Comparison of excess costs of care and production losses because of morbidity in diabetic patients.

OBJECTIVE: To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general population of a Swedish community. RESEARCH DESIGN AND METHODS: Costs of production losses were calculated from medical and social insurance records on sickness benefit days (short-term illness) and premature retirement (permanent disability) in people with diabetes and in the entire population of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral antidiabetic medications, other drugs, test material, and treatment devices, and they were obtained from patient records, the health care administration, and the statistics of community pharmacy sales. RESULTS: Of the diabetic patients < 65 years of age, above which both diabetic and nondiabetic people get retirement pension, and sickness benefits cease, 62% of those on insulin treatment in each gender had insulin-dependent diabetes mellitus (IDDM). All insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients were > 40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were prematurely retired twice as often as the average population and had twice as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, the costs of lost production as a result of excess morbidity (< 65 years of age) would be $12 billion and $9 billion for people with insulin-treated and non-insulin-treated diabetes, respectively. CONCLUSIONS: If improved metabolic control by intensified treatment would reduce excess morbidity in both IDDM and NIDDM, the predominant costs of production losses imply that intensified antidiabetic treatment might save costs.

Improved blood pressure control with isradipine in hypertensive patients treated with pindolol.

Isradipine is a new calcium antagonist of the dihydropyridine type with marked vasodilator activity and minimal negative inotropic effects. It is a potent antihypertensive drug when given as monotherapy. This was a randomized double-blind crossover study of 16 weeks' duration, including 80 hypertensive patients with diastolic blood pressures of at least 95 mm Hg who had shown clinically relevant antihypertensive responses, but no normalization of blood pressure during pindolol 10 to 15 mg once daily as monotherapy. Either isradipine or placebo was added to the beta-blocker at doses of either 2.5 mg or 5 mg twice daily, which was doubled after four weeks if the diastolic blood pressure remained more than 90 mm Hg. The addition of isradipine (in either dose regimen) caused a pronounced reduction of blood pressure with no changes in heart rate. Five patients were withdrawn from the study because of adverse events while receiving isradipine compared with three taking placebo. A further three patients withdrew from the study because of adverse events (one patient) or lack of efficacy (two patients) during placebo treatment. These results indicate that isradipine is an effective and well-tolerated adjunct to beta-blockers in hypertensive patients.

Clearance of triglycerides from the circulation and its relationship to serum lipoproteins: influence of age and sex.

In this study of a randomly selected population from 20 to 70 years of age, the clearance of triglycerides from the blood was studied after i.v. injection of an artificial triglyceride emulsion Intralipid. In women, the triglyceride clearance from the blood decreases with increasing age, but for men there was no change with age. Women had faster fractional removal rates of i.v. injected triglycerides than men in all age-groups. The triglyceride clearance showed a negative correlation to Broca index (obesity), serum triglyceride, serum cholesterol, triglycerides in very low density lipoproteins, and to cholesterol in very low density lipoproteins and in low density lipoproteins, but showed a strong positive correlation to cholesterol in high density lipoproteins.

Decreased removal of triglycerides from the blood--a mechanism for the hypertriglyceridemia in male patients with coronary artery disease.

We determined serum apolipoprotein A I and A II concentrations and triglyceride and cholesterol concentrations in serum lipoprotein density classes in 28 male patients with severe ischaemic heart disease (IHD) and with angiographically verified coronary artery disease (CAD) and in age-matched controls. Both triglyceride and cholesterol concentrations in very low density lipoproteins and in low density lipoproteins were higher in IHD-patients than in the controls. The triglyceride but not the cholesterol concentration in serum was higher in IHD-patients than in the controls. The cholesterol in high density lipoproteins and the serum apolipoprotein A I concentration were lower in IHD-patients than in the controls. At least in part the higher triglyceride concentration in very low density lipoproteins could be attributed to a decreased removal of triglycerides from the blood since the fractional removal rate of an i.v. injected artificial triglyceride emulsion (Intralipid) was slower in IHD-patients than in the controls.

Serum lipoproteins, apolipoproteins and intravenous fat tolerance in young athletes.

Serum lipoproteins, apolipoproteins and intravenous fat tolerance were studied in 22 male athletes and compared with healthy age and weight-height matched controls. All of the subjects were non-smokers. Athletes had lower serum, very low density lipoprotein (VLDL) and low density lipoprotein (LDL) triglycerides, lower serum VLDL and LDL cholesterol and an increase in apolipoprotein A I. High density lipoprotein (HDL) cholesterol was similar in both groups. The clearance of i.v. injected triglyceride emulsion was faster in athletes. This suggests that the lower serum and VLDL triglycerides in athletes are at least in part due to a more rapid triglyceride clearance.

Serum lipoproteins and apolipoproteins A I and A II in male patients with peripheral arterial insufficiency.

Serum apolipoprotein A I and A II concentrations and triglyceride and cholesterol concentrations in serum lipoprotein density classes were determined in male patients with peripheral arterial insufficiency (PAI) and in controls. Both triglyceride and cholesterol concentrations in serum, very low and low density lipoproteins were higher in PAI patients than in controls. The cholesterol in high-density lipoproteins and the serum apolipoprotein A I concentration were lower in PAI patients than in controls. No difference between the groups was found for serum apolipoprotein A II concentration. The results show that the lipoprotein pattern in PAI is changed in roughly the same way as in ischemic heart disease.

Isolated FSH deficiency in a male. A case report.

This report describes the case of a 26-year-old man investigated because of infertility. The patient appeared healthy with normal sexual activity, physical appearance and karyotype. Repeated semen analyses showed a marked oligozoospermia. A testicular biopsy specimen revealed arrested spermatogenesis and normal Leydig cells. Hormone analyses were normal except for a markedly reduced serum FSH level. Only a few such cases have been previously reported.