bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Procedures for Catheter Malfunction in Programmable Impiantante Intraperitoneal Insulin Infusion Devices
Authors: Olsen Craig L , Turner Dee S , Iravani Mohamad , Waxman Kenneth , Selam Jean-Louis , Charles M Arthur
Published: March 2007

OBJECTIVE

To evaluate the roles of 1) abdominal radiography, 2) a pressure diagnostic procedure (PDP) using a standardized diluent infusion into the catheter sideport, and 3) radiocontrast imaging of the catheter lumen as procedures for diagnosing catheter malfunction in diabetic patients implanted with a programmable intraperitoneal infusion device.

RESEARCH DESIGN AND METHODS

Sixteen type I diabetic patients implanted with Infusaid programmable intraperitoneal insulin pumps were studied. The ability of the above three procedures to assist diagnosis of catheter malfunction and distinguish between occlusion and catheter breakage was retrospectively analyzed. Glycated hemoglobin was measured to determine the clinical importance of catheter malfunctions and decreases in pump flow due to insulin aggregation in the pump chamber.

RESULTS

; Mean glycated hemoglobin levels increased significantly from 8.0 ± 0.3 to 9.0 ± 0.4% (P < 0.05) before and after catheter malfunction, but not during pump flow slowdowns. Mean peak pressure during PDP was 1.96 ± 0.14 psi (P < 0.01 vs. normal) in reversibly occluded catheters and 1.86 ± 0.35 psi (P < 0.05 vs. normal) in broken catheters, compared with 1.32 ± 0.23 psi in normal catheters. Decay times during PDP were >50 s for both reversibly occluded and broken catheters (P < 0.001 vs. normal of 3.6 ± 0.82 s). Abdominal radiographs and sideport injections of contrast material were used to distinguish the types of broken catheters.

CONCLUSIONS

Catheter breakage and occlusion are complications in im-plantable insulin infusion systems and result in metabolic deterioration. The presence of a sideport allows pressure data and radiographie procedures to assist in determining the cause of catheter malfunction. A diagnostic algorithm was generated to improve efficiency in investigating catheter problems.
Pancreatic Transplantation: Impact on the quality of life of diabetic renal transplant recipients
Authors: Milde Frances K , Hart Laura K , Zehr Pamela S
Published: March 2007

OBJECTIVE

To determine the impact of pancreas transplantation on the quality of life of renal transplant recipients with diabetes.

RESEARCH DESIGN AND METHODS

In this quasi-experimental comparative study of 41 successful pancreas transplant (SP) recipients, 13 failed pancreas transplant (FP) recipients, and 28 kidney alone (KA) transplant recipients, we collected data from individuals who had their pancreas/kidney or kidney alone transplants ≥6 months before at a university tertiary care center. This study was an extension of a 1992 study of SP and FP recipients. The subject group was enlarged with additional pancreas/kidney recipients and a control group of KA recipients. Five dimensions of life quality were measured.

RESULTS

Groups did not differ significantly regarding age, gender, marital status, comorbidity, type of prior dialysis, current kidney function, length of time since transplant, physical activity, symptom burden, emotional state, and feelings of well-being. A significant time by group interaction occurred for quality of life (P = 0.0023) and health (P = 0.0001). Patients in the SP and KA groups perceived their past life and health quality to be significantly lower and their present and future life and health quality to be significantly better than did the FP group. The groups' major concerns differed significantly. The FP group's concern related to diabetes, the SP group's to immunosuppression, and the KA group's to graft rejection.

CONCLUSION

Patients with failed pancreas but successful kidney transplants see less improvement in their quality of life than do patients who meet their transplant goals, irrespective of whether they receive a pancreas.
Effects of Insulin on Cholesterol Synthesis in Type II Diabetes Patients
Authors: Scoppola Alessandro , Testa Guido , Frontoni Simona , Maddaloni Elvira , Gambardella Sergio , Menzinger Guido , Lala Alberto
Published: March 2007

OBJECTIVE

To evaluate the effects of intensive insulin therapy and subsequent optimized metabolic control on daily urinary mevalonic acid (MVA) excretion, an index of whole-body cholesterol synthesis, and the acute effects of insulin on plasma MVA concentrations in type II diabetes.

RESEARCH DESIGN AND METHODS

Ten (five men and five postmenopausal women) nonobese, normolipidemic (total cholesterol < 6.2 mmol/l, triglycerides < 2.82 mmol/l), type II diabetic patients in poor metabolic control (HbA1c > 10%, fasting plasma glucose > 11 mmol/l) and receiving sulfonylurea treatment were selected. The 24-h urinary MVA excretion and plasma lipid values were determined before and after intensive insulin therapy. The acute effects of insulin on plasma MVA concentrations were also evaluated during a 3-h euglycemic hyperinsulinemic clamp study.

RESULTS

Urinary MVA excretion rates (μmol/24h) were 1.82 ± 0.21 in control subjects and 2.49 ± 0.35 (P < 0.01 vs. control subjects) and 1.78 ± 0.28 in patients before and after intensive insulin therapy, respectively. Total cholesterol, low-density-lipoprotein (LDL) cholesterol, and triglycerides decreased by 9, 8, and 12%, respectively, after blood glucose optimization. Acute insulin infusion during the euglycemic clamp studies reduced mean plasma MVA concentrations at 120 and 180 min by 29 and 38%, respectively (P < 0.01 for both vs. baseline).

CONCLUSIONS

Our study demonstrates that in nonobese, normolipidemic, type II diabetic patients under poor metabolic control, an increased cholesterol synthesis is normalized by insulin therapy. Hyperinsulinemia in the presence of euglycemia acutely decreases the circulating levels of MVA, the immediate product of hydroxymethylglutaryl-CoA reductase activity and an index of whole-body cholesterol synthesis.
Risk Factors for Poor Glycemic Control in Diabetic Children in France
Authors: Tubiana-Rufi Nadia , Moret Leila , Czernichow Paul , Chwalow Judith
Published: March 2007

OBJECTIVE

To test whether immigrant versus nonimmigrant origin, among other factors, is associated with differences in glycemic control in diabetic children.

RESEARCH DESIGN AND METHODS

A cross-sectional multicenter survey was performed in 165 French diabetic children aged 7–13 years and their parents. HbA1c was measured by high-performance liquid chromatography in a single laboratory (reference value: 5.1 ± 0.6%). Standardized questionnaires were used to evaluate cognitive, familial, and socioeconomic factors and adherence to diabetes regimen.

RESULTS

The mother's place of birth was found to account for 6.6% of the HbA1c variance. Two groups of children were identified with French-speaking immigrant (n = 27) and native French mothers (n = 138) who had significantly different HbA1c values of 9.1 ± 8% vs. 8.1 ± 1.4%, respectively (P < 0.001). Adherence to diabetes treatment was significantly lower in immigrant mothers for diet and insulin changes (P < 0.01), as well as their level of diabetes knowledge (P < 0.01). This immigrant group had no significant differences in parents' socioeconomic status, educational background, family status, family functioning, diabetes education background, and social support compared with the native French mothers' group.

CONCLUSIONS

Despite no differences in socioeconomic status, a group of children with less well-controlled diabetes was identified by the mother's place of birth. Cultural factors have a crucial importance in glycemic control in diabetic children and in parents' adherence to treatment and must be taken into account in the development of educational programs.
Progression of Retinopathy After Change of Treatment From Oral Antihyperglycemic Agents to Insulin in Patients With NIDDM
Authors: Henricsson Marianne , Janzon Lars , Groop Leif
Published: March 2007

OBJECTIVE

In insulin-dependent diabetes mellitus, institution of good glycemic control has been shown to retard development of retinopathy even though temporary progression has occurred. Few data have been available from patients with non-insulin-dependent diabetes mellitus (NIDDM). To determine the impact of improved glycemic control on retinopathy in patients with NIDDM, we examined, in a case-control study, the progression of retinopathy in 94 patients who changed treatment from oral antihyperglycemic agents to insulin.

RESEARCH DESIGN AND METHODS

We used the Wisconsin retinopathy scale and related progression of retinopathy during a 2-year observation period to changes in HbA1c after institution of insulin therapy.

RESULTS

Progression of retinopathy ≥3 levels occurred in 23% of the patients and was significantly more common in the patient group in which HbA1c was lowered ≥3% compared with progression in the group in which HbA1c was lowered <3% (P = 0.0001; relative risk 3.2; 95% confidence interval 1.5–6.9).

CONCLUSIONS

Improved glycemic control as achieved by insulin therapy may be associated with worsening of retinopathy in patients with NIDDM.
Effect of Glipizide Treatment on Response to an Infused Glucose Load in Patients With NIDDM
Authors: Sheu Wayne H H , Jeng Chii-Yuan , Fuh Martin M T , Chen Y D Ida , Reaven Gerald M
Published: March 2007

OBJECTIVE

This study was initiated to compare the effect of sulfonylurea treatment on the response to an infused glucose load of patients with non-insulin-dependent diabetes mellitus (NIDDM) at a basal insulin concentration and in response to physiological hyperinsulinemia.

RESEARCH DESIGN AND METHODS

We used the insulin suppression test, in which subjects were infused for 180 min with somatostatin, exogenous insulin, and glucose. Since similar steady-state plasma insulin (SSPI) concentrations are reached in all subjects, the resultant steady-state plasma glucose (SSPG) concentration permits comparison of the ability of a given individual to maintain glucose homeostasis in response to the infused glucose load.

RESULTS

We studied 15 nonobese patients at two different SSPI concentrations, before and after glipizide treatment, at basal (68 ± 4 pmol/l) and high (470 ± 31 pmol/l) levels. Values for SSPG concentrations were lower after treatment at both the basal (15.3 ± 0.5 vs. 18.5 ± 0.6 mmol/l; P < 0.001) and the high (10.6 ± 0.7 vs. 14.2 ± 0.7 mmol/l; P < 0.001) SSPI concentrations. To compare the responses of each patient before and after treatment, we calculated the fractional glucose metabolic rate, i.e., (glucose infusion rate — urinary glucose loss) ÷ by SSPG. To provide an alternative method of comparing the effect of sulfonylurea treatment, we divided the incremental increase in fractional metabolic glucose rate between the studies done at the low and high SSPI by the incremental increase in SSPI between the two studies (insulin sensitivity index [S1]).

CONCLUSIONS

The results of these calculations indicated that glipizide treatment was associated with a significant increase in fractional glucose metabolic rate at a basal insulin concentration (29 ± 3 to 42 ± 2 ml · m−2 · min−1, P < 0.001), and in response to the incremental change in SSPI (14 ± 4 to 23 ± 3 ml · m−2 · min−1, P < 0.02). Finally, S1 also increased in association with sulfonylurea (0.24 ± 0.06 to 0.43 ± 0.07 ml · m−2 · min−1/μU · ml−1, P < 0.001).
Infected Puncture Wounds in Diabetic and Nondiabetic Adults
Authors: Lavery Lawrence A , Walker Steven C , Harkless Lawrence B , Felder-Johnson Kim
Published: March 2007

OBJECTIVE

To evaluate bone and soft tissue pathogens resulting from puncture wounds among diabetic and nondiabetic adults.

