We studied whether sensory function abnormalities are present at diagnosis and whether they devel... more We studied whether sensory function abnormalities are present at diagnosis and whether they develop in the early stages of non-insulin-dependent diabetes (NIDDM). Quantitative assessments of vibration sensitivity at the hallux and index fingers, and thermal sensitivity at the hallux were performed at screening (2-h oral glucose tolerance tests) for diabetes in 364 individuals. Twenty-five subjects diagnosed with NIDDM and 25 matched nondiabetic subjects were restudied after an interval of 12-41 mo. When those with NIDDM (n = 41) or impaired glucose tolerance (IGT) (n = 38) were compared with nondiabetic subjects, there were no significant differences in sensory function indices. However, the vibration threshold and HbA1c were related among those found to be hyperglycemic (IGT and NIDDM combined P less than 0.05; NIDDM alone P less than 0.05). Among diabetic subjects, the vibration threshold and interaction term of height and Hba1c were positively related in a multiple regression analysis (P less than 0.01). There were increments in all sensory thresholds in diabetic patients at follow-up (P less than 0.05 for all). Increments were smaller in control subjects. These data suggest that although sensory function tends to be normal at diagnosis in NIDDM patients, there appears to be a diminution in sensory function as the disease progresses. An interaction between metabolic factors and height may influence sensory function early in the course of NIDDM.
We have specifically examined warm and cool sensitivities in 60 diabetic and 43 nondiabetic indiv... more We have specifically examined warm and cool sensitivities in 60 diabetic and 43 nondiabetic individuals. Diabetic patients tended to have less warm and cool sensitivity than the control subjects (P less than .001 for age less than 50 yr and P less than .05 for age greater than or equal to 50 yr). Both patients asymptomatic for neuropathy and patients with symptoms had impairment of warm and cool sensitivity (P less than .05 for comparisons with control subjects). These differences persisted (P less than .05) in covariance analyses with age included as a covariate. There was a nonlinear association between warm sensitivity and hemoglobin A1c. Warm-sensitivity values in the lowest and middle tertiles of the hemoglobin A1c distribution were similar; however, warm-sensitivity values of patients in the highest tertile were markedly increased (P less than .05 for the comparison of the highest tertile with the lowest and middle tertiles combined). There tended to be more warm insensitivity than cool insensitivity among the diabetic patients, and this difference increased with worsening glycemia. These data indicate that both warm and cool sensations are markedly impaired in asymptomatic adult diabetic patients. They also suggest that warm sensitivity is more impaired than cool sensitivity, and that this is the result of a stronger association between warm sensitivity and metabolic factors.
Sensory function was prospectively examined in 201 Type 2 diabetic patients over a 2-year period.... more Sensory function was prospectively examined in 201 Type 2 diabetic patients over a 2-year period. Quantitative sensory testing for vibration, cool, warm, and pressure perception at the hallux was performed at baseline, 1-month, 1-year, and 2-year visits. There were statistically significant increments of thresholds for all sensory modalities from the baseline visit to the 1-year visit (p < 0.001) and from the 1-year visit to the 2-year visit (p < 0.001). Thirty percent of 77 subjects considered to be at low risk for foot ulceration at baseline progressed to a higher risk category at the 2-year visit. There were no significant differences in mean glycosylated haemoglobin, height, sex distribution, age, or diabetes duration when patients who had a faster progression of insensitivity were compared with patients who had a slower progression. There was a high degree of autocorrelation between baseline and 2-year visits for all sensory modalities (r = 0.83 to r = 0.88, p < 0.001 for all). Also, changes in sensory thresholds from the baseline to 2-year visits for one modality tended to correlate with other modalities (r = 0.36 to r = 0.70, p < 0.001 for all). These data indicate that an appreciable proportion of Type 2 diabetic patients are at risk for a marked rate of decline of sensory function, and suggest a need for at least yearly quantitative sensory testing.
We compared the accuracy of cutaneous pressure perception-threshold measurements with that of oth... more We compared the accuracy of cutaneous pressure perception-threshold measurements with that of other sensory-threshold measurements for detecting diabetic foot ulcer patients. Three hundred fourteen non-insulin-dependent diabetic patients were studied, of whom 91 had either a current foot ulcer or a history of foot ulceration. Foot ulcer patients had much higher pressure perception thresholds at the hallux than those without foot ulcers (mean +/- SE 4.63 +/- 0.05 vs. 3.54 +/- 0.04 U, P less than 0.001). The magnitude of association was higher than that for vibration thresholds and markedly greater than those for cool and warm thresholds. Pressure thresholds were highly accurate for identifying foot ulcer patients. At a threshold level of 4.21 U, the sensitivity was 0.84, with a specificity of 0.96. At similar sensitivities for vibration and thermal thresholds, specificities were lower. Foot ulceration and cutaneous pressure perception threshold are strongly associated. Pressure-threshold measurements are extremely accurate and perform at least as well as other quantitative sensory tests in identifying foot ulcer patients. Assessment of the foot pressure threshold may have promise as a simple and inexpensive method for detecting diabetic patients at risk for foot ulcers.
El ser humano es omnívoro, es decir, que come prácticamente de todo, y, en cierta forma, lo neces... more El ser humano es omnívoro, es decir, que come prácticamente de todo, y, en cierta forma, lo necesita para su desarrollo físico y para fortalecer su organismo y proteger su salud. Muchos mamíferos son cien por cien vegetarianos; otros, como los monos y los gorilas (los más cercanos al hombre), comen vegetales, insectos y gusanos; y otros más, como los cánidos y los felinos, comen, básicamente, carne. Por supuesto, cada animal ha tenido que adecuarse a su medio ambiente para poder comer, echando mano de aquello que no le intoxica y sí le alimenta. Un perro, por ejemplo, puede convertirse del carnivorismo al vegetarianismo si se le acostumbra a ello, y un gato callejero no tarda mucho en convertirse en un ser omnívoro si quiere sobrevivir en la jungla de asfalto. Hay primates, como los babuinos y los mandriles, que pueden ser eventualmente carnívoros, de la misma manera que hay hombres que pueden pasar de comer todo tipo de alimentos a consumir casi exclusivamente frutas y verduras. Mucho se ha hablado de lo que debe ser una alimentación natural para el ser humano, dando por sentado que el vegetarianismo debe de serlo, pero, ni siquiera el hombre de las cavernas, o el Pitecantropus erectus, se alimentaban exclusivamente de frutas y hierbas. En muchas culturas, el vegetarianismo fue adoptado más como una filosofía espiritual que como una forma de alimentación. Oriente es una buena prueba de ello. Los occidentales han copiado de Oriente las ideas espirituales y alimentarias, pero el vegetarianismo no se introdujo genéricamente en nuestras culturas junto al budismo, sino como un recurso para adelgazar o recuperar la salud, aduciendo que el vegetarianismo es más sano y natural que el comer de todo. El vegetarianismo es un tipo de alimentación que se puede asumir o adoptar durante un tiempo determinado, y entre un sector de la población que va de los 21 a los 41 años. Ni antes ni después de estas edades se recomienda seguir un vegetarianismo a ultranza, ya que los alimentos de origen animal son importantes y necesarios para el desarrollo de los niños y para el cuidado de salud de los mayores. Es cierto que el mundo vegetal puede ofrecernos un amplio abanico de nutrientes, y que, en ausencia de la carne, el ser humano podría adecuarse a una vida completamente vegetariana, pero para ello habría que cambiar no solamente la alimentación, sino toda una serie de hábitos. En este libro propondremos una serie de recetas basadas en una
We studied whether sensory function abnormalities are present at diagnosis and whether they devel... more We studied whether sensory function abnormalities are present at diagnosis and whether they develop in the early stages of non-insulin-dependent diabetes (NIDDM). Quantitative assessments of vibration sensitivity at the hallux and index fingers, and thermal sensitivity at the hallux were performed at screening (2-h oral glucose tolerance tests) for diabetes in 364 individuals. Twenty-five subjects diagnosed with NIDDM and 25 matched nondiabetic subjects were restudied after an interval of 12-41 mo. When those with NIDDM (n = 41) or impaired glucose tolerance (IGT) (n = 38) were compared with nondiabetic subjects, there were no significant differences in sensory function indices. However, the vibration threshold and HbA1c were related among those found to be hyperglycemic (IGT and NIDDM combined P less than 0.05; NIDDM alone P less than 0.05). Among diabetic subjects, the vibration threshold and interaction term of height and Hba1c were positively related in a multiple regression analysis (P less than 0.01). There were increments in all sensory thresholds in diabetic patients at follow-up (P less than 0.05 for all). Increments were smaller in control subjects. These data suggest that although sensory function tends to be normal at diagnosis in NIDDM patients, there appears to be a diminution in sensory function as the disease progresses. An interaction between metabolic factors and height may influence sensory function early in the course of NIDDM.
We have specifically examined warm and cool sensitivities in 60 diabetic and 43 nondiabetic indiv... more We have specifically examined warm and cool sensitivities in 60 diabetic and 43 nondiabetic individuals. Diabetic patients tended to have less warm and cool sensitivity than the control subjects (P less than .001 for age less than 50 yr and P less than .05 for age greater than or equal to 50 yr). Both patients asymptomatic for neuropathy and patients with symptoms had impairment of warm and cool sensitivity (P less than .05 for comparisons with control subjects). These differences persisted (P less than .05) in covariance analyses with age included as a covariate. There was a nonlinear association between warm sensitivity and hemoglobin A1c. Warm-sensitivity values in the lowest and middle tertiles of the hemoglobin A1c distribution were similar; however, warm-sensitivity values of patients in the highest tertile were markedly increased (P less than .05 for the comparison of the highest tertile with the lowest and middle tertiles combined). There tended to be more warm insensitivity than cool insensitivity among the diabetic patients, and this difference increased with worsening glycemia. These data indicate that both warm and cool sensations are markedly impaired in asymptomatic adult diabetic patients. They also suggest that warm sensitivity is more impaired than cool sensitivity, and that this is the result of a stronger association between warm sensitivity and metabolic factors.
