bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychosocial Slate of Patients With IDDM Prone to Recurrent Episodes of Severe Hypoglycemia
Authors: Wredling Regina AM , Theorell PG Töres , Roll H Martin , Lins Per Eric S , Adamson Ulf KC
Published: March 2007

Objective

The aim of this study was to investigate the psychosocial situation in patients with insulin-dependent diabetes mellitus (IDDM) with recurrent attacks of severe hypoglycemia (SH).

Research Design and Methods

The study group consisted of 17 adult patients with SH and 17 patients matched to the study group with regard to sex, age, and duration of diabetes without severe attacks. The psychosocial situation was measured by means of self-rated questionnaires and an observer's rating scale.

Results

Parameters such as social support, life events, type A behavior, neuroticism, and vital exhaustion were not different, although a higher anxiety rating (P <0.05) and a lower rating of happiness (P <0.01) were found in the SH group.

Conclusions

We conclude that the anxiety level is increased and that experienced happiness is decreased in patients prone to recurrent severe hypoglycemia.
Somatosensory Conduction Delay in Central and Peripheral Nervous System of Diabetic Patients
Authors: Nakamura Ryohji , Noritake Masayuki , Hosoda Yoshito , Kamakura Keiko , Nagata Naokazu , Shibasaki Hiroshi
Published: March 2007

Fifty-four diabetic patients with or without clinical evidence of neuropathy and with no clinical evidence of CNS dysfunction were studied by somatosensory-evoked potentials after electrical stimulation of the median nerve at the wrist and recorded from the scalp electrode against a noncephalic reference. Peripheral conduction index, calculated as the distance from the wrist to the C7 spinous process divided by the P9 latency, was significantly decreased (P <0.01) in diabetic patients (69.81 ± 6.47 m/s) compared with 28 age-matched nondiabetic subjects (76.85 ± 5.65 m/s). The P11–P13 interpeak latency, representative of the transit time from the dorsal column at the level of the sensory input into the cervical cord to the brain stem along the somatosensory pathways (CCT1), and the P13-N19 interpeak latency, representative of the transit time from the brain stem to the somatosensory cortex (CCT2), were significantly increased in diabetic patients (CCT1, 2.51 ± 0.63 ms; CCT2, 5.76 ± 0.92 ms) compared with nondiabetic subjects (CCT1, 2.28 ± 0.36 ms, P <0.05; CCT2, 5.18 ± 0.51 ms, P <0.01). We conclude that, in diabetic patients, neurophysiological abnormalities may be present in two distinct parts of the CNS and the peripheral nervous system.
Accuracy of Home Blood Glucose Monitors
Authors: Tate Phyllis F , Clements Carol A , Walters J Edward
Published: March 2007

Objective

To determine the accuracy of five home blood glucose monitors (HBGM) in reference to a standard laboratory reference method.

Research Design and Methods

The study took place in the laboratory of a 350-bed private acute-care hospital. Subjects were a sample of convenience of 207 diabetic and nondiabetic adult and pediatric patients scheduled for fasting blood work that included a blood glucose test. Venous blood samples were collected for laboratory determination of blood glucose level. A separate sample was collected for testing on two each of five HBGMs: AccuChek II M, Tracer II, ExacTech, Glucometer II with Memory, and One Touch.

Results

Multiple regression analysis showed that all 10 monitors could be used to predict laboratory blood glucose values. The monitors with the highest predictabilities were One Touch, Tracer II, and AccuChek II M. Consistency between monitors of the same brand was lowest with One Touch. AccuChek II M had the smallest SD between the 2 monitors used in the study.

Conclusions

HBGM can be used to predict actual laboratory values of blood glucose. However, the controlled environment of the study should be considered and patient education made a high priority when recommending monitors.
Beneficial Effect of Low-Glycemic Index Diet in Overweight NIDDM Subjects
Authors: Wolever Thomas M S , Jenkins David JA , Vuksan Vladimir , Jenkins Alexandra L , Wong Gerald S , Josse Robert G
Published: March 2007

Objectives

To determine whether low-glycemic index (GI) diets have clinical utility in overweight patients with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design and Methods

Six patients with NIDDM were studied on both high- and low-GI diets of 6-wk duration with metabolic diets with a randomized crossover design. Both diets were of similar composition (57% carbohydrate, 23% fat, and 34 g/day dietary fiber), but the low-GI diet had a GI of 58 compared with 86 for the high-GI diet.

Results

Small and similar amounts of weight were lost on both diets: 2.5 kg on high-GI diet and 1.8 kg on low-GI diet. On the low-GI diet, the mean level of serum fructosamine, as an index of overall blood glucose control, was lower than on the high-GI diet by 8% (P <0.05), and total serum cholesterol was lower by 7% (P <0.01).

Conclusions

In overweight patients with NIDDM, reducing diet GI improves overall blood glucose and lipid control.
Muscle Blood Flow in Diabetes Mellitus: Evidence of Abnormality After Exercise
Authors: Menon Ram K , Grace Andrew A , Burgoyne William , Fonseca Vivian A , James Ian M , Dandona Paresh
Published: March 2007

Objective

To determine whether muscle blood flow before and after exercise is abnormal in patients with diabetes mellitus.

Research Design and Methods

Muscle blood flow (MBF) was measured with the 133Xe clearance technique in 15 nondiabetic subjects, 10 patients with insulin-dependent diabetes mellitus (IDDM), and 11 patients with non-insulin-dependent diabetes (NIDDM) at rest and after exercise. None of the patients had neuropathy.

