R. Peter - Academia.edu (original) (raw)
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
International Journal of Clinical Practice, 2010
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].
Current Opinion in Lipidology, 2012
Clinical Endocrinology, 2004
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
International Journal of Clinical Practice, 2010
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].
Current Opinion in Lipidology, 2012
Clinical Endocrinology, 2004
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).