RESEARCH DESIGN AND METHODS

We used a case-control design to compare bacterial pathogens in diabetic and nondiabetic subjects with foot infections precipitated by puncture injuries. We used ICD-9-CM code E920.8 to identify 77 diabetic and 69 nondiabetic patients admitted to the hospital for infected puncture wounds. We identified surgical bone and soft tissue cultures and number and type of organisms per culture.

RESULTS

Nondiabetic subjects had significantly less osteomyelitis (13 vs. 35%, P < 0.01) than diabetic subjects and were infected by fewer organisms. Pseudomonas was the most common cause of osteomyelitis among nondiabetic subjects (P < 0.001). Staphylococcus aureus was more common in diabetic bone (P < 0.001) and soft tissue (P < 0.001) infections. Polymicrobial osteomyelitis was more common in diabetic subjects. There was a longer delay until diabetic subjects received medical treatment compared with nondiabetic subjects (8.7 vs. 5.3 days, P < 0.002). Diabetic subjects were more likely to have neuropathy (P < 0.001) and to have sustained their injuries while barefoot (P < 0.006).

CONCLUSIONS

Puncture wounds in diabetic subjects were commonly associated with polymicrobial infections. Pseudomonas was the most common cause of nondiabetic osteomyelitis. These results have implications for differential emergent and chronic treatment of puncture wounds in diabetic versus nondiabetic subjects.
Biomedical and Psychiatric Risk Factors for Retinopathy Among Children With IDDM
Authors: Kovacs Maria , Mukerji Protap , Drash Allan , Iyengar Satish
Published: March 2007

OBJECTIVE

Illness duration and glycemic control influence the development of retinopathy in childhood-onset insulin-dependent diabetes mellitus (IDDM). Psychiatric disorders and sociodemographic factors also affect diabetes-related outcomes. However, biomedical and psychosocial factors have not been examined together in modeling the risk of retinopathy.

RESEARCH DESIGN AND METHODS

We conducted a single-site prospective longitudinal study of 66 children (aged 8-13 years) newly diagnosed with IDDM. Repeated assessments served to derive psychiatric diagnoses. Poor glycemic control was defined as the upper 15th percentile of all HbA1 values. After a median follow-up of 10 years, severity of retinopathy was determined. It was modeled with a stepwise polychotomous regression procedure using antecedent biomedical and psychosocial variables.

RESULTS

Young adults with childhood-onset IDDM were found to be at increased risk of retinopathy the longer they had IDDM, the more persistently they evidenced poor antecedent glycemic control, and the longer they suffered from depressive illness. These three factors operated individually and additively, with duration of IDDM conferring a baseline level of risk. In depressed patients (27%), depression onset antedated the detection of retinopathy generally by 7 years.

CONCLUSIONS

Duration of childhood-onset IDDM confers a baseline level of risk of retinopathy irrespective of glycemic control; antecedent clinical depression is also a risk factor. Depression therefore may serve as a marker of vulnerability and help to identify a subgroup of patients at risk for complications. The findings raise the question whether timely treatment of depression could forestall diabetic retinopathy.
Incidence and Determinants of Elevated Urinary Albumin Excretion in Pima Indians With NIDDM
Authors: Nelson Robert G , Knowler William C , Pettitt David J , Hanson Robert L , Bennett Peter H
Published: March 2007

OBJECTIVE

To examine the incidence and determinants of elevated urinary albumin excretion in Pima Indians with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

The incidence of elevated urinary albumin excretion (≥30 mg albumin/g creatinine) and its relationship with baseline characteristics was determined in 456 Pima Indians ≥15 years old with NIDDM who were followed for up to 11.6 years (median 4.7 years).

RESULTS

Of these 456 subjects, 192 (42%; 58 men, 134 women) developed elevated urinary albumin excretion, 172 of whom (90%) were within the microalbu-minuric range (30–299 mg/g). The incidence of elevated urinary albumin excretion was related to retinopathy, type of diabetes treatment, longer duration of diabetes, lower body mass index, and higher values of mean arterial pressure, HbA1, and fasting and 2-h postload plasma glucose concentration at the baseline examination, but not to sex. A relationship with cholesterol was found in durations of diabetes of ≥10 years. The cumulative incidence of elevated albumin excretion was 17% after 5 years of NIDDM.

CONCLUSIONS

The incidence of elevated urinary albumin excretion in Pima Indians with NIDDM is at least as high as that reported previously in insulin-dependent diabetes mellitus, and its major determinants are the same as those shown previously to predict the development of more advanced renal disease in this population.
No Association of Antibodies to Glutamic Acid Decarboxylase and Diabetic Complications in Patients With IDDM
Authors: Roll Ursula , Nuber Axel , Schröder Anja , Gerlach Evelin , Janka Hans-U , Ziegler Anette-G
Published: March 2007

OBJECTIVE

To evaluate the association of antibodies to glutamic acid decarboxylase (GAD-ab) and diabetic complications (neuropathy, retinopathy, and nephropa-thy) in patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

We examined the prevalence of GAD-ab (immunoprecipitation assay) and islet cell antibodies (ICAs) (indirect immu-nofluorescence) in a representative sample of IDDM patients (n = 146) with different disease duration (2–52 years, median 13.2 years). Of all patients characterized for the existence of diabetic complications, 56 of 146 had peripheral neuropathy, 24 of 142 had autonomie neuropathy, 67 of 141 had retinopathy, and 39 of 146 had nephrop-athy.

RESULTS

GAD-ab (>2 SD) were detected more frequently than ICA (>5 Juvenile Diabetes Foundation units) in IDDM patients of different disease duration (GAD-ab+ 37% [54 of 146] vs. ICA+ 22% [32 of 146], P = 0.011; diabetes duration less than median: GAD-ab+ 47% vs. ICA+ 23%, P = 0.0046; diabetes duration greater than median: GAD-ab+ 27% vs. ICA+ 22%, P < 0.05). For GAD-ab and for ICA, respectively, no difference was observed in frequency of positivity or titers between patients with or without diabetic complications.

CONCLUSIONS

Both GAD-ab and, to a lesser extent, ICA persist for a long time in several individuals. This persistence is not related to diabetic neuropathy or any other diabetic complication.
Prospective Study of Lipoprotein(a) as a Risk Factor for Atherosclerotic Cardiovascular Disease in Patients With Diabetes
Authors: Hiraga Takaki , Kobayashi Tetsuro , Okubo Minoru , Nakanishi Kohji , Sugimoto Tadao , Ohashi Yasuo , Murase Toshio
Published: March 2007

OBJECTIVE

To assess whether lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease in diabetes.

RESEARCH DESIGN AND METHODS

We studied 221 patients with non-insulin-dependent diabetes mellitus (NIDDM) without diabetic complications who were followed for 2.2–3.1 years. Their serum Lp(a) levels were semiquantified by a rapid electrophoretic method that accurately discriminates high from low serum Lp(a) at the 20 mg/dl level.

RESULTS

Seven of 105 diabetic patients with a high serum Lp(a) experienced a clinical event related to atherosclerotic cardiovascular disease. This incidence was significantly higher than that of the 110 diabetic patients with a low serum Lp(a). The logistic regression analysis revealed that Lp(a) was an independent risk factor for the event.

CONCLUSIONS

Lp(a) is a significant risk factor for atherosclerotic cardiovascular disease in NIDDM.
Improvement of Impaired Counterregulatory Hormone Response and Symptom Perception by Snort-Term Avoidance of Hypoglycemia in IDDM
Authors: Lingenfelser Thomas , Buettner Ulrich , Martin Juergen , Tobis Mark , Renn walter , Kaschel Rainer , Jakober Bernhard
Published: March 2007

OBJECTIVE

To test the hypothesis that impaired counterregulatory hormone response and symptom perception, induced by recurrent Hypoglycemic episodes over 2 days, may be improved by short–term (2–day) avoidance of hypoglycemia.

RESEARCH DESIGN AND METHODS

We examined two groups of insulin-dependent diabetes mellitus (IDDM) patients (n = 16), none of whom exhibited signs of peripheral or autonomie neuropathy. Two sequential euglycemic-hypoglycemic clamp studies were performed applying stable glycemie plateaus of 5.6, 3.3, 2.2, and 1.7 mmol/l, at which the patients' awareness of and responses to hypoglycemia were evaluated. In the intervention group (n = 11), three short-term Hypoglycemic (<2.2 mmol/l) episodes (days 1–3) preceded the first clamp study (day 4), whereas the second clamp study (day 6) followed a 2-day interval of strict avoidance of hypoglycemia. A control group (n = 5) was introduced to detect adaptation effects caused by the study procedure per se.

RESULTS

This short-term avoidance of hypoglycemia caused improvement of the impaired counterregulatory hormone response during insulin-induced hypoglycemia involving adrenaline (P < 0.05), adrenocorticotrophic hormone (P < 0.03), and cortisol (P < 0.05). Improvement of hypoglycemia symptom awareness encompassed overall symptom perception (multiple analysis of variance, P < 0.04) and the autonomie symptoms of heart pounding (P < 0.05) and sweating (P < 0.05).

CONCLUSIONS

The previously reported compromised neuroendocrine coun-terregulation and symptom awareness, occurring as a consequence of repetitive Hypoglycemic episodes over 2 days, may be improved by a single 2-day interval of strict avoidance of hypoglycemia.
The Reliability and Repeatability of the Blood Glucose Response to Prolonged Exercise in Adolescent Boys with IDDM
Authors: McNiven Temple Marilyn Y , Bar-Or Oded , Riddell Michael C
Published: March 2007

OBJECTIVE

To determine the intrasubject reliability and repeatability of the blood glucose response to prolonged exercise in adolescents with insulin-dependent diabetes mellitus (IDDM) when pre-exercise meal, exercise, and insulin regimens are kept constant.

RESEARCH DESIGN AND METHODS

Nine IDDM adolescent boys with diabetes duration of 9.7 ± 4.8 years participated in two testing sessions 5–17 days apart. Carbohydrate intake, subcutaneous insulin injections, exercise bouts, and their timing were identical in both sessions. Exercise started 1 h after breakfast and consisted of six 10-min cycling bouts at moderate intensity (heart rate 145–150 beats/min), separated by 5-min rest periods. During rest periods, blood samples for glucose were taken and a supplemental carbohydrate beverage was consumed. Subjects were asked periodically to guess their own blood glucose levels.

RESULTS

Intersession plasma glucose levels for each time period from the start of exercise to the end of the final recovery period were unchanged between sessions (P > 0.05) and highly correlated (r = 0.88 to r = 0.96, P < 0.01). The intraclass correlation for plasma glucose was 0.95. Decreases in plasma glucose from the start of exercise to the end of exercise were, at most, 5 mmol/l, and intersession decreases did not differ significantly (P > 0.05). One subject experienced hypoglycemia. The decrease in plasma glucose did not differ significantly between fair and poor glycemie control (glycosylated hemoglobin ≤10% and >10%, respectively). Subjects markedly underestimated their blood glucose levels when they were high, but their guesses were closer to the measured values at lower levels.

CONCLUSIONS

Intersession observations demonstrated that the intrasubject blood glucose responses to prolonged moderate-intensity exercise were reliable and repeatable when pre-exercise meal, exercise, and insulin regimens were kept constant. This is an important finding for implementing and evaluating educational strategies for improving the metabolic control associated with prolonged exercise, as well as for future research on means for preventing exercise-induced hypoglycemia.
Body Sway in Diabetic Neuropathy
Authors: Uccioli Luigi , Giacomini Pier Giorgio , Monticone Giovanna , Magrini Antonio , Durola Laura , Bruno Ernesto , Parisi Leo , Girolamo Stefano Di , Menzinger Guido
Published: March 2007

OBJECTIVE

To evaluate the influence of peripheral neuropathy on body sway assessed by posturography.

RESEARCH DESIGN AND METHODS

The age-matched study subjects included 10 insulin-dependent diabetes mellitus (IDDM) patients with peripheral neuropathy (DN), 23 IDDM patients without peripheral neuropathy (D) according to the San Antonio Consensus Conference guidelines, and 21 control subjects (C). All subjects with symptoms and/or clinical signs of postural instability were excluded from the study.

RESULTS

The trace surface was significantly larger in the DN than in the C and D groups (P < 0.05), and the trace length was longer in the DN than in the C and D groups (P < 0.01). Mean velocity was faster in the DN than in the other two groups (P < 0.001). A direct relationship was found between the parameters of posturography and some parameters of the nerve conduction velocity.

CONCLUSIONS

Diabetic patients with peripheral neuropathy demonstrate a relative deficit in their ability to maintain posture. Posturography allows an early disclosure of the failure of postural control.
Feasibility of Intraperitoneal Insulin Therapy With Programmable Implantable Pumps in IDDM: A multicenter study
Authors: Hanaire-Broutin Hélène , Broussolle Christiane , Jeandidier Nathalie , Renard Eric , Guerci Bruno , Haardt Marie-Joelle , Lassmann-Vague Veronique ,   The EVADIAC study group
Published: March 2007

OBJECTIVE

To report the overall French experience, obtained through the collaboration of seven centers (EVADIAC [Evaluation dans le Diabète du Traitement par Implants Actifs] register), on the safety, feasibility, and efficacy of intraperitoneal insulin therapy by programmable implantable pumps, using three different devices.

RESEARCH DESIGN AND METHODS

This is a multicenter prospective study involving 224 type I diabetic patients implanted with a programmable implantable pump (cumulative follow-up: 353 patient-years; mean duration: 1.5 ± 0.9 years [mean ± SD]). The Infusaid and the Promedos devices are equipped with a side port and refilled with U100 insulin (Hoechst 21 PH); the Minimed pump is not equipped with a side port and is refilled with U400 insulin (Hoechst 21 PH). Metabolic data and adverse events were recorded in a central register run by EVADIAC.

RESULTS

A total of 29 local pump-pocket events (8/100 patient-years) and 9 pump failures (2.5/100 patient-years) occurred. The major technical problems were 1) pump flow rate reduction related to insulin aggregates, reversible after alkaline rinsing of the pump, and 2) 47 catheter obstructions requiring laparoscopie or conventional surgery. Pump therapy was abandoned in only 11 patients. HbAlc (7.4 ±1.8 vs. 6.8 ± 1.0%, P < 0.001), mean glycemia (8.7 ± 1.5 vs. 7.8 ± 1.0 mmol/l, P < 0.001), and blood glucose SDs (3.8 ± 0.8 vs. 3.3 ± 0.8 mol/l, P < 0.001) decreased significantly after 6 months and remained lower than baseline thereafter.

CONCLUSIONS

Intraperitoneal insulin infusion using an implantable programmable pump is a feasible and relatively safe technique that may improve metabolic control and glycemie stability. Long-term studies, however, are needed to demonstrate whether or not the improvement in glycemie control could be sustained for several years.
Dietary Composition, Body Weight, and NIDDM: Comparison of high-fiber, high-carbohydrate, and modified-fat diets
Authors: Walker Karen Z , O'Dea Kerin , Nicholson Geoffrey C , Muir Jane G
Published: March 2007

OBJECTIVE

To examine the effects of a high-carbohydrate low-fat (HCLF) and a modified-fat (MF) diet on body weight and metabolic control in subjects with non-insulin-dependent diabetes mellitus (NIDDM) living at home.

RESEARCH DESIGN AND METHODS

Twenty-four NIDDM patients followed HCLF and MF diets alternately and in random order for a 3-month period while at home, with a 1-month baseline and washout between diets. Before and after each diet, fasting glucose and lipids, HbAlc, blood pressure, and body weight were measured. Dietary preferences were assessed by questionnaire.

RESULTS

Subjects consumed 50% of energy as carbohydrate and 23% as fat on the HCLF diet and 40% of energy as carbohydrate and 36% as fat (over half of which was monounsaturated fat) on the MF diet. Subjects lost weight on both HCLF and MF diets (mean loss 0.7 and 1.3 kg, respectively). Although the MF diet resulted in a small decrease in fasting glucose levels, there was no significant change in HbA1c. Similarly, there was no significant difference between the diets in changes in blood pressure or fasting blood lipids. Most subjects (65%) preferred the MF diet.

CONCLUSIONS

Although the MF diet is not a low-fat diet, it did not appear to facilitate weight gain in subjects with NIDDM living at home. The MF diet provides an alternative for individuals unable to comply with HCLF diets.
Captopril-Induced Acute Pancreatitis
Authors: Jeandidier N , Klewansky M , Plnget M
Published: March 2007

OBJECTIVE

To increase awareness concerning abdominal pain asociated with the use of captopril, which is a molecule frequently used in diabetic patients.

CASE:— One case of acute pancreatitis associated with captopril, confirmed by a reintroduction, is described in a type II diabetes patient.

CONCLUSIONS

Captopril and other angiotensin-converting enzyme inhibitors are very frequently prescribed in diabetic patients. Therefore, it is important to be aware of the possibility of pancreatitis linked to these molecules and to withdraw the treatment in case of severe unexplained abdominal pain.
Risk Factors for Lower Extremity Amputation in Persons With Diabetes
Authors: Selby Joe V , Zhang Danya
Published: March 2007

OBJECTIVE

To determine the predictors of lower extremity amputation (LEA) in a cohort of persons with diabetes (primarily non-insulin-dependent).

RESEARCH DESIGN AND METHODS

We conducted a nested case-control study among 10,068 patients from a large health maintenance organization who reported a diagnosis of diabetes at a multiphasic health checkup (MHC) (baseline) between 1964 and 1984. Average length of follow-up after baseline was 13.2 years. Case patients were 150 cohort members with a first, nontraumatic LEA after baseline. Control subjects were 278 cohort members who did not experience an LEA during follow-up, matched to patients on age, sex, and year of baseline MHC. The presence of diabetes at baseline was verified by chart review for both patients and control subjects. Cardiovascular disease risk factors were obtained at the baseline MHC; glucose control, other diabetes-related variables, preventive services, and other complications were obtained from chart review.

RESULTS

Level of glucose control (P < 0.0001), duration of diabetes (P = 0.04), and baseline systolic blood pressure (P = 0.004) were independent predictors of amputation, as were microvascular complications (retinopathy, neuropathy, and nephropathy). History of stroke, but not myocardial infarction, was also independently predictive; type of diabetes, cigarette smoking, and total cholesterol level were not. Being African-American was unrelated to amputation risk in univariate or multivariate analyses in this insured population.

CONCLUSIONS

LEA shares a risk factor profile with other microvascular complication of diabetes. Thus, control of blood glucose and blood pressure should reduce risk for amputation. African-Americans do not appear to be at increased risk for diabetes-related amputation when access to medical care is comparable.
Determinants of 24-H Blood Pressure in IDDM Patients
Authors: Hansen Klavs W , Poulsen Per L , Christiansen Jens S , Mogensen Carl Erik
Published: March 2007

OBJECTIVE

To assess the influence of basic clinical data on ambulatory blood pressure (AMBP) in insulin-dependent diabetes mellitus (IDDM) patients and to evaluate the reproducibility of the method.

RESEARCH DESIGN AND METHODS

AMBP was measured in 66 IDDM patients with urinary albumin excretion (UAE) <20 μg/min and in 53 healthy subjects. Determinants of AMBP were identified in a stepwise multiple regression model. In addition, 14 diabetic patients were monitored on two days of the same type, and 14 patients were monitored on one work day and one day off.

RESULTS

In healthy subjects, sex was the most important determinant of 24-h blood pressure (BP), whereas UAE and age were the main covariates in diabetes patients. The male-female difference in 24-h diastolic BP (dBP) was 5.6 mmHg lower in diabetic patients than in healthy control subjects (P < 0.05). In patients with long diabetes duration, nighttime dBP (69 ± 7 mmHg) was higher than in patients with medium diabetes duration (63 ± 8 mmHg, P < 0.05; after matching for age and sex). Daytime dBP was 5 mmHg higher on a work day than on a day off (P < 0.02). Standard deviation of the difference for repeated measurement of 24-h systolic/diastolic BP in the same subject was 5.7/2.5 mmHg.

CONCLUSIONS

The male-female difference in 24-h dBP was attenuated in diabetes. The influence of UAE on AMBP was noticed even in normoalbuminuric diabetic patients. Standardized AMBP was highly reproducible.
Prevalence of Diabetes and Hypertension in a Rural Population of Bangladesh
Authors: Sayeed M Abu , Banu Akhtar , Khan Abdur Rahman , Hussain M Zafirul
Published: March 2007

OBJECTIVE

To determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and hypertension in a rural community of Bangladesh.

RESEARCH DESIGN AND METHODS

A cluster sampling of 1,005 subjects > 15 years of age in the rural community of Dohar was investigated. Capillary blood glucose of fasting and 2 h after 75 g oral glucose (2hBG) were estimated. World Health Organization criteria were used for diagnosis of NIDDM and IGT. Blood pressure, height, and weight were also measured.

RESULTS

The crude prevalence of NIDDM was 2.1% (men 3.1, women 1.3%) and IGT was 13.3% (men 14.4, women 12.4%). Age-adjusted (30–64 years of age) prevalence was 2.23% (95% confidence interval [CI] 1.01–3.45) for NIDDM and 15.67% (95% CI 12.59–18.75) for IGT. Prevalence of hypertension with systolic blood pressure (sBP) ≥140 mmHg was 10.5% and with diastolic blood pressure (dBP) >90 mmHg was 9.0%. Increased age was the risk factor for NIDDM, IGT, and hypertension; whereas increased BMI showed inconsistent association with them. Relative risk for sBP with higher BMI (<22.0 vs. ≥22.1) was 1.94 with CI 1.55–2.43 and for dBP it was 2.2 with CI 1.40–3.46. Correlation of sBP was significant with age, BMI, and 2hBG. Similar correlation was also observed with dBP.

CONCLUSIONS

High prevalences of NIDDM, IGT, and hypertension were observed among rural subjects. Increased age was shown to be an important risk factor for all these disorders, whereas BMI-associated risk was significant with NIDDM and hypertension but not with IGT.
Diabetic Cardiomyopathy: A unique entity or a complication of coronary artery disease?
Authors: Bell David S H
Published: March 2007

The increased incidence of congestive heart failure and the increased mortality and morbidity in the diabetic patient following myocardial infarction or coronary artery bypass graft can be explained by the presence of diabetic cardiomyopathy. Noninvasive studies in young diabetic patients show no cardiac abnormality, but in older diabetic patients mild cardiac diastolic dysfunction is detectable. This mild cardiomyopathy can become clinically detectable in the presence of hypertension and can be severe in the presence of myocardial ischemia. Microvascular disease is unlikely to cause diabetic cardiomyopathy. Cellular changes, including defects in calcium transport and fatty acid metabolism, may lead to myocellular hypertrophy and myocardial fibrosis, initially causing diastolic dysfunction that may advance to systolic dysfunction. Glycemie control, energetic detection and treatment of hypertension with appropriate antihypertensive agents, and early detection and treatment of ischemie heart disease are essential in preventing and treating diabetic cardiomyopathy.
Mortality and Morbidity Associated With Body Weight in People With IDDM: The WHO Multinational Study of Vascular Disease in Diabetes
Authors: Chaturvedi Nishi , Stevens Lynda K , Fuller John H ,   The WHO Multinational Study Group
Published: March 2007

OBJECTIVE

Strict glycemic control in people with insulin-dependent diabetes mellitus (IDDM) reduces the risk of microvascular complications, but improvementsin control are also associated with weight gain. Fears about the mortality risks of obesity may limit the acceptability of tight control. Therefore, we examined morbidity and mortality risks associated with body weight in people with IDDM.

RESEARCH DESIGN AND METHODS

This was a cohort study of 644 men and 576 women with IDDM from nine centers worldwide. Baseline examinations were performed in 1975–1977, and mortality follow-up continued until 1988.

RESULTS

Body weight was positively associated with blood pressure and, in men, with cholesterol. Fasting blood glucose was higher in the most obese groups in women only. There were 204 deaths among the men and 148 among the women. There was a reverse J-shaped relationship between body weight and all-cause mortality, with the highest mortality rates occurring in the leanest body mass index (BMI) category. The age-, duration-, and center-adjusted mortality rate ratio (95% confidence interval) comparing BMI category < 20 kg/m2 with BMI category ≥22 and <24 kg/m2 was 2.64 (1.59–4.38) in men and 1.54 (0.77–3.06) in women. Additional adjustment for smoking, blood pressure, glucose, cholesterol, and proteinuria did not qualitatively alter these findings.

CONCLUSIONS

We conclude that except in very lean people with IDDM, body weight is not significantly associated with mortality. Thus, efforts to improve glycemic control should not be restricted by concerns about the effects of weight gain on mortality.
Effects of Vitamin E on Susceptibility of Low-Density Lipoprotein and Low-Density Lipoprotein Subfractions to Oxidation and on Protein Glycation in NIDDM
Authors: Reaven Peter D , Herold David A , Barnett Joellen , Edelman Steve
Published: March 2007

OBJECTIVE

To evaluate the effect of vitamin E supplementation on the susceptibility of low-density lipoprotein (LDL) and LDL subfractions to oxidation and on protein glycation in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Twenty-one men with NIDDM (HbA1c = 6-10%), ages 50–70, were randomly assigned to either 1,600 IU/day of vitamin E or placebo for 10 weeks after a 4-week placebo period. LDL and LDL subfractions were isolated after 4 weeks of placebo and after 6 and 10 weeks of therapy. Susceptibility of LDL to copper-mediated oxidation was measured by conjugated diene formation (lag time) and formation of thiobarbituric acid-reactive substances (TBARS). Fasting serum glucose, mean weekly blood glucose, HbA1c, and glycated plasma protein concentrations were also determined at these time points.

RESULTS

Vitamin E content in plasma and LDL increased 4.0- and 3.7-fold, respectively, in the vitamin E-treated group. Vitamin E decreased the susceptibility of LDL to oxidation in comparison with placebo (lag time, 243 ± 46 vs. 151 ± 22 min, P < 0.01; 3 h TBARS, 24 ± 12 vs. 66 ± 18 nmol malondialdehyde/mg LDL, P < 0.05). Vitamin E content also increased significantly in both buoyant and dense LDL subfractions, and their oxidation was dramatically reduced. The lag time of LDL oxidation correlated well with the content of vitamin E in both LDL and its subfractions (r = 0.69–0.92). Glycemic indexes did not change significantly in either group during the study. Protein glycation, including glycated hemoglobin, glycated albumin, glycated total plasma proteins, and glycated LDL were unchanged in the vitamin E group.

CONCLUSIONS

Supplementation of vitamin E in NIDDM leads to enrichment of LDL and LDL subfractions and reduced susceptibility to oxidation. Despite a greater percentage increase in vitamin E content in small dense LDL, it remained substantially more susceptible to oxidation than was buoyant LDL. This suggests that dense, LDL may gain less protection against oxidation from antioxidant supplementation than does larger, more buoyant LDL. In contrast to previous reports, vitamin E supplementation did not reduce glycation of intracellular or plasma proteins.
Reduction of Glycosylated Hemoglobin and Postprandial Hyperglycemia by Acarbose in Patients With NIDDM: A placebo-controlled dose-comparison study
Authors: Coniff Robert F , Shapiro Joann A , Robbins David , Kleinfield Robert , Seaton Timothy B , Beisswenger Paul , McGill Janet B
Published: March 2007

OBJECTIVE

To compare the safety and efficacy of three doses of acarbose (100, 200, and 300 mg three times daily) with placebo for the treatment of non-insulin-dependent diabetes mellitus (NIDDM) in patients maintained on dietary therapy alone.

RESEARCH DESIGN AND METHODS

This multicenter double-blind placebo-controlled trial was 22 weeks in duration. The trial consisted of a 2-week screening period, a 4-week placebo run-in period, and a 16-week double-blind treatment period. The primary measure of drug efficacy was the mean change from baseline in HbA1c levels. Additional efficacy variables included the mean change from baseline in fasting and postprandial plasma glucose and serum insulin levels.

RESULTS

After 16 weeks of treatment, acarbose-treated patients had statistically significant reductions in mean HbA1c levels of 0.78, 0.73, and 1.10% (relative to placebo) in the 100-, 200-, and 300-mg t.i.d. groups, respectively. Significant reductions in fasting and postprandial plasma glucose levels, glucose area under the time-concentration curve, and maximum glucose concentration were also observed in acarbose-treated patients. Although there were no statistically significant differences among the 100-, 200-, and 300-mg treatment groups, there was a trend toward a dose-response relationship for most plasma glucose variables that were measured. Gastrointestinal side effects (e.g., abdominal pain, flatulence, and diarrhea) and serum transaminase elevations (e.g., aspartate aminotransferase [AST] and alanine aminotransferase [ALT] were more frequently reported in the acarbose-treated patients than in the placebo-treated control patients. Transaminase elevations occurred only at the 200-, and 300-mg dosages and were readily reversible on discontinuation of treatment.

CONCLUSIONS

Acarbose at doses of 100, 200, and 300 mg administered three times daily for 16 weeks significantly reduced HbA1c levels and postprandial hyperglycemia. Treatment with acarbose is a safe and effective adjunct to dietary therapy for the treatment of NIDDM.
Diabetes Care Policies and Practices in Michigan Nursing Homes, 1991
Authors: Funnell Martha M , Herman William H
Published: March 2007

OBJECTIVE

To describe local standards of care for nursing home patients with diabetes, to characterize the care that nursing home patients with diabetes receive in Michigan, and to determine if the care provided meets local and national standards.

RESEARCH DESIGN AND METHODS

In March 1991, a questionnaire was administered and chart reviews were conducted as part of the Medical Review and Nursing Evaluation conducted by the Michigan Department of Public Health. The questionnaire was completed by the head nurses at 17 skilled nursing homes to learn about local institutional standards of care. Chart reviews were conducted on a sample of five patients with diabetes from each nursing home to describe the care provided and to compare it with local and national standards.

RESULTS

Almost all nursing homes had some diabetes care orders or protocols. Standing orders were most often present to guide nutritional and nursing care (e.g., diet, blood glucose monitoring, foot care). Standing orders were less often present to guide medical care (e.g., blood glucose parameters to contact physician) and surveillance of complications (e.g., eye exams). In general, the care provided did not meet local or national standards for diabetes care. Care practices were closer to national standards when registered dietitians (RDs) participated in meal planning and written institutional policies existed.

CONCLUSIONS

In this sample of Michigan nursing homes, those with RDs and standing orders provided care more in keeping with guidelines. There is room for improvement in diabetes care practices in nursing homes. It may be time for diabetesrelated organizations to re-examine standards for diabetes care in nursing homes.
A Double-Blind Placebo-Controlled Trial Evaluating the Safety and Efficacy of Acarbose for the Treatment of Patients With Insulin-Requiring Type II Diabetes
Authors: Coniff Robert F , Shapiro Jo Ann , Seaton Timothy B , Hoogwerf Byron J , Hunt John A
Published: March 2007

OBJECTIVE

To determine whether a forced titration of acarbose (from 50 to 300 mg three times daily) administered over a 24-week period, in conjunction with diet and insulin therapy, improves glycemic control and reduces daily insulin requirements in insulin-requiring type II diabetes.

RESEARCH DESIGN AND METHODS

This multicenter, randomized, double-blind, placebo-controlled trial was 36 weeks in duration. The trial consisted of a 6-week pretreatment period, a 24-week double-blind treatment period, and a 6-week post-treatment follow-up period. The primary efficacy variables were the mean change from baseline in HbA1c levels and the mean percentage change from baseline in total daily insulin dose.

RESULTS

Treatment with acarbose was associated with significant reductions in HbA1c levels of 0.40% (P = 0.0001) and in total daily insulin dose of 8.3% (P = 0.0015). There were also significant reductions in all plasma glucose variables measured, including a 0.9 mmol/l reduction in fasting glucose (P = 0.0440), a 2.6 mmol/l reduction in glucose Cmax (P = 0.0001) and a 270 mmol·min−1·l−1 reduction in glucose area under the curve (P = 0.0002). Although acarbose treatment was associated with a greater incidence of adverse events than was placebo treatment, primarily flatulence and diarrhea, these events did not generally prevent patients from completing the study.

CONCLUSIONS

The results of this study suggest that acarbose is a safe and effective adjunct to diet and insulin therapy for the management of insulin-requiring type II diabetes.
Feasibility and Acceptability of a Proposed Infant Feeding Intervention Trial for the Prevention of Type I Diabetes
Authors: Gerstein Hertzel C , Simpson Janis Randall , Atkinson Stephanie , Taylor D Wayne , VanderMeulen John
Published: March 2007

OBJECTIVE

To determine the feasibility of a randomized double-blind controlled trial of an infant formula without intact cow's-milk protein for preventing type I diabetes in high-risk children.

RESEARCH DESIGN AND METHODS

We surveyed 83 people who either were parents of a child with type I diabetes or were pregnant women with type I diabetes in the ambulatory diabetes and obstetrics clinics in a university hospital. After a written and verbal description of the cow's milk-diabetes hypothesis, participants were asked to sign a sham consent form. A questionnaire designed to explore factors affecting their decision to either sign or not sign the consent form, as well as infant-feeding patterns, was subsequently administered.

RESULTS

Overall, 69.9% (95% confidence interval, 60.0–79.8%) consented to participation in the proposed randomized trial. The decision to consent was not affected by the degree of belief in the cow's milk-diabetes hypothesis, the child's risk of diabetes, the respondent's demographic data, or infant feeding habits.

CONCLUSIONS

A randomized feeding intervention study is an acceptable and feasible way to determine whether avoidance of cow's-milk protein during the first 6 months of life prevents type I diabetes in North American children.