bluuebunny/crossref_metadata_2025 huggingface dataset:
Susceptibility of low‐ and high‐density lipoproteins from diabetic subjects to in vitro oxidative modification
Authors: Julier K. , Mackness M. I. , Dean J. D. , Durrington P. N.
Published: March 2003

Aims To investigate the hypothesis that lipid peroxidation of both low‐density lipoproteins (LDL) and high‐density lipoproteins (HDL) is important in the development of atherosclerosis.

Methods We have investigated whether LDL and HDL from patients with Type 1 diabetes mellitus (DM, n = 16) and Type 2 DM (n = 15) is more susceptible to Cu2+‐induced lipid peroxidation than LDL and HDL from a similar number of nondiabetic controls matched for age, gender and serum cholesterol.

Results The vitamin E content of LDL and HDL from both groups of diabetic patients was not significantly different from controls. The LDL from Type 2 diabetic patients and HDL from both diabetic groups were significantly richer in triglyceride than controls. Phospholipid was decreased in LDL from Type 2 diabetic patients and protein was decreased in HDL in Type 1 DM, but otherwise the composition of LDL and HDL in diabetic subjects was similar to controls. No significant differences were observed in the generation of conjugated dienes or lipid peroxides in either LDL or HDL when the two groups were compared with each other or with their respective controls.

Conclusions Increased lipid peroxidation occurring in vivo in diabetes is unlikely to be the result of increased susceptibility of lipoproteins to lipid peroxidation, but rather to increased generation of free radicals, to oxidation of lipids other than those present in serum lipoproteins or to decreases in antioxidant systems other than the fat‐soluble antioxidants present in lipoproteins.

Diabet. Med. 16, 415–423 (1999)
Laboratory‐based calculation of coronary heart disease risk in a hospital diabetic clinic
Authors: Bayly G. R. , Bartlett W. A. , Davies P. H. , Husband D. , Haddon A. , Game F. L. , Jones A. F.
Published: March 2003

Aims To develop an estimation of risk of coronary heart disease (CHD) based on the Framingham equation for use in a diabetes clinic, given concerns about the accuracy of the Sheffield risk tables in this setting.

Methods A computer program using the Framingham equation based on patients’ age, sex, systolic blood pressure, smoking history, presence of diabetes and left ventricular hypertrophy was applied to requests for lipid screening of patients attending the diabetes clinics of Birmingham Heartlands Hospital. The calculated risks for the population were compared with those estimated from the Sheffield tables.

Results Of 1060 patients with diabetes mellitus, 215 (20%) had an annual CHD risk ≥ 3%, which is considered to be the threshold at which lipid‐lowering drugs are cost‐effective. Only 24 of these 215 patients (11%) were correctly identified by the Sheffield tables, which we conclude have an unacceptably low sensitivity in diabetes mellitus.

Conclusions A laboratory‐based CHD risk calculation system is a practical alternative to the Sheffield system and may have a greater sensitivity in the diabetic clinic.
Enterovirus variants in the serum of children at the onset of Type 1 diabetes mellitus
Authors: Nairn C. , Galbraith D. N. , Taylor K. W. , Clements G. B.
Published: March 2003

Aims This study was designed to assess further the possible links between enterovirus infection and Type 1 diabetes mellitus (DM).

Methods Sera from 110 children in the age range 0–15 years was obtained shortly after the diagnosis of Type 1 DM, in paediatric centres throughout the UK. They were tested for the presence of enteroviral sequences by the polymerase chain reaction (PCR) of the 5′ nontranslated region (5′ NTR). One hundred and eighty‐two controls tested were matched for age, geographical location and time of year.

Results A significantly greater number of diabetic children (27% vs. 4.9%, P <0.005) had evidence of enteroviral RNA sequences. Proportionally, more younger children were enterovirus PCR positive, thus eight out of 20 children aged ≤2 years were enterovirus PCR positive. Sequence analysis showed that there was considerable variation in the sequences detected, although all appeared to be of the coxsackie/echovirus type.

Conclusion This study re‐emphasizes that a link exists between enteroviral infection and the onset of Type 1 DM, particularly at a very early age, and suggests that these viruses are aetiologically important in diabetes in a significant proportion of children.
Analysis of a polycytosine tract and heteroplasmic length variation in the mitochondrial DNA D‐loop of patients with diabetes, MELAS syndrome and race‐matched controls
Authors: Gill‐Randall R. , Sherratt E. J. , Thomas A. W. , Gagg J. W. , Lee A. , Alcolado J. C.
Published: March 2003

Aim The T to C substitution at position 16189 nt of the human mitochondrial genome has been associated with the development of heteroplasmic length variation in the control region of mtDNA. Previous reports have suggested that this defect may be associated with the development of other pathogenic mtDNA mutations, including the diabetogenic A to G mutation in the tRNALEU(UUR). Recently the 16189 nt variant has also been associated with insulin resistance in British adult men. In order to investigate these associations further we studied 23 patients with the 3243 nt mutation, 150 patients with Type 2 diabetes and 149 non‐diabetic controls.

Methods The region around 16189 nt was investigated by polymerase chain reaction‐restriction fragment length polymorphism analysis and automated sequencing.

Results We find that the T to C substitution at 16189 nt is associated with heteroplasmic length variation only when the resultant polycytosine tract is not interrupted by a second mutation. There are no significant differences in the prevalence of the 16189 nt variant or heteroplasmic length variation between patients with the 3243 nt mutation, patients with Type 2 diabetes or race‐matched normal controls.