Results

The median resting MBF was similar in all three groups. The median postexercise MBF was significantly greater in nondiabetic subjects (40.1 ml· min−1·100 g−1 of tissue) than in patients with IDDM (25.7 ml· min−1·100 g−1 of tissue; P <0.01) or NIDDM (14 ml· min−1·100 g−1 of tissue; P <0.01). The difference between IDDM and NIDDM was not significant.

Conclusions

Diabetic patients have abnormalities of MBF in response to exercise. This abnormality occurs in the absence of clinical diabetic neuropathy.
Rationale and Application of Fatty Acid Oxidation Inhibitors in Treatment of Diabetes Mellitus
Authors: Foley James E
Published: March 2007

There are elevated fatty acid levels in non-insulin-dependent diabetes mellitus that are due to diminished insulin action in inhibiting fatty acid release from adipocytes. Insulin therapy and other inhibitors of fatty acid release from adipocytes (e.g., nicotinic acid) suppress these elevated fatty acid levels and bring about a reduction in hyperglycemia. One mechanism by which fatty acids may be causal in hyperglycemia is in stimulating gluconeogenesis in the liver in the postabsorptive state. Another mechanism is in attenuating glucose disposal in skeletal muscle in the fed state. Potential nonglycemia-related effects of fatty acids are in substrate utilization in the heart and lipid synthesis in the liver. Inhibition of fatty acid oxidation is useful in reducing hyperglycemia by inhibiting glucose production in humans. However, there is less evidence that such inhibition can be useful in increasing glucose utilization in muscle, as predicted by the Randle hypothesis. This, coupled with potential adverse effects on heart muscle, make liver targeting of fatty acid oxidation inhibitors an important factor in their potential for development. Although such agents have advantageous effects on lipid metabolism, overdosing can lead to adverse liver lipid effects via the same mechanism. These adverse liver lipid effects could be minimized by development of reversible inhibitors that allow fatty acid oxidation to occur only during the overnight fast. The potential usefulness of such agents is evident; however, no drug that meets these objectives has been developed.
New Pharmacological Approaches to Therapy of NIDDM
Authors: Bressler Rubin , Johnson David
Published: March 2007

Currently available pharmacological agents have not been completely successful in restoring euglycemia in the non-insulin-dependent diabetes mellitus (NIDDM) patient. Several new approaches to the therapy of NIDDM have been formulated in recent years and are in various stages of laboratory or pharmaceutical development. Several of these agents are discussed in this article under categories relating to their mechanisms of lowering blood glucose: 1) inhibition of the release or action of counterregulatory hormones; 2) inhibition of postprandial glucose rise; 3) sensitization of tissues to insulin's actions; and 4) inhibition of gluconeogenesis, including inhibition of the long-chain acyl-CoA-carnitine acyltransferase I, the long-chain acylcarnitine translocase, and pyruvate carboxylase.
Metabolic Impact of Education in NIDDM
Authors: D'Eramo-Melkus Gail A , Wylie-Rosett Judith , Hagan Julie A
Published: March 2007

Objective

To evaluate the impact of a model program of diabetes education and weight reduction on diabetes control and weight loss in obese individuals with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design and Methods

Eighty-two obese diabetic subjects were randomized to three levels of educational intensity: 1) a single individual session, 2) a 12-wk behavior-oriented diabetes education and weight control group intervention, or 3) group intervention plus six individual follow-up sessions. Repeated measures of weight, fasting blood glucose, and HbA1c were collected. Measures of diabetes knowledge, skills, and attitudes were also obtained.

Results

By 6 mo, all three intervention groups had a significant weight loss (P < 0.01). The mean weight loss of ∼ 10 lb was independent of treatment group and was maintained over the duration of the study. However, significant improvement in metabolic control was associated with participation in the diabetes education-weight reduction intervention.

Conclusions

The findings of this study indicate that a cognitive behavioral group intervention of diabetes knowledge and weight reduction training can produce weight loss and improvements in diabetes control. The addition of individual counseling as a follow-up maintenance strategy does not appear to have any advantage.
Foot Pressure Measurements in Diabetic and Nondiabetic Amputees
Authors: Veves Aristidis , Van Ross Ernest RE , Boulton Andrew JM
Published: March 2007

Objective

Foot problems are common in the remaining foot of diabetic amputees. Because high foot pressures are associated with foot ulceration, we studied foot pressures of the remaining foot of diabetic and nondiabetic unilateral amputees.

Research Design and Methods

Four age-matched groups of 11 subjects were studied. The groups were comprised of diabetic subjects with previous major amputation, nondiabetic nonneuropathic amputees, diabetic nonamputee patients with similar peripheral nerve involvement as the diabetic amputees, and nondiabetic control subjects. Vibration perception threshold (VPT) was assessed by biothesiometry and foot pressures with an optical pedobarograph.

Results

Mean ± SE VPT in the diabetic amputees was significantly higher than the nondiabetic amputees (40.2 ± 3.7 vs. 17.7 ± 2.8 V, P < 0.002) and similar to diabetic nonamputees (43.4 ± 3.3 V, NS). VPT was abnormal in 9 (82%) diabetic amputees, 2 (18%) nondiabetic amputees, and 10 (91%) nonamputee diabetic patients. The mean peak foot pressure in the diabetic amputees was higher compared with nondiabetic amputees (18.3 ± 2.2 vs. 11.3 ± 1.4 kg/cm2, P < 0.05) and control subjects (10.0 ± 1.5 kg/m2, P < 0.01), but no difference existed with diabetic nonamputees. Abnormally high foot pressures (> 12.3 kg/cm2) were present in 8 (73%) diabetic amputees, 3 (27%) nondiabetic amputees, 8 (73%) diabetic nonamputees, and 4 (36%) healthy subjects.

Conclusions

We conclude that high pressures are present under the remaining foot in diabetic amputees, and that these pressures are associated with diabetic neuropathy. Prosthetic usage does not increase the pressures under the remaining foot in nondiabetic amputees.
High Systolic Blood Pressure Increases Prevalence and Severity Of Retinopathy in NIDDM Patients
Authors: Cignarelli Mauro , Cicco Maria Luigia De , Damato Aurelio , Paternostro Adriano , Pagliarini Sergio , Santoro Salvatore , Cardia Luigi , Pergola Giovanni De , Giorgino Riccardo
Published: March 2007

OBJECTIVE

To determine whether the severity of retinopathy is higher in a group of NIDDM patients with sBP ≥ 140 mmHg compared with NIDDM patients with sBP < 140 mmHg.

RESEARCH DESIGN AND METHODS

Ophthalmoscopy and FAG were conducted among a group of NIDDM patients with either a sBP above (n = 54) or below (n = 55) 140 mmHg. The groups were matched according to diabetes duration, metabolic control (HbA1c), and AER.

RESULTS

Patients with sBP > 140 mmHg had a higher prevalence of retinopathy, as established according to a rating scale (4.9 ± 3.8 vs. 3.2 ± 3.3, P < 0.02); furthermore, their BMI values were higher (28.1 ± 4.5 vs. 24.9 ± 4.1 kg/m2, P < 0.001). The group of normotensive subjects showed the highest rate of low grading (0–2) values. However, the highest prevalence rates of 8–10 grading values (proliferative retinopathy) were found in the hypertensive group.

CONCLUSIONS

These data suggest that sBP values ≥ 140 mmHg favor the onset of retinopathy in NIDDM patients during their 1st 10 yr of disease.
Severe Hypoglycemia Incidence and Predisposing Factors in 85 Pregnancies of Type I Diabetic Women
Authors: Kimmerle Renate , Heinemann Lutz , Delecki Alexander , Berger Michael
Published: March 2007

OBJECTIVE

To evaluate the incidence and predisposing factors of severe hypoglycemia (SH) in pregnant women with insulin-dependent (type I) diabetes mellitus.

RESEARCH DESIGN AND METHODS

SH (impairment of consciousness due to hypoglycemia subsequently treated with glucagon or i.v. glucose) was recorded in all pregnant type I diabetic women (n = 77) who attended our pregnancy clinic during 85 pregnancies from 1986 to 1990.

RESULTS

Ninety-four SHs were reported during 35 pregnancies. Of 94 SHs, 84% occurred before the 20th gestational wk (median 12th wk) and 77% during sleep. In the group with SH, there was no permanent maternal sequelae, and there was a favorable fetal outcome (no perinatal death and no congenital malformation). Mean HbA1c values were not different between the group with and without SH for the first half (6.4 ± 1.1 vs. 6.3 ± 0.9%) and 2nd half (5.4 ± 0.6 vs. 5.5 ± 0.7%) of pregnancy. The percentage of women with SH before pregnancy (51 vs. 28%, P < 0.05) and the incidence of SH patients before pregnancy (0.49 vs. 0.08 SH/patient/yr) was different between the group with and without SH.

CONCLUSIONS

SH is frequent during pregnancies of type I diabetic women with near normoglycemia. The risk for SH is particularly pronounced during the first half of pregnancy and in women with a history of SH.
Is Combination Sulfonylurea and Insulin Therapy Useful in NIDDM Patients?: A metaanalysis
Authors: Pugh Jacqueline A , Wagner Mary L , Sawyer John , Ramirez Gilbert , Tuley Michael , Friedberg Samuel J
Published: March 2007

OBJECTIVE

To assess the efficacy of combination therapy with insulin and sulfonylurea in the treatment of NIDDM.

RESEARCH DESIGN AND METHODS

Studies published between January 1966 and January 1991 were identified through a computerized Medline search and by hand searching the bibliographies of identified articles. We identified 17 eligible randomized, controlled trials of combination therapy in NIDDM. These trials had a minimum duration of 8 wk and at least one of three outcome measures (fasting glucose, HbA1, or C-peptide) with SD or SE of the mean reported to do metaanalysis. With standardized forms, three independent reviews abstracted measures of study quality and specific descriptive information about population, intervention, and outcome measurements.

RESULTS

We calculated effect size and weighted mean changes of the three outcome measures for control and treatment groups. In the treatment group, the fasting plasma glucose decreased from a mean of 11.4 mM (206 mg/dl) at baseline to a mean of 9.16 mM (165 mg/dl) posttreatment, whereas the control group decreased from (11.3 to 10.8 mM) (204 to 194 mg/dl) (effect size 0.39, P < 0.0001). For HbA1, the treatment group decreased from a baseline of 11.0 to 10.2% compared to 11.0 and 11.2% in the control group (effect size 0.43, P < 0.0001). For fasting C-peptide, the treatment group increased from 0.49 to 0.58 nM (1.45 to 1.75 ng/ml) compared with 0.47 and 0.43 (1.42 and 1.30) for the control group (effect size 0.26, P < 0.017).

CONCLUSION

Combined insulin-sulfonylurea therapy leads to modest improvement in glycemic control compared with insulin therapy alone. With combined therapy, lower insulin doses may be used to achieve similar control. Obese patients with higher fasting C-peptides may be more likely to respond than others.
Diabetic Ketoacidosis: A rare complication of gestational diabetes
Authors: Maislos Maximo , Harman-Bohem Ilana , Weitzman Simon
Published: March 2007

OBJECTIVE

To describe a case of severe DKA in an otherwise healthy pregnant woman.

