The purpose of this study was to evaluate the psy- chometric properties of a Swedish version of The Krantz Health Opinion Survey (KHOS). A conven- ience sample of 79 persons (47 men and 32 women) was recruited from The Heart and Lung Patients’ National Association at ten local meeting places in different areas in Sweden. The questionnaire was examined for face and content validity, internal con-sistency and test-retest reliability. The findings showed that the Swedish version of KHOS is accept- able in terms of face and content validity, internal consistency and test-retest reliability over time among 79 individuals >65 years of age and with a cardiac disease. In conclusion, wider evaluations of the psy- chometric use of KHOS for other populations and settings are recommended.

The patients’ sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of ‘The 25-item Sex after MI Knowledge Test’ in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients’ National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test–retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test–retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.

Background: 

As part of preparation for a Swedish multicentre study, exploring sexual and married life in patients with myocardial infarction and their partners, a Swedish validated instrument was required. 

Aims:

The aim of this pilot study was to evaluate the validity and reliability of a Swedish version of the Watts Sexual Function Questionnaire (WSFQ) among persons with a heart disease.

Methods:

A convenience sample of 79 persons (47 men and 32 women) living with a heart disease was recruited from the members of the National Association of Heart and Lung Patients. They completed a Swedish version of the WSFQ on two occasions.

 Results:

Two separate factor analyses each revealed a two-factor structure on both occasions: “Sexual appetite” and “Sexual expectations ”with gender-neutral questions and “Sexual sensitiveness” and “Sexual ability” with gender-specific questions. Cronbach's alpha coefficients ranged from 0.48 to 0.86 and test – retest values for all but one question exceeded 0.70.

Conclusions:

The Swedish version of the WSFQ showed good validity and stability and acceptable internal homogeneity. Extended evaluations of the questionnaire are recommended.

Abstract

Background: Earlier studies have shown that individuals with an impaired glucose tolerance have an increased risk for cardiovascular disease. 

The present study is a substudy of a broader investigation concerning clinical and laboratory parameters in healthy individuals during a screening process found to have impaired glucose tolerance (IGT) - defined as having a 2 hour value for p-glucose in the range 7.8-11.0 mmol/L on OGTT (oral glucose tolerance test).

Method: Blood pressure, pulse rate, laboratory parameters, blood and plasma viscosity were studied in 27 individuals (age range 39-76 years, 14 women and 13 men) with IGT – all of them without clinical signs of vascular or other somatic disease.

Results: The individuals with IGT had a laboratory profile close to patients with overt diabetes type II.  Compared to the healthy control group, IGT individuals had higher values for both systolic and diastolic blood pressure, pulse rate, blood and plasma viscosity (p<0.05 – p<0.001), higher values for B-glucose, triglycerides and S-GT (p<0.05 - p<0.01) but lower values for S-Kreatinine (p<0.001). Blood pressure and ESR (erythrocyte sedimentation rate) were positively correlated to plasma viscosity. Pulse rate at rest and after exercise was negatively correlated to blood and plasma viscosity.     

Conclusion: The study shows that even minor abnormalities of glucose metabolism tend to be harmful and may create a health risk and especially a risk for vascular disease. It is thus strongly recommended to identity and follow these asymptomatic individuals to avoid or postpone, by preventive measures, the onset of overt clinical disease.                                                               

Abstract

BACKGROUND: The institution of insulin therapy may be easy and uncomplicated in some Type 2 diabetics, but in others, mainly the obese patients, problems often arise (e.g. poor compliance, worsening B-cell function and/or insulin resistance).  

METHODS: As a substudy of a broader investigation, concerning hemorheological effects of insulin treatment in insufficiently controlled type 2 diabetics, blood pressure was recorded in 12 patients at baseline, after two months and after four months on insulin.

RESULTS: After two months on insulin analyses of triglycerides, high density lipoprotein cholesterol and total cholesterol indicated metabolic improvement (p<0.05 to 0.001) and a surprisingly uniform increase of blood pressure values (p<0.05 to 0.01) was found. At the same time, the serum sodium concentration increased (p<0.01) and was positively correlated to both systolic and diastolic blood pressure (p<0.01).

After four months on insulin, blood pressure returned to pre-treatment values or even lower (p<0.05 to 0.01). Serum sodium also decreased to pretreatment values. No significant changes of the flow behaviour of blood were seen after institution of insulin.

CONCLUSIONS: The number of patients was small and the study was not primarily designed to examine blood pressure. The preliminary conclusion from this study, however, is that the initiation of insulin treatment in poorly controlled type 2 diabetics causes a temporary and possibly clinically significant elevation of blood pressure. A changed renal handling of sodium caused by insulin, may be one of several possible explanations to the results, but further studies are warranted to confirm the findings.

Key words: Blood pressure; Insulin therapy; NIDDM; Sodium excretion.

Background: Body weight tends to rise on institutions of insulin theraphy in type 2 diabetics. one possible reason can be stimulated feelings of hunger but there may also be other reasons for this phenomenon.

Method:Blood pressure and body weight were studied in seventeen (age range 51-73 years) obese type 2 diabetics (81-104 kg) before start of insulin therapy and after two, four and six months on insulin. Blood lipids, blood glucose, HbA_1C, S-potassium, S-sodium, S-bilirubin, S-ALP, S-ALAT and S-GT were followed. Some patients had medication for hypertension. Oral anti-diabetic agents had proved to be insufficient.

Results:There was a significant rise of body weight in all patients (p<0,01) which seemed to level off after two months on insulin. Between four and six months on insulin there was only slight further weight gain. More surprisingly, a rather uniform increase of both diastolic and systolic blood pressure was seen after two months on insulin treatment (p<0,05). After four months blood pressure was back to pre-insulin values.

Conclusions:One possible explanation for temporary increase of blood pressure could be effects of insulin on renal absorption of sodium as in cases of insulin oedemas (DeFronzo 1981, Gupta et al 1992, Singh et al 1999). If so, besides creating feelings of hunger etc, insulin treatment may also to some extent increase body weight by enhancing retention of sodium and water. Further studies are warranted to confirm our findings and preliminary theories.   

Studies on effects of insulin therapy on body weight and blood pressure in obese

type 2 diabetics

Sylvi Persson1, PhD, BSc, Hans Larsson2, MD, PhD,

1Department of Health Sciences and Social Work, University of Vaxjo, Sweden

2Department of Medicine / Endocrinology, Hospital of Varberg, Sweden

Background: Body weight tends to rise on institution of insulin therapy in type 2 diabetics. One possible reason is stimulated feelings of hunger but there may also be other reasons for this phenomenon.

Method: Blood pressure and body weight were studied in seventeen obese type 2 diabetics before start of insulin therapy and after two, four and six months on insulin. Blood glucose and lipids, HbA1C, S-bilirubin, S-electrolytes, S-enzymes were followed. Oral agents had proved to be insufficient.

Results: There was a significant rise of body weight (p<0,01) which seemed to level off after two months on insulin. Between four and six months on insulin there was only slight further weight gain. More surprisingly, a uniform increase of both diastolic and systolic blood pressure was seen after two months on insulin treatment (p<0,05). After four months blood pressure was back to pre-insulin values.

Conclusion: One explanation for the temporary increase of blood pressure could be effects of insulin on renal absorption of sodium as in insulin oedemas (Gupta et al 1992, Singh et al 1999). If so, insulin treatment may also to some extent increase body weight by enhancing retention of sodium and water. Further studies are needed for confirmation of our finding/results.

Abstract

As a substudy of a broader investigation, concerning hemorheological effects of insulin treatment in insufficiently controlled type 2 diabetics, blood pressure was recorded in twelve patients before, after two months and after four months on insulin. After two months on insulin analyses of  MCV, S-Na, S-GT, total cholesterol, HDL-cholesterol and triglycerides indicated metabolic improvement (p<0.05-0.00 1). Besides a surprisingly uniform increase of both systolic and diastolic blood pressure (p<0.05) was found. No significant changes of the flow behaviour of blood were seen. After four months on insulin blood pressure had returned to pre-treatment values (p<0.05-0.01) or even lower. Further metabolic improvement (p<0.05-0.001) but no significant hemorheological improvement was now seen. Our number of patients was rather small and the study was not primarily designed for studies on blood pressure. Our preliminary conclusion from this study, however, has to be that institution of insulin treatment in poorly controlled type I1 diabetics causes a temporary and possibly clinically significant elevation of blood pressure. Further studies seem to be warranted to confirm our findings. Earlier studies have shown that insulin treatment may cause an increased albumin escape rate, increased plasma volume and systemic ("insulin-") oedema. A changed renal handling of sodium caused by insulin, might be one of several possible explanations to our results.

Abstract

BACKGROUND: The institution of insulin therapy may be easy and uncomplicated in some Type 2 diabetics, but in others, mainly the obese patients, problems often arise (e.g. poor compliance, worsening B-cell function and/or insulin resistance).  

METHODS: As a substudy of a broader investigation, concerning hemorheological effects of insulin treatment in insufficiently controlled type 2 diabetics, blood pressure was recorded in 12 patients at baseline, after two months and after four months on insulin.

RESULTS: After two months on insulin analyses of triglycerides, high density lipoprotein cholesterol and total cholesterol indicated metabolic improvement (p<0.05 to 0.001) and a surprisingly uniform increase of blood pressure values (p<0.05 to 0.01) was found. At the same time, the serum sodium concentration increased (p<0.01) and was positively correlated to both systolic and diastolic blood pressure (p<0.01).

After four months on insulin, blood pressure returned to pre-treatment values or even lower (p<0.05 to 0.01). Serum sodium also decreased to pretreatment values. No significant changes of the flow behaviour of blood were seen after institution of insulin.

CONCLUSIONS: The number of patients was small and the study was not primarily designed to examine blood pressure. The preliminary conclusion from this study, however, is that the initiation of insulin treatment in poorly controlled type 2 diabetics causes a temporary and possibly clinically significant elevation of blood pressure. A changed renal handling of sodium caused by insulin, may be one of several possible explanations to the results, but further studies are warranted to confirm the findings.

Abstract

 As a substudy to a broader investigation concerning clinical parameters in patients with impaired glucose tolerance blood and plasma viscosity were studied in 55 patients in ages from 39 to 81 years (mean age 62,4 years).  These patients were selected from a large health study in southern Sweden where they presented with impaired glucose tolerance but without signs of  vascular disease.  At the time of our study these 55 patients were still not, 20 years after their first oral glucose tolerance test, classified as ouvert diabetes. Our intention was to study effects of minor disturbances of glucose tolerance on blood rheology.  The patients had a laboratory profile close to that of patients with ouvert type 2 diabetes. Compared to a ontrol group of healthy individuals they had higher values for blood and plasma viscosity at all shear rates (p<0.001), higher values for b-glucose, ESR, triglycerides, s-GT  (p<0.05-0.005) and lower values for s-creatinine p<0.001). It was also found that diastolic pressure, both at rest and after exercise, was positively correlated to plasma viscosity. This holds true also for systolic arm pressure. Pulse rate at rest and after exercise showed a negative correlation to blood rheology parameters. The pool of data is very large and further analyses are under way. So far our data show that even minor abnormalities of glucose metabolism are harmful and create a risk for vascular disease.