Diabetologists' judgments of diabetic control: reliability and mathematical simulation.

In study 1, laboratory and supervised blood or urine test data from actual cases were used to develop patient profiles. Seven diabetologists from the same institution rated the diabetic control of 125 profiles on a four-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent). Six of the 7 diabetologists demonstrated adequate intra- and interrater reliability. Study 2 assessed the reliability of judgments of diabetic control made by diabetologists working in two different settings. There were 9 raters from institution 1 and 8 from institution 2. The impact of the amount and type of information on judgment reliability was evaluated by developing two types of profiles. The test form contained only laboratory and supervised blood or urine test data similar to that utilized in study 1. The history form contained this information as well as other descriptive data typically available to diabetologists. The 17 diabetologists rated 125 anonymous profiles on each of two separate occasions approximately 1 wk apart. On one occasion they rated profiles presented on the test form. On the other occasion they rated profiles presented on the history form. As in study 1, the diabetologist raters demonstrated adequate intra- and interrater reliability. Intrarater reliability was somewhat better when rating test form profiles compared with history form profiles. Reliability was not higher within than between institutions. An analysis of the relative contribution of different diabetes control indices to the diabetologists' judgments indicated that HbA1 influenced raters' judgments at both institutions more than any other single variable.(ABSTRACT TRUNCATED AT 250 WORDS)

Gonadal dysfunction in diabetic men with organic impotence.

Previous studies of the relationship of gonadal function to impotence in men with diabetes mellitus have yielded conflicting results. Pituitary-testicular function was studied in 28 impotent diabetic men and 15 normal men. Impotence was documented by clinical history and subdivided into categories of primary organic (n = 16), primary psychogenic (n = 7), and unclassified (n = 5) on the basis of nocturnal penile tumescence (NPT) testing, psychological testing, and penile vascular studies. All NPT parameters were diminished (P less than or equal to 0.001) in the impotent diabetic men compared to values in the normal men. Endocrine studies revealed increased urinary LH (P less than or equal to 0.05) and diminished serum free testosterone levels in the diabetic men with primary organic impotence. These changes were not found in normal men or diabetic men with primary psychogenic impotence. Six months of treatment in a home blood glucose-monitoring program resulted in significant improvement in metabolic control but no improvement in pituitary-testicular function, NPT, or sexual performance in the primary organic impotent group. Eight patients with primary organic impotence and no evidence of penile vascular disease had significant improvement (P less than or equal to 0.01) in NPT results as well as subjective improvement in sexual function after 6 months of parenteral testosterone administration. These studies suggest that primary gonadal dysfunction may be related to organic impotence in diabetes, and improvement in selected patients can occur with androgen therapy.

Adding to the controversy: pitfalls in the diagnosis of testosterone deficiency syndromes with questionnaires and biochemistry.

PURPOSE: To determine the value of available questionnaires used for the diagnosis of testosterone deficiency syndromes (TDS) by correlating their ratings with a panel of hormonal determinations in a male population. MATERIALS AND METHODS: Participants completed the ADAM questionnaire and underwent biochemical evaluation at the local site. Assessments determined entry into Group A (symptomatic) or Group B (non-symptomatic). After stratification, subjects provided a morning sample of blood, completed the Aging Male Survey (AMS) and the newly developed Canadian Society for the Study of the Aging Male (CSAM-Q) questionnaires. Serum aliquots were analysed at a central lab for 8 putative markers commonly associated with symptomatic testosterone deficiency associated with aging: total testosterone (T); bioavailable T (BT); dehydroepiandrosterone sulphate (DHEA-S); sex-hormone binding globulin (SHBG); luteinizing hormone (LH), prolactin (PRL); thyroid-stimulating hormone (TSH) and insulin-like growth factor-1 (IGF-1). RESULTS: 92 men were screened; of these 59 (mean age of 58+/-11 years) completed the study, 30 (51%) scored positively (mean 61.5 years) to the ADAM while 29 (49%) did not (mean 54.1 years). For the AMS the weight of the three domains (psychological, somato-vegetative and sexual) was significantly greater in Group A (p<0.001) than in Group B. Equally, for the CAS questionnaire, the scores for the variables energy, global performance, frequency of intercourse, mood and quality of sleep were lower in Group A than in their asymptomatic counterparts (p<0.001). The domain of memory assessment within the CSSAM-Q was not discriminatory. ADAM and AMS are self-administered and completed within 10 minutes. CSSAM-Q is more time consuming, requires an investigator to administer, and memory domain is biased in favour of specific professional training. No difference was found between the two groups in 6 of 8 biochemical tests. However, significant lower values (p<0.001) were found for DHEA-S and IGF-1 in the symptomatic group as compared with the non-symptomatic cohort. CONCLUSIONS: This study confirms that newer, more complex tools perform similarly to the simpler ADAM questionnaire. The lack of correlation between the clinical picture and the most commonly used biochemical confirmatory tests, again, clearly points to the paramount importance of the clinical evaluation. An emphasis and reliance on serum T alone hinders the clinician's ability to manage testosterone deficiency syndromes (TDS).