Conclusions We conclude that these variants are likely to represent normal polymorphisms and that previously reported associations should be treated with caution unless they can be replicated in other populations.

Diabet. Med. 18, 413–416 (2001)
Metabolic impact of a family history of Type 2 diabetes. Results from a European multicentre study (EGIR)
Authors: Vaag A. , Lehtovirta M. , Thye‐Rönn P. , Groop L.
Published: March 2003

Background Insulin resistance was found in some but not in all previous studies of non‐diabetic first degree relatives of Type 2 diabetic patients. Small study groups, ethnic differences and/or non‐optimal techniques may explain the conflicting results.

Aim To study the impact of a family history of Type 2 diabetes on insulin action in a large group of non‐diabetic Europeans using the ‘gold standard’ euglycaemic hyperinsulinaemic clamp technique.

Methods Non‐diabetic subjects (n = 235) with a positive family history of Type 2 diabetes (FH+) and 564 subjects with no family history of diabetes (FH−) were recruited from The European Group of Insulin Resistance (EGIR) database. This database includes measurements of insulin action using the insulin clamp technique (1 mU/kg per min) in normal glucose‐tolerant individuals from 20 different European centres. In a subset of subjects the measurements were performed in combination with indirect calorimetry (n = 80 vs. 213 with and without family history of Type 2 diabetes).

Results The body mass index (BMI) was slightly higher in FH+ compared with FH− (26.7 ± 4.6 vs. 25.1 ± 4.7 kg/m2; P < 0.02). After correction for covariates according to differences between investigators and subject characteristics including BMI (multiple regression analysis), insulin‐stimulated glucose disposal was lower in FH+ compared with FH− (P < 0.00001). Insulin‐stimulated glucose oxidation was slightly increased in FH+ compared with FH−, and insulin‐stimulated non‐oxidative glucose metabolism was consequently markedly reduced in FH+ compared with FH− (P < 0.0005).

Conclusion Insulin resistance is present in European non‐diabetic relatives of Type 2 diabetic patients. The insulin resistance is independent of degree of obesity and is restricted solely to the pathway of non‐oxidative glucose metabolism.

Diabet. Med. 18, 533–540 (2001)
Insulin resistance as a major determinant of increased coronary heart disease risk in postmenopausal women with Type 2 diabetes mellitus
Authors: Stoney R. M. , O'Dea K. , Herbert K. E. , Dragicevic G. , Giles G. G. , Cumpston G. N. , Best J. D.
Published: March 2003

Aim  To investigate the risk factors associated with clinically defined coronary heart disease (CHD) in women with Type 2 diabetes mellitus (DM).

Methods  CHD status was assessed via standard history and resting electrocardiogram in 41 postmenopausal diabetic and 41 age‐ and body mass index‐matched normoglycaemic women recruited from a community‐based cohort. The following parameters were assessed: body composition by dual energy X‐ray absorptiometry, blood pressure, metabolic and lipoprotein profile and haemostatic factors.

Results  Diabetic women with CHD (n = 14) had greater insulin resistance, calculated by homeostasis model assessment (10.2 (7.0–14.8) vs. 6.5 (5.5–7.7), P = 0.010), and higher plasminogen activator inhibitor‐1 (PAI‐1) levels (45 (29–69) vs. 24 (19–32) ng/ml, P = 0.013), than those without CHD. They also had higher triglycerides (2.9 (2.2–3.8) vs. 2.1 (1.8–2.4) mmol/l, P = 0.016) and a trend towards reduced low‐density lipoprotein particle size (25.5 ± 0.6 vs. 25.8 ± 0.5 nm, P = 0.097). In a logistic regression model, insulin resistance was a significant independent predictor of CHD status (odds ratio = 1.33, 95% confidence interval = 1.06–1.68, P = 0.015). In contrast, in normoglycaemic women the major risk factors for CHD were elevated cholesterol, apolipoprotein(a), apolipoprotein B and systolic blood pressure (P = 0.018, P = 0.016, P = 0.006 and P = 0.049, respectively).

Conclusions  Increased insulin resistance in association with elevated PAI‐1 and dyslipidaemia appears to underpin the increased risk of CHD in women with Type 2 DM. Therapeutic approaches that increase insulin sensitivity may serve to reduce CHD risk in this vulnerable group.

Diabet. Med. 18, 476–482 (2001)
Fungal infection of the diabetic foot: two distinct syndromes
Authors: Heald A. H. , O'Halloran D. J. , Richards K. , Webb F. , Jenkins S. , Hollis S. , Denning D. W. , Young R. J.
Published: March 2003

Aims  Fungal infection of diabetic foot ulcers has not been described. We analysed the features of 17 patients with diabetic foot ulcers probably infected with fungi.

Methods  Seventeen patients were identified with clinically infected foot ulcers, (i) which had failed to heal despite prolonged antibiotic therapy and intensive podiatric care, (ii) from which Candida spp. was isolated or hyphae ± yeasts were visualized in material from ulcers or surrounding skin.

Results  Multiple ulcers arising simultaneously were present in 10 patients (59%), preceded by blistering in seven cases. Single ulcers with markedly ulcerated margins were present in seven (41%) patients and were preceded by blisters in two. All 17 cases had neuropathy and 15 (88%) had severe peripheral vascular disease. All ulcers responded to antifungal therapy.

Conclusions  Candida spp. is associated with two distinctive patterns of protracted ulceration in diabetic feet which improve following systemic antifungal therapy.

