bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of α-Glucosidase Inhibition on Meal Glucose Tolerance and Timing of Insulin Administration in Patients With Type I Diabetes Mellitus
Authors: Dimitriadis George , Hatziagellaki Eryfilli , Alexopoulos Evangelos , Kordonouri Olga , Komesidou Vasiliki , Ganotakis Manolis , Raptis Sotirios
Published: March 2007

Objective

Miglitol, an α-glucosidase inhibitor, delays absorption of carbohydrates. This study was undertaken to determine the potential of this agent as an adjunct to insulin in the treatment of diabetes.

Research Design And Methods

Twelve nonobese patients with insulin-dependent (type I) diabetes mellitus were randomly selected from the outpatient diabetes clinic. The patients were made euglycemic with the Biostator, and postprandial hyperglycemia was determined under the following conditions: protocol 1, subcutaneous injection of insulin (13 ± 1 U) given 60 min before the meal, with insulin dosages determined by the Biostator; protocols 2 and 3 same as protocol 1 but with insulin given at the time of meal ingestion; protocols 4 and 5 same as protocol 1 but with insulin given 30 min before the meal. Miglitol (100 mg) was administered in protocols 2 and 4 and placebo in protocols 3 and 5.

Results

When insulin was given 30 min before the meal with miglitol (protocol 4) or placebo (protocol 5), plasma glucose increased from 4.94 ± 0.16 to 5.94 ± 0.55 mM and from 5.11 ± 0.22 to 8.22 ± 0.72 mM, respectively (P < 0.01). When insulin was given at the time of the meal with miglitol (protocol 2) or placebo (protocol 3), plasma glucose increased from 5.44 ± 0.27 to 7.77 ± 0.5 mM and from 5.72 ± 0.22 to 10.83 ± 0.77 mM, respectively (P < 0.01). When insulin was given 60 min before the meal (protocol 1), plasma glucose initially decreased from 5.61 ± 0.38 to 4.33 ± 0.33 mM and then increased to 6.94 ± 0.66 mM after the meal.(ABSTRACT TRUNCATED AT 250 WORDS)
Na+-H+ Exchanger and Its Role in Essential Hypertension and Diabetes Mellitus
Authors: Huot Stephen J. , Aronson Peter S.
Published: March 2007

The Na+-H+ exchanger is a ubiquitous transport system that is involved in the regulation of intracellular pH, cell growth and proliferation, cell volume regulation, and transepithelial absorption of Na+, Cl-, and HCO3-. Altered activity of the Na+-H+ exchanger has been implicated as a mechanism contributing to the development of high blood pressure in subgroups of patients with essential hypertension and in various animal models of hypertension. Many of these studies measured Na+-Li+ exchange rather than Na+-H+ exchange, hypothesizing that Na+-Li+ exchange represents a functional mode of the Na+-H+ exchanger. However, this is a controversial assumption. Several studies have also shown an association between erythrocyte Na+-Li+–exchange rate and predisposition to nephropathy in patients with insulin-dependent diabetes mellitus. The recent cDNA cloning of at least one isoform of the Na+-H+ exchanger will help clarify the cellular mechanisms of regulation of the exchanger and its possible role in pathophysiological states such as hypertension.
Short-term Effects Of Alterations in Dietary Fat on Metabolic Control in IDDM
Authors: Ireland Paul , O'Dea Kerin , Nankervis Alison
Published: March 2007

OBJECTIVE

Two experimental diets were evaluated to investigate the hypothesis that dietary fat has an independent influence on metabolic control in IDDM.

RESEARCH DESIGN AND METHODS

The diets had similar CHO contents (26 and 22% of energy intake) but differed markedly in fat (53 vs. 16% energy) and protein (20 vs. 62% energy). We had 10 subjects follow the low-CHO, high-fat diet, and 8 subjects follow the low-CHO, low-fat, high-protein diet. In each case, markers of glycemic and lipid control obtained after adherence to the experimental diet for 2 wk were compared with corresponding data from a preceding control period during which subjects had followed their usual diet (protein 18–19%, CHO 41–46%, fat 33–37%).

RESULTS

Despite the low CHO content of the high-fat diet, insulin requirements were unchanged relative to the control diet. Moreover, the glycemic response to a standard breakfast was elevated significantly (P < 0.001), suggesting that insulin resistance had either been induced or exacerbated. The small rise in total cholesterol concentration in response to the high-fat diet was accounted for by a rise in HDL cholesterol. Glycemic control and lipid metabolism were unchanged after the low-CHO, low-fat diet, although insulin requirements fell by an average of 6 U/day (P < 0.05) relative to those recorded during the 2-wk control period.

CONCLUSIONS

Diets high in fat are deleterious to glycemic control in IDDM, but general applicability is limited by the small sample size and short duration of this study.
I'm Running on Insulin: Summary of the history of the International Diabetic Athletes Association
Authors: Thurm Ulrike , Harper Paula N
Published: March 2007

The changes that physical activity brings in the functioning of the human body have a special interest to active individuals with diabetes. Certain adjustments in dosing are necessary. Even today, with such an emphasis on healthy life-style, little information is available to assist an individual with diabetes to exercise safely. Granted, no easy formula exists. Many different factors influence blood glucose. Most often, individuals with diabetes learn by trial and error how to best manage their favorite activity. In 1985, Paula Harper founded the International Diabetic Athletes Association (IDAA) in hopes of educating people with diabetes about the benefits of regular exercise. For most individuals with insulin-dependent (type I) diabetes mellitus, it is not encouragement, but safety that is the issue. The IDAA offers great opportunities for sharing ideas at its annual meetings. These meetings attract an exceptional faculty of speakers and offer a mix of workshops led by experienced diabetic athletes on various sports. A quarterly newsletter is published that presents new information and recognizes success stories. IDDA chapters exist in the U.S., Canada, U.K., Germany, France, Luxembourg, Switzerland, Belgium, the Netherlands, and Spain.
Microalbuminuria Associated With Diabetic Neuropathy
Authors: Bell David SH , Ketchum Catherine H , Robinson C Andrew , Wagenknecht Lynne E , Williams Burson T
Published: March 2007

Objective

To test the hypothesis that microalbuminuria may show an independent statistical association with diabetic neuropathy.

