Difference between revisions of "Wilkinson"
(Created page with " <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:black">Hyperbaric oxygen, an...") |
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| − | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:"><span style="color:black">Hyperbaric oxygen, and not hyperbaric air, resulted in increased insulin sensitivity in diabetic volunteers</span></span></span>'''</span> |
| − | {| class="Table" style="width: | + | {| class="Table" style="width: 877px;" width="598" |
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| − | <span style="line-height:normal"><span style="height:72.6pt">'''<span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="height:72.6pt">'''<span style="font-size:14.0pt"><span style="font-family:">Clinical bottom line:</span></span>'''</span></span> |
| − | <span style="line-height:normal"><span style="height:72.6pt"><span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal"><span style="height:72.6pt"><span style="font-size:14.0pt"><span style="font-family:">1. Exposure to hyperbaric oxygen resulted in an increased insulin sensitivity in diabetic patients compared to no change in sensitivty on exposure to hyperbaric air.<br/> 2. This study shows that it is oxygen breathing and not pressurization that drives this change.</span></span></span></span> |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Citation/s:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">1. Wilkinson DC, Chapman IM, Heilbronn LK. Hyperbaric oxygen but not hyperbaric air increases insulin sensitivity in men with type 2 diabetes mellitus. Diving Hyperb Med. 2020 Dec 20;50(4):386-390. doi: 10.28920/dhm50.4.386-390.</span></span></span></span><br/> |
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| − | <span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal"><span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">'''Lead author's name and fax: '''Dave Wilkinson Email: dwi75741@bigpond.net.au</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Three-part Clinical Question:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">For patients with type-2 diabetes, does the administration of hyperbaric air compared to hyperbaric oxygen, result in increased sensitivity to insulin?<br/> '''Search Terms:''' Diabetes, insulin sensitivity, hyperbaric air</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">The Study:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Single-blinded concealed randomised controlled trial with intention-to-treat.<br/> '''The Study Patients:''' Adult patients over 40 years with Type-2 diabetes mellitus.<br/> '''Control group''' (N = 12 ; 11 analysed): Application of a hyperinsulinaemic euglycaemic glucose clamp technique designed to measure insulin sensitivity before, during and after a 2 ATA, 100% oxygen breathing period of 90 minutes.<br/> '''Experimental group''' (N = 13 ; 13 analysed): As above but breathing air at the same pressure.</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">The Evidence:</span></span></span>'''</span> |
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{| class="Table" style="border: 1pt solid windowtext; width: 881px;" | {| class="Table" style="border: 1pt solid windowtext; width: 881px;" | ||
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| − | | rowspan="2" style="width: 381px; border: 1pt solid windowtext;" width="205" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | rowspan="2" style="width: 381px; border: 1pt solid windowtext;" width="205" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Measure</span></span>'''</span></p> |
| − | | colspan="2" style="width: 97px; border: 1pt solid windowtext;" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | colspan="2" style="width: 97px; border: 1pt solid windowtext;" width="92" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBOT Group</span></span>'''</span></p> |
| − | | colspan="2" style="width: 110px; border: 1pt solid windowtext;" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | colspan="2" style="width: 110px; border: 1pt solid windowtext;" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">HBA Group</span></span>'''</span></p> |
| − | | rowspan="2" style="width: 133px; border: 1pt solid windowtext;" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | rowspan="2" style="width: 133px; border: 1pt solid windowtext;" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Difference</span></span>'''</span></p> |
| − | | rowspan="2" style="width: 120px; border: 1pt solid windowtext;" width="126" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | rowspan="2" style="width: 120px; border: 1pt solid windowtext;" width="126" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI</span></span>'''</span></p> |
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| − | | style="width: 50px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 50px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean</span></span>'''</span></p> |
| − | | style="width: 40px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 40px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">SD</span></span>'''</span></p> |
| − | | style="width: 64px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 64px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean</span></span>'''</span></p> |