RESEARCH DESIGN AND METHODS

We describe 2.5 yr of close follow-up of a Bedouin woman who was hospitalized for DKA while pregnant with her 11th child. Plasma glucose returned to normal levels immediately after delivery of a dead conceptus. Four months later, while normoglycemic, the patient became pregnant again. During the subsequent pregnancy, GDM was diagnosed at week 20 of gestation. Tight plasma glucose control was achieved with an insulin regimen, and the patient delivered a healthy girl at term. Plasma glucose again returned to normal and remained so to date, 18 mo postpartum. An OGTT and a euglycemic hyperinsulinemic clamp were performed between pregnancies; another OGTT was performed at week 14 of the last pregnancy. Plasma glucose, insulin, and C-peptide were measured in blood samples during these procedures.

RESULTS

We established beyond doubt that the patient developed GDM and returned to essentially normal glucose tolerance after her last (12th) delivery. During the 11th pregnancy, gestational diabetes was complicated by severe DKA.

CONCLUSIONS

GDM is a common abnormality of glucose metabolism during pregnancy, which affects fetal development and leads to peripartum complications. Our report stresses that under certain circumstances, gestational diabetes can be complicated by DKA and become life-threatening to the mother and fetus.
Telephone Modem Access Improves Diabetes Control in Those with Insulin-Requiring Diabetes
Authors: Ahring Kirsten Kiar , Ahring Jørgen Philip Kiaer , Joyce Carol , Farid Nadir R
Published: March 2007

OBJECTIVE

To assess whether modem access improves diabetes control in IDDM patients.

RESEARCH DESIGN AND METHODS

Forty-two patients participated in the study and were followed for 12 wk. The patients were randomly divided into two groups at baseline, a modem group and a control group. There were no significant differences between HbA1c, random blood glucose, and weight between the groups at the beginning of the study. Patients were asked to perform five blood glucose determinations/day (before breakfast, before lunch, afternoon [1500], before dinner, and at bedtime) twice/week. The modem group transferred their data over the phone once/week. The control group would bring in their results on their regular visits every 6 wk. Patients in the modem group were counseled every week over the telephone after transferring results to adjust insulin and food intake if necessary.

RESULTS

In the modem group, HbA1c improved from 0.106 to 0.092 (13.20%). The control group improved from 0.112 to 0.102 (8.9%). There was no significant change in weight, random blood glucose, or insulin.

CONCLUSIONS

The use of telephone modem-based patient-monitoring systems in diabetes clinical research seems to stimulate the patient to keep closer control of blood glucose levels. It might be especially useful in rural settings, for which this study was designed.
Microalbuminuria: Implications for micro- and macrovascular disease
Authors: Deckert Torsten , Kofoed-Enevoldsen Allan , Nørgaard Kirsten , Borch-Johnsen Knut , Feldt-Rasmussen Bo , Jensen Tonny
Published: March 2007

Microalbuminuria is diagnosed when the UAER is > 20 but < 200 μg/min. The prevalence of microalbuminuria among diabetic patients is 15–20%. Persistent microalbuminuria in diabetic patients is a risk marker not only of renal disease, but also of proliferative retinopathy and cardiovascular morbidity and mortality. Even among nondiabetic individuals, those with microalbuminuria tend to have an increased cardiovascular morbidity. The established cardiovascular risk factors, such as smoking, elevated plasma cholesterol, fibrinogen, and hypertension, are seen more frequently in diabetic patients with persistent microalbuminuria than in normoalbuminuric diabetic patients of similar age, sex, and diabetes duration. However, these risk factors cannot by themselves explain the cardiovascular overmortality in these patients. In addition, insulin resistance or genetic disposition to hypertension or cardiovascular disease fails to be the missing link. Accumulating evidence suggests a common pathogenetic mechanism for microalbuminuria and premature atherosclerosis (i.e., qualitative alterations of the extracellular matrix, including decreased density and sulfation of HS-PG). Decreased density of HS in the glomeruli may lead to albuminuria and mesangial proliferation. In the intima of large vessel walls, decreased density and/or sulfation of HS may enhance several of the processes involved in premature atherosclerosis. Diabetes affects the composition and structure of the extracellular matrix in many ways and leads to decreased density and sulfation of HS-PG by several mechanisms. Genetic differences in the sulfation of HS and/or genetic defects in the coordinated biosynthesis of HS-PG might contribute to decreased concentration and sulfation of HS-PG in susceptible individuals. It is hoped that susceptibility genes can be identified soon, thereby making prevention of severe late diabetic complications more successful.
Glomerular Hyperfiltration in NIDDM Patients Without Overt Proteinuria
Authors: Silveiro Sandra P , Friedman Rogério , Gross Jorge L
Published: March 2007

Objective— To evaluate the frequency and correlates of glomerular hyperfiltration in NIDDM patients without overt proteinuria.

Research Design and Methods— A cross-sectional study was conducted. Seventy-one consecutive NIDDM patients attending an outpatient clinic, with Albustix-tested negative urine and a 24-h AER <200 μgrams/min, were examined for long-term complications of diabetes. We measured their GFR (51Cr-EDTA single-injection method), 24-h AER (RIA), plasma creatinine, HbA1c, total cholesterol, triglycerides, urinary glucose, and urea.

Results— GFR above the upper limit of the normal range for age-matched control subjects (137.1 ml·min−1 · 1.73 m2) was present in 15 of 71 (21%) NIDDM patients. Subjects with normal and hyperfiltration did not differ in terms of age, sex distribution, BMI, duration of NIDDM, BP, AER, or frequency of long-term complications. Plasma glucose was significantly higher in subjects with hyperfiltration (mean [range]: 12.8 [4.3–18.7] vs. 8.7 [2.6–17.5] mM). HbA1c failed to reach statistical significance, although it tended to be higher in the group with hyperfiltration (10.4 [6.7–13.9] vs. 9.4 [4.2–16.5]%, P = 0.10). Age (rS −0.37, P = 0.002), FPG (rS 0.45, P < 0.0005), total cholesterol (rS −0.31, P = 0.008), and glycosuria (rS 0.40, P = 0.001) correlated significantly with GFR. In a stepwise multiple regression analysis, FPG, age, and total cholesterol emerged as significant correlates of the dependent variable GFR.

Conclusions— Hyperfiltration occurred in 21% of NIDDM patients without overt proteinuria. FPG and age significant correlates of the GFR in these patients. Cholesterol is significantly (although only modestly) correlated with the GFR.
Deranged Platelet Calcium Homeostasis in Poorly Controlled IDDM Patients
Authors: Pellegatta Fabio , Folli Franco , Ronchi Paola , Caspani Lucia , Galli Laura , Vicari Aurelio M
Published: March 2007

Objective— Platelet hyperfunction frequently occurs in IDDM. As in many other cellular systems, cytosolic free Ca plays a key role in platelet activation.

Research Design and Methods— We measured cytosolic free Ca concentration ([Ca2+]i) by means of the fluorescent probe fura-2 in 60 IDDM patients (mean age 30.8 yr, range 18–50 yr) and in 31 age-matched healthy control subjects. Platelets were studied in both resting conditions and after stimulation with thrombin at 0.05, 0.1, and 0.5 U/ml.

Results— No differences were noted between control subjects and diabetic patients, as a whole. Patients with a poor metabolic control (HbA1c >8%) had significantly (P <0.01 and P <0.03) higher [Ca2+]i in resting platelets. The presence or absence of retinopathy did not modify resting platelet [Ca2+]i. After stimulation with thrombin, a significantly (P < 0.009) higher rise of platelet [Ca2+]i was observed only in those patients who were both free from complications and had good metabolic control. A highly significant (P < 0.001) correlation was found between resting [Ca2+]i and both blood cholesterol and HbA1c in the diabetic patients. Platelets from 10 young healthy subjects also were studied after in vitro incubation with various glucose concentrations (from 1.68 to 56 mM): resting and thrombin-stimulated platelet [Ca2+]i and thrombin-induced aggregation were not modified.

Conclusions— These data confirm that platelet hyperfunction is present in IDDM patients who have unsatisfactory metabolic control, and give evidence that such an activation involves Ca homeostasis. Acute variations of blood glucose concentration are probably not influent, in this respect.
Strategies for Improving Maintenance of Weight Loss: Toward a continuous care model of obesity management
Authors: Perri Michael G , Sears Samuel F , Clark Judith E
Published: March 2007

The management of obesity represents an important objective in the care of many NIDDM patients. In recent years, progress has been made in increasing initial weight reductions, but poor long-term maintenance of weight loss remains a vital clinical concern. This article reviews the challenge of weight-loss maintenance and recommends the adoption of a continuous care model of obesity management. Strategies to improve the long-term maintenance of weight loss are described, and empirical tests of their effectiveness are reviewed. Collectively, the findings suggest that, after treatment for obesity, multifaceted programs comprised of continued professional contact, skills training, social support, and exercise, can enhance the long-term maintenance of weight loss.
Determinants of Diabetes Mellitus in the Pima Indians
Authors: Knowler William C , Saad Mohammed F , Pettitt David J , Nelson Robert G , Bennett Peter H
Published: March 2007

Objective— To review the research findings on the determinants of diabetes mellitus in Pima Indians.

Research Design and Methods— Pima Indians in Arizona have participated in a longitudinal diabetes study that has provided data on and hypotheses about the development of NIDDM. Findings from this study are reviewed and updated.

Results— Frequency distributions of plasma glucose and HbA1 are bimodal in Pima adults, and substantial risk of the specific vascular complications of diabetes is confined to those in the higher components of these distributions. These findings contributed to the adoption of internationally recognized criteria for classification of glucose tolerance. Diabetes in the Pimas is strongly familial, and probably of genetic origin, although the precise nature of the gene or genes involved remains unknown. Obesity, which is at least in part environmentally determined, is a major factor interacting with the presumed genetic susceptibility to result in diabetes. The incidence of diabetes in the Pimas has increased during the last several decades, providing further evidence for environmental-genetic interaction. Longitudinal studies suggest that the progression from normal to diabetes can be considered to involve two stages. The first, primarily attributable to insulin resistance, leads to impaired glucose tolerance, and the second, which depends on insulin secretory failure, leads to worsening hyperglycemia and overt diabetes.

Conclusions— The Pimas and many other American Indian populations suffer from a high incidence of diabetes and its characteristic disabling or fatal complications, and would benefit from continued research on the pathogenesis and prevention of the disease.
Energy Metabolism in Obesity: Studies in the Pima Indians
Authors: Ravussin Eric
Published: March 2007

Objective— To review the major data collected over the past 8 yr regarding energy expenditure in relationship to obesity and the development of obesity in the Pima Indian population.

Research Design and Methods— The different components of 24-h energy expenditure (i.e., the RMR, the thermic effect of food, and the energy cost of spontaneous physical activity) were measured in a respiratory chamber after a few days on a weight-maintenance diet.

Results— Fat-free body mass, the major determinant of RMR, explains 82% of its variance. However, an extra 7% of the variance in RMR observed between people is related to family membership. The variability of RMR for a given body size and composition is of importance, because a low metabolic rate is a major risk factor for weight gain in man. Also, genetic factors seem to be the cause of the familial aggregation of metabolic rate in man.