Research Design and Methods

An observational study of a prospectively identified cohort was conducted at the University Medical Center. The cohort consisted of 78 consecutive diabetic patients who fulfilled the criteria of having diabetes for >10 yr, a normal serum creatinine, urine negative for macroalbuminuria by a commonly used dipstick method, a blood glucose <13.8 mM (<250 mg/dl), and an HbA1 <11% (normal range 5.5–8.5%). Medical record review established the presence of chronic complications of diabetes. Urine albumin level was measured by radioimmunoassay. Albumin concn ≥15 mg/L was used as a cutoff value for microalbuminuria.

RESULTS

Twenty-five of 78 patients (32%) showed microalbuminuria. Of these, 51% had neuropathy, 39% had retinopathy, 35% arterial hypertension, 17% peripheral vascular disease, and 15% ischemic heart disease. After adjusting for age, sex, and type and duration of diabetes, diabetic neuropathy and hypertension showed a significant association with microalbuminuria. After adjusting for other diabetic complications, diabetic neuropathy showed a significant association with microalbuminuria.

Conclusions

Microalbuminuria is independently associated with diabetic neuropathy. This association lends support to the theory of a vascular etiology for diabetic distal symmetrical neuropathy.
Comparison of Combined Therapies in Treatment of Secondary Failure to Glyburide
Authors: Trischitta Vincenzo , Italia Salvatore , Mazzarino Salvatore , Buscema Massimo , Rabuazzo Agata Maria , Sangiorgio Lidia , Squatrito Sebastiano , Vigneri Riccardo
Published: March 2007

Objective

To compare the effectiveness of alternative combined treatments in patients with non-insulin-dependent diabetes mellitus (NIDDM) with secondary failure to sulfonylureas.

Research Design and Methods

A crossover study was carried out by randomly assigning 16 NIDDM patients to a combined treatment with the addition of either a single low-dose bedtime injection of 0.2 U/kg body wt NPH insulin or an oral three times a day administration of 1.5 g/day metformin to the previously ineffective glyburide treatment.

Results

Both combined therapies significantly (P <0.01) reduced fasting plasma glucose (FPG), postprandial plasma glucose (PPPG) and percentage of HbA1. The addition of metformin was more effective than the addition of insulin (P <0.01) in improving PPPG in the 8 patients with higher post-glucagon C-peptide levels. In contrast, the efficacy of neither combined therapy was related to patient age, age of diabetes onset, duration of the disease, percentage of ideal body weight, and FPG. The addition of insulin but not metformin caused a significant (P <0.01) increase of mean body weight. Neither combined treatment caused changes in serum cholesterol and triglyceride levels. No symptomatic hypoglycemic episode was reported in any of the 16 patients.

CONCLUSIONS

The addition of bedtime NPH insulin or metformin was effective in improving the glycemic control in most NIDDM patients with secondary failure to glyburide. The combination of metformin and sulfonylurea was more effective in reducing PPPG and did not induce any increase of body weight.
Relationship Between Plasma Insulin and Blood Pressure in South African Black Women in Johannesburg
Authors: Joffe Barry I , Panz Vanessa R , Wing Jefrey R , Raal Frederick J , Seftel Harold C
Published: March 2007

Objectives

To examine the relationship between fasting plasma insulin and blood pressure (BP) in 40 urbanized normotensive South African black women aged 24–60 yr, and to assess the effects of body mass index (BMI) and fasting plasma glucose on BP.

Research Design and Methods

The women comprised equal numbers of young nonobese nondiabetic subjects, middle-aged nonobese nondiabetic subjects, middle-aged obese nondiabetic subjects, and middle-aged obese newly diagnosed non-insulin-dependent diabetic subjects. Systolic and diastolic BPs were recorded (in duplicate) after 15 min of recumbency, and fasting plasma glucose and insulin levels were determined thereafter. The data were analyzed by simple and multivariate regression.

Results

There was a wide distribution of individual physical and biochemical features. With simple correlations, systolic BP correlated significantly with age, BMI, and fasting glucose but not with insulin. Diastolic BP correlated significantly with all four variables (r = 0.37, P <0.05). When adjusted for age, BMI, and glucose, however, the significant correlation between diastolic BP and insulin diminished (r = −0.04).

Conclusions

As in other nonwhite communities, plasma insulin does not appear to play a major role in regulating the BP of South African black women.
Biguanides and NIDDM
Authors: Bailey Clifford J
Published: March 2007

