bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of Early Sympathetic Cardiovascular Neuropathy by Squatting Test in NIDDM
Authors: Marfella Raffaele , Salvatore Teresa , Glugliano Dario , Maro Giosue Di , Giunta Riccardo , Torella Roberto , Juchmes Jacques , Scheen Andre , Lefebvre Pierre J
Published: March 2007

OBJECTIVE

To determine the role of the squatting test in the detection of early sympathetic neuropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Three groups of nonsmoking, nonobese subjects were studied: 10 healthy subjects, 10 NIDDM patients without autonomic neuropathy (AN), and 10 NIDDM patients with AN defined by the presence of a pathological deep-breathing value. All subjects were given three postural tests: lying-to-standing, sitting-to-standing, and squatting test. Heart rate (HR) and finger arterial pressure were recorded with a noninvasive technique.

RESULTS

Blood pressure (BP) fall (expressed as decremental area) was not significantly different among the groups at standing up after sitting or lying. By contrast, a significantly greater BP drop occurