Utilization and cost analysis of bedside capillary glucose testing in a large teaching hospital: implications for managing point of care testing.

Purpose: To study the use and cost of bedside capillary glucose testing in a large teaching hospital.

Patients And Methods: In a prospective study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital, records were maintained by each unit of the date, time, operator, and results of patient and quality control tests. Cost analysis was performed using data from time studies, test tallies in logbooks, and hospital administration records.

Pancreatic cystic islet-cell tumors. Clinical and pathologic features in two cases with cyst fluid analysis.

Cystic islet-cell tumors are rare neoplasms that may be confused with more familiar cystic pancreatic lesions, such as pseudocysts, serous cystadenoma, and mucinous tumors. Analysis of aspirated cyst fluid for tumor markers (carcinoembryonic antigen [CEA], CA-125, and CA-15.3), enzymes (amylase and lipase), viscosity, and cytology has been proposed as an aid to preoperative differential diagnosis.

Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing.

Purpose: To study the implementation of bedside capillary glucose monitoring using a hospital-wide quality control (QC) program.

Methods: A prospective study of QC performance in 7 outpatient and 39 inpatient treatment units was performed in a large teaching hospital over a 2-year period. Approximately 800 nurses were trained to perform bedside capillary glucose monitoring (Accu-Chek II, Boehringer-Mannheim, Indianapolis, IN).

Role of diabetologist in evaluating diabetic retinopathy.

Objective: To evaluate the ability of diabetologists to screen diabetic patients for diabetic retinopathy.

Research Design And Methods: Comparison of eye examination performed by diabetologists with direct ophthalmoscopy through an undilated pupil and by ophthalmologists through a dilated pupil with seven-field stereoscopic fundus photography (gold standard). The study consisted of 67 insulin-dependent and non-insulin-dependent diabetic outpatients attending a diabetes clinic.

Adrenal crisis in the setting of high-dose ketoconazole therapy.

We describe a patient with type I diabetes mellitus and hypothyroidism who developed frank adrenocortical insufficiency while receiving a high-dose ketoconazole therapy for keratitis caused by Acanthamoeba species. While impaired cortisol responses to corticotropin and mildly symptomatic hypoadrenalism have been described previously with ketoconazole therapy, to our knowledge, this case represents the first documented article of an actual adrenal crisis associated with this drug. Two reasons are postulated for the development of this complication in our patient: high-dose ketoconazole therapy given in divided doses during the day, and a possibly impaired central response to stress because of hypothyroidism.

Increased insulin-like growth factor II production and consequent suppression of growth hormone secretion: a dual mechanism for tumor-induced hypoglycemia.

We investigated the pathophysiology of fasting hypoglycemia associated with large tumors of mesenchymal origin. We studied two patients with symptomatic fasting hypoglycemia (plasma glucose, 1.92 and 2.

The relationship between metabolic control and vascular complications of diabetes mellitus.

Animal studies strongly support the notion that the microvascular complications of diabetes are a consequence of the metabolic derangements. The evidence from human studies is not nearly as persuasive, but controlled prospective clinical trials are examining this issue more incisively than has been possible previously.

Glyburide or insulin for metabolic control in non-insulin-dependent diabetes mellitus. A randomized, double-blind study.

Study Objective: To compare the relative efficacy, risks, and benefits of insulin with glyburide in achieving normoglycemia in non-insulin-dependent diabetes mellitus.

Design: Randomized, double-blind, placebo-controlled trial with a 9-month treatment period.

Setting: University hospital.

Non-insulin-dependent diabetes in older patients. Complications and risk factors.

Non-insulin-dependent diabetes mellitus is predominantly a disease of aging, with more than 70 percent of non-insulin-dependent (type II) diabetic patients older than 55 years of age. The prevalence of macrovascular, microvascular, and neurologic complications in outpatients with type II diabetes between the ages of 55 and 74 was compared with that in a similarly aged nondiabetic group of patients. The association between duration of diabetes, hypertension, age, and other putative risk factors that are prevalent in this elderly diabetic population and the occurrence of complications was explored.

Retinopathy in older type II diabetics. Association with glucose control.

Non-insulin-dependent (type II) diabetics over the age of 55 comprise most of the diabetic population and are at considerable risk for the development of both macrovascular and microvascular complications. We studied the prevalence of retinopathy and its association with putative risk factors for its development in an elderly (55- to 75-yr-old) population of type II diabetics. Our cross-sectional analysis revealed that duration of diabetes and hemoglobin A1c (HbA1c) concentration were the two major predictors of the presence of retinopathy.