The main biguanides, metformin and phenformin, were introduced in 1957 as oral glucose-lowering agents to treat non-insulin-dependent diabetes mellitus (NIDDM). Phenformin was withdrawn in many countries because of an association with lactic acidosis, but metformin does not have the same risk if appropriately prescribed. Metformin is now widely used as a monotherapy and in combination with a sulfonylurea. Unlike sulfonylureas, metformin is not bound to plasma proteins, is not metabolized, and is eliminated rapidly by the kidney. The glucose-lowering effect occurs without stimulation of insulin secretion and results mainly from increased glucose utilization. The presence of insulin is required, and enhancement of insulin action at the postreceptor level occurs in peripheral tissues such as muscle. In peripheral tissues metformin increases insulin-mediated glucose uptake and oxidative metabolism. Metformin also increases glucose utilization by the intestine, primarily via nonoxidative metabolism. The extra lactate produced is largely extracted by the liver and serves as a substrate to sustain gluconeogenesis. This limits the extent to which metformin reduces hepatic glucose production but provides a safeguard against excessive glucose lowering. Because metformin does not cause clinical hypoglycemia, it is actually an antihyperglycemic drug. It does not cause weight gain, it helps combat hypertriglyceridemia, and it has been ascribed some vasoprotective properties. Metformin offers a useful treatment for insulin-resistant overweight NIDDM patients.
Coronary Heart Disease Incidence in NIDDM Patients In The Helsinki Heart Study
Authors: Koskinen Pekka , Mänttäri Matti , Manninen Vesa , Huttunen Jussi K , Heinonen Olli P , Frick M Heikki
Published: March 2007

Objective

To determine coronary heart disease (CHD) incidence among dyslipidemic subjects with non-insulin-dependent diabetes mellitus (NIDDM) and to assess the effect of lipid-modifying treatment on serum and lipoprotein lipids and the CHD incidence in these patients.

Research Design and Methods

Of the 4081 men participating in the Helsinki Heart Study, a coronary primary prevention trial with gemfibrozil in middle-aged men with high non-high-density lipoprotein (HDL) cholesterol (> 5.2 mM; 200 mg/dL), 135 had NIDDM at entry. The incidence of definite myocardial infarction and cardiac death and changes in serum and lipoprotein lipids were determined during the 5-yr trial in the NIDDM patients and compared with those observed in nondiabetic trial participants.

Results

Compared with nondiabetic subjects, NIDDM patients had lower HDL cholesterol (P < 0.001), higher triglyceride concentration (P < 0.0001), and greater body mass index (P < 0.001), there were more hypertensive patients (P < 0.001) among them. The incidence of myocardial infarction and cardiac death was significantly higher among diabetic than nondiabetic participants (7.4 vs. 3.3%, respectively, P < 0.02). CHD incidence in the gemfibrozil-treated diabetic men (n = 59) was 3.4% compared with 10.5% in the placebo group (NS). In multivariate analysis, diabetes (P < 0.05), age (P < 0.0001), smoking (P < 0.0001), low HDL cholesterol (P < 0.05), and high low-density lipoprotein cholesterol (P < 0.005) were independently related to CHD incidence. Gemfibrozil-induced serum and lipoprotein lipid changes in diabetic patients were similar to those observed in nondiabetic subjects.

Conclusions

Compared with similarly dyslipidemic nondiabetic subjects, patients with NIDDM are at markedly increased risk of CHD. This elevated risk can be somewhat reduced by gemfibrozil.
Effect of Glycemic Control on Growth Velocity in Children With IDDM
Authors: Wise Joyce E , Kolb Elsie L , Sauder Sue E
Published: March 2007

Objective

To determine the effect of glycemic control on growth velocity in children with insulin-dependent diabetes mellitus.

Research Design and Methods

One hundred twenty-two children with insulin-dependent diabetes mellitus were studied over a 5-yr period. Every 4 mo, glycemic control was assessed by measuring total glycosylated hemoglobin (GHb), pubertal status was determined by physical examination, and height was measured with a stadiometer. Height measurements were normalized for age and sex by converting them to Ζ scores (the number of SD above or below the mean for age and sex). Alterations in growth velocity were determined by the change in Ζ scores (ΔΖ) between visits (i.e., no change in tau score = normal growth velocity; decrease in Ζ score = growth deceleration; and increase in Ζ score = growth acceleration).

Results

A linear relationship was seen between GHb levels and the change in Ζ scores (r = −0.117, P = 0.001). GHb values < 8% were associated with growth acceleration (ΔΖ = +0.10 ± 0.03), and the greatest growth deceleration occurred when GHb was > 16% (ΔΖ =−-0.07 ± 0.03). The level of GHb at which growth suppression occurred (mean ΔΖ became negative) was dependent on pubertal status: Tanner stage 1 ≤ 10%, Tanner stages 2 and 3 ≤ 8%, Tanner stages 4 and 5 ≤ 16%.

Conclusions

Linear growth velocity in children with insulin-dependent diabetes mellitus is heavily related to metabolic control. Children who are prepubertal or in the early stages of puberty are the most vulnerable to growth suppression. Once puberty is well established, growth suppression does not occur until marked hyperglycemia (GHb > 16%) exists.
Xerostomia in Diabetes Mellitus
Authors: Sreebny Leo M , Yu Albert , Green Andrew , Valdini Anthony
Published: March 2007

Objective

To determine the prevalence of xerostomia in a group of ambulatory diabetic patients and to compare the following in patients with and without xerostomia: 1) flow rates of saliva and lacrimal fluid, 2) the presence of other symptoms suggestive of oral and extraoral dryness, 3) indexes of glycemic control, and 4) noninvasive measures of cardiovagal autonomic nervous system function.

Research Design and Methods

Forty adult diabetic patients and an equal number of age- and sex-matched healthy nondiabetic control subjects were studied. Subjects who consumed xerogenic drugs or had other significant diseases were excluded from the study. A questionnaire was administered to all patients, and the following tests were performed: resting and stimulated flow rates on whole saliva; Schirmer's test (lacrimal fluid), serum glucose and HbA1, expiration-inspiration ratio, 30:15 ratio, Valsalva ratio, and the systolic blood pressure response to standing.

