Comparison of long-term indwelling catheters and bed-pads in the treatment of urinary incontinence in elderly patients.

Bed-pads and long-term indwelling catheters were compared in the treatment of urinary incontinence in two groups of eight elderly bedridden women. The same silicone catheter could be left in situ on average for 2 months. A detailed description of the changes of urinary bacterial flora in patients of both experimental groups is given. At the end of the 6 months' study all of the patients in both groups had significant bacteriuria (greater than or equal to 10(8) CFU/1), Proteus species being the most common pathogen in catheterised patients. The development of multiple resistance was observed in both groups, but it was more pronounced in the catheterised group. The indwelling catheter was more economical (P less than 0.001), but carried a higher risk of infection.

Dietary vitamin c supplementation and common laboratory values in the elderly.

The effects of dietary supplementation with vitamin C on several common laboratory values were assessed in 27 elderly patients in long-stay wards. The patients had shown low plasma ascorbic acid concentrations before the study. During three consecutive periods of six weeks the patients received either placebo or moderate (200 mg/day) or high (2000 mg/day) doses of vitamin C. There was a significant rise of serum folate concentration after both doses of vitamin C. A decrease of serum uric acid concentration after high doses of vitamin C was found. Supplementation with vitamin C did not affect other values of laboratory examinations determined. The results suggest that dietary supplementation with either moderate or high doses of vitamin C has only very few and small influences on common laboratory values in elderly patients.

Sulphonylurea in combination with insulin therapy: does it make sense? A review.

Apart from their effects upon pancreas, sulphonylureas have been shown to influence the insulin action upon extrapancreatic tissues: they increase the number of insulin receptors in peripheral cells, enhance insulin binding to cells and alter postreceptor insulin action. Consistently, sulphonylureas potentiate the impact of insulin in vivo. Recent observations of this kind have renewed interest in the use of sylphonylureas in combination with insulin in diabetes. Several reports have lately been published on the use of combination treatment. Some type 2 diabetics with preserved beta cell function quite obviously benefit from the addition of sulphonylurea treatment to insulin therapy. This has been demonstrated in patients exhibiting secondary failure to oral drugs, and in diabetics requiring large amounts of insulin. Combination therapy does not seem to be effective in type 1 diabetics. The mechanism by which sulphonylureas improve the glycaemic control in diabetics on insulin is not clear. Both enhanced endogenous insulin secretion and potentiation of insulin activity may be involved. Further controlled clinical studies comparing the effects of combination therapy with those of insulin monotherapy are needed before the general utility of sulphonylurea + insulin therapy can be assessed.

Serum C-peptide concentrations and their value in evaluating the usefulness of insulin therapy in elderly diabetics.

Serum C-peptide concentrations were determined in 121 elderly subjects: 25 nondiabetic controls aged 69-86 years, and 96 type 2 (noninsulin-dependent diabetes mellitus) diabetics aged 64-96 years. Forty-seven of the diabetics were treated with tablets, 35 with insulin, and 14 with diet alone. Fasting serum C-peptide concentrations (nmol/l; mean +/- SD) were 0.51 +/- 0.20 for controls; 0.60 +/- 0.16 for diabetics on diet alone; 0.72 +/- 0.33 for diabetics on tablets and 0.46 +/- 0.23 for diabetics on insulin (p less than 0.001 for diabetics on tablets vs. controls and diabetics on tablets vs. diabetics on insulin). The glucagon-stimulated C-peptide concentrations were similar in all groups; the increment after glucagon was less in the diabetic patients on tablets or on insulin than in the nondiabetics. In 10 patients on insulin treatment and with fasting C-peptide of 0.24-1.46 nmol/l an attempt was made to withdraw insulin. In 4 subjects the transfer to tablets was possible. Serum C-peptide level did not predict the outcome of the attempt to change the therapy, but the possibility of an adequate dietary regimen seemed to be important. The results demonstrate a wide range of basal C-peptide concentrations in elderly diabetics on different treatments, which may indicate varying pathogenetic contributions of insulin deficiency and resistance in these patients. Our observations emphasize the necessity for regular re-evaluation of the therapeutic management of elderly diabetic patients.

Combination of insulin and glibenclamide in the treatment of elderly non-insulin dependent (type 2) diabetic patients.

A double-blind crossover study was undertaken to determine whether glibenclamide could improve glycaemic control in patients not adequately controlled by insulin. Nine elderly outpatients with non-insulin dependent (type 2) diabetes participated in the study. In addition to their regular insulin treatment, the patients were given either glibenclamide 5 mg twice daily or placebo tablets for 2 months followed by the opposite combination for a further 2 months. The fasting plasma glucose concentrations were lower during the insulin plus glibenclamide period than during the insulin plus placebo period and the difference tended to increase at the end of each study period (p less than 0.01 and 0.001). The level of haemoglobin A, (HbA1) decreased significantly from 13.8 +/- 0.6% (mean +/- SE) to 12.4 +/- 0.6% during the insulin + glibenclamide period (p less than 0.01); in contrast, there was no change during the insulin + placebo period. The 24-hour urinary glucose excretion was reduced during the insulin + glibenclamide period compared with insulin + placebo (p less than 0.05). Basal and glucagon stimulated C-peptide concentrations did not significantly differ between the two treatment regimens. The results suggest that glibenclamide can improve the glycaemic control in insulin-treated elderly diabetics by mechanisms which still are to be elucidated.

beta-N-acetylglucosaminidase and beta-glucuronidase activities in insulin-dependent diabetic subjects with retinopathy.

The serum activities of two lysosomal enzymes, beta-N-acetylglucosaminidase (EC 3.2.1.30, NAG) and beta-glucuronidase (EC 3.2.1.31, GLU), were determined in 41 insulin-dependent diabetics, 27 age-matched non-diabetic first-degree relatives of the diabetics and 103 age-matched non-diabetic blood-donors. The diabetics were divided into three groups on the basis of ophthalmoscopy: (1) no retinal abnormalities; (2) non-proliferative retinopathy; and (3) proliferative retinopathy. The activities of both serum enzymes were higher in diabetics (NAG 21.39 +/- 5.99; GLU 2.19 +/- 1.01) than in their relatives (NAG 17.22 +/- 3.99; GLU 1.62 +/-0.61). The diabetics with non-proliferative retinopathy had higher serum enzyme levels (NAG 24.05 +/- 6.26; GLU 2.60 +/- 1.06) than diabetics without retinopathy (NAG 17.88 +/- 3.00; GLU 1.69 +/ 0.64), whereas no statistically significant difference was found in patients with the proliferative form of retinopathy (NAG 18.67 +/- 6.28; GLU 1.99 +/- 1.04). In diabetics a positive correlation was found between serum beta-N-acetylglucosaminidase activity and blood glucose (p < 0.01), but not between beta-glucuronidase and blood glucose. Furthermore, the activities of both enzymes in diabetics correlated with the plasma triglyceride level (p < 0.05 for both correlations). No correlation was found between the enzyme levels and signs of other diabetic late complications.

No effect on serum lipids by moderate and high doses of vitamin C in elderly subjects with low plasma ascorbic acid levels.

The influence of dietary supplementation with moderate (200 mg/day) and high (2,000 mg/day) doses of vitamin C on serum lipid levels was studied in 27 female long-stay hospital patients characterized by low plasma ascorbic acid levels during the preceding year. The two doses of vitamin C were compared with placebo in a double-blind, cross-over design during randomly determined 6-week periods followed by 2-week washout intervals. No effect was observed on serum cholesterol, HDL cholesterol, and triglyceride levels. Plasma ascorbic acid levels were highly significantly increased (p less than 0.001) by both doses of vitamin C. It is concluded that dietary supplementation with moderate or high doses of vitamin C does not affect serum lipids of persons who have low plasma ascorbic acid levels suggestive of possible marginal deficiency of vitamin C.