Diabet. Med. 18, 567–572 (2001)
Glibenclamide improves postprandial hypertriglyceridaemia in Type 2 diabetic patients by reducing chylomicrons but not the very low‐density lipoprotein subfraction levels
Authors: Skrapari I. , Perrea D. , Ioannidis I. , Karabina S.‐A. P. , Elisaf M. , Tselepis A. D. , Karagiannacos P. , Katsilambros N.
Published: March 2003

Aim  There are scarce data dealing with the degree of postprandial lipaemia after sulphonylurea administration. The aim of this study was to examine the effect of acute glibenclamide administration on postprandial lipaemia in Type 2 diabetic patients.

Methods  Eight randomly selected Type 2 diabetic individuals, aged 43–65 years (mean, 54 years), who had never received any anti‐diabetic drug, were included in the study. Each patient was given a 485 kcal mixed meal (45% fat, 40% carbohydrate and 15% protein) twice on separate days after an overnight fast: once with placebo and once with 5 mg glibenclamide, per os, in a random order. The two tests were performed with an interval of 7 days. Venous blood samples were drawn just before and 2 h, 4 h and 6 h after meal consumption. Total triglyceride levels in plasma, in chylomicrons (CM), in CM‐deficient plasma, in very low‐density lipoprotein (VLDL) subfractions (VLDL‐1, VLDL‐2) and in intermediate‐density lipoprotein (IDL) were determined. Free fatty acid (FFA) and total cholesterol levels in plasma, as well as high‐density lipoprotein (HDL) cholesterol and low‐density lipoprotein (LDL) cholesterol levels in CM‐deficient plasma, were also measured. Finally, serum glucose, insulin and C‐peptide concentrations were measured in each sample.

Results  As expected there was a significant decrease in postprandial glycaemia after glibenclamide administration compared to placebo (mean area under the curve values: AUC = 53.3 ± 18.2 and 69.1 ± 21.6 mm/h, P = 0.00009). In addition, the mean AUC values of insulin and C‐peptide were significantly greater after drug administration. The AUC values of total plasma triglyceride and of CM triglyceride following glibenclamide administration were significantly lower compared to placebo, while the AUC values of postprandial triglyceride in CM‐deficient plasma and of postprandial triglyceride in VLDL‐1, VLDL‐2 and IDL were not different after drug administration compared to placebo. Finally, no significant differences were noted in the AUC values of total cholesterol, LDL cholesterol, HDL cholesterol and plasma FFA levels after glibenclamide administration.

Conclusions  These results demonstrate that glibenclamide administration improves postprandial hypertriglyceridaemia acutely by reducing postprandial triglycerides of intestinal origin.

Diabet. Med. 18, 781–785 (2001)
The vitamin D receptor gene variant is associated with the prevalence of Type 2 diabetes mellitus and coronary artery disease
Authors: Ortlepp J. R. , Lauscher J. , Hoffmann R. , Hanrath P. , Joost H. G.
Published: March 2003

Aims  Vitamin D can influence lipolysis and insulin secretion. A common genetic polymorphism of the vitamin D receptor, which has been found to be associated with bone mineral density, has also been reported to be associated with insulin‐dependent diabetes mellitus. To test the influence of the vitamin D receptor polymorphism on the prevalence of Type 2 diabetes mellitus and coronary artery disease we studied a population of high‐risk patients, who were referred to our clinic for diagnostic coronary angiography.

Methods  A total of 293 patients considered at high risk for coronary artery disease because of angina pectoris and known hypercholesterolaemia underwent diagnostic coronary angiography. The BsmI vitamin D receptor polymorphism was analysed by polymerase chain reaction.

Results  Prevalence of Type 2 diabetes mellitus and coronary artery disease was gradually dependent on the number of B alleles (BB 28%, Bb 13%, bb 8% for Type 2 diabetes mellitus, P = 0.002; BB 88% Bb 72%, bb 66% coronary artery disease, P = 0.01). Patients with the BB genotype had an odds ratio of 3.64 (95% confidence interval 1.53–8.55, P = 0.002) to have Type 2 diabetes mellitus compared with patients with the bb genotype.

Conclusions  The genotype of the vitamin D receptor polymorphism determines the prevalence of Type 2 diabetes mellitus and coronary artery disease in a high‐risk cohort population.

Diabet. Med. 18, 842–845 (2001)
Visual symptomatology in patients with sight‐threatening diabetic retinopathy
Authors: Bailey C. C. , Sparrow J. M.
Published: March 2003

Aims  To assess the level of visual symptomatology in patients with sight‐threatening diabetic retinopathy.

Methods  Questionnaires were completed by patients undergoing first photocoagulation treatment for diabetic maculopathy or proliferative retinopathy during a 2‐month period throughout the UK, and at 9 months' follow‐up.

Results  There were high levels of visual symptomatology prior to the first laser treatment and at follow‐up for both patients with maculopathy or with proliferative retinopathy. Only 25.1% of patients with maculopathy and 17.2% of patients with proliferative retinopathy were asymptomatic in terms of reading, seeing the television screen, recognizing faces or with their night vision at baseline. For those with maculopathy 20.1% were aware of colour vision abnormality in the eye to be treated at baseline and 9.5% were aware of new central scotomata since the treatment. Of those with proliferative retinopathy, 13% said that they had given up driving due to poor eyesight and 19% were aware of new peripheral field defects since the treatment.