Results

Forty-three percent of diabetic patients complained of xerostomia, of which 82% were women. The oral dryness was not related to age or the type and duration of diabetes. Symptoms of water loss and oropharyngeal, ocular, and vaginal dryness were much more common in the xerostomic than the nonxerostomic diabetic patients. The salivary flow rates of the diabetic subjects was consistently lower than those of healthy, nondiabetic control subjects. The mean, resting, and whole-saliva flow rate was abnormally low in the diabetic patients who complained of xerostomia; no significant differences were observed for the stimulated salivary and the lacrimal flow rates. Significant inverse relationships were shown between salivary flow and the level of HbA1; none were shown between flow and autonomic function.

Conclusions

Dry mouth is a common complaint among ambulatory diabetic patients. It is strongly associated with objective measurements of poor salivary flow and with other oral and extraoral symptoms of desiccation. The oral dryness is not associated with cardiovagal autonomic system dysfunction but may be due to disturbances in glycemic control.
Plasma Endothelinlike Immunoreactivity Levels in IDDM Patients with Microalbuminuria
Authors: Collier Andrew , Leach John P , McLellan Alistair , Jardine Alan , Morton James J , Small Michael
Published: March 2007

OBJECTIVE

To determine whether plasma endothelin, a potent vasoconstrictor and growth factor for vascular smooth muscle, is elevated in microalbuminuric insulin-dependent diabetes mellitus patients.

RESEARCH DESIGN AND METHODS

Plasma endothelinlike immunoreactivity was measured by radioimmunoassay in 15 microalbuminuric diabetic patients, 12 normoalbuminuric diabetic patients, and 12 control subjects.

RESULTS

The mean levels of plasma endothelinlike immunoreactivity were raised in the normoalbuminuric patients (8.4 pM [range 4.8–12.7 pM]; P < 0.01) and the microalbuminuric patients (10.2 pM [range 5.6–31.1 pM]; P < 0.001) compared with control subjects (6.1 pM [range 4.5–7.6 pM]). Plasma endothelinlike immunoreactivity was also higher in the microalbuminuric patients compared with the normoalbuminuric patients (P < 0.05).

CONCLUSIONS

The increase in plasma endothelinlike immunoreactivity further confirms endothelial dysfunction in diabetes and this increase in plasma endothelin may contribute to the vascular disease prevalent in diabetes.
Lipoprotein(a) in Diabetic Patients with and Without Chronic Renal Failure
Authors: Guillausseau Pierre Jean , Peynet Jacqueline , Chanson Philippe , Legrand Alian , Altman Jean Jacques , Poupon Joel , N'Guyen Maï , Rousselet François , Lubetzki Jean
Published: March 2007

OBJECTIVE

To examine the distribution of Lp(a) plasma levels in patients with IDDM and NIDDM, and in nondiabetic and IDDM patients with chronic renal failure.

RESEARCH DESIGN AND METHODS

Cross-sectional study of Lp(a) plasma levels in a population of diabetic patients with stable metabolic control, with simultaneous determination of plasma lipids, fasting plasma glucose, and HbA1. Thirty-six patients with IDDM, 90 with NIDDM, and 41 with chronic renal failure (20 IDDM, 21 nondiabetic) were compared with 78 control subjects.

RESULTS

Lp(a) plasma levels were significantly higher in IDDM and NIDDM patients, as well as in nondiabetic and IDDM patients with chronic renal failure compared with control subjects. No correlation was observed between Lp(a) and lipid plasma levels, fasting plasma glucose, and HbA1.

CONCLUSIONS

Lp(a) may contribute to the increased prevalence of atherosclerotic disease in diabetic patients and patients with chronic renal failure, especially in IDDM patients whose lipoprotein pattern was not different from that of the control group.
Glycemic Control and Diabetic Complications
Authors: Strowig Suzanne , Raskin Philip
Published: March 2007

The relationship between glycemic control and diabetic complications remains unclear. Epidemiological studies reveal that ∼25% of diabetic individuals do not develop complications, irrespective of degree of glycemic control. Studies of genetic factors, including HLA type, capillary basement membrane thickness, genetic predisposition to hypertension, and familial clustering of diabetic complications, suggest that there is a genetic component to developing the complications of diabetes. On the other hand, clinical trials have demonstrated that the progression of early, mild background retinopathy, microalbuminuria, and parameters of nervous system function are stabilized with improved glycemic control. Other metabolic parameters, such as serum lipoprotein levels, are significantly improved with near normoglycemia. No studies to date have evaluated the effect of blood glucose control on the prevention of diabetic complications. The degree of glycemic control required to impact on diabetic complications is unknown. In addition, achieving near normoglycemia carries increased risk for severe hypoglycemia and weight gain. Further study is needed to determine the long-term benefits of blood glucose control and to weigh that against the risks of improving glycemic control. Further investigation also is needed to address the probable interrelationship of genetic factors and glycemic control on the development of diabetic complications.
Local Skin-Fold Thickness as a Clinical Predictor of Depot Size During Basal Rate Infusion of Insulin
Authors: Hildebrandt Per R , Vaag Allan A
Published: March 2007

Objective— To determine the influence of local adiposity on insulin depot size during CSII at basal rate.

Research Design and Methods— In 27 diabetic patients, a constant infusion of 125I-labeled Actrapid insulin was given, with U-40 insulin at a rate of 1.12 IU/h in 20 patients, and U-100 at a rate of 1 IU/h in 7 patients. After 16 h of infusion, the steady-state depot size was measured by external counting, and the local skin fold was measured with a Harpenden skin-fold caliper.

Results— U-40 insulin infusion resulted in a steady-state depot size of 5.1 U (2.1–10.9 U), and a corresponding skin-fold thickness of 17.8 mm (5–34 mm). A positive correlation was found between depot size and skin-fold thickness. A similar correlation was observed with U-100 insulin.

Conclusions— During basal rate CSII, large variations in local skin-fold thickness create large variations in the steady-state depot size, which is partly predictable just by lifting the skin fold.
Diabetic Retinopathy
Authors: Ferris Frederick L
Published: March 2007

OBJECTIVE— To review the natural history and treatment indications for diabetic retinopathy.

RESEARCH DESIGN AND METHODS— Studies of the natural history of diabetic retinopathy and major clinical trials sponsored by the National Eye Institute were reviewed.

RESULTS— Diabetic retinopathy remains a leading cause of vision disability in the U.S. Vision loss results from the consequences of proliferative retinopathy or macular edema. Photocoagulation has been demonstrated to be an effective treatment for these complications of diabetes.

CONCLUSIONS— All people with diabetes should be evaluated regularly to determine whether they would benefit from photocoagulation. As a referral guideline, any person with type I diabetes of >5 yr duration and all people with type II diabetes or any retinopathy should be referred to an ophthalmologist.
Diabetic Kidney Disease in Pima Indians
Authors: Nelson Robert G , Knowler William C , Pettitt David J , Saad Mohammed F , Bennett Peter H
Published: March 2007

OBJECTIVE— To describe the natural history of kidney disease in Pima Indians with NIDDM.

RESEARCH DESIGN AND METHODS— Review of previous studies describing diabetic kidney disease in this Native-American population and in other populations.

RESULTS— NIDDM is the leading cause of renal failure in Pima Indians, among whom the incidence of ESRD is 23 times that of the general U.S. population. The high incidence of NIDDM and its early onset in the Pima undoubtedly contribute to this difference. The incidence of overt nephropathy and ESRD, as a function of diabetes duration, is at least as high in Pima Indians with NIDDM as that reported in other populations with IDDM. Furthermore, nearly all of the excess mortality associated with NIDDM is found in individuals with overt nephropathy. Mild elevations of UAE, which may be present even shortly after the onset of diabetes, predict the development of overt nephropathy in diabetic Pimas. Additional predictors include high blood pressure, level of glycemia, duration of diabetes, family history of diabetic nephropathy, and type of diabetes treatment.

CONCLUSIONS— Diabetic kidney disease is a major cause of morbidity and mortality in Pima Indians. The natural history of diabetic kidney disease in this population is similar, in many ways, to the natural history described in individuals with IDDM.
Risk Factors for the Development of Type II Diabetes Among Men Enrolled in the Usual Care Group of the Multiple Risk Factor Intervention Trial
Authors: Shaten B Jessica , Smith George Davey , Kuller Lewis H , Neaton James D
Published: March 2007

OBJECTIVE

To study the association between selected risk factors and the subsequent incidence of type II diabetes over a 5-yr period.

RESEACH DESIGN AND METHODS

Between 1973 and 1976, a cohort of men from 22 clinical centers throughout the U.S. enrolled in the Usual Care group of the Multiple Risk Factor Intervention Trial. The men (5420 white, 428 black, 56 Asian, 70 Hispanic, and 26 other) were nondiabetic at baseline, were in the upper 15% of risk for coronary heart disease, and had at least two annual follow-up visits for fasting glucose measurements. The average age was 46 yr and average body mass index was 27.6 kg/m . Incidence of diabetes was defined as use of insulin or hypoglycemic agents, fasting glucose ≥140 mg/dl on two consecutive annual visits, or fasting glucose ≥ 140 mg/dl followed the next year by insulin or hypoglycemic use. Observations were taken annually over a 5-yr period.

RESULTS

Cumulative incidence of diabetes over 5 yr was 4.1%, with 247 incident cases. Development of diabetes was directly associated with race (blacks higher than non-blacks), reported parental history of diabetes, and with baseline levels of body mass index, fasting glucose, and glucose 1 h after a 75-g oral glucose load. These associations were statistically significant in both univariate and multivariate models. A significant interaction was observed between race and reported parental history of diabetes in development of diabetes, particularly within black men who reported a parental history. These individuals had higher than expected rates of diabetes development.

CONCLUSIONS

The data from men in the Usual Care group enrolled in the Multiple Risk Factor Intervention Trial confirm previous findings regarding the associations between the development of diabetes and baseline glucose levels, obesity, race, and parental history of diabetes. The identification of these risk factors provides very powerful tools to identify individuals at high risk of diabetes mellitus who may be amenable to intervention, thereby reducing their risk of developing the disease and its complications.
Comparison of Diets of Diabetic and Nondiabetic Women
Authors: Shimakawa Tomoko , Herrera-Acena MG , Colditz Graham A , Manson JoAnn E , Stamper Meir J , Willett Walter C
Published: March 2007

OBJECTIVE

To assess the dietary habits of diabetic women.

RESEARCH DESIGN AND METHODS

Participants in the Nurses Health Study, a cohort of 121,700 registered female nurses, were followed since 1976. We compared the usual dietary intakes of women who had been diagnosed with diabetes mellitus by 1980 and age-matched nondiabetic control women; diets of these women were assessed in 1980 and 1984 by a semiquantitative food frequency questionnaire. The study examined 162 IDDM women and 738 NIDDM women. Similar comparisons were made for 429 women who developed NIDDM between 1980 and 1984.

RESULTS

Although differences were small, women with IDDM in 1984 and women with NIDDM in 1980 and 1984 consumed less energy from carbohydrates, especially from sucrose, and more energy from protein and fat than did control women. Similar results were also found in 1984 for the 429 women who developed NIDDM between 1980 and 1984. In 1980, energy from nonsucrose carbohydrate was slightly higher in both IDDM and NIDDM women than in the control women. However, in 1984, using a dietary questionnaire designed to assess more complete dietary intake, less consistent results were obtained. Diabetic women tended to avoid desserts and sweets, sugar-containing beverages, and alcoholic beverages but consumed more meat and meat products. Intakes of foods high in complex carbohydrates (e.g., bread, rice, pasta, and potatoes) were similar between diabetic and control women.

CONCLUSIONS

The results suggest that these diabetic women did not consume the high-carbohydrate, low-fat diets that the American Diabetes Association has been recommending over the past decade.
Relationship Between Glycemic Control and Collagen-Linked Advanced Glycosylation End Products in Type I Diabetes
Authors: Beisswenger Paul J , Moore Lynn L , Curphey Thomas J
Published: March 2007

OBJECTIVE

To evaluate the relationship between glycemic control over a 3-yr period and tissue levels of advanced glycosylation end products. The development of renal failure, blindness, and generalized vascular occlusion continue to be the most serious ravages of diabetes. Tissue glycosylation and AGEs are felt to play an important role in the development of these sequelae, but no data are available on the relationship between AGEs and long-term glycemic control.

RESEARCH DESIGN AND METHODS

We studied 48 subjects with type I diabetes. Glycemic control was determined by mean levels of HbA1 and AGEs were determined on collagenase digests of skin collagen by fluorescence at excitation/ emission readings of 335/385 and 370/440 nm.

RESULTS

To evaluate the relationship between glycemic control and AGE levels, control was classified as good (<8.5%), fair (>8.5% but ≤ 10%), or poor (> 10%) on the basis of mean HbA: levels during 1- and 3-yr periods. Analysis of the mean AGE levels for each level of glycemic control over 1–3 yr showed that AGEs differed significantly across categories of glycemic control (P = 0.04 and 0.003), with thelowest AGE levels associated with good and the highest with poor glycemic control. The relationship also was highly significant when adjusted for age, sex, and duration of diabetes, and when examined by Pearson's correlation coefficients (P = 0.02 and 0.008).

CONCLUSIONS

Finding a relationship between glycemic control over 1–3 yr and tissue levels of AGEs suggests that AGEs can be modified and possibly reversed by improved glucose levels.
Comparison of Bolus and Infusion Protocols for Determining Acute Insulin Response to Intravenous Glucose in Normal Humans
Authors: McCulloch David K , Bingley Polly J , Colman Peters G , Jackson Richard A , Gale Edwin A M ,   The ICARUS Group
Published: March 2007

OBJECTIVE— To help standardize methodology for intravenous glucose tolerance testing in preclinical IDDM by comparing a 30-s bolus and a 3-min infusion of glucose.

RESEARCH DESIGN AND METHODS— We tested 20 healthy nondiabetic adults at four centers (in Seattle, Boston, Melbourne, and London). Each subject had four intravenous glucose tolerance tests (two bolus and two infusion). The acute insulin response to glucose was calculated as the mean of the 1′ + 3′, the mean of 1′ to 10′, or as the integrated area from 0 to 10′. Glucose and insulin profiles and intrasubject coefficient of variation were compared.

RESULTS— With the infusion protocol, the 1′ insulin was significantly higher, resulting in a higher acute insulin response to glucose when calculated as 1′ + 3′ (525 ± 66 vs. 376 ± 35 pM, P < 0.004). When calculated over 10 min, however, the acute insulin response to glucose was not different between protocols. In addition, the intrasubject coefficient of variation was significantly better when calculated over 10 min in both protocols, but no significant differences were noted between the bolus and infusion (infusion: AIRg [area from 0 to 10′] 10.4 ± 2.1% vs. AIRg [1′ + 3′] 14.9 ± 2.8%, P < 0.007; bolus: AIRg [area from 0 to 10′] 14.6 ± 2.8% vs. AIRg [1′ + 3′] 19.8 ± 3.5%, P < 0.007). Comparison of the insulin assays between the four centers showed close correlation and gave indistinguishable results in terms of within-subject coefficient of variation. Glucose profiles were similar in both protocols. Although the glucose values were lower with the bolus protocol from 4′ to 40′, the rate of fall from 10 to 30′ (and thus the rate of glucose disposal) was indistinguishable between the two.

CONCLUSIONS— These data suggest that neither protocol gives significant advantage over the other. However, to allow comparison of the acute insulin response to glucose between different protocols used in centers around the world, the ICARUS 3-min infusion protocol is recommended, with acute insulin response to glucose calculated over 10 min after the end of glucose administration; this reduces the within-subject coefficient of variation and provides similar acute insulin response to glucose with both protocols.
The Epidemiology of Type I Diabetes in Children 0–14 Yr of Age in Philadelphia
Authors: Lipman Terri H
Published: March 2007

OBJECTIVE— To determine the epidemiology of type I diabetes in children in Philadelphia, particularly with respect to racial differences.

RESEARCH DESIGN AND METHODS— This is a descriptive epidemiological study using a retrospective population-based registry in Philadelphia, Pennsylvania, a city with large white, black, and Hispanic populations. All hospitals in Philadelphia that admit children were identified. All charts meeting the following criteria were reviewed: 1) newly diagnosed IDDM, 2) 0–14 yr of age, 3) residing in Philadelphia at the time of diagnosis, and 4) diagnosed from 1 January 1985 to 31 December 1989. Standard IDDM registry data were abstracted from the charts. Ascertainment of the completeness of the hospital registry was validated by two secondary sources: 1) diabetes camp records, 2) Philadelphia School District data.

RESULTS— A total of 215 cases were identified, and the combined hospital, camp, and school registry was determined to be 93% complete. The overall age-adjusted incidence rate in Philadelphia was 13.4/100,000/yr. The highest incidence rate was in Hispanics (15.16), followed by whites (13.31), and blacks (10.95).

