A randomized clinical trial of the anti-caries efficacy of 5,000 compared to 1,450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents.

Root caries is prevalent in elderly disabled nursing home residents in Denmark. This study aimed to compare the effectiveness of tooth brushing with 5,000 versus 1,450 ppm of fluoridated toothpaste (F-toothpaste) for controlling root caries in nursing home residents. The duration of the study was 8 months. Elderly disabled residents (n = 176) in 6 nursing homes in the Copenhagen area consented to take part in the study. They were randomly assigned to use one of the two toothpastes. Both groups had their teeth brushed twice a day by the nursing staff. A total of 125 residents completed the study. Baseline and follow-up clinical examinations were performed by one calibrated examiner. Texture, contour, location and colour of root caries lesions were used to evaluate lesion activity. No differences (p values >0.16) were noted in the baseline examination with regards to age, mouth dryness, wearing of partial or full dentures in one of the jaws, occurrence of plaque and active (2.61 vs. 2.67; SD, 1.7 vs.1.8) or arrested lesions (0.62 vs. 0.63; SD, 1.7 vs. 1.7) between the 5,000 and the 1,450 ppm fluoride groups, respectively. Mean numbers of active root caries lesions at the follow-up examination were 1.05 (2.76) versus 2.55 (1.91) and mean numbers of arrested caries lesions were 2.13 (1.68) versus 0.61 (1.76) in the 5,000 and the 1,450 ppm fluoride groups, respectively (p < 0.001). To conclude, 5,000 ppm F-toothpaste is significantly more effective for controlling root caries lesion progression and promoting remineralization compared to 1,450 ppm F-toothpaste.

Effect of acute selective beta-1-adrenoceptor blockade on hormonal and cardiovascular response to insulin-induced hypoglycaemia in insulin-dependent diabetic patients.

The hormonal and cardiovascular responses to intravenous (i.v.) insulin were studied in 16 insulin-dependent normotensive diabetic patients after acute injection of selective beta-1-adrenoceptor blocking agents. The lowest blood glucose levels were not affected by beta-1-adrenoceptor blockade while the time for reaching nadir was significantly reduced. Plasma adrenaline levels increased significantly during selective beta-1-adrenoceptor blockade. Plasma noradrenaline, glucagon and human growth hormone levels, however, remained unaffected. The insulin-induced tachycardia was not prevented by the beta-1-blockade, and the mean arterial blood pressure was unchanged. The ability to recognize the symptoms of insulin-induced hypoglycaemia persisted in all patients, although less pronounced in nine of them. We suggest that selective beta-1-adrenergic blocking agents may be employed without risk in the treatment of hypertensive insulin-dependent diabetic patients.

Diabetic nephropathy: fault or destiny?

Twenty-one young onset Type 1 (insulin dependent) diabetics who developed severe diabetic nephropathy after 14.5 +/- 3.3 years (mean +/- SD) and 21 age and sex matched Type 1 diabetics without evidence of nephropathy after more than 32 years of disease were compared with particular reference to body build, insulin requirements, stability of diabetes, heart rate and blood pressure before the development of nephropathy. Attempts were made to evaluate the quality of metabolic control during the first 20 years of diabetes from more than 1,600 out-patient measurements of blood and urinary glucose in each group. The renal tubular reabsorption capacity for glucose was calculated in both groups. No differences between the two groups were found for any of the parameters examined, except that the frequency of ketoacidosis was higher in the patients who developed nephropathy. It is concluded that many Type 1 diabetics seem to be protected against the deleterious effect of diabetes on the kidney. The nature of the protecting factors is unknown.

The prognosis of insulin dependent diabetes mellitus and the importance of supervision.

1451 patients with IDDM, onset before 1953 and before the age of 30 were followed until death or until 1976. Survival with diabetes, relative survival and the influence of supervision on survival were examined. It is shown that only 50% of the patients survived more than 30 diabetes years. The patients had an overmortality of more than 600% in relation to age and sex matched non-diabetics. Frequent supervisions in the out-patient clinic reduced as well the overmortality as the prevalence of severe complications significantly.

Prognosis of diabetics with diabetes onset before the age of thirty-one. II. Factors influencing the prognosis.

In 307 patients with diabetes mellitus, developed prior to 1933 and before age 31 it was demonstrated that: (1) frequent contact with a specialized diabetes clinic from an early stage of the disease; (2) a good quality of "metabolic control"; (3) a low insulin dose; (4) a body weight of 10% less than ideal; and (5) a mean blood pressure below 100 mm Hg, all had significantly beneficial effects upon the survival. It was also found that patients domiciled in Copenhagen had a significantly better prognosis than patients domiciled outside Copenhagen. Frequent contact with a diabetes centre was accompanied by an appreciable decrease in disabling late diabetic complications.

Morphology of experimental, organ-specific insulitis of the mouse pancreas.

The morphologic and metabolic effect of a single intracutaneous injection of homologous endocrine pancreas in Freund's complete adjuvant (CFA) was studied in 100 mice and compared with control groups which had been (1) immunized with murine insulin in CFA, (2) injected with CFA alone, or had (3) received no treatment. There were no differences between the control groups as regards the morphology of the pancreatic islets, and the glucose tolerance was normal. Mice immunized with islet homogenate exhibited morphological changes in the form of degranulation and cytoplasmic disintegration. These changes involved B-cells as well as A2-cells and were present from 7 to 18 days after the immunization. A significant reduction in glucose tolerance was observed 14 days after the immunization. Another characteristic finding in the islets from the immunized mice was the extra-vascular presence of mononuclear, agranular cells which on the basis of their morphological criteria appeared to represent lymphocytes.

The impact of August Krogh on the insulin treatment of diabetes and our present status.

The influence of August Krogh on the introduction of insulin preparations in Scandinavia is mentioned, and his outstanding physiological background is outlined. Developments in preparation of insulin depending on the progress in protein-chemistry are summarized. The latest step in the purification of insulin extracted from pork pancreas now allows treatment of diabetics with protamine-pork-insulin without causing formation of insulin-antibodies in at least 90 per cent treated with insulin through several months. In only 3 out of 51 diabetics was it possible to demonstrate insulin-antibodies. This new step may be of great interest in two ways 1) it is now possible to make insulin-estimations in the plasma of insulin-treated cases and 2) it will be possible to find out whether elimination of insulin-antibody-formation will reduce the degree of vascular lesions in diabetics, such lesions being the greatest problem in clinical diabetes.