bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental and Professional Estimates of Self-Care Independence of Children and Adolescents With IDDM
Authors: Wysocki Tim , Meinhold Patrical A , Abrams Keith C , Barnard Martha U , Clarke William L , Bellando B Jayne , Bourgeois Michael J
Published: March 2007

Objective

–To report the results of a survey of 490 parents of children with insulin-dependent diabetes mellitus (IDDM) regarding the children's mastery of 38 diabetes-care skills. Parental responses are contrasted with those of a previous survey in which 229 diabetes professionals estimated ages at which typical children with IDDM master the same skills.

Research Design and Methods

–Parents were recruited at five pediatric endocrinology clinics with a response rate of 88.9%.

Results

–For 33 of 38 skills, professionals' median mastery age estimates exceeded, by ≥1 yr, the median ages that parents reported skill mastery by their estimates, children. Despite the parent-professional disagreement about mastery-age their survey responses yielded substantial agreement about the order of mastery of specific skills. The data also revealed two profiles of comparative results. For many items, parents reported earlier skill mastery, but parental and professional estimates eventually converged during adolescence. These skills consisted of rote, motoric acts, or more complex tasks for which errors yield relatively certain aversive consequences. For other skills, more professional estimated skill mastery among adolescents than did parents. These skills required substantial organization and self-regulation by the adolescent, involved treatment components for which the aversive consequences of errors are deferred and uncertain, or they were skills infrequently required of most patients with IDDM.

Conclusions

–The parent-professional discordance revealed by this survey illustrates the importance of clear specification of treatment responsibilities, careful monitoring of self-care competence, and periodic reeducation of children with IDDM.
Natural Course of Remission in IDDM During 1st yr After Diagnosis
Authors: Martin Stephen , Pawlowski Brigette , Greulich Burkard , Ziegler Anette G , Mandrup-Poulsen Thomas , Mahon Jeffrey
Published: March 2007

Objective

–To describe the natural course of clinical remission in insulin-dependent diabetes mellitus (IDDM) when insulin dose is minimized without loss of target glycemia and to identify factors that predict clinical remission.

Research Design and Methods

–Ninety-five patients, who were placebo-treated control subjects in the Canadian-European multicenter randomized trial of cyclosporin A in recent-onset IDDM, were studied.

Results

–The mean insulin dose decreased during the first months after diagnosis, with a nadir at 3 mo, when 27% of the patients did not require insulin to maintain target glycemia. At 1 yr, 10% of patients still did not need insulin. Patients not receiving insulin who had glycosylated hemoglobin within the normal range were called remitters. Mean basal and glucagon-stimulated C-peptide values were significantly (P < 0.025) higher in remitters than nonremitters at the start of the study. Therefore, all patients were divided into those with values above the mean stimulated C-peptide (0.4 nM) and those with values below the mean at entry. The probability of entering a remission with a stimulated C-peptide > 0.4 nM was 10 times as high (P < 0.05) as for those with a stimulated C-peptide below this level. Surprisingly, the beginning and end of the remission were associated with neither major changes in C-peptide levels nor islet cell antibody and insulin-antibody titer. A more rapid loss of stimulated C-peptide occurred in patients who lacked HLA-DR3 and -DR4 (P < 0.05 at mo 9).

Conclusions

–This study shows a higher spontaneous clinical remission rate than expected during the 1st yr after diagnosis. Preserved beta-cell function at entry predicts a greater chance of entering a remission, and a more rapid loss of beta-cell function was seen in patients without HLA-DR3 and -DR4.
Community-Based Epidemiological Study on Diabetes in Pu-Li, Taiwan
Authors: Chou Pesus , Chen Hsu-Hsi , Hsiao Kwang-Jen
Published: March 2007

Objective

–To determine the prevalence and possible risk factors associated with diabetes in Pu-Li, Taiwan.

Research Design and Methods

–The project was a community-based cross-sectional study with stratified cluster sampling of residents ≥ 30 yr of age. Medical students conducted home-visit interviews with public health nurses, drew fasting blood samples from 1738 of 2573 registered residents ≥ 30 yr of age in Pu-Li, Taiwan.

Results

–The prevalence of diabetes, including those with a history of diabetes and newly diagnosed cases determined by modified World Health Organization criteria, was 12.4%. With the standard world population of Segi, the age-adjusted prevalences were 6.9% for previous diabetes and 4.4% for new diabetes. The age-specific prevalence of diabetes increased significantly with age for new diabetes cases but not for previously diagnosed cases. To study factors associated with diabetes, we first applied univariate analysis. Stratified analyses by age and sex were used for interaction assessment. A significant interaction effect on diabetes was found between age and sex. Logistic regression was used for multivariate analysis. The final model showed that, after controlling for all other covariates, the significant factors associated with diabetes were family history of diabetes (father and/or mother, yes vs. no, odds ratio [OR] 3.13, 95% confidence interval [CI] 1.17–8.33), obesity (yes vs. no, OR 2.69, 95% CI 1.09–6.63), and age (continuous, OR 1.04, 95% CI 1.00–1.08). Locality and physical activity were not significantly correlated with diabetes.

Conclusions

–The age-adjusted prevalence of diabetes in Pu-Li were 6.9% for previous diabetes and 4.4% for new diabetes. Possible risk factors associated with diabetes with logistic regression were family history of diabetes, obesity, and age. Locality and physical activity were not significantly correlated with diabetes.
Hyperfibrinogenemia: An important risk factor for vascular complications in diabetes
Authors: Ganda Om P , Arkin Charles F
Published: March 2007

OBJECTIVE

To evaluate the determinants of elevated fibrinogen levels and the impact of hyperfibrinogenemia on vascular complications in diabetes.

