaemia to the excess hyperglycaemia above the designated international thresholds for fasting plasma glucose. Results HbA 1c was more strongly correlated with the fasting plasma glucose (r = 0.85, P < 0.001) than the overall postprandial glucose exposure (r = 0.539, P = 0.003). The contribution of fasting hyperglycaemia to excess hyperglycaemia using the WHO criteria for normal fasting plasma glucose for the three groups (Groups 1, 2 and 3) was 50.4%, 54.3% and 69.8%, respectively, and 57.8%, 58.8% and 71.4% using the ADA criteria. Conclusions The contribution of fasting hyperglycaemia to excess hyperglycaemia increases as glycaemic control deteriorates, becoming dominant with an HbA 1c in excess of 7.0%. These findings indicate which therapeutic approach needs to be adopted based on the HbA 1c of the person with T2DM.

QJM, 2011

Mrs LG a 60-year-old woman was referred to the medical outpatient department by her general pract... more Mrs LG a 60-year-old woman was referred to the medical outpatient department by her general practitioner with a 2-month history of increased tiredness, lethargy and weight loss having lost approximately 2 stones in the preceding 5 months. She had been diagnosed with hypothyroidism a few years previously and had been on thyroxine intermittently. She was not on thyroxine when seen in clinic. Blood tests carried out by her general practitioner indicated a free T4 6.7 pmol/l (12-22), thyroid stimulating hormone (TSH) 6.3 mU/l (0.5-4.5) and prolactin 1965 u/l (<650), sodium 139 mmol/l (135-145), potassium 5.1 mmol/l (3.5-5.1) and eGFR 57 ml/min. In the clinic she also complained of generalized myalgia, arthralgia and constipation. There was no history of cold intolerance or hair loss. She also did not give a history of headaches, visual disturbance or galactorrhoea. She was post menopausal with her periods having stopped 10 years earlier and had incidentally been diagnosed with primary biliary cirrhosis many years previously which had been stable and her medications included ursodeoxycholic acid and atenolol. She had a family history of thyrotoxicosis and her sister had died of a ruptured cerebral artery aneurysm 10 years earlier. On examination she had a pulse of 64 bpm and BP 120/70 mm of Hg. There was reduced visual acuity in her left eye, which had been longstanding with no abnormality on visual field testing on confrontation. Cardiovascular, respiratory and abdominal systems were normal. Her repeat

The Journal of Laryngology & Otology, 2011

Background:Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless... more Background:Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless, the treating physician should consider this condition within the differential diagnosis of a submandibular mass.Method:Case report of ectopic thyroid tissue presenting as a submandibular mass in a patient with hyperthyroidism, together with a review of the English-literature concerning ectopic thyroid tissue.Conclusion:To our knowledge, this is the first report of ectopic thyroid tissue presenting as a submandibular mass and causing hyperthyroidism. Removal of the submandibular mass resulted in normalisation of thyroid function, and subsequent reduction in the patient's antithyroid medication dosage. Ectopic thyroid tissue should be suspected in any patient with a submandibular mass. Prior to resection of such a lesion, it is essential to ensure that normal, functioning thyroid tissue is present elsewhere. Ectopic thyroid tissue can also present with pathology similar to that affec...