Sensory function was prospectively examined in 201 Type 2 diabetic patients over a 2-year period.... more Sensory function was prospectively examined in 201 Type 2 diabetic patients over a 2-year period. Quantitative sensory testing for vibration, cool, warm, and pressure perception at the hallux was performed at baseline, 1-month, 1-year, and 2-year visits. There were statistically significant increments of thresholds for all sensory modalities from the baseline visit to the 1-year visit (p < 0.001) and from the 1-year visit to the 2-year visit (p < 0.001). Thirty percent of 77 subjects considered to be at low risk for foot ulceration at baseline progressed to a higher risk category at the 2-year visit. There were no significant differences in mean glycosylated haemoglobin, height, sex distribution, age, or diabetes duration when patients who had a faster progression of insensitivity were compared with patients who had a slower progression. There was a high degree of autocorrelation between baseline and 2-year visits for all sensory modalities (r = 0.83 to r = 0.88, p < 0.001 for all). Also, changes in sensory thresholds from the baseline to 2-year visits for one modality tended to correlate with other modalities (r = 0.36 to r = 0.70, p < 0.001 for all). These data indicate that an appreciable proportion of Type 2 diabetic patients are at risk for a marked rate of decline of sensory function, and suggest a need for at least yearly quantitative sensory testing.
We compared the accuracy of cutaneous pressure perception-threshold measurements with that of oth... more We compared the accuracy of cutaneous pressure perception-threshold measurements with that of other sensory-threshold measurements for detecting diabetic foot ulcer patients. Three hundred fourteen non-insulin-dependent diabetic patients were studied, of whom 91 had either a current foot ulcer or a history of foot ulceration. Foot ulcer patients had much higher pressure perception thresholds at the hallux than those without foot ulcers (mean +/- SE 4.63 +/- 0.05 vs. 3.54 +/- 0.04 U, P less than 0.001). The magnitude of association was higher than that for vibration thresholds and markedly greater than those for cool and warm thresholds. Pressure thresholds were highly accurate for identifying foot ulcer patients. At a threshold level of 4.21 U, the sensitivity was 0.84, with a specificity of 0.96. At similar sensitivities for vibration and thermal thresholds, specificities were lower. Foot ulceration and cutaneous pressure perception threshold are strongly associated. Pressure-threshold measurements are extremely accurate and perform at least as well as other quantitative sensory tests in identifying foot ulcer patients. Assessment of the foot pressure threshold may have promise as a simple and inexpensive method for detecting diabetic patients at risk for foot ulcers.
El ser humano es omnívoro, es decir, que come prácticamente de todo, y, en cierta forma, lo neces... more El ser humano es omnívoro, es decir, que come prácticamente de todo, y, en cierta forma, lo necesita para su desarrollo físico y para fortalecer su organismo y proteger su salud. Muchos mamíferos son cien por cien vegetarianos; otros, como los monos y los gorilas (los más cercanos al hombre), comen vegetales, insectos y gusanos; y otros más, como los cánidos y los felinos, comen, básicamente, carne. Por supuesto, cada animal ha tenido que adecuarse a su medio ambiente para poder comer, echando mano de aquello que no le intoxica y sí le alimenta. Un perro, por ejemplo, puede convertirse del carnivorismo al vegetarianismo si se le acostumbra a ello, y un gato callejero no tarda mucho en convertirse en un ser omnívoro si quiere sobrevivir en la jungla de asfalto. Hay primates, como los babuinos y los mandriles, que pueden ser eventualmente carnívoros, de la misma manera que hay hombres que pueden pasar de comer todo tipo de alimentos a consumir casi exclusivamente frutas y verduras. Mucho se ha hablado de lo que debe ser una alimentación natural para el ser humano, dando por sentado que el vegetarianismo debe de serlo, pero, ni siquiera el hombre de las cavernas, o el Pitecantropus erectus, se alimentaban exclusivamente de frutas y hierbas. En muchas culturas, el vegetarianismo fue adoptado más como una filosofía espiritual que como una forma de alimentación. Oriente es una buena prueba de ello. Los occidentales han copiado de Oriente las ideas espirituales y alimentarias, pero el vegetarianismo no se introdujo genéricamente en nuestras culturas junto al budismo, sino como un recurso para adelgazar o recuperar la salud, aduciendo que el vegetarianismo es más sano y natural que el comer de todo. El vegetarianismo es un tipo de alimentación que se puede asumir o adoptar durante un tiempo determinado, y entre un sector de la población que va de los 21 a los 41 años. Ni antes ni después de estas edades se recomienda seguir un vegetarianismo a ultranza, ya que los alimentos de origen animal son importantes y necesarios para el desarrollo de los niños y para el cuidado de salud de los mayores. Es cierto que el mundo vegetal puede ofrecernos un amplio abanico de nutrientes, y que, en ausencia de la carne, el ser humano podría adecuarse a una vida completamente vegetariana, pero para ello habría que cambiar no solamente la alimentación, sino toda una serie de hábitos. En este libro propondremos una serie de recetas basadas en una
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