Conclusions  There are high levels of visual symptomatology for patients with sight‐threatening diabetic retinopathy in the UK despite that fact that screening should aim to detect retinopathy prior to visual loss occurring. Patients should be aware that there may not be any significant improvement in their vision with laser treatment, and that the main aim of treatment is to reduce the likelihood of further visual deterioration.

Diabet. Med. 18, 883–888 (2001)
Diabetic nephropathy is associated with the 5¢‐end dinucleotide repeat polymorphism of the aldose reductase gene in Chinese subjects with Type 2 diabetes
Authors: Liu Y. F. , Wat N. M. S. , Chung S. S. M. , Ko B. C. B. , Lam K. S. L.
Published: March 2003

Aims We investigated whether the promoter dinucleotide repeat polymorphism of the aldose reductase gene (5′‐ALR2), implicated in the development of nephropathy in Type 1 diabetes, was associated with diabetic nephropathy in Type 2 diabetes.

Methods In 265 Southern Chinese with Type 2 diabetes the 5′‐ALR2 polymorphism was identified in genomic DNA using polymerase chain reaction and automated fluorescent scanning. They were classified as normoalbuminuric (n = 128), microalbuminuric (n = 85) or albuminuric (n = 52) according to the mean albumin excretion rate of two 12‐h overnight collections.

Results The 5′‐ALR2 allele and genotype distributions differed significantly among the three groups of patients (P < 0.003 and P < 0.01, respectively). Normoalbuminuric patients had the lowest Z − 2 allele frequency: 17.6% vs. 28.2% and 23.1% for microalbuminuric and albuminuric patients, respectively, and the highest Z + 2 allele frequency: 36.7% vs. 21.2% and 23.1% in microalbuminuric and albuminuric patients, respectively. They also had the lowest Z − 2/X genotype frequency (X = any allele other than Z + 2): 18.8% vs. 36.5% in microalbuminuric (P < 0.01) and 38.5% in albuminuric patients (P < 0.02), respectively, but the highest Z + 2/Y genotype frequency (Y = any allele other than Z − 2): 50.7% vs. 27.0% and 34.6% in microalbuminuric (P < 0.001) and albuminuric patients, respectively. In a multiple logistic regression model, the Z − 2/X genotype (odds ratio 3.10; P < 0.025) was an independent risk factor of diabetic nephropathy, microalbuminuria or albuminuria, together with age, mean arterial pressure and body mass index.

Conclusions The 5′‐ALR2 dinucleotide repeat polymorphism is associated with the development of diabetic nephropathy in Southern Chinese with Type 2 diabetes.

Diabet. Med. 19, 113–118 (2002)
Quality assurance in screening for sight‐threatening diabetic retinopathy
Authors: Pandit R. J. , Taylor R.
Published: March 2003

Aims There is a need for continuous evaluation of screening services for diabetic retinopathy against agreed performance standards. We describe a quality assurance programme implemented in Newcastle in January 1999 and report on outcomes at 18 months.

Methods Annual retinal screening is performed using combined retinal photography and direct ophthalmoscopy in two streams. Diabetologists perform screening in the Hospital Screening Programme, which serves patients whose diabetes is managed in specialist clinics, and trained retinal screeners perform screening in the District Screening Programme, which serves patients whose diabetes is managed in the community. Reference standard examination of dilated fundoscopy with a slit‐lamp and condensing lens was performed by an ophthalmologist at periodic sessions on consecutive patients attending for screening.

Results Six hundred and nine (6.4%) of 9468 patients screened underwent reference standard examination. The sensitivity and specificity of detection of sight‐threatening diabetic retinopathy (STDR) was 82.5% and 98%, respectively, for the Hospital Screening Programme; 85.7% and 95.7%, respectively, for the District Screening Programme; and 83.3% and 96.8% for both services combined. One hundred and ten (18.1%) of 609 patients audited were referred to ophthalmology as a result of screening, and this led to 16 patients (2.6%) receiving laser photocoagulation for STDR. Reference standard examination identified a further four patients (0.7%) who required laser photocoagulation.

Conclusions Preliminary data indicate that satisfactory performance standards are being achieved. The National Service Framework for Diabetes requires that all units institute quality assurance for retinal screening, and we report the practical implementation of this in one district.

Diabet. Med. 19, 285–291 (2002)
Current methods of transfer of young people with Type 1 diabetes to adult services
Authors: Kipps S. , Bahu T. , Ong K. , Ackland F. M. , Brown R. S. , Fox C. T. , Griffin N. K. , Knight A. H. , Mann N. P. , Neil H. A. W. , Simpson H. , Edge J. A. , Dunger D. B.
Published: March 2003

Aims To determine the efficacy and patient perception of various transfer procedures from paediatric to adult diabetes services.

Methods Comparison between four districts in the Oxford Region employing different transfer methods, by retrospective study of case records and interviews of patients recently transferred from paediatric diabetes clinics. The main outcome measures were age at transfer, clinic attendance rates, HbA1c measurements and questionnaire responses.

Results Two hundred and twenty‐nine subjects (57% males) > 18 years old in 1998 and diagnosed with Type 1 diabetes < 16 years of age between 1985 and 1995, identified from the regional diabetes register. The notes audit was completed for 222 (97%) and 164 (72%) were interviewed by a single research nurse. Mean age at transfer was 17.9 years (range 13.3–22.4 years). Few young people were lost to follow‐up at the point of transfer. There was a high rate of clinic attendance (at least 6 monthly) 2 years pretransfer (94%), but this declined to 57% 2 years post‐transfer (P < 0.0005). There was large interdistrict variation in clinic attendance 2 years post‐transfer (29% to 71%); higher rates were seen in districts where young people had the opportunity to meet the adult diabetes consultant prior to transfer. The importance of this opportunity was confirmed by questionnaire responses on interview.

