Physiologically Based Modelling Framework for Prediction of Pulmonary Pharmacokinetics of Antimicrobial Target Site Concentrations.

Background And Objectives: Prediction of antimicrobial target-site pharmacokinetics is of relevance to optimize treatment with antimicrobial agents. A physiologically based pharmacokinetic (PBPK) model framework was developed for prediction of pulmonary pharmacokinetics, including key pulmonary infection sites (i.e.

Self-monitoring of blood glucose in tablet-treated type 2 diabetic patients (ZODIAC).

Background: Whether self-monitoring of blood glucose (SMBG) improves glycaemic control in patients with type 2 diabetes mellitus (T2DM) not using insulin is questionable. Our aim was to investigate the effects of SMBG in patients with T2DM who were in persistent moderate glycaemic control whilst not using insulin.

Methods: Patients were eligible when between 18 and 70 years of age, with an HbA1c between 7 and 8.

Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history.

Objective: To develop a clinical prediction rule that can help the clinician to identify women at high and low risk for gestational diabetes mellitus (GDM) early in pregnancy in order to improve the efficiency of GDM screening.

Design: We used data from a prospective cohort study to develop the clinical prediction rule.

Setting: The original cohort study was conducted in a university hospital in the Netherlands.

External validation of a clinical scoring system for the risk of gestational diabetes mellitus.

Aim: A prediction rule for gestational diabetes mellitus (GDM) could be helpful in early detection and increased efficiency of screening. A prediction rule by means of a clinical scoring system is available, but has never been validated externally. The aim of this study was to validate the scoring system.

Improved glycemic control with intraperitoneal versus subcutaneous insulin in type 1 diabetes: a randomized controlled trial.

OBJECTIVE Continuous intraperitoneal insulin infusion (CIPII) with an implantable pump has been available for the past 25 years. CIPII, with its specific pharmacodynamic properties, may be a viable treatment alternative to improve glycemic control in patients with type 1 diabetes for whom other therapies have failed. There have been few studies in which CIPII was compared with subcutaneous insulin treatment for patients with type 1 diabetes with poor glycemic control.

Comparison of accuracy measures of two screening tests for gestational diabetes mellitus.

Objective: To compare the accuracy measures of the random glucose test and the 50-g glucose challenge test as screening tests for gestational diabetes mellitus (GDM).

Research Design And Methods: In this prospective cohort study, pregnant women without preexisting diabetes in two perinatal centers in the Netherlands underwent a random glucose test and a 50-g glucose challenge test between 24 and 28 weeks of gestation. If one of the screening tests exceeded predefined threshold values, the 75-g oral glucose tolerance test (OGTT) was performed within 1 week.

Glycaemic control, health status and treatment satisfaction with continuous intraperitoneal insulin infusion.

Background: Continuous intraperitoneal insulin infusion(CIPI ) has been in use for over 20 years. High costs and technical problems have prevented its widespread use. In the Netherlands, the Isala Clinics in Zwolle is the centre with the most extensive experience with CIPII .

Introduction of diabetes passports involving both patients and professionals to improve hospital outpatient diabetes care.

Aim: To investigate whether a comprehensive strategy involving both patients and professionals, with the introduction of a diabetes passport as a key component, improves diabetes care.

Methods: The first 150 consecutive patients who visited their internist for a diabetes check up at the internal medicine outpatient departments at each of nine Dutch general hospitals were included in this 1 year clustered, randomised, controlled trial. Health care professionals attended an educational meeting about the use and dissemination of the diabetes passport which is a patient held record.

[Diagnosis of diabetes mellitus: limited use for portable blood-glucose measuring devices].

In the Netherlands, guidelines for the diagnosis of diabetes mellitus are confusing and differ from the international guidelines. Capillary blood-glucose testing using a blood-glucose device is allowed used as a diagnostic tool, although this test is imprecise. The Dutch laboratories measure blood-glucose concentrations by a more precise accurate method, but sometimes measure glucose levels in capillary whole blood and sometimes in venous plasma.

Patients and nurses determine variation in adherence to guidelines at Dutch hospitals more than internists or settings.

Aims: To measure adherence to recently developed diabetes guidelines at Dutch hospital outpatient clinics and distinguish determinants for variations in care on hospital, internist and patient levels.

Methods: Thirteen general hospitals with 58 internists recruited 1950 diabetic patients. Data were extracted from medical files (n = 1915) and from patient questionnaires (n = 1465).

Continuous intraperitoneal insulin infusion in patients with 'brittle' diabetes: favourable effects on glycaemic control and hospital stay.

Aims: To evaluate the effects of continuous intraperitoneal insulin infusion (CIPII) using implantable pumps on glycaemic control and duration of hospital stay in poorly controlled 'brittle' Dutch diabetes patients, and to assess their current quality of life.

Methods: Thirty-three patients were included. Glycaemic control was retrospectively assessed with HbA(1c) levels acquired before implantation, 1 year later and at long-term follow up of 58 months.