Conclusions— The high prevalence of obesity and NIDDM in the Pima Indian community might be the consequence of a “thrifty genotype.” The increasing evidence that obesity cannot always be attributed to gluttony and sloth forces us to consider obesity as a “real metabolic disease” that needs to be treated as such, using new behavioral and pharmacological therapies.
Diabetes in American Indians: An overview
Authors: Gohdes Dorothy , Kaufman Stephen , Valway Sarah
Published: March 2007

Objective— To review the growth of diabetes as a major health problem for American Indians and Alaska Natives.

Research Design and Methods— Pertinent studies of diabetes in Indians previously published are reviewed and compared with current data.

Results— Although diabetes rates may vary among different Indian tribes, diabetes has become a widespread health problem.

Conclusions— Our understanding of the natural history of diabetes among Indians has improved, but better strategies to prevent complications and ultimately to prevent diabetes are urgently needed in Indian communities.
Prevalence of Diagnosed Diabetes and Selected Related Conditions of Six Reservations in Montana and Wyoming
Authors: Acton Kelly , Rogers Barbara , Campbell Gregory , Johnson Charlene , Gohdes Dorothy
Published: March 2007

Objective— To describe the prevalence of diabetes and related complications in Plains Indians.

Research Design and Methods— The medical records of individuals with diagnosed diabetes seen in IHS facilities before 1 January 1987 were reviewed. Records were obtained from primary care clinics and hospitals accessible to the following six reservation communities in Montana and Wyoming: Blackfeet, Crow, Fort Belknap, Fort Peck, Northern Cheyenne, and Wind River. Medical records were reviewed to ascertain accuracy of diagnosis and associated complications.

Results— Age-adjusted prevalence rate of diagnosed diabetes was 119/1000 adults ≥15 yr of age.

Conclusions— Diabetes rates in Plains Indians are higher than rates described for the general U.S. population.
Diabetes in a Northern Minnesota Chippewa Tribe: Prevalence and incidence of diabetes and incidence of major complications, 1986–1988
Authors: Rith-Najarian Stephen J , Valway Sarah E , Gohdes Dorothy M
Published: March 2007

Objective— To determine the prevalence and incidence of diabetes, and the incidence of major diabetic complications, in a Chippewa Indian population.

Research Design and Methods— The format was a longitudinal population study that used active community and health center–based surveillance. The setting was a North American Indian reservation community of 4075 residents, served by an IHS clinic from 1986 to 1988. Patients were American Indians of Chippewa descent living on or near the Red Lake Reservation.

Results— Midway through the study, 346 people had been diagnosed with diabetes, which yielded an age- and sex-adjusted point prevalence of 148/1000 population. The adjusted rate for individuals ≥25 yr of age was 252/1000 population, 3.82 times the U.S. rate (CI 2.95–4.93). Some 97 new cases of diabetes were identified for an age- and sex-adjusted average annual incidence of 17/1000 population. The incidence of hospitalization for LEA was 26/1000 diabetic person-yr, 4.3 times the 1978 U.S. rate (95% CI 2.8–6.8). Twelve individuals developed proliferative retinopathy, for an incidence of 12/1000 diabetic person-yr. Newly diagnosed ESRD incidence was 6/1000 diabetic person-yr. Twenty-three acute myocardial infarctions were observed, yielding an incidence of 22/1000 diabetic person-yr.

Conclusions— Diabetes and its complications are prevalent in this Chippewa population, and further surveillance is needed to evaluate the effectiveness of prevention efforts.
Prevalence of Diabetes Mellitus in Pregnancy Among Yup'ik Eskimos, 1987–1988
Authors: Murphy Neil J , Bulkow Lisa R , Schraer Cynthia D , Lanier Anne P
Published: March 2007

OBJECTIVE–To evaluate the prevalence of diabetes mellitus in pregnancy in Yup'ik Eskimos.

RESEARCH DESIGN AND METHODS— A retrospective review of consecutive birth-log data and medical records was conducted. Records were taken from the primary care and tertiary referral facilities in Alaska Area Native Health Service. Some 630 consecutive deliveries were reviewed from 1 March 1987 to 29 February 1988, with 25 excluded for ancestry other than Alaska Native. Another 605 Alaska Native patient charts were reviewed, with 545 Alaska Native patients screened for diabetes in pregnancy. The study population had a mean age of 25.6 yr, mean gravidity of 3.4, mean parity of 1.9, and mean birth weight of 3567 ± 493 g.

RESULTS— Patients were screened with a 50-g glucose oral load with a plasma glucose 1 h later. 156 of 605 (25.7%) patients, with a screen ≥7.8 mM received a 100-g OGTT. Of 605, 35 (5.8%) patients met O'Sullivan criteria, and 2 of 605 (0.3%) patients met WHO criteria for previous diabetes mellitus, for a total 37 of 605 (6.1%) women with diabetes in pregnancy. The subjects who met O'Sullivan criteria had statistically greater mean age (29.9 yr), gravidity (4.9), parity (2.9), and birth weight of their infants (3678 ± 389 g), compared with women with a screen <7.8 mM.

CONCLUSIONS— The prevalence of diabetes in pregnancy among Yup'ik Eskimos is twice the rate for the U.S. for all races, despite the Yup'ik having the lowest rate of diabetes mellitus among Alaska Natives. This may represent a large number of undiagnosed patients with impaired glucose tolerance, and may reflect the wide-spread dietary and life-style changes that have occurred in the Yup'ik in the last 30 yr. The Yup'ik present a unique opportunity to apply prevention techniques in a population with an emerging problem with glucose tolerance.
Diabetic End-Stage Renal Disease Among Native Americans
Authors: Muneta Ben , Newman Jeff , Stevenson John , Eggers Paul
Published: March 2007

OBJECTIVE— To examine why ESRD has become a major source of morbidity and mortality for Native Americans with diabetes mellitus.

RESEARCH DESIGN AND METHODS— Using data from the Medicare ESRD Program, we examined incidence rates for ESRD among Native Americans for the years 1983–1987.

RESULTS–During this period, the annual incidence of total ESRD in Native Americans increased by 18%, from 170.5/million to 200.1/million. The incidence of diabetic ESRD increased by 47%, from 80.6/million to 118.2/million. In 1987, the age-adjusted incidence rate of diabetic ESRD was 6.8 times higher in Native Americans than in whites.

CONCLUSIONS— Recommendations for the prevention of diabetic ESRD include early identification of renal disease and improved control of hypertension and blood glucose. The magnitude of diabetic ESRD among Native Americans also underscores the need for primary prevention of non-insulin-dependent diabetes mellitus.
Effects of Gemfibrozil on Triglyceride Levels in Patients With NIDDM: Hyperlipidemia in Diabetes Investigators
Authors: Vinik Aaron I , Colwell John A
Published: March 2007

Objective— Patients with NIDDM have a two- to fourfold increased risk of macrovascular disease. The constellation of elevated TGs and decreased HDL cholesterol are recognized as risk factors and constitute the major dyslipidemia in NIDDM. We therefore sought to determine if gemfibrozil (600 mg b.i.d.) was effective in correcting the dyslipidemia of NIDDM.

Research Design and Methods– After 8 wk of placebo stabilization, 442 patients from 46 study centers were randomized to double-blind treatment, in a designated 2:1 ratio, 295 received gemfibrozil and 147 received placebo for 20 wk. The primary end point was plasma TG; secondary end points were TC, LDL cholesterol, VLDL cholesterol, HDL cholesterol, and HbA1c. No baseline differences were noted between groups in sex, age, weight, type of diabetic therapy, fasting plasma levels of TGs, HbA1c, or C-peptide. About two-thirds received oral hypoglycemic drugs, one-third insulin

Results– TG fell 26.4% in the gemfibrozil group and rose 7.4% in the placebo group (P < 0.023), by an intent-to-treat analysis. When patients who were noncompliant or with inadequate data were excluded, similar results were found—a 30.4% fall with gemfibrozil and a 4.8% increase with placebo (P < 0.0001). TG levels fell within 4 wk and remained low for 20 wk (P < 0.001). Mean HDL cholesterol rose by 4 wk and increased further at 12 wk (8–12%), P < 0.0001. TC fell. We observed a significant rise in LDL cholesterol in both gemfibrozil- and placebo-treated groups, with no significant differences between these groups. Changes in HbA1c were similar in gemfibrozil and placebo groups. No differences were observed in responses in groups treated with insulin and or oral hypoglycemic drugs. Overall AEs that were clinically important occurred in 6.1% in the gemfibrozil group vs. 2.0% in the placebo group (NS).

Conclusions– We conclude that gemfibrozil is an effective and safe agent in combating the dyslipidemia of NIDDM, irrespective of type of diabetic therapy.
Improving Diabetes Care for American Indians
Authors: Acton Kelly , Valway Sarah , Helgerson Steven , Huy James B , Smith Kermit , Chapman Victoria , Gohdes Dorothy
Published: March 2007

In 1986, a diabetes control program was implemented in the Billings area of the IHS. Baseline health-care practices in the program were described using a structured audit. The program included adoption of the IHS Minimum Standards of Care for diabetes, technical assistance, and professional and patient education. A second audit was performed in 1988. Care practices improved significantly for all facilities in 7 of 10 parameters measured. Facilities that implemented key program activities showed more overall improvement in screening practices, education, and immunization than those that did not organize diabetes care. Factors associated with improved care practices include establishment of a coordinated, multidisciplinary diabetes team with regular meetings, acceptance of standards of care by the medical staff, use of flow sheets by multiple providers, and diabetes-related professional and patient education sessions.
Treatment of Diabetic Neuropathy With γ-Linolenic Acid
Authors: Keen Harry , Payan Jose , Allawi Jaffar , Walker James , Jamal Goran A , Weir Andrew I , Henderson Lesley M , Bissessar Elizabeth A , Watkins Peter J , Sampson Michael , Gale Edwin A M , Scarpello John , Boddie Hugh G , Hardy Kevin J , Thomas Peter K , Misra Peter , Halonen Jukka-Pekka ,   The γ-Linolenic Acid Multicenter Trial Group
Published: March 2007

Objective— To compare the effects of placebo and GLA on the course of mild diabetic neuropathy over 1 yr.

Research Design and Methods— We entered 111 patients with mild diabetic neuropathy from seven centers into a randomized, double-blind, placebo-controlled parallel study of GLA at a dose of 480 mg/day. MNCV, SNAP, CMAP, hot and cold thresholds, sensation, tendon reflexes, and muscle strength were assessed by standard tests in upper and lower limbs.

Results— For all 16 parameters, the change over 1 yr in response to GLA was more favorable than the change with placebo, and for 13 parameters, the difference was statistically significant. Sex, age, and type of diabetes did not influence the result, but treatment was more effective in relatively well-controlled than in poorly-controlled diabetic patients.