Conclusions Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.

Diabet. Med 19, 649–654 (2002)
Comparison of vibration perception thresholds obtained with the Neurothesiometer and the CASE IV and relationship to nerve conduction studies
Authors: Bril V. , Perkins B. A.
Published: March 2003

Aims Vibration perception thresholds (VPTs) are used frequently to assess somatosensory pathways in clinical trials. Different equipment, testing paradigms, and stimulation sites produce varying results which make comparisons between trials and patient populations challenging. Information comparing the VPT obtained with the Neurothesiometer with that with the Vibratron is available, but not for a similar comparison with the CASE IV (computer‐assisted sensory examination device).

Methods Subjects (n = 478) including reference, non‐neuropathic subjects with diabetes mellitus (DM), and diabetic patients with mild, moderate and severe diabetic sensorimotor polyneuropathy (DSP) had VPTs measured with the CASE IV and Neurothesiometer, as well as standard sural nerve conduction studies (NCS), all performed during the same half‐day. The dorsum of the foot was used as the site of stimulation for the CASE IV VPT determination and the distal phalanx of the first toe for the Neurothesiometer.

Results VPTs by the CASE IV and the Neurothesiometer compared moderately by linear regression analyses (R2 = 0.547, P < 0.0001), and by 95% confidence intervals. Sensitivity for the diagnosis of mild DSP was 70% with the Neurothesiometer and 49% with the CASE IV. VPTs determined by either the Neurothesiometer or the CASE IV correlated with similar agreement to the sural nerve action potential amplitude as determined by nerve conduction studies (NCS) (R2 = 0.456 and 0.461, respectively, P < 0.0001).

Conclusions The results demonstrated a significant correlation of VPT values in different stages of DSP obtained by the two methods. The Neurothesiometer was more sensitive for the diagnosis of DSP, particularly in those with mild neuropathy. Similar correlations between VPTs and electrophysiological parameters were observed, indicating that both methods are valid, and thus the Neurothesiometer may be preferable due to the ease and rapidity of testing by this method.

Diabet. Med. 19, 661–666 (2002)
Gliclazide improves anti‐oxidant status and nitric oxide‐mediated vasodilation in Type 2 diabetes
Authors: Fava D. , Cassone‐Faldetta M. , Laurenti O. , De Luca O. , Ghiselli A. , De Mattia G.
Published: March 2003

Aims To evaluate the effects of gliclazide on oxidative status and vascular response to systemic administration of L‐arginine, the natural precursor of nitric oxide (NO), in Type 2 diabetic patients.

Methods Thirty Type 2 diabetic patients received glibenclamide (n = 15) or gliclazide (n = 15) in a 12‐week, randomized, observer‐blinded, parallel study. Plasma lipid peroxides, total radical‐trapping anti‐oxidant parameter (TRAP), and blood pressure responses to an intravenous bolus of L‐arginine were measured pre‐ and post‐treatment.

Results At 12 weeks, gliclazide patients had lower plasma lipid peroxides (13.3 ± 3.8 µmol/l vs. 19.2 ± 4.3 µmol/l; P = 0.0001) and higher plasma TRAP (1155.6 ± 143.0 µmol/l vs. 957.7 ± 104.3 µmol/l; P = 0.0001) than the glibenclamide patients. Gliclazide but not glibenclamide significantly reduced systolic and diastolic blood pressure (P = 0.0199 and P = 0.00199, respectively, two‐way repeated measures analysis of variance) in response to intravenous L‐arginine.

Conclusions Gliclazide reduces oxidative stress in Type 2 diabetic patients by improving plasma anti‐oxidant status. This effect is associated with enhanced NO‐mediated vasodilation.
Comparison of serum concentrations of soluble adhesion molecules in diabetic microangiopathy and macroangiopathy
Authors: Matsumoto K. , Sera Y. , Ueki Y. , Inukai G. , Niiro E. , Miyake S.
Published: March 2003

Aims To clarify the correlation between serum concentrations of soluble adhesion molecules and diabetic microangiopathy or macroangiopathy in patients with Type 2 diabetes.

Methods Patients with diabetic retinopathy and intima‐media thickness of common carotid artery (CCA‐IMT) < 1.1 mm were classified as the microangiopathy group (n
 
=
 62). Patients with CCA‐IMT ≥
 1.1 mm and without retinopathy were classified as the macroangiopathy group (n
 
=
 95). Patients with CCA‐IMT < 0.9 mm and without retinopathy were assigned to the no complications group (n   =  139). Clinical characteristics and soluble intercellular adhesion molecule‐1 (ICAM‐1), vascular cell adhesion molecule‐1 (VCAM‐1), and E‐selectin levels were compared between the groups.

Results Patients with microangiopathy had a significantly longer duration of diabetes, were hypertensive and more likely to have a positive family history of diabetes than the control group. Patients with macroangiopathy were more likely to be smokers, hypertensive, and have a family history of hypertension. Soluble ICAM‐1, VCAM‐1, and E‐selectin levels were significantly higher in the microangiopathy group than in the control group. Soluble VCAM‐1 and E‐selectin levels, but not ICAM‐1 levels, were significantly elevated in the macroangiopathy group. These results were unchanged after adjustment for age, sex, duration of diabetes, blood pressure, HbA1c, HDL‐cholesterol, and smoking status.