RESEARCH DESIGN AND METHODS

Plasma fibrinogen, glucose, HbA1, and lipids were measured in 116 ambulatory type I and type II diabetic patients with (n = 59) or without (n = 57) clinical evidence of micro- or macrovascular complications. In 56 of these patients, factor VII activity and CRP also were measured. Univariate and multivariate data analyses were conducted.

RESULTS

Overall mean ± SE fibrinogen levels in patients (339 ± 7.3 mg/dl) were elevated markedly compared with control subjects (248 ± 9.1 mg/dl). Fibrinogen levels were elevated disproportionately in patients with type II diabetes (P < 0.0001), hypertension (P = 0.0001), obesity (P < 0.0001), and vascular complications (P < 0.0001). Fibrinogen was correlated significantly with age (P < 0.001), cholesterol (P = 0.002), CRP (P < 0.001), and factor VII activity (P = 0.032), but not with plasma glucose, triglycerides, HDL cholesterol, or disease duration. Stepwise multiple regression analyses revealed that type II diabetes and presence of vascular complications were major determinants of fibrinogen. For vascular complications, fibrinogen emerged as one of only three independent predictors, the other two being diabetes duration and hypertension.
Prevalence and clinical picture of IDDM in Nigerian Igbo schoolchildren
Authors: Afoke Anthony O , Ejeh Ndubuisi M , Nwonu Eunice N , Okafor Christopher O , Udeh Nnanna J , Ludvigsson Johnny
Published: March 2007

OBJECTIVE

To evaluate the prevalence and clinical picture of IDDM in Nigerian Igbo schoolchildren born and living in continental Africa.

RESEARCH DESIGN AND METHODS

In three school districts (Ezza, Ishielu, Ohaukwu), 77,862 schoolchildren aged 5–17 yr answered our questionnaires on age, sex, known disease, drugs being taken, family history, and diabetic symptoms like polyuria, polydipsia, polyphagia, and weight loss. Positive respondents were given glucosuric tests, and glucosuric subjects had hyperglycemic tests. Diagnosis of IDDM was established in hyperglycemic patients by referred hospital clinicians based on insulin requirements.

RESULTS

Twelve new cases of IDDM were found in addition to 14 previously diagnosed cases, giving a CPR of 0.33/1000. Ishielu had a CPR of 0.46/1000 compared with 0.25 (P < 0.01) for Ohaukwu. Boys had a CPR of 0.38/1000 compared with 0.25/1000 (P < 0.06) for girls. Boy-to-girl prevalence ratio was ∼ 3:1.

CONCLUSIONS

The relatively high prevalence of IDDM in this poor African population, despite potential deaths caused by minimal medical attention, may be because of long-term protein malnutrition and endemic childhood infections, which have been implicated in the etiology of IDDM in similar malnourished populations.
Insulin Requirements in Insulin-Dependent and Insulin-Requiring GDM Women During Final Month of Pregnancy
Authors: McManus Ruth M , Ryan Edmond A
Published: March 2007

OBJECTIVE

To determine the significance of falling insulin requirements after the 36th wk of gestation in insulin-requiring pregnant women.

RESEARCH DESIGN AND METHODS

Insulin requirements of women with IDDM and IRGDM were assessed from the 36th wk of pregnancy, with evaluation of maternal characteristics and fetal outcomes.

RESULTS

In 32 pregnancies of women with IDDM, there was a 5 ± 2% decrease in insulin requirements, and in 19 pregnancies of women with IRGDM, there was a 28 ± 10% increase. Of the 62% of women whose insulin requirements declined, the decrement was 12 ± 2% and was associated with longer duration of diabetes (12 ± 2 vs. 6 ± 1 yr, P < 0.05) but not with age, prepregnancy BMI, weight gain, or maternal or fetal complications. Only 3 pregnancies in IRGDM women were associated with a decrease in insulin requirements. Although maternal parameters were no different from those with IDDM, infants born to women with IRGDM were smaller (3531 ± 123 vs. 3874 ± 94 g, P < 0.005).

CONCLUSIONS

Insulin requirements from the 36th wk of gestation commonly decreased in women with IDDM, associated with longer duration of diabetes but did not carry any adverse prognostic indication for the infants. Women with IRGDM experienced a continual increase in insulin requirements over the final weeks of pregnancy.
Cost-Effectiveness of Alternative Methods for Diabetic Retinopathy Screening
Authors: Lairson David R , Pugh Jacqueline A , Kapadia Asha S , Lorimor Ronald J , Jacobson James , Velez Ramon
Published: March 2007

OBJECTIVE

To assess from the perspectives of a government delivery system and patients, the cost-effectiveness of the 45-degrees retinal camera compared to the standard ophthalmologist's exam and an ophthalmic exam by a physician's assistant or nurse practitioner technician, for detecting nonproliferative and proliferative diabetic retinopathy.

RESEARCH DESIGN AND METHODS

Comparison of 45-degrees fundus photographs with and without pharmacological pupil dilation taken by technicians and interpreted by experts, direct and indirect ophthalmoscopy by ophthalmologists, and direct ophthalmoscopy by technicians with seven-field stereoscopic fundus photography (reference standard). Costs were estimated from market prices and actual resource use. The study included 352 patients attending outpatient diabetes and general-medicine clinics at VA and DOD facilities.

RESULTS

Medical system costs per true positive were: 45-degrees photos with dilation, $295; 45-degrees photos without dilation, $378; ophthalmologist, $390; and technician, $794. Patient costs per true positive were: 45-degrees photos with dilation, $139; 45-degrees photos without dilation, $171; ophthalmologist, $306; and technician, $1009. Cost-effectiveness is sensitive to program size due to high fixed cost of the camera methods but not to prevalence. Cost-effectiveness of the technician exam is strongly affected by its sensitivity.

CONCLUSIONS

Primary-care screening with retinal photographs through pharmacologically dilated pupils for diabetic retinopathy is an appropriate and cost-effective alternative to screening by an ophthalmologist in this setting. Ophthalmologists are scarce, primary-care physicians are extremely busy, and large clinics allow fixed equipment costs to be spread across many patients.
Growth of Children Before Onset of Diabetes
Authors: Price David E , Burden Andrew C
Published: March 2007

OBJECTIVE

To examine the growth of children before the onset of diabetes.

RESEARCH DESIGN AND METHODS

Heights before diagnosis, expressed as SDS, of each diabetic child identified from the diabetes register and of two age- and sex-matched control subjects were obtained from records of routine examinations performed at 3.5, 6, 11, and 13 yr. The heights of their siblings, with control subjects, also were obtained.

RESULTS

Diabetic children were considerably taller than control subjects before diagnosis (0–1 yr before diagnosis SDS 0.82 ± 0.26 vs. 0.16 ± 0.14, P < 0.05, n = 24; 1–2 yr before diagnosis SDS 1.02 ± 0.17 vs. 0.16 ± 0.14, P < 0.001, n = 30; 2–3 yr before diagnosis SDS 0.97 ± 0.23 vs. 0.04 ± 0.20, P < 0.005, n = 16). At more than 3 yr before diagnosis, the diabetic children were not significantly taller than control subjects (SDS 0.8 ± 0.2 vs. 0.27 ± 0.13, respectively; n = 33). The siblings of the diabetic children were no taller than control subjects.

CONCLUSIONS

Diabetic children, but not their siblings, were taller than control subjects before diagnosis, suggesting growth-inducing metabolic changes may precede the onset of clinical diabetes by at least 3 yr.
Eating Disorders and IDDM: A problematic association
Authors: Rodin Gary M , Daneman Denis
Published: March 2007

IDDM and eating disorders are common conditions in young women. Whether a specific association exists between these two disorders remains controversial. Some studies have suggested an increased incidence of eating disorders in young women with IDDM, whereas others have not detected such an increase. These differences may be attributable, at least in part, to methodological issues in study design, measurement tools, and relatively small sample sizes. Whether the prevalence of eating disorders in IDDM is increased will be resolved only by larger studies that use standardized diagnostic interviews. We suspect that certain aspects of IDDM and its management may trigger the expression of an eating disorder in susceptible individuals. Required dietary restraint and weight gain related to diabetes management are the factors most likely to be implicated. Eating disorders are relatively common in young women with IDDM and may contribute to impaired metabolic control with hypoglycemia and DKA, and to long-term microvascular complications of diabetes. Omission or reduction of required insulin, an extremely common means of weight control in these young women, is likely an important factor in this regard. Further research is required to determine more precisely the relationship between IDDM and eating disorders, and the effects of eating disorders on metabolic control and chronic complications of IDDM.
Relationship Between Absorption of Radiolabeled Soluble Insulin, Subcutaneous Blood Flow, and Anthropometry
Authors: Vora Jiten P , Burch Anna , Peters John R , Owens David R
Published: March 2007

OBJECTIVE

To evaluate the interrelationships between the rate of absorption of soluble insulin, SCBF, and anthropometry in normal subjects.

RESEARCH DESIGN AND METHODS

In 12 normal men (age range 23–30 yr, BMI 18.2–41.3 kg/m2), simultaneous assessment of the absorption of 125I-labeled soluble insulin and SCBF (99mTc clearance) was performed, on separate study days, for the anterior abdominal wall, anterior midthigh, and the upper arm sites. Each site was examined in a randomized order on two separate occasions. Absorption of 125I-soluble insulin was determined by external monitoring of residual radioactivity levels at the injection site for 6 h postinjection. Residual radioactivity level-time curves, including the characteristic early phase of slow absorption of soluble insulin (the lag phase), were described using two- and three-parameter biexponential models. Anthropometric measurements included BMI, ultrasonic measurement of the subcutaneous adipose tissue layer, and caliper skin fold thickness at the anterior abdominal wall, biceps, triceps, anterior midthigh, and subscapular sites.

RESULTS

A highly significant positive relationship was observed between the rate of absorption of 125I-soluble insulin and SCBF (rS =0.44–0.52; P < 0.01–0.001). The duration of the lag phase was inversely correlated with SCBF (rS = −0.34 – −0.51; P < 0.01–0.001). Inverse relationships also were observed for the subjects' degree of adiposity with the rate of soluble insulin absorption (rs = −0.43–−0.71; P < 0.001) and SCBF (rS = −0.27–−0.62; P < 0.05–0.001). Significantly shorter lag phase was observed for the abdominal site compared with thigh and arm injection sites (P < 0.05–0.01).

CONCLUSIONS

The rate of absorption of soluble insulin, including during the lag phase, is positively correlated with SCBF. Increasing adiposity prolongs the duration of the early lag phase and reduces the rate of absorption of soluble insulin and SCBF.
Analysis of Early-Phase Insulin Responses in Nonobese Subjects With Mild Glucose Intolerance
Authors: Yoneda Hiroko , Ikegami Hiroshi , Yamamoto Yoshihiro , Yamato Eiji , Cha Tepyon , Kawaguchi Yoshihiko , Tahara Yasuhiro , Ogihara Toshio
Published: March 2007

OBJECTIVE

To study the possible contribution of a B-cell defect in the development of glucose intolerance in nonobese subjects.

RESEARCH DESIGN AND METHODS

There were 41 normal, nondiabetic subjects; 18 subjects with IGT; and 21 patients with NIDDM. All subjects were nonobese (BMI < 27 kg/m2). Insulin secretory responses to an OGTT, IVGTT, and GST were studied.

RESULTS

Early-phase insulin responses to OGTT and IVGTT were decreased in subjects with IGT to levels comparable with those in NIDDM patients, whereas the response to GST was preserved in the subjects with IGT compared with NIDDM patients. The insulinogenic index of OGTT correlated well (r = 0.78) with early-phase insulin response to IVGTT, suggesting that the insulinogenic index in OGTT is related to the early-phase insulin response to IVGTT in nonobese subjects.

CONCLUSIONS

Impaired early-phase insulin response to glucose was associated with mild glucose intolerance, suggesting the importance of impaired insulin secretion in the development of glucose intolerance in nonobese subjects.
Early Disturbances of Ambulatory Blood Pressure Load in Normotensive Type I Diabetic Patients With Microalbuminuria
Authors: Benhamou Pierre Y , Halimi Serge , Gaudemaris Régis De , Boizel Robert , Pitiot Muriel , Siche Jean P , Bachelot Ivan , Mallion Jean M
Published: March 2007

OBJECTIVE

To compare 24-h ABP in normotensive type 1 diabetic patients with and without microalbuminuria.

RESEARCH DESIGN AND METHODS

The study was a retrospective comparison of cases and matched control subjects. The first phase included 35 type 1 diabetic patients, normotensive by OMS criteria. The 23 patients with normoalbuminuria (< 15 μg/min) were compared with 12 patients with microalbuminuria (≥ 15 μg/min). In the second phase, the 12 microalbuminuric patients were paired by sex- and age-matched with 12 normoalbuminuric patients and 12 nondiabetic healthy control subjects. We measured casual systolic and diastolic BP and HR, 24-h ABP and AHR (recorded with a Spacelabs automatic recorder), and microalbuminuria.

RESULTS

No correlation between microalbuminuria and casual BP was observed. Microalbuminuria was correlated significantly with diastolic 24-h APR and nocturnal systolic and diastolic ABP (r = 0.35, 0.38, and 0.33, respectively; P < 0.05) and with AHR during all time periods (24-h, r = 0.46; day, r = 0.39; night, r = 0.39; P < 0.05). Normo- and microalbuminuric patients did not differ in casual BP and HR. However, microalbuminuric patients had a significant increase in systolic 24-h ABP (119.1 ± 8.2 vs. 113.1 ± 8.1, P = 0.05), diastolic 24-h ABP (74.9 ± 7.5 vs. 70.2 ± 5.7, P = 0.04), nocturnal systolic ABP (112.8 ± 7.1 vs. 105.8 ± 7.9, P = 0.01), and AHR during all time periods. The same results were observed when patients were paired by age and sex.

CONCLUSIONS

Normotensive microalbuminuric type 1 patients, although strictly comparable with normoalbuminuric patients for casual BP and HR, have an increased ABP and HR, especially during the night. This difference might reflect dysautonomia. Ambulatory measurement of BP and HR is more appropriate than casual measurements in hemodynamic studies of incipient diabetic nephropathies and could be proposed as an interesting tool for an early prediction of diabetic nephropathy.
Use of Premixed Insulin Among the Elderly: Reduction of errors in patient preparation of mixtures
Authors: Coscelli C , Calabrese G , Fedele D , Pisu E , Calderini C , Bistoni S , Lapolla A , Mauri M G , Rossi A , Zappella A
Published: March 2007

OBJECTIVE

To evaluate the accuracy of elderly patients in their mixing of regular and intermediate insulins, to assess the safety and efficacy of premixed insulins compared with extemporarily mixed insulins, and to determine patients' preferences.

RESEARCH DESIGN AND METHODS

We conducted a crossover multicenter study of 5 mo duration. Premixed insulins and patient-mixed, human biosynthetic (rDNA) insulins were used among 64 insulin-treated patients with NIDDM. After a 4-wk run-in period, eligible patients were randomly assigned to treatment 1 (extemporarily mixed insulins) or treatment 2 (premixed insulins) for 8 wk. After that period, the two treatments were crossed for an additional 8-wk period. A blood glucose profile was recorded monthly and HbA1c was measured at the beginning and at the end of each treatment period. An in vitro skills test was performed to assess the accuracy and reproducibility of the patient preparation of insulin doses, and a questionnaire was used to determine their personal preferences for premixed versus extemporarily mixed insulin.

RESULTS

In our study, the quality of the metabolic control was the same whether patients used self-mixed or premixed insulin. The differences in blood glucose profiles and HbA1c were negligible between type and periods of treatment. The overall number of hypoglycemic episodes increased during the trial in both groups, but the difference between treatments was not significant.

The in vitro skills test, however, indicated that the accuracy in the preparation of insulin doses was significantly higher when patients aspirated from one vial compared with preparation from two vials (P < 0.001). The CVs were 3.7% when drawing up a single dose and 5.0% when preparing a mixture, but the ranges were rather elevated (0.1–20.7 and 0.6–35.8%, respectively). Forty-two patients described the preparation of their daily insulin dose as very easy and 21 described it as easy when using premixed insulins versus 11 and 43, respectively, when using extemporarily mixed insulins (P < 0.001).

CONCLUSIONS

While the quality of the metabolic control was the same whether patients used self-mixed or premixed insulin, the in vitro skills test indicated that insulin preparation by elderly patients is highly inaccurate. In some patients, a modification of the contents of the insulin is likely to occur in a few days. The use of premixed insulins should lessen the errors that occur in mixing insulins and from the contamination of the second insulin vial. Draw-up errors could partially account for the lack of improvement of glucose control during the period when patients received premixed insulins. A longer observation period probably is needed to assess appreciable changes in the quality of diabetes control.
Effects of Physical Training on the Metabolism of Skeletal Muscle
Authors: Henriksson Jan
Published: March 2007

With moderate training (30-60 min daily at 70–80% of VO2 max, 3–5 times weekly), the trained muscles display a 40–50% increase in the content of mitochondrial oxidative enzymes. Concomitantly, the total number of muscle capillaries may increase by 50%, whereas the content of glycolytic enzymes is not, or only marginally, affected. The oxidative enzyme increase, which occurs over 6–8 wk, is lost in 4–6 wk if training is stopped. This loss occurs faster than the decrease in muscle capillarization and in the whole-body VO2 max. Trained muscles of athletes have 3–4 times higher oxidative enzyme levels and two- to threefold more capillaries per muscle fiber than untrained muscle. Extensive endurance training results in an enhanced percentage of slow-twitch fibers, but the time course of this change is not known. More extensive changes are observed in chronically stimulated rabbit muscle. In this case, enzymes of oxidation display large increases (6- to 12-fold), whereas there is a decrease of 70–90% in enzymes of glycolysis, glycogenolysis, gluconeogenesis, and high-energy phosphate transfer. There is a normal training response in mitochondrial enzyme activities in individuals with insulin-dependent and non-insulin-dependent diabetes, but the ability to form new skeletal muscle capillaries in response to physical training may be deficient in insulin-dependent diabetes. Training-induced changes in the metabolic character of skeletal muscle leads to an increased reliance on fat metabolism during exercise, with a lowered blood lactate concentration and a sparing of muscle glycogen.
Prevention of Type II Diabetes by Physical Training: Epidemiological considerations and study methods
Authors: King Hilary , Kriska Andrea M
Published: March 2007

Disease prevention may be considered at three levels: primary (avoiding disease occurrence), secondary (early detection and reversal), and tertiary (prevention or delay of complications). Physical exercise could potentially contribute to all of these. Metabolic studies suggest the major effect of exercise is at the level of insulin sensitivity/resistance. Therefore, it may have the greatest benefit in primary prevention and in the early stages of the disease. Studies of migrants and of active and inactive professions support this notion. There is also provisional support for the benefit of exercise on metabolic control and prevention or delay of chronic complications in non-insulin-dependent (type II) diabetic patients. In designing a trial of exercise, aspects such as single/multifactorial intervention, the age range of subjects, and choice of outcome measures must be considered. The most widely used methodological tool in assessing physical activity levels in population studies is the activity questionnaire, which is nonreactive, practical, applicable, and accurate relative to other methods. A positive approach to exercise training for both the patient with type II diabetes and the general community appears to be warranted. However, trials examining the efficacy of activity intervention, with independent evaluation of both short- and long-term outcomes, are still needed.
Ten-Year Experience with an Exercise-Based Outpatient Life-Style Modification Program in the Treatment of Diabetes Mellitus
Authors: Schneider Stephen H , Khachadurian Avedis K , Amorosa Louis F , Clemow Lynn , Ruderman Neil B
Published: March 2007

Exercise is frequently recommended in the treatment of diabetes mellitus. Nevertheless, its use has been limited in clinical practice, and concerns about safety and efficacy persist. We have reviewed a 10-yr experience with 255 patients enrolled in a comprehensive diabetes program that emphasized physical training.

A low maximal oxygen uptake () was found in patients with non-insulin-dependent diabetes mellitus compared with sedentary control subjects. This was not accounted for by autonomic neuropathy and is unlikely to be due to subtle differences in life-style. Exercise-related proteinuria was common and occurred in 29% of patients and was associated with higher blood pressure levels at rest and during exercise, impaired , and decreased R-R interval variation.

Regular exercise was associated with a modest decrease in resting and exercise blood pressure. Glycosylated hemoglobin levels and plasma triglycerides improved only in patients with non-insulin-dependent diabetes mellitus. Insulin requirements were significantly reduced in patients with insulin-dependent diabetes mellitus. Compliance for up to 3 mo in the program was acceptable but longer-term compliance was poor. Serious complications during the program were rare.

Our experience suggests a program of regular aerobic training can be safely and effectively used in an outpatient population with diabetes mellitus for up to 3 mo.
Epidemiology of Proliferative Diabetic Retinopathy
Authors: Klein Ronald , Klein Barbara E K , Moss Scot E
Published: March 2007

OBJECTIVE

This review examines recent epidemiological data about the prevalence and incidence of and risk factors for proliferative diabetic retinopathy. In addition, the relation of proliferative retinopathy to other systemic complications associated with diabetes is reviewed.

RESEARCH DESIGN AND METHODS

The data come mostly from the baseline and 4-yr follow-up examinations of a large population-based study, the WESDR, which involved 996 younger-onset insulin-dependent people whose diabetes was diagnosed at < 30 yr of age and 1370 older-onset people whose diabetes was diagnosed at ≥ 30 yr of age, and who were taking or not taking insulin.

RESULTS

The major finding is that proliferative retinopathy is a prevalent complication (23% in the WESDR younger-onset group, 10% in the WESDR older-onset group that takes insulin, and 3% in the group that does not take insulin). Hyperglycemia, longer duration of diabetes, and more severe retinopathy at baseline were associated with an increased 4-yr risk of developing proliferative retinopathy. However, higher blood pressure at baseline was associated only with the development of proliferative retinopathy in the younger-onset group. The presence of proliferative diabetic retinopathy was associated with an increased 4-yr risk of loss of vision, cardiovascular disease, diabetic nephropathy, and mortality. In the WESDR, a significant number of diabetic people with proliferative retinopathy at risk for vision loss were not under the care of an ophthalmologist or had not undergone panretinal photocoagulation.

CONCLUSIONS

These data suggest that hyperglycemia and, possibly, high blood pressure are related to proliferative retinopathy. They also suggest that once proliferative diabetic retinopathy is detected, people should have a medical evaluation, because it is a strong indicator for the presence and development of systemic disease. These data also indicate that diabetic patients and their physicians should be aware of the need for routine ophthalmological examinations to detect and treat proliferative retinopathy.
Complications: Neuropathy, Pathogenetic Considerations
Authors: Greene Douglas A , Sima Anders A F , Stevens Martin J , Feldman Eva L , Lattimer Sarah A
Published: March 2007

The most common form of neuropathy associated with diabetes mellitus is distal symmetric sensorimotor polyneuropathy, often accompanied by autonomic neuropathy. This disorder is characterized by striking atrophy and loss of myelinated and unmyelinated fibers accompanied by Wallerian degeneration, segmental, and paranodal demyelination and blunted nerve fiber regeneration. In both humans and laboratory animals, this progressive nerve fiber damage and loss parallels the degree and/or duration of hyperglycemia. Several metabolic mechanisms have been proposed to explain the relationship between the extent and severity of hyperglycemia and the development of diabetic neuropathy. One mechanism, activation of the polyol pathway by glucose via AR, is a prominent metabolic feature of diabetic rat peripheral nerve, where it promotes sorbitol and fructose accumulation, myo-inositol depletion, and slowing of nerve conduction by alteration of neural Na+-K+-ATPase activity or perturbation of normal physiological osmoregulatory mechanisms. ARIs, which normalize nerve myo-inositol and nerve conduction slowing, are currently the focus of clinical trials. Other specific metabolic abnormalities that may play a role in the pathogenesis of diabetic neuropathy include abnormal lipid or amino acid metabolism, superoxide radical formation, protein glycation, or potential blunting of normal neurotrophic responses. Metabolic dysfunction in diabetic nerve is accompanied by vascular insufficiency and nerve hypoxia that may contribute to nerve fiber loss and damage. Although major questions about the pathogenesis of diabetic neuropathy remain unanswered and require further intense investigation, significant recent progress is pushing us into the future and likely constitutes only the first of many therapies directed against one or more elements of the complex pathogenetic process responsible for diabetic neuropathy.
Metabolic Effects of New Oral Hypoglycemic Agent CS-045 in NIDDM Subjects
Authors: Suter Stephan L , Nolan John J , Wallace Penny , Gumbiner Barry , Olefsky Jerrold M
Published: March 2007

Objective

— To study the metabolic effects of a new oral antidiabetic agent, CS-045, in subjects with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design And Methods

— Eleven NIDDM subjects (mean age 59 yr and body mass index 32.3) were treated with 400 mg/day CS-045 for 6-12 wk. Patients were hospitalized before and at the end of the drug-treatment period for metabolic studies, including oral glucose tolerance test (OGTT), meal tolerance test (MTT), euglycemic glucose-clamp studies, and lipid analyses.

Results

— Eight subjects showed a marked clinical response to the drug, whereas 3 were nonresponders. The data were analyzed both for the total group and for the responders. Fasting plasma glucose (FPG) fell from 12.5 ± 0.7 to 10.7 ± 1.0 mM in the total group but fell more dramatically from 12.7 ± 0.5 to 8.3 ± 0.6 mM in the responder group. The area under the OGTT glucose curve improved by 17% in the total group and by 29% in the responders. The area under the MTT glucose curve improved by 38 and 52%, respectively. MTT levels of insulin, free fatty acids, and glucagon were significantly lower after treatment. Glucose disposal rates during glucose-clamp studies were increased in all subjects after CS-045 treatment. Mean increases were 63% at 120 mU · m−2 · min−1 and 41% at 300 mU · m−2 · min−1. Basal hepatic glucose production fell by 17% in the total group and by 28% in the responders.

Conclusions

— CS-045 improves insulin resistance, reduces insulinemia, lowers hepatic glucose production, and improves both fasting and postprandial glycemia in NIDDM subjects. CS-045 may represent a new therapeutic option for NIDDM.
Alterations in Glucose Metabolism During Menstrual Cycle in Women With IDDM
Authors: Widom Barbara , Diamond Michael P , Simonson Donald C
Published: March 2007

Objective

— To examine the hormonal mechanisms underlying the variability in glycemic control during the different phases of the menstrual cycle in women with insulin-dependent diabetes mellitus (IDDM).

Research Design And Methods

— Hyperglycemic (11.7 ± 0.1 mM), hyperinsulinemic (24 ± 3 mU/L) clamp studies were performed in 16 women with IDDM during the follicular (day 8 ± 1) and luteal (day 23 ± 1) phases of the menstrual cycle. Seven of the patients (group 1) experienced worsening glucose control during the luteal phase, whereas nine patients (group 2) did not.

Results

— In group 1, glucose metabolism fell from 30.2 ± 3.8 μmol·kg−1·min−1 during the follicular phase to 24.5 ± 2.0 μmol·kg−1·min−1 during the luteal phase (P = 0.09), whereas in group 2 it increased from 18.5 ± 1.2 to 23.2 ± 2.3 μmol·kg−1·min−1 (P = 0.03). The decrease in glucose metabolism during the luteal phase in patients in group 1 was associated with a significant rise in the serum estradiol levels from the follicular to luteal phase (164 ± 39 vs. 352 ± 59 pM, P = 0.006), whereas this rise was not observed in group 2 (334 ± 156 vs. 423 ± 74 pM, NS). Changes in other reproductive hormones (progesterone, testosterone, dihydrotestosterone, androstenedione, luteinizing hormone, follicular-stimulating hormone, or prolactin) were not related to the differences in glucose uptake in the two groups.

Conclusions

— 1) Marked heterogeneity in glucose metabolism is seen throughout the menstrual cycle in women with IDDM, 2) a subgroup of patients exhibits worsening premenstrual hyperglycemia and a decline in insulin sensitivity during the luteal phase, and 3) the deterioration in glucose uptake in this subgroup was associated with a greater increment in estradiol levels from the follicular to the luteal phase.
Combination Therapy for NIDDM With Biosynthetic Human Insulin and Glyburide
Authors: Mezitis Nicholas H E , Heshka Stanley , Saitas Valerie , Bailey Timothy S , Costa Rafaella , Pi-Sunyer F Xavier
Published: March 2007

Objective

To investigate the effects of the addition of glyburide to the regimen of insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients with regard to their overall insulin requirement and dosage schedule and to assess persistence of these effects.

Research Design and Methods

A double-blind randomized parallel-group, placebo-controlled, 20-wk outpatient trial at the Clinical Research Unit (CRU) at St. Luke's/Roosevelt Hospital (New York). Subjects were 20 insulindependent NIDDM patients previously managed on insulin alone. After a baseline period of satisfactory diabetes control on biosynthetic human insulin alone, insulin dosage was halved, and patients were placed on a combination with either glyburide or placebo. Diabetes control equivalent to baseline was reestablished by adjusting insulin as required on subsequent visits to the CRU.

Results

Insulin requirements in the glyburide group decreased by 29 U at 14 wk compared with 9 U in the placebo group (P < 0.05). At 20 wk, the decreases remained significant (25 vs. 11 U, respectively; P < 0.05). The mean ± SD reduction in insulin requirement in the glyburide group was relatively constant (25 ± 10 U) and was not related to premedication insulin requirement. Successful response to glyburide was inversely correlated with initial serum alkaline phosphatase level.

Conclusions

Glyburide reduces insulin requirements for 20 wk of combination therapy in NIDDM patients. Patients whose initial insulin requirement is ≤25 U have a 50% chance of achieving equivalent glycemic control on glyburide alone.
Prevalence and Health-Care Features of Hyperglycemia in Semiurban-Rural Communities in Southern Saudi Arabia
Authors: Abu-Zeid Hassan A H , Al-Kassab Abdul Salam K
Published: March 2007

Objective

To determine the prevalence of hyperglycemia in semiurban-rural Saudi Arabian communities and to assess some of its important health-care related aspects.

Research Design and Methods

A cluster of 12 villages near the city of Abha, the capital of the southern region in Saudi Arabia, with a total population of 2150 (290 families) has been included in this study. The family head was interviewed about diagnosed diabetes among family members. Also, the capillary blood glucose level was measured in subjects ≥ 10 yr (the target population, n = 1419) with a reflectance meter after 2-h fasting after the main midday meal.

Results

The 87% of the target population who responded for screening showed a prevalence of 4.6% of diabetes, which was higher among men (5.5%, age adjusted, P <0.05) than among women (3.6%). Estimates were based on 57 cases ascertained by positive history of the disease (n = 49) or blood glucose level ≥ 11.1 mM (200 mg/dl) without previous diagnosis of diabetes (n = 8). The prevalence of impaired glucose tolerance (blood glucose between 7.8 (140 mg/dl) and 11.0 mM (199 mg/dl) with no history of diabetes) was 3.7%, being higher among women than among men (P <0.01). Eighty-eight percent of the previously diagnosed cases were receiving treatment at the time of screening. However, in only 12.2% of those receiving treatment was glucose found to be controlled (level <7.8 mM [140 mg/dl]).

Conclusions

Diabetes frequency in this Saudi community is relatively high. There is a pressing need to promote public awareness about the disease and to improve the competency of the health-care team for achieving better control and early detection of the disease.
Urinary Excretion of IGF-I and Growth Hormone in Children With IDDM
Authors: Quattrin Teresa , Albini Christine H , Reiter Edward O , Mills Barbara J , MacGillivray Margaret H
Published: March 2007

Objective

To compare the urinary output of insulinlike growth factor I (IGF-I) and growth hormone (GH) in prepubertal and pubertal children with insulin-dependent diabetes mellitus (IDDM) versus nondiabetic subjects and to analyze the relationship between the urinary excretion of these peptides and degree of metabolic control.

Research Design and Methods

Group 1 included 30 IDDM patients who had had diabetes for 4.9 ± 0.7 yr and had normal renal function (mean age 11.6 ± 0.9 yr); group 2 consisted of 31 control subjects (mean age 9.2 ± 0.6 yr). Sensitive radioimmunoassays were used to measure IGF-I and GH in urine aliquots from 12-h timed overnight collections that had been dialyzed, concentrated 50-fold, and lyophilized.

Results

Significantly lower IGF-I and GH outputs per kilogram body weight per 12 h were observed in IDDM subjects compared with control subjects. When data were expressed per kilogram of body weight, no difference was observed between the urinary output of IGF-I and GH between prepubertal and pubertal subjects within group 1 or group 2. The prepubertal children had significantly lower HbA1 than the pubertal population; however, no correlation was found between urinary output of IGF-I or GH and HbA1. A positive correlation was observed between urinary IGF-I and GH (r = 0.85, P < .001).

Conclusions

Patients with long-standing IDDM excrete significantly lower urinary levels of IGF-I and GH compared with normal subjects. Serial measurements of these peptides from onset of IDDM are needed to define whether the changes observed are present at diagnosis or are secondary to duration of disease.
Day-to-Day Variation of Blood Glucose and Insulin Responses in NIDDM Subjects After Starch-Rich Meal
Authors: Rasmussen Ole W , Gregersen Søren , Dørup Jens , Hermansen Kjeld
Published: March 2007

Objective

To study day-to-day variation of postprandial blood glucose and insulin increments in non-insulin-dependent diabetes mellitus (NIDDM) subjects and to analyze intra- and interperson variance of response.

Research Design and Methods

Ten NIDDM subjects attending the outpatient clinic at Aarhus Kommunehospital were studied. The subjects ate three meals of 90 g of white bread, with 7 days between tests.

Results

Mean ± SD areas under the blood glucose response curve (above basal) over a 3-h period were 557 ± 60, 569 ± 74, and 565 ± 67 mM × 180 min (NS), and areas under the insulin-response curve were 3350 ± 448, 2815 ± 359 and 3551 ± 679 mU/L × 180 min (NS) on each of the three occasions. The 95% confidence intervals of blood glucose and insulin areas for the test meal repeated three times were 564 ± 120 mM × 180 min and 3240 ± 1645 mU/L } 180 min, respectively. Intra- and interperson components of variance were 25 vs. 75% (glucose) and 78 vs. 22% (insulin) of the total variance. The intraperson components of variance included all sources of variation other than between-person variation. There was no significant correlation between blood glucose and insulin response areas.

Conclusions

A valid estimate of the glycemic response in a single patient is obtained after a single meal. Because of the large between-person variation, paired data should preferably be used when comparing glycemic responses to different foods.
Erythrocyte Spermidine Levels in IDDM Patients
Authors: Seghieri Giuseppe , Gironi Alfredo , Mammini Piero , Alviggi Lorenzo , De Giorgio Lamberto A , Bartolomei Giancarlo , Ignesti Giovanni , Franconi Flavia
Published: March 2007

Objectives

To evaluate whether erythrocyte levels of polyamines spermidine and spermine (expressed in nmol/ml packed erythrocytes [PRBCs]) are modified in insulin-dependent diabetes mellitus (IDDM) and are associated with the presence of retinopathy or nephropathy.

Research Design and Methods

We studied erythrocyte spermidine and spermine levels in 38 IDDM patients with or without persistent microalbuminuria (urinary albumin excretion rate [AER] between 20 and 200 μg/min), macroalbuminuria (AER >200 μg/min), or retinopathy compared with 60 sex- and age-matched control subjects.

Results

Mean ± SD erythrocyte spermine content was similar in both diabetic (9.7 ± 5.5 nmol/ml PRBCs) and control (8.8 ± 3.5 nmol/ml PRBCs) subjects, whereas spermidine was higher in diabetic (19.1 ± 7.2 nmol/ml PRBCs) than in control (14.5 ± 4 nmol/ml PRBCs, P = 0.0007) subjects. Moreover, spermidine was significantly higher in the groups with microalbuminuria (n = 11, 22.5 ± 9.2 nmol/ml PRBCs) and macroalbuminuria (n = 4, 22.2 ± 5.7 nmol/ml PRBCs) than in both normoalbuminuric (n = 23, 16.9 ± 5.6 nmol/ml PRBCs) and control (F = 9.78, P = 0.0001) subjects, and correlated with log AER (r = 0.41, P = 0.009). Similarly, proliferative retinopathy was associated with a significant increase in spermidine (n = 5, 20 ± 7 nmol/ml PRBCs compared with control subjects [P = 0.0009]).

Conclusions

Our data suggest that erythrocyte spermidine content is increased in IDDM patients associated with both diabetic nephropathy and advanced retinopathy.
Vascular Endothelial Cell Antibodies in Diabetic Patients: Association With Diabetic Retinopathy
Authors: Jones David B , Wallace Robert , Frier Brian M
Published: March 2007

Objectives

To determine the incidence of antiendothelial cell antibodies in diabetic patients with and without retinopathy.

Research Design and Methods

The study consisted of 70 insulin-dependent diabetic (IDDM) subjects, 36 non-insulin-dependent diabetic (NIDDM) subjects, and 40 nondiabetic control subjects. Blood samples were obtained from diabetic patients and control subjects and patients with background and proliferative retinopathy were identified.

Results

Vascular endothelial cell (VEC) antibodies were examined in the sera of 36 NIDDM subjects, 70 IDDM subjects, and 40 nondiabetic control subjects by indirect immunofluorescence. VEC antibodies were present in 5 of 40 (12%) control subjects, 7 of 23 (30%) newly diagnosed IDDM patients, 6 of 17 (35%) IDDM patients without retinopathy, 12 of 18 (67%) IDDM patients with background retinopathy (P <0.05), and 9 of 12 (75%) IDDM patients with proliferative retinopathy (P <0.01). Three of 13 (23%) NIDDM patients with retinopathy and 6 of 23 (26%) without retinopathy were VEC antibody positive. No associations were observed between the presence of VEC antibodies and either the quality of glycemic control or the duration of diabetes. A significant association between VEC antibodies and large-vessel disease was found in IDDM patients with retinopathy (P <0.05).

Conclusions

Antibodies directed against vascular endothelial cells may play a role in the development of microvascular, and possibly macrovascular, disease in diabetes.