CONCLUSIONS— The incidence of IDDM in Philadelphia is similar to what has been found in other U.S. registries. The unexpected finding was that the incidence in the Puerto Rican Hispanic population was the highest in the city. This is the first data reported on this population, and more studies are needed to elucidate the genetic and environmental causes of this high incidence of IDDM.
Role of Experimental Socks in the Care of the High-Risk Diabetic Foot: A multicenter patient evaluation study
Authors: Murray Heather J , Veves Aristids , Young Matthew J , Richie Douglas H , Boulton Andrew J M ,   American Group for the Study of Experimental Hosiery in the Diabetic Foot
Published: March 2007

OBJECTIVE

To assess the acceptability of specially designed socks to provide satisfactory pressure relief in the insensitive, high-risk, diabetic foot. We have conducted a longitudinal multicenter patient evaluation study to assess the acceptability of such hosiery in neuropathic diabetic patients.

RESEARCH DESIGN AND METHODS

A group of 86 neuropathic diabetic patients (69 males, 14 with type I diabetes) with a mean age of 63 yr (range 34–85 yr), and a diabetes duration of 16 yr (range 1–45 yr) participated in the study. Peripheral vascular disease was present in 28 (33%) patients, previous foot ulceration in 39 (44%) patients, and active ulceration was present in 11 (13%) patients. All patients were provided with three pairs of specially designed socks and 80 patients with extra-depth shoes. Evaluation and foot examination were performed at 3 and 6 mo.

RESULTS

Socks were worn for a mean of 6 days/wk (range 1–7 days/wk). Patient satisfaction evaluated at both visits was good or very good in 85%, average in 12%, and poor in 3% of patients. Ten ulcers healed during this period, and seven new ulcers occurred. Intention to continue wearing the socks, most or all of the time, was expressed by 84% of patients.

CONCLUSIONS

We conclude that the experimental socks have a high level of patient satisfaction when worn with suitable shoes, and may be an acceptable and inexpensive addition to existing methods of protecting the high-risk insensitive diabetic foot.
Structural Equation Modeling of Symptoms, Awareness and Fear of Hypoglycemia, and Personality in Patients With Insulin-Treated Diabetes
Authors: Hepburn David A. , Deary Ian J. , MacLeod Kenneth M. , Frier Brian M.
Published: March 2007

OBJECTIVE

To assess the possible influence of personality on self-reported awareness, symptoms, and fear of hypoglycemia and also to identify the relationship among these self-reported measures using formal structural equation modeling.

RESEARCH DESIGN AND METHODS

A structured questionnaire, which included questions about sociodemographic details, awareness of the onset of hypoglycemia, and a list of symptoms of hypoglycemia, was completed by 305 consecutive insulin-treated diabetic patients attending the diabetic clinic at the Royal Infirmary of Edinburgh. They also completed the Hypoglycemia Fear Survey (HFS), and personality was assessed using the short form of the shortened Eysenck Personality Questionnaire-Revised (EPQ-R). Formal structural equation modeling was performed using the following variables: awareness, autonomic symptoms, neuroglycopenic symptoms, severe hypoglycemic episodes in the last year, worry and behavior (from the HFS), and extroversion and neuroticism (from the short EPQ-R). This allowed a model to be constructed that expressed the putative causal associations among the variables that could be tested statistically.

RESULTS

Of the 302 patients who had experienced hypoglycemia, 111 (37%) reported reduced awareness, and these patients scored higher on the worry subscale of the HFS (reduced awareness: 41 ± 12 vs. normal awareness: 34 ± 12, P < 0.001). The patients with reduced awareness scored higher for neuroticism than did the patients with normal awareness (reduced awareness: 6.1 ± 3.4 vs. normal awareness: 4.9 ± 3.3, P < 0.01) and scored lower for extroversion (reduced awareness: 5.8 ± 3.7 vs. normal awareness: 7.1 ± 3.7, P < 0.01). In the structural equation modeling exercise, neuroticism was a significant putative determinant of many of the other variables.

CONCLUSIONS

Personality was the major determinant of the variance that could be accounted for in this study and influenced self-reported symptoms, awareness, and fear of hypoglycemia. Personality factors may, therefore, influence self-reports from patients, particularly when soft measures, such as symptoms, are assessed and even when using validated clinical questionnaires. This finding stresses the importance of using additional evidence, such as reports from relatives, to substantiate reports from patients of loss of hypoglycemia awareness.
Long-Term Glycemic Control Has a Nonlinear Association to the Frequency of Background Retinopathy in Adolescents With Diabetes: Follow-up of the Berlin Retinopathy Study
Authors: Danne Thomas , Weber Bruno , Hartmann Reinhard , Enders Ingo , Burger Walter , Hovener Gerd
Published: March 2007

OBJECTIVE

To assess the influence of long-term glycemic control on the development of background retinopathy in adolescents followed longitudinally from the onset of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Repeated retinal fluorescein angiographies, in intervals of 1–2 years, were evaluated prospectively in 346 patients (190 males, 156 females; 19.8 [8.8–35.4] years of age; diabetes duration of 10.4 [1.1–27.4] years at their latest eye examination, median [range]). The influences of long-term HbA1c (mean of 18 [1–95] determinations per person) and microalbuminuria (≥2 of ≥3 measurements ≥ 15 μg/min × 1.73 m2) were studied by multiple linear regression, life-table analysis, and trend analyses.