Conclusions— GLA had a beneficial effect on the course of diabetic neuropathy.
Effectiveness of Glucose Monitoring Systems Modified for the Visually Impaired
Authors: Bernbaum Marla , Albert Stewart G , Brusca Stephanie , McGinnis Joan , Miller Deborah , Hoffmann Joseph W , Mooradian Arshag D
Published: March 2007

OBJECTIVE

To compare three glucose meters modified for use by individuals with diabetes and visual impairment regarding accuracy, precision, and clinical reliability.

RESEARCH DESIGN AND METHODS

Ten subjects with diabetes and visual impairment performed self-monitoring of blood glucose using each of the three commercially available blood glucose meters modified for visually impaired users (the AccuChek Freedom [Boehringer Mannheim, Indianapolis, IN], the Diascan SVM [Home Diagnostics, Eatontown, NJ], and the One Touch [Lifescan, Milpitas, CA]). The meters were independently evaluated by a laboratory technologist for precision and accuracy determinations.

RESULTS

Only two meters were acceptable with regard to laboratory precision (coefficient of variation <10%)—the Accuchek and the One Touch. The Accuchek and the One Touch did not differ significantly with regard to laboratory estimates of accuracy. A great discrepancy of the clinical reliability results was observed between these two meters. The Accuchek maintained a high degree of reliability (y = 0.99X + 0.44, r = 0.97, P = 0.001). The visually impaired subjects were unable to perform reliable testing using the One Touch system because of a lack of appropriate tactile landmarks and auditory signals.

CONCLUSIONS

In addition to laboratory assessments of glucose meters, monitoring systems designed for the visually impaired must include adequate tactile and audible feedback features to allow for the acquisition and placement of appropriate blood samples.
Systolic Blood Pressure Relates to the Rate of Decline of Glomerular Filtration Rate in Type II Diabetes
Authors: Nielsen Søren , Schmitz Anita , Rehung Michael , Mogensen Carl Erik
Published: March 2007

OBJECTIVE

To relate deterioration in kidney function to some potential cardiovascular risk factors in type II diabetic patients.

RESEARCH DESIGN AND METHODS

Twenty-four normoalbuminuric and 13 microalbuminuric patients completed a 3.4-yr prospective observational study. Glomerular nitration rate, urinary albumin excretion rate, blood pressure, glycemic control, and lipids were measured on entry and at the end of the study. Of the patients, 19 normoalbuminuric and 8 microalbuminuric (73%) patients had no history of antihypertensive treatment.

RESULTS

The glomerular filtration rate was significantly reduced during the follow-up period (−1.34 ± 0.54 ml · min−1 · 1.73 m−2 [mean ± SE], P < 0.02). The rate of decline varied considerably in normoalbuminuric and microalbuminuric patients (from −13.5 to 4.3 and from −7.0 to 4.2 ml · min−1 · 1.73 m−2 per year, respectively) but was on average not accelerated in normoalbuminuric or microalbuminuric patients (−1.3 ± 0.7 and −1.5 ± 0.8 ml · min−1 · 1.73 m−2 per year, respectively). Significant correlations were observed between the glomerular filtration rate fall rate and initial systolic blood pressure (r = −0.47, P < 0.01; patients without antihypertensive treatment: r = −0.42, P = 0.03) but not diastolic blood pressure. In a stepwise multiple linear regression analysis, baseline systolic blood pressure significantly determined the fall rate of the glomerular filtration rate (regression coefficient = −0.050, SE = 0.018, P = 0.011; patients without antihypertensive treatment: regression coefficient = −0.047, SE = 0.021, P = 0.030).

CONCLUSIONS

In these type II diabetic patients neither normoalbuminuria nor microalbuminuria are at an average associated with an accelerated decline in kidney function. Still, systolic blood pressure is a determining factor for the rate of decline in the glomerular filtration rate. A longer follow-up time with consecutive glomerular filtration rate measurements are needed to determine the long-term implications of normoalbuminuria and microalbuminuria on kidney function in type II diabetic patients.
A Prospective Study Identifying Risk Factors for Discontinuance of Insulin Pump Therapy
Authors: Floyd John C , Cornell Richard G , Jacober Scott J , Griffith Lauren E , Funnell Martha M , Wolf Leora L , Wolf Fredric M
Published: March 2007

OBJECTIVE

To identify characteristics of adult patients at baseline associated with duration of subsequent, continuous, subcutaneous infusion of insulin treatment (pump therapy) of type I diabetes.

RESEARCH DESIGN AND METHODS

For 6 wk, patients followed a standardized conventional therapy and kept a record of insulin dosages, capillary blood glucose concentrations, and symptomatic hypoglycemia. They were then hospitalized. Additional baseline data were obtained and pump therapy was started. Survival analysis was used to determine the relationship between baseline independent variables or risk factors and duration of pump therapy, which is the dependent variable.

RESULTS

Of the 68 participants, 33 (49%) terminated pump therapy after an average of 9.9 mo of treatment. Two models (each P < 0.00005) were developed that exhibited a high degree of consistency. Of the 6 variables, 5 were common to both models (HbA1 autonomic neuropathy, mean amplitude of glycemic excursions, frequency of symptoms of hypoglycemia when blood glucose was < 70 mg/dl, and erythema at injection sites). The sixth variable in model 1 (insulin dosage) was replaced in model 2 by a variable, Adult Self-Efficacy for Diabetes, which was obtained on the 33 more recently enrolled patients; this variable related to patient perceptions of self-care behaviors.

CONCLUSIONS

We found that, at baseline, the presence of a high concentration of HbAx and a low estimation by the patient of their ability to treat the disease portend failure of insulin pump therapy as evidenced by its discontinuation. This effect is accentuated when clinical evidence of autonomic neuropathy is observed. These findings offer guidance in selecting patients with type I diabetes for insulin pump therapy.