Journal of Clinical Pathology, 2003

Aim: To compare amounts of salicyluric acid (SU) and salicylic acid (SA) excreted daily in the ur... more Aim: To compare amounts of salicyluric acid (SU) and salicylic acid (SA) excreted daily in the urine of non-vegetarians and vegetarians not taking salicylate drugs, and patients taking 75 or 150 mg aspirin/day. Methods: Urine excreted over 24 hours was collected from volunteers in the four groups. The volumes were recorded and the concentrations of SU and SA were determined electrochemically after separation by high performance liquid chromatography. Results: Significantly more SU was excreted daily by vegetarians (median, 11.01; range, 4.98-26.60 µmol/24 hours) than by non-vegetarians (median, 3.91; range, 0.87-12.23 µmol/24 hours), although amounts were significantly lower than those excreted by patients taking aspirin. Median amounts of SU excreted by patients taking 75 and 150 mg/day of low dose aspirin were 170.69 (range, 13.15-377.18) µmol/24 hours and 165.17 (range, 5.61-429.12) µmol/24 hours, respectively. The amount of SU excreted by patients taking either 75 or 150 mg of aspirin/day was not significantly different. Significantly more SA was excreted by vegetarians (median, 1.19; range, 0.02-3.55 µmol/24 hours) than by non-vegetarians (median, 0.31; range, 0.01-2.01 µmol/24 hours). The median amounts of SA excreted by vegetarians and the patients taking aspirin were not significantly different. Conclusions: More SU and SA is excreted in the urine of vegetarians than in non-vegetarians, consistent with the observation that fruits and vegetables are important sources of dietary salicylates. However, significantly less SU was excreted by vegetarians than patients taking aspirin, indicating that the daily intake of bioavailable salicylates by vegetarians is considerably lower than that supplied by a single 75 or 150 mg dose of aspirin.

International Journal of Clinical Practice, 2010

Diabetologia, 2008

Aims/hypothesis Estimation of GFR (eGFR) is recommended for the assessment of kidney function in ... more Aims/hypothesis Estimation of GFR (eGFR) is recommended for the assessment of kidney function in all patients with diabetes. We studied performance of the traditional '186' Modification of Diet in Renal Disease (MDRD) equation, and the 2005 revised '175' MDRD equation in patients with type 2 diabetes. Methods Two hundred and ninety-three mainly normoalbuminuric (267/293) patients were recruited. Patients were classified as having mild renal impairment (group 1, GFR <90 ml min -1 1.73 m -2 ) or normal renal function (group 2, GFR ≥90 ml min -1 1.73 m -2 ). eGFR was calculated by the traditional 186 MDRD equation using traditional creatinine values and the revised 175 MDRD equation using isotope dilution mass spectrometry-standardised creatinine values. Isotopic GFR was measured by the four-sample plasma clearance of 51 Cr-EDTA. Results For patients in group 1, mean±SD isotopic 51 Cr-EDTA GFR (iGFR) was 83.8±4.3 ml min -1 1.73 m -2 , and eGFR was 73.2±11.9 and 75.8±13.7 ml min -1 1.73 m -2 using the 186 and 175 MDRD equations, respectively. Method bias was -10.6 with the 186 MDRD and -7.9 ml min -1 1.73 m -2 (p<0.05) with the 175 MDRD equation. In group 2, iGFR was 119.4±20.2 ml min -1 1.73 m -2 , and eGFR was 92.3±18.6 and 97.5±21.6 ml min -1 1.73 m -2 using the 186 and 175 MDRD equations, respectively. Method bias was -27.1 with the 186 MDRD equation and -21.9 ml min -1 1.73 m -2 (p<0.05) with the 175 MDRD equation. In patients newly diagnosed with type 2 diabetes, the revised 175 MDRD equation was less biased than the traditional 186 MDRD equation. Despite a continued tendency to underestimate isotopically measured GFR, use of standardised creatinine values is a positive step towards improved estimation of GFR. Keywords eGFR . 175 MDRD equation . Standardised creatinine . Type 2 diabetes Abbreviations CKD chronic kidney disease 51 Cr-EDTA 51 Cr-labelled EDTA eGFR estimation of GFR IDMS isotope dilution mass spectrometry iGFR isotopic 51 Cr-labelled EDTA GFR MDRD Modification of Diet in Renal Disease

Therapy and clinical trials: glycaemia and prevention of macroangiopathy in type 2 diabetes