RESULTS

The rate of background retinopathy per 100 patient-years increased with poorer glycemic control from 0.7 (long-term HbA1c < 7% to 7.3 (HbA1c > 11%) following an exponential function. Life-table analysis after subdivision in HbA1c quartiles of equal sizes (HbA1c < 8, 8–9, 9–10, and > 10%) revealed an individual median expectation of background retinopathy after more than 25, 16.2, 12.7, or 12.0 years of diabetes, respectively. However, significant differences were found only between 8–9% and 9–10%, calculated either as prevalence, life-table analysis, or relative incidence, thus suggesting that a threshold model may also fit the data. After 12 years of diabetes, < 25% of those patients exhibiting microalbuminuria (n = 18) were expected to be free from retinopathy compared with 81% of those with normoalbuminuria (n = 86).

CONCLUSIONS

Two statistical models are appropriate to explain the relationship between glycemic control and risk for background retinopathy: 1) a continuous exponential relationship as described by the DCCT or 2) the presence of a threshold HbA1c level at 9%. Thus, diabetes treatment in children should aim at long-term HbA1c levels < 9.0%, but every progress closer to normal may further reduce the risk.
Genes Within the Major Histocompatibility Complex Predict NIDDM in African-American Women in Alabama
Authors: Acton Ronald T , Roseman Jeffrey M , Bell David S H , Goldenberg Robert L , Tseng Mei-Ling , Vanichanan Chotip , Harman Leigh A , Go Rodney C P
Published: March 2007

OBJECTIVE

To test the hypothesis that genes within the major histocompatibility complex (MHC) are associated with gestational diabetes mellitus (GDM) and, subsequently, non-insulin-dependent diabetes mellitus (NIDDM) in African-American women.

RESEARCH DESIGN AND METHODS

African-American women who presented with GDM were compared with pregnant African-American control subjects. Following pregnancy, GDM patients were assessed at various intervals of time (median = 6 years) to determine whether they had developed diabetes.

RESULTS

GDM patients who required insulin during pregnancy possessed a significantly higher frequency of A33, DR2, DR9, and BF-S phenotypes than control subjects. GDM patients who subsequently developed NIDDM had a significantly higher frequency of B41, DR2, and BF-S and a lower frequency of DR1 and DR6 phenotypes than control subjects. Even after controlling for age and body mass index, B41 and DR2 were independent predictors of developing insulin-requiring GDM and NIDDM in GDM subjects.

CONCLUSIONS

These results suggest that either one or more genes within the MHC are involved in the etiology of NIDDM.
Radiographic Abnormalities in the Feet of Patients With Diabetic Neuropathy
Authors: Cavanagh Peter R , Young Matthew J , Adams Judith E , Vickers Karen L , Boulton Andrew J M
Published: March 2007

OBJECTIVE

To investigate the prevalence of radiographie bone and joint abnormalities in the feet of diabetic patients.

RESEARCH DESIGN AND METHODS

In a blinded randomized study, 94 diabetic patients with peripheral neuropathy (54 with a history of foot ulcers) and 43 non-neuropathic patients were drawn at random from the data base of a large university diabetes clinic in the United Kingdom. Fifty nondiabetic age-matched control subjects also were studied. Lateral and dorsi-plantar weight-bearing plain radiographs of the foot and ankle were taken by a single radiographer. Abnormalities in the bones and joints were determined according to a structured reading of the radiographs by a single radiologist.

RESULTS

Diabetes per se resulted in no excess of bony abnormality. Diabetic patients with neuropathy had significantly more radiographic abnormalities of the bones and joints than non-neuropathic and age-matched nondiabetic control subjects. However, except for periosteal reaction, this was predominantly caused by an excess of abnormalities in diabetic patients with a history of foot ulceration. Traumatic fractures (most previously unrecognized) were found in 12 (22%) of the 54 neuropathic patients with previous foot ulceration, and 9 (16%) patients who had experienced foot ulcers exhibited characteristic Charcot changes.

CONCLUSIONS

These results suggest that bony abnormalities, particularly Charcot changes and traumatic fractures, are more frequent than previously recognized in neuropathic diabetic patients, especially in those with a history of foot ulceration. Early recognition of bony abnormality and appropriate treatment may prevent progression of foot deformity and thereby reduce the morbidity caused by ulceration or reulceration.
Insulin Availability Among International Diabetes Federation Member Associations: Report of the Task Force on Insulin Distribution
Authors: Deeb Larry C , Tan Meng H , Alberti K G M M
Published: March 2007

OBJECTIVE

To assess the availability of insulin and diabetes supplies among International Diabetes Federation (IDF) member associations.

RESEARCH DESIGN AND METHODS

A mail survey of IDF member associations asked about the following issues: 1) diabetes prevalence and insulin use, 2) availability and cost of insulin and supplies, 3) availability of glycemic monitoring supplies, 4) cost of insulin and supplies to patients, and 5) availability of oral hypoglycemic agents.

RESULTS

Of 85 member associations, 60 responded. The mean prevalence of diabetes was 3.7%. Of the 39 with a population-based survey data, the prevalence was 3.9%. Insulin use was reported for 19.2% of diabetes patients and, for the 15 with population-based data, the proportion using insulin was 16.1%. Of the respondents, 47 (78%) reported insulin was always available, 11 (18%) reported insulin was available from 25 to 99% of the time, and 2 (Uganda and Tanzania) reported insulin was available <25% of the time. Insulin is free to patients in 39 (65%) of the countries. The average cost of the least expensive insulin was U. S. $9.62 per vial. Fifteen countries imposed a mean 13% customs charge. Disposable syringes were available in 42 (72%) of countries all of the time. Glucose meters were in use in 49 countries: The most common oral agent was glyburide, which was available in 57 countries.

CONCLUSIONS

Insulin is in reasonable supply in IDF member countries. Cost and customs charges are an impediment to universal access. IDF now can recommend programs based on this data.