[Pregnancy in women with diabetes mellitus type I: maternal and perinatal complications, in spite of good blood glucose control].

Objective: To examine the maternal and neonatal outcome of pregnancies of women with type I diabetes mellitus.

Design: Retrospective.

Methods: The medical records of pregnancies (> or = 16 weeks) in women with type I diabetes mellitus between 1986/'97 were studied in University Medical Center Utrecht, Academic Hospital Groningen and Isala Clinics, location 'De Weezenlanden', Zwolle, the Netherlands.

Perceived barriers to the implementation of diabetes guidelines in hospitals in The Netherlands.

Objective: To determine the organisational and personal barriers to the implementation of diabetes guidelines in hospitals in The Netherlands and relate them to structural factors of diabetes care.

Method: In a written survey internists specialised (or with a specific interest) in diabetes in all general hospitals in The Netherlands (n = 120) were asked to indicate the perceived organisational and personal barriers to adherence to the diabetes guidelines. In the same questionnaire their activities related to diabetes care and the working hours of the additional personnel involved were measured.

[CBO guidelines on diagnosis, treatment, and prevention of complication in diabetes mellitus: retinopathy, foot ulcers, nephropathy and cardiovascular diseases. Dutch Institute for Quality Assurance].

Early detection and adequate treatment of complications of diabetes mellitus (DM) are important for many patients in maintaining independence and ability to work. Diabetic retinopathy cannot be prevented. Limitation of damage is possible by aiming for normoglycaemia and normotension.

[Prevalence of asymptomatic cardiac ischemia in men with diabetes mellitus type I].

Objective: To establish the prevalence of 'silent ischaemia' of the myocardium in male patients with type 1 diabetes mellitus using a non-invasive cardiac examination, and to determine what clinical variables are related to silent ischaemia.

Design: Prospective, cross-sectional.

Method: Males aged 20-69 years who visited the outpatient department of Internal Medicine of the De Weezenlanden Hospital in Zwolle between 1 February 1992 and 31 January 1995, and who showed no symptoms of ischaemic cardiopathy (angina pectoris, myocardial infarction or arrhythmias) or of chronic obstructive pulmonary disease, were examined for cardiac ischaemia by means of a 24-hour Holter registration and a perfusion scintigram after administration of dipyridamol.

[Differences between diabetes mellitus type 2 patients switched and not switched over to insulin treatment after specialist consultation].

Objective: To describe the characteristics of patients with diabetes mellitus type 2 who were referred to an outpatient department for insulin therapy.

Setting: Hospital De Weezenlanden, Department of Internal Medicine, Zwolle, the Netherlands.

Design: Descriptive.

[Is fundus photography useful in screening for diabetic retinopathy in patients with type II diabetes mellitus?].

Objective: To determine the value of a screening programme with fundus photography for diabetic retinopathy in diabetes mellitus type II patients.

Design: Prospective.

Setting: General practices in the region Zwolle, The Netherlands.

Long term use of captopril or nifedipine in normotensive microalbuminuric patients with insulin-dependent diabetes mellitus.

Several studies have suggested that ACE-inhibition may be effective in postponing the onset of nephropathy in insulin-dependent diabetic subjects. In contrast, other drugs might have opposing effects. To study the long term effects of either captopril or nifedipine in normotensive, microalbuminuric patients with insulin-dependent diabetes mellitus, eighteen subjects received either placebo (n = 5, P), 20 mg nifedipine daily (n = 7, N) or 50 mg captopril daily (n = 6, C) for one year.

Impact of late complications in type 2 diabetes in a Dutch population.

The prevalence of late complications was determined in four general practices in a representative group of 137 patients with Type 2 diabetes and a control group of 128 non-diabetic individuals. Retinopathy was found in 35% of all diabetic patients, with the same prevalence below and above the age of 70 years. Microalbuminuria was found in 42% of diabetic patients and in 22% of the control group (p less than 0.

Renal function and renal function reserve in insulin-dependent diabetic patients during (near) normoglycaemia.

Twenty-three normoalbuminuric (N) and 7 microalbuminuric (M) insulin-dependent diabetes mellitus (IDDM) patients were studied under (near) normoglycaemic conditions. They were reasonably well controlled during the period preceding the renal function test (HbA1: N = 7.6 +/- 1.

[The prevalence of late complications of type II diabetes mellitus].

Prevalence of late complications determined in a representative group of 137 patients with type II diabetes mellitus and a control group of 128 persons without diabetes from the same population. Retinopathy was not rare in type II diabetes mellitus (prevalence 35%), but only 50% of diabetic patients had proper ophthalmological care. Microalbuminuria was found in 42% of the patients with diabetes mellitus, although serious renal dysfunction was seldom found.

[Outpatient adjustment to insulin in patients with diabetes mellitus].

Starting insulin treatment of patients with diabetes mellitus commonly takes place during hospital admission. Home blood glucose monitoring and specially trained nurses, however, enable the physician to start insulin treatment on an outpatient basis. Consistent application of this procedure starting 1-10-1986 resulted in a fall of hospital admissions from 98.