Conclusions Our results suggest that soluble adhesion molecules are related to both diabetic micro‐ and macroangiopathy. The relative contributions of adhesion molecules may be greater in the former than latter patients with Type 2 diabetes.
Familial clustering of diabetic retinopathy in South Indian Type 2 diabetic patients
Authors: Rema M. , Saravanan G. , Deepa R. , Mohan V.
Published: March 2003

Aim The aim of the study was to determine whether there is familialclustering of diabetic retinopathy among South Indian Type 2 diabeticsubjects.

Methods During the period September 1991 to September 1997, 322 families withat least two diabetic siblings who were registered at our centreand had undergone a retinal examination were selected for the study.The sibling with the longest duration of diabetes was defined as theproband. The prevalence of retinopathy was compared between thesiblings of probands with and without retinopathy.

Results Diabetic retinopathy was diagnosed in 11.2% of the siblingsof the probands without diabetic retinopathy and in 35.3% ofthe siblings of the probands with diabetic retinopathy (P < 0.0001). Theincreased prevalence of retinopathy among siblings of probands withretinopathy represented all grades of retinopathy, namely non‐proliferativediabetic retinopathy with and without maculopathy and proliferative diabeticretinopathy, although the latter did not reach statistical significancedue to the small numbers. Hypertension, metabolic control and theduration of diabetes among the probands did not affect the clusteringof retinopathy. The odds ratio for retinopathy in the siblings of probandswith retinopathy after adjusting for age, glycosylated haemoglobin, durationof diabetes, proteinuria and other confounding variables was 3.37(95% confidence interval 1.56–7.29, P = 0.002).

Conclusions Familial clustering of diabetic retinopathy was three times higherin siblings of Type 2 diabetic subjects with diabetic retinopathy.

Diabet. Med. 19, 910–916 (2002)
Pertussis infection in childhood and subsequent Type 1 diabetes mellitus
Authors: Montgomery S. M. , Ehlin A. G. C. , Ekbom A. , Wakefield A. J.
Published: March 2003

Aims Pertussis has been implicated but not proven as a risk for Type 1 diabetes mellitus (DM). Previous studies have investigated paediatric, but not adult‐onset Type 1 DM. We investigated association of pertussis exposures and Type 1 DM with follow‐up into adulthood.

Methods Longitudinal analysis of 16 820 members (100 with Type 1 DM) of two nationally representative British birth cohorts (the 1970 British Cohort Study (BCS70) and the National Child Development Study (NCDS)) followed from birth to ages 30 years (BCS70) and 42 years (NCDS). Cox regression analysis with age of onset for Type 1 DM as the dependent variable investigated relationships with pertussis infection and immunization, modelled as time‐dependent co‐variates. Simultaneous adjustment was made for Wild measles, mumps and chickenpox infections; tetanus and smallpox immunizations; sex, parental social class and cohort. The potential confounding factors were modelled as fixed co‐variates.

Results Cox regression analysis produced adjusted odds ratios (ORs) (with 95% confidence intervals (CIs)) of 2.21 (1.35–3.59) and 0.73 (0.49–1.05) for Type 1 DM (with onset at any age) associated with pertussis infections and immunization (trend over number of vaccinations), respectively. Adjusted ORs from Cox regression for Type 1 DM with onset after age 10 years are 2.59 (1.56–4.30) for pertussis infection and 0.63 (0.42–0.94) for pertussis immunization. None of the other infections or immunizations are notably associated with Type 1 DM.

Conclusions Some pertussis infections may be a risk for Type 1 DM and immunization may confer protection. Further research should consider delayed Type 1 DM following pertussis exposures.

Diabet. Med. 19, 986–993 (2002)
Microalbuminuria is more frequent in South Asian than in European origin populations: a comparative study in Newcastle, UK
Authors: Fischbacher C. M. , Bhopal R. , Rutter M. K. , Unwin N. C. , Marshall S. M. , White M. , Alberti K. G. M. M.
Published: March 2003

Aims We aimed to compare levels of urinary albumin excretion and the prevalence of microalbuminuria in UK South Asians and Europeans. Microalbuminuria predicts cardiovascular disease in European origin populations, but evidence from the general population of South Asians is lacking. Coronary heart disease (CHD) mortality is 40–50% higher in UK South Asians compared with the whole population, for reasons that are incompletely understood.

Methods Microalbuminuria was measured using the albumin–creatinine ratio in an age‐ and sex‐stratified random sample of 1509 adults from European (n = 825), Indian (n = 259), Pakistani (n = 305) and Bangladeshi (n = 120) ethnic groups.

Results Levels of urinary albumin excretion were substantially higher in South Asians (geometric mean albumin creatinine ratio (95% confidence interval) 0.83 (0.75, 0.91)) than in Europeans (0.55 (0.51, 0.60)). Microalbuminuria was associated with older age, hypertension and diabetes, but independently of these risk factors urinary albumin excretion was higher in South Asians than Europeans.

Conclusions Urinary albumin excretion is higher and microalbuminuria more frequent in UK South Asians compared with the majority ethnic population. Microalbuminuria may be relevant to the causal pathways leading to the excess of cardiovascular mortality and possibly renal failure in UK South Asians.
Responsiveness of the Problem Areas In Diabetes (PAID) questionnaire
Authors: Welch G. , Weinger K. , Anderson B. , Polonsky W. H.
Published: March 2003

Aim Responsiveness (sensitivity to change over time) is a key psychometric quality for an outcome measure. We examined the responsiveness of the Problem Areas In Diabetes (PAID) questionnaire, a measure of diabetes‐specific emotional distress.