Bedside capillary glucose measurement by staff nurses in a general hospital.

The accuracy of capillary blood glucose monitoring has been well demonstrated when applied by patients in the outpatient setting or by specially trained nurses on inpatient diabetes units. In order to determine the applicability of this technique in the more general hospital setting, a program was initiated for instructing general staff nurses in the use of Chemstrips bG strips and the Accu-Chek bG meter. As a pilot study, nurses on four general medical and surgical hospital floors performed capillary glucose determinations within 15 minutes of the drawing of venous blood samples for determination of plasma glucose in the hospital's Chemistry Laboratory.

The preparation of an acceptable placebo for NPH insulin.

A suitable placebo for NPH insulin has not previously been available for clinical investigation. A series of organic and inorganic compounds were formulated as insulin placebos and analyzed according to the following criteria: (1) degree of visual similarity to insulin, (2) stability, (3) absence of local side effects, and (4) clinical safety. Dilute suspensions of cortisone acetate (1.

Ice cream in the diet of insulin-dependent diabetic patients.

We investigated the effect of ice cream ingestion on blood glucose control in conventionally treated and intensively treated insulin-dependent (type I) diabetic patients. After the ingestion of 100 g of ice cream, plasma glucose excursions as measured by the peak increment (90 +/- 30 mg/dL) and area under the curve (166 +/- 59 mg/dL X hour) were modest and not significantly different between the subgroups of intensively treated and conventionally treated diabetics. A small dose (3 to 5 units) of rapid-acting insulin given 30 minutes before ingestion of ice cream reduced the modest plasma glucose excursion.

Nucleotide sequence of the cDNA encoding the precursor of the beta subunit of rat lutropin.

We have determined the nucleotide sequences of cDNAs encoding the precursor of the beta subunit of rat lutropin, a polypeptide hormone that regulates gonadal function, including the development of gametes and the production of steroid sex hormones. The cDNAs were prepared from poly(A)+ RNA derived from the pituitary glands of rats 4 weeks after ovariectomy and were cloned in bacterial plasmids. Bacterial colonies containing transfected plasmids were screened by hybridization with a 32P-labeled cDNA encoding the beta subunit of human chorionic gonadotropin, a protein that is related in structure to lutropin.

alpha Subunit of rat pituitary glycoprotein hormones. Primary structure of the precursor determined from the nucleotide sequence of cloned cDNAs.

Double-stranded complementary DNAs were constructed enzymatically from polyadenylated RNA extracted from pituitary glands of ovariectomized rats, were inserted into the Pst I site of plasmid pBR322 and were cloned in Escherichia coli chi 1776. Cloned cDNAs encoding the precursor to the alpha subunit (pre-alpha) of the glycoprotein hormones were identified by hybridization with a restriction fragment of a previously cloned and sequenced cDNA encoding the precursor to the alpha subunit of mouse thyrotropin (Chin, W. W.

Cell-free synthesis and processing of the precursors to the subunits of luteinizing hormone.

Polyadenylated RNA prepared from pituitary glands of ovariectomized rats was translated in heterologous cell-free systems derived from wheat germ and rabbit reticulocytes in the absence and in the presence of pancreatic microsomal membranes. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis demonstrated that the major 14,000-dalton product immunoprecipitated by antisera to the alpha subunit of rat and bovine luteinizing hormone from membrane-free translations was processed to a major 21,000-dalton and a minor 17,000-dalton product in the presence of microsomal membranes. These membrane-dependent products were sensitive to cleavage by the glycosidase endo-beta-N-acetylglucosaminidase H, but the 14,000-dalton product was resistant.

Luteinizing and follicle-stimulating hormones. Cell-free translations of messenger RNAs coding for subunit precursors.

Polyadenylated RNA prepared from pituitary glands of normal and castrate rats was translated in membrane-free heterologous cell-free systems derived from wheat germ and rabbit reticulocytes. Sodium dodecyl sufate (SDS)-polyacrylamide gel electrophoresis and autoradiography demonstrated a major [35S]methionine-labeled translation product of castrate pituitary mRNA with apparent Mr = 14,000. This Mr = 14,000 product was specifically immunoprecipitated by anti-sera to the alpha subunit of rat and bovine luteinizing hormone (LH alpha) and was much reduced in the translation products of normal pituitary RNA.