Nonmedical drug use by high school students: a three-year survey study.

The characteristics of high school student nonmedical drug users and nonusers were assessed by three successive yearly surveys. The surveys asked about respondents' personal, parent, and family characteristics; their behavior; their attitudes concerning themselves; their parents and family, adult society, and school. Drug use estimates for respondents' parents and peers, as well as themselves, were also assessed. Drug users were consistently different from nonusers in many areas. The incidence of drug increased in each of the three successive surveys, drug users tending to be older and male. With regard to behavior, drug users more frequently acted in a nonadult approved manner than nonusers. Drug users estimated their parents more likely to use alcohol and cigarettes, and estimated more peers to use nonmedical drugs than nonusers. Prediction of drug users from the data could be made with 80% and better accuracy. The findings are discussed in terms of their significance in understanding the nature of adolescent drug use.

Changing the coronary-prone (type A) behavior pattern in a nonclinical population.

This report presents the design and initial findings of an attempt to reduce the risk of coronary heart disease in healthy men by modifying their type A behavior pattern. A group of 27 professional and executive volunteers, aged 39--59, who had been medically assessed as free from coronary heart disease, were randomly assigned to brief psychotherapy and behavior therapy groups. Each treatment group met for 14 sessions over a period of 5 months. Pre- and postmeasures of physiological (serum cholesterol, serum triglycerides, blood pressure) and psychological (anxiety, psychological symptoms, satisfaction) variables were taken. Results indicate that both treatment groups changed in the desired direction on most of the psychological and physiological variables without apparent change in habits of diet, exercise, smoking, or work load. The findings are provocative, but only tentative, leaving questions of clinical validity, durability, and generalizability unresolved. Nevertheless, they indicate that this approach to modifying type A behavior may reduce coronary risk and therefore warrants further exploration.

An evaluation of the Minnesota Multiphasic Personality Inventory as a discriminator of primary organic and primary psychogenic impotence in diabetic males.

The ability of the MMPI to discriminate between primary psychogenic impotence and primary organic impotence in males with diabetes mellitus was assessed. In order to provide the MMPI with the optimal situation to discriminate between the two groups, we attempted to form a homogeneous sample in terms of physical conditions. Thirty impotent diabetic males were classified as primary organic or primary psychogenic based on nocturnal penile tumescence data. Beutler et al.'s MMPI decision rules yielded a 63% misclassification of the two groups. Possible explanations for the lack of discriminative power of the MMPI with this sample of diabetic males were discussed in relation to previous findings. The power of nocturnal penile tumescence to classify men as having primary organic or primary psychogenic impotence was examined with reference to other vascular and endocrine variables.

Generalizability and durability of treatment effects in an intervention program for coronary-prone (Type A) managers.

To test the reliability and durability of positive treatment effects obtained in a type A intervention project for healthy managers, the analysis was extended to data available from a third treatment group (a special behavior therapy group for participants eliminated from the main sample because of manifestations of clinical CHD) and to measures obtained 6 months following the end of treatment. Immediately after treatment all three groups showed a similar pattern of improvement, although the two behavior therapy groups did show a greater decrease in serum cholesterol levels. Six months after treatment the sample as a whole showed good maintenance of treatment effects, but the differences between groups had become somewhat sharper, with the special behavior therapy group faring best, the regular behavior therapy group intermediate, and the psychotherapy group worst. The logical consistency of these findings increases our confidence in the initial treatment results, as well as permitting cautious optimism concerning the possibility of developing effective intervention programs for coronary-type (type A) behavior.