| − | | style="width: 39px; border: 1pt solid windowtext;" width="36" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 39px; border: 1pt solid windowtext;" width="36" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">SD</span></span>'''</span></p> |
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| style="width: 381px; border: 1pt solid windowtext;" width="205" | | | style="width: 381px; border: 1pt solid windowtext;" width="205" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Glucose infusion rate (mg/m-sq/min) at steady state 2</span></span>'''</span> |
| − | | style="width: 50px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 50px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">189</span></span></span></p> |
| − | | style="width: 40px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 40px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">81</span></span></span></p> |
| − | | style="width: 64px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 64px; border: 1pt solid windowtext;" width="45" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">198</span></span></span></p> |
| − | | style="width: 39px; border: 1pt solid windowtext;" width="36" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 39px; border: 1pt solid windowtext;" width="36" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">95</span></span></span></p> |
| − | | style="width: 133px; border: 1pt solid windowtext;" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 133px; border: 1pt solid windowtext;" width="83" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-9</span></span></span></p> |
| − | | style="width: 120px; border: 1pt solid windowtext;" width="126" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width: 120px; border: 1pt solid windowtext;" width="126" | <p align="center" style="margin-bottom:0cm; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-6,725 to 6,707</span></span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Comments:</span></span></span>'''<br/> <span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">1. Well-conducted but small experiment with good methodology, well-reported.<br/> 2. Baseline session conducted after a 10 hour fast and lasting for 3.5 hours at 1 ATA breathing air to establish insulin sensitivity at normal conditions.<br/> 3. Standard dose of insulin infused and glucose infusion rate varied to maintain euglycaemia.<br/> 4. Baselines were different between groups and the authors measured the steady state glucose infusion rate twice during the hyperbaric exposures. The figures here are for the second period and show no important difference in the raw numbers.<br/> 5. Glucose infusion rate increased by 26% in the HBO group compared to no change in the HBA group (P= 0.04).</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Appraised by:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Mike Bennett m.bennett@unsw.edu.au; Monday, 18 April 2022<br/> '''Kill or Update By:''' April 2025</span></span></span></span> |
| + | <p style="text-align: center;"> </p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p> <p style="text-align: center;"><span style="font-size:xx-large;">[[Physiology|BACK]]</span></p> | ||
Latest revision as of 01:09, 25 April 2022
Hyperbaric oxygen, and not hyperbaric air, resulted in increased insulin sensitivity in diabetic volunteers
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Clinical bottom line: 1. Exposure to hyperbaric oxygen resulted in an increased insulin sensitivity in diabetic patients compared to no change in sensitivty on exposure to hyperbaric air. |
Citation/s:1. Wilkinson DC, Chapman IM, Heilbronn LK. Hyperbaric oxygen but not hyperbaric air increases insulin sensitivity in men with type 2 diabetes mellitus. Diving Hyperb Med. 2020 Dec 20;50(4):386-390. doi: 10.28920/dhm50.4.386-390.
Lead author's name and fax: Dave Wilkinson Email: dwi75741@bigpond.net.au
Three-part Clinical Question:For patients with type-2 diabetes, does the administration of hyperbaric air compared to hyperbaric oxygen, result in increased sensitivity to insulin?
Search Terms: Diabetes, insulin sensitivity, hyperbaric air
The Study:Single-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients over 40 years with Type-2 diabetes mellitus.
Control group (N = 12 ; 11 analysed): Application of a hyperinsulinaemic euglycaemic glucose clamp technique designed to measure insulin sensitivity before, during and after a 2 ATA, 100% oxygen breathing period of 90 minutes.
Experimental group (N = 13 ; 13 analysed): As above but breathing air at the same pressure.
The Evidence:
Measure |
HBOT Group |
HBA Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Glucose infusion rate (mg/m-sq/min) at steady state 2 |
189 |
81 |
198 |
95 |
-9 |
-6,725 to 6,707 |
Comments:
1. Well-conducted but small experiment with good methodology, well-reported.
2. Baseline session conducted after a 10 hour fast and lasting for 3.5 hours at 1 ATA breathing air to establish insulin sensitivity at normal conditions.
3. Standard dose of insulin infused and glucose infusion rate varied to maintain euglycaemia.
4. Baselines were different between groups and the authors measured the steady state glucose infusion rate twice during the hyperbaric exposures. The figures here are for the second period and show no important difference in the raw numbers.
5. Glucose infusion rate increased by 26% in the HBO group compared to no change in the HBA group (P= 0.04).
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Monday, 18 April 2022
Kill or Update By: April 2025
