An intensified lifestyle intervention programme may be superior to insulin treatment in poorly controlled Type 2 diabetic patients on oral hypoglycaemic agents: results of a feasibility study.

AIMS: The aims of this study were to assess whether, in Type 2 diabetic patients with inadequate glycaemic control on oral hypoglycaemic agents (OHA), a lifestyle intervention programme based on exercise and diet counselling (i) was as effective as insulin treatment in controlling blood glucose, and (ii) could prevent the weight gain usually accompanying the introduction of insulin treatment. METHODS: Thirty-eight Type 2 diabetic subjects treated with OHA, HbA(1c) 8-10.5% and body mass index (BMI) 26-40 kg/m2, were randomized to the following treatments: (i) lifestyle intervention (L), (ii) lifestyle intervention + insulin treatment (L+I) and (iii) insulin treatment alone (I). RESULTS: There was a reduction in HbA(1c) of -1.2 (interquartile range 1.0), -1.0 (1.7) and -1.5 (2.5)% in group L, L+I and I, respectively, and all treatment groups achieved beneficial changes in blood lipid variables. There was no significant difference between the groups in the change observed in levels of HbA(1c) between start and 12 months of treatment (P = 0.74). There was a significant difference in weight changes between groups (P < 0.01): group L reduced weight by median -3.0 (4.0) kg, groups L+I and I increased weight by 3.5 (3.4) and 4.9 (6.9) kg, respectively. CONCLUSIONS: Lifestyle intervention was as effective as insulin treatment in improving glycaemic control in poorly controlled subjects with Type 2 diabetes, and resulted in weight loss during the intervention year. However, glycaemic control deteriorated and body weight increased in the lifestyle intervention group 1 year after the intervention stopped.

Appropriate replacement dose of thyroxine in primary hypothyroidism.

An ultrasensitive thyrotropin (TSH) assay was used to determine how many of 65 patients with primary hypothyroidism on thyroxine (T4) replacement therapy had suppressed serum TSH. In 13 patients (20%) TSH levels less than or equal to 0.1 mIU/l were found, indicating an overdose of thyroxine. After correction of the dose, 48 patients had normal TSH values. Their mean dose of thyroxine was 119 micrograms/24 hours, and the appropriate replacement dose tended to decline with advancing age. The serum level of thyroid hormones during replacement therapy with thyroxine very imperfectly reflected serum TSH values. It is concluded that overdose of thyroxine is common when suppressed serum TSH is used as an end point. Biochemical follow-up of replacement therapy with thyroxine in primary hypothyroidism therefore requires the use of an ultrasensitive TSH assay in order to detect such suppression. Serum levels of thyroxine or triiodothyronine (T3) during thyroxine therapy are poor indicators of pituitary TSH secretion and are therefore not useful as parameters of adequate thyroxine dosage.

[Investigation of Cushing's syndrome. The diagnostic value of the dexamethasone suppression test, the metopirone test and the CRF test]. / Utredning av Cushings syndrom. Den diagnostiske verdi av Dexametasonsuppresjonstest, Metopirontest og CRF-test.

We describe thirty-one patients with Cushing's syndrome, with the object of evaluating the relative merit of the Dexamethasone suppression test, Metyrapone test and Corticotrophin Releasing Factor (CRF) test in classifying the syndrome. Bilateral adrenocortical hyperplasia (Cushing's disease) was present in sixteen patients. Three had bilateral macrodular hyperplasia of the adrenal cortex, six had adrenocortical adenoma, four had adrenocortical carcinoma, and two patients presented ectopic ACTH-syndrome. The diagnosis was surgically verified in every case. The Metyrapone test was found to give the safest classification in patients with Cushing's syndrome. The Dexamethasone test will diagnose Mb. Cushing reliably when suppression of serum cortisol is present following the large dose of Dexamethasone, but failure to suppress does not exclude the diagnosis. The CRF test is easy to perform and distinguished reliably between Mb. Cushing and other causes of the syndrome in eight out of ten patients in whom it was performed. Outpatient examination including the CRF test and CT-scanning of the pituitary and adrenal glands is advocated as a preliminary step in the classification of biochemically and clinically suspected cases of Cushing's syndrome.

[Long-term result of a life style intervention group program]. / Langtidsresultat ved livsstilsintervensjon i grupper.

156 former participants in a lifestyle modification programme for persons with coronary heart disease, or at high risk of developing this disease, were invited to a follow-up examination. The aim was to evaluate the long-term effect of a lifestyle intervention programme. Median time since completion of the programme was 3 years. The participants' serum cholesterol level at the time of the control examination was lower than before they attended the programme, but slightly higher than at the end of it. The body weight was similar at the control and before participation. The self-reported amount of physical activity of persons with established coronary heart disease was higher at the control examination than before the programme. For persons with no established coronary heart disease, the self-reported level of physical activity was the same before and after attending the programme. The most pronounced effect as regards a reduction of the risk factor profile was seen among the participants with established coronary heart disease. The number of smokers was reduced, but not significantly.

[Thyroid hormone resistance. Clinical, biochemical and genetic study of a family]. / Thyreoideahormonresistens. Klinisk, biokjemisk og genetisk utredning av en familie.

We here present a family where three individuals in three generations had varying degrees of goiter, tachycardia, fatigue, hyperactivity, and learning disability. Serum T3 and free T4 were elevated, whereas TSH was normal or slightly increased. The clinical findings in combination with the hormone values led to several supplementary investigations and therapies being carried out, but they had no beneficial influence on the patients' symptoms. The commonest form of thyroid hormone resistance (RTH) is an autosomal dominantly inherited disorder with varying degrees of hypo- and hyperthyroidism, including the hormonal changes described above. Several mutations, particularly in exons 9 and 10 of the thyroid hormone receptor beta gene, have been described and shown to be responsible for RTH. Exons 7, 8, 9, and 10 in the thyroid hormone receptor beta gene were amplified by polymerase chain reaction and analyzed by DNA sequencing. A heterozygous point mutation in nucleotide 1244 in exon 9 was demonstrated in the two patients with RTH that were available for the study. The guanidine to thymidine point mutation changed the codon for arginine in position 320 in the receptor protein to leucine. This mutation has previously been shown to decrease receptor affinity for T3; it has been demonstrated in some patients with RTH, and it is probably the cause of RTH in the family described in this study.

[Integration of preventive medicine in an emergency department. A pedagogic model for improvement of communication]. / Integrering av forebyggende medisin i en akuttmedisinsk avdeling. En pedagogisk modell for utvikling av kommunikasjon.

At the Medical Department, Telemark Central Hospital, a project has been going on for five years now to evaluate consultations in lifestyle groups in preference to individual consultations for persons with dyslipidemia. 363 persons were recruited to participate in a series of 5 group consultations at intervals of 3 months, each session to last for 2 hours. Altogether 1469 consultations were of this type. After the first session 79% said they preferred lifestyle group consultations, rather than spending their share of the allotted time on personal consultations, and after the fifth session 81%. The concept has been extended to include patients with chronic disease (asthma and chronic inflammatory bowel disease), with the principal aim of improving the patients' understanding of their disease, and showing them how to control it themselves. The project has attracted much attention, and a consultant in preventive medicine has recently been appointed to the staff. We think it important in terms of impact that the initiative to establish local expertise in preventive medicine emerged from a department that deals with emergency admissions due to lifestyle-related diseases.