Methods PAID data were obtained from seven diabetes intervention studies following a literature search that included both published papers and conference abstracts. To estimate responsiveness we used two indices: (i) a statistical test (the dependent t‐test), and (ii) a commonly used effect size index (Cohen's d).

Results Mean patient PAID scores improved from baseline to follow‐up for all seven studies. Specifically, t‐statistics ranged from t= 8.5 (P < 0.001) to t= 2.1 (P < 0.06). Effect size results ranged from 0.32 (i.e. small) for a disease management intervention to 0.65 (i.e. moderate) for an intensive medical/educational intervention.

Conclusions Despite the pilot nature of the studies, the pattern of findings provided strong support for the responsiveness of the PAID. Information on responsiveness helps clinical researchers select measures, accurately estimate sample size to ensure adequate statistical power, and prioritize outcomes to be assessed.
Products of a managed landscape: non‐timber forest products in the parklands of the Bassila region, Benin
Authors: Schreckenberg Kathrin
Published: March 2003

The sustainable use of non‐timber forest products (NTFPs) is often put forward as a means for ensuring the conservation of forest vegetation types. This paper presents the results of research carried out in the savanna zone of Benin, which highlights the fact that the majority of species yielding important NTFPs are, in fact, located in the fields and fallows. The paper describes how the presence of villages affects the distribution of different vegetation types and how farmers selectively retain certain NTFP tree species, thereby creating a characteristic parkland landscape. It is suggested, however, that changes in the agricultural system and a gradual decline in the importance of NTFPs in people's lives will reduce the incentive for maintaining NTFP species and lead to the eventual loss of the parklands.
Evaluating interactions between soil drainage and seedling performance in a restoration of Pinus sylvestris woodland, Scotland
Authors: Crowell M. D. , Lane S. N.
Published: March 2003

This paper evaluates the role of soil drainage in tree seedling performance at a site being restored from Calluna vulgaris moorland to Pinus sylvestris woodland, in Glen Affric, Scotland. The investigation focuses on the relationships between height of planted seedlings, type of ground vegetation and drainage conditions.

 Slope, aspect, and soil depth were assessed as potential surrogates for direct measures of soil drainage, all of which were derived from digital terrain data.

 Six variables related to drainage were recorded at 58 seedling locations and used in a factor analysis to understand links between soil moisture conditions, topographic variables and soil depth characteristics.

 Factor analysis generated two factors that accounted for 70.5% of the variance in the correlation matrix of these variables: Factor 1 correlated strongly with variables that controlled peat accumulation and Factor 2 correlated strongly with topographic controls upon drainage patterns.

 These two factors explained a significant amount of the variance in height of the Pinus seedlings planted at these locations. Significant differences were found between the factor scores associated with different types of ground vegetation, as well as between the seedling heights observed at locations with different vegetation types.

 Multiple regressions were developed that indicated that slope, aspect, and soil depth were significant as independent variables in models where soil moisture content and aerobic soil depth were the dependent variables.
The effect of 50 years of landscape change on species richness and community composition
Authors: Parody Jennifer M. , Cuthbert Francesca J. , Decker Ethan H.
Published: March 2003

We analysed a 50‐year dataset of avian species observations to determine how richness and community composition varied over a period of landscape‐scale environmental change. Our study area, northern lower Michigan, has experienced substantial land‐use and land‐cover change over time. Like much of the northern Midwest, it has shifted from a largely unpopulated, post‐logging shrubland to a moderately populated closed‐canopy forest. Such changes are generally expected to influence overall richness and community composition. We found that regional richness per year remained virtually unchanged over the study period. Year‐to‐year variation in species number was surprisingly low. Richness totals included vastly different species groups as the composition of the regional bird community changed substantially over time. Changes in the types of species present appear to reflect deterministic changes in habitat. The number of grassland and open‐habitat species decreased, for example, while species associated with older forests and urban habitats increased. Our results suggest that habitat changes at the landscape scale do not necessarily lead to changes in the number of species a region can support. Such changes, however, do appear to influence the types of species that will occupy a region, and can lead to substantial changes in community composition.
Integrating fluxes from heterogeneous vegetation
Authors: Woodward F. Ian , Lomas Mark R.
Published: March 2003

The vegetated landscape of Europe has been strongly impacted by human management to produce a heterogeneous patchwork of semi‐natural and agricultural vegetation varying over a wide range of spatial scales. A model is described for averaging vegetation fluxes from a landscape of forest and grassland into the planetary boundary layer (PBL). At a scale of 1 km, model simulations indicate that vegetation heterogeneity exerts little effect on the PBL and regional fluxes will be simple areal averages of the different vegetation types. Above 5 km the model simulates significant effects of different vegetation types on the whole PBL. Averaging fluxes to the regional scale will therefore need to consider explicitly the nature, extent and behaviour of different vegetation types.
River corridor plants (Stromtalpflanzen) in Central European lowland: a review of a poorly understood plant distribution pattern
Authors: Burkart Michael
Published: March 2003

Aim and location

In Central European lowlands certain plant species grow mainly or exclusively in the corridors of large rivers. In German‐speaking plant geography, they are known as ‘Stromtalpflanzen’. The aim of this paper is to review the literature about definitions, explanations and species characteristics and to suggest future directions in research concerning this species group.