Current Opinion in Lipidology, 2008

Type 2 diabetes (T2DM) is a common disease affecting approximately 3–5% of people living in the w... more Type 2 diabetes (T2DM) is a common disease affecting approximately 3–5% of people living in the western world. Cardiovascular disease (CVD) is an important cause of morbidity and mortality among patients with T2DM. Compared with a normal glucose tolerant patient, a person with T2DM has a two to four fold increased risk of dying from a myocardial infarction (MI) [1,2]. It is now generally accepted that T2DM is a coronary artery disease (CAD) equivalent; that is, having diabetes confers a risk for a future cardiovascular event similar to that of established CVD [3,4]. The pathogenesis of CVD in patients with T2DM is multifactorial and typically results from clustering of risk factors such as hyperglycaemia, hypertension, dyslipidaemia and smoking. In the landmark Steno-2 trial, 160 people with T2DM and microalbuminuria were randomized to conventional treatment or intensive treatment with lifestyle modification and pharmacological interventions. Hyperglycaemia, hypertension, dyslipidaemia, microalbuminuria and prevention of CVD with aspirin were targeted in the intensive treatment arm. Over the 7.8 years of follow-up, it was found that patients receiving intensive therapy had a significantly lower risk of CVD (hazard ratio 0.47; 95% CI, 0.24–0.73; P1⁄4 0.008) compared with the conventionally treated group [5].

Diabetes

Current Opinion in Lipidology, 2012

Clinical Endocrinology, 2004

BACKGROUND Adult GH deficiency (AGHD) is associated with osteoporosis and reduced bone turnover; ... more BACKGROUND Adult GH deficiency (AGHD) is associated with osteoporosis and reduced bone turnover; factors improved by GH replacement (GHR), with men gaining greater benefit than women. Reduction in sensitivity of bone and kidney to the effects of PTH may underlie AGHD changes in bone turnover. We determined the gender difference in PTH target-organ sensitivity following GHR in AGHD patients. DESIGN , PATIENTS AND MEASUREMENTS Twenty AGHD patients (10 men) were admitted to hospital before and after GHR initiation. Half-hourly blood samples were collected for PTH, calcium, nephrogenous cyclic AMP (NcAMP, marker of PTH activity), type-I collagen C-telopeptide (CTX, bone resorption marker) and procollagen type-I amino-terminal propeptide (PINP, bone formation marker). The 24-h mean PTH concentration decreased in both genders ( P < 0•001), with maximal changes seen 6 and 12 months following GHR in men and women, respectively. Increases in 24-h mean NcAMP ( P < 0•05), calcium ( P < 0•001) and bone turnover markers ( P < 0•001) occurred in both genders following GHR, with maximal changes at 1 month in men, but at 3 months for NcAMP, calcium and CTX and 12 months for PINP in women. Maximal NcAMP increase was higher in men ( P = 0•009). CONCLUSIONS Following GHR, PTH target-organ sensitivity increased in both genders, demonstrated by simultaneous reduction in PTH concentration and increase in NcAMP, calcium and bone turnover. In women, improvement in renal PTH sensitivity was delayed and reduced, and changes in bone turnover were delayed, with increase in bone resorption preceding bone formation. Both factors may contribute to the reduced bone mineral density (BMD) response to GHR observed in women.

Diabetes Care, 2005

OBJECTIVE—To study the effects of exercise on the absorption of the basal long-acting insulin ana... more OBJECTIVE—To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine (Lantus), administered subcutaneously in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS—A total of 13 patients (12 men, 1 woman) with type 1 diabetes on a basal-bolus insulin regimen were studied. 125I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening (2100) before the study day on two occasions 1 week apart. Patients were randomly assigned to 30 min intense exercise (65% peak oxygen uptake [Vo2peak]) on one of these visits. The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter. Blood samples were collected at regular intervals on the study days to assess plasma glucose and insulin profiles. RESULTS—No significant difference was found in the 125I-labeled insulin glargine decay rate on the two occasions (exercise vs. no exe...

Diabetic Medicine, 2006

To determine the relationship between HbA 1c and other indices of glycaemic status derived during... more To determine the relationship between HbA 1c and other indices of glycaemic status derived during a standardized meal tolerance test (MTT) in newly diagnosed treatment-naive subjects with Type 2 diabetes (T2DM).