Results

A preliminary list contains 129 ecologically heterogeneous plant species. The mechanisms generating the peculiar distribution pattern may include hydrochory along river corridors, high levels of disturbance by water, variable water availability including inundation and summer drought, warm summers and high nutrient supply on alluvial soils. There is evidence from observational studies for all above mechanisms. However, none of them has been tested experimentally. Demographic data of river corridor plants are limited to very few species, including mainly invasive annuals (Artemisia annua,Bidens frondosa,Cuscuta campestris,Xanthium albinum) and annual (hemi)parasites (Cuscuta campestris,Melampyrum cristatum). Metapopulation studies do not exist to date for European species. Apart from their habitat requirements, river corridor plants were grouped according to their similarities in overall distribution pattern or their distribution within particular river corridors.

Main conclusions

River corridor plants include a high proportion of threatened plant species. In order to preserve them, and in order to understand the mechanisms generating the peculiar distribution pattern, much more has to be known about their population biology and metapopulation dynamics.
Influences of the El Niño/Southern Oscillation and the North Atlantic Oscillation on avian productivity in forests of the Pacific Northwest of North America
Authors: Nott M. Philip , Desante David F. , Siegel Rodney B. , Pyle Peter
Published: March 2003

To model the effects of global climate phenomena on avian population dynamics, we must identify and quantify the spatial and temporal relationships between climate, weather and bird populations. Previous studies show that in Europe, the North Atlantic Oscillation (NAO) influences winter and spring weather that in turn affects resident and migratory landbird species. Similarly, in North America, the El Niño/Southern Oscillation (ENSO) of the Pacific Ocean reportedly drives weather patterns that affect prey availability and population dynamics of landbird species which winter in the Caribbean. Here we show that ENSO‐ and NAO‐induced seasonal weather conditions differentially affect neotropical‐ and temperate‐wintering landbird species that breed in Pacific North‐west forests of North America. For neotropical species wintering in western Mexico, El Niño conditions correlate with cooler, wetter conditions prior to spring migration, and with high reproductive success the following summer. For temperate wintering species, springtime NAO indices correlate strongly with levels of forest defoliation by the larvae of two moth species and also with annual reproductive success, especially among species known to prey upon those larvae. Generalized linear models incorporating NAO indices and ENSO precipitation indices explain 50–90% of the annual variation in productivity reported for 10 landbird species. These results represent an important step towards spatially explicit modelling of avian population dynamics at regional scales.
Body size increase in insular rodent populations: a role for predators?
Authors: Michaux Johan R. , De Bellocq Joëlle Goüy , Sarà Maurizio , Morand Serge
Published: March 2003

Insular mammalian populations living in areas of small size are often characterized by a drastic change in body mass compared to related continental populations or species. Generally, small mammals (less than 100 g) evolve into giant forms while large mammals (up to 100 g) evolve into dwarf forms. These changes, coupled with changes in other life, behavioural, physiological or demographic traits are referred to generally as the insular syndrome. We tested in this study the relative contribution of three factors — area of island, numbers of competitor species and number of predator species — to changes in body size of the woodmouse (Apodemus sylvaticus) in the Western Mediterranean Sea. Our results, based on a comparative analysis using the phylogenetic independent contrasts method, indicate that the increase in body size is related both to the decrease of island size and to the lower number of predator species. A decrease of competitor species does not seem to have an important effect.
Climate change‐integrated conservation strategies
Authors: Hannah L. , Midgley G. F. , Millar D.
Published: March 2003

Aim  Conservation strategies currently include little consideration of climate change. Insights about the biotic impacts of climate change from biogeography and palaeoecology, therefore, have the potential to provide significant improvements in the effectiveness of conservation planning. We suggest a collaboration involving biogeography, ecology and applied conservation. The resulting Climate Change‐integrated Conservation Strategies (CCS) apply available tools to respond to the conservation challenges posed by climate change.

Location  The focus of this analysis is global, with special reference to high biodiversity areas vulnerable to climate change, particularly tropical montane settings.

Methods  Current tools from climatology, biogeography and ecology applicable to conservation planning in response to climate change are reviewed. Conservation challenges posed by climate change are summarized. CCS elements are elaborated that use available tools to respond to these challenges.

Results  Five elements of CCS are described: regional modelling; expanding protected areas; management of the matrix; regional coordination; and transfer of resources. Regional modelling uses regional climate models, biotic response models and sensitivity analysis to identify climate change impacts on biodiversity at a regional scale appropriate for conservation planning. Expansion of protected areas management and systems within the planning region are based on modelling results. Management of the matrix between protected areas provides continuity for processes and species range shifts outside of parks. Regional coordination of park and off‐park efforts allows harmonization of conservation goals across provincial and national boundaries. Finally, implementation of these CCS elements in the most biodiverse regions of the world will require technical and financial transfer of resources on a global scale.

Main conclusions  Collaboration across disciplines is necessary to plan conservation responses to climate change adequately. Biogeography and ecology provide insights into the effects of climate change on biodiversity that have not yet been fully integrated into conservation biology and applied conservation management. CCS provide a framework in which biogeographers, ecologists and conservation managers can collaborate to address this need. These planning exercises take place on a regional level, driven by regional climate models as well as general circulation models (GCMs), to ensure that regional climate drivers such as land use change and mesoscale topography are adequately represented. Sensitivity analysis can help address the substantial uncertainty inherent in projecting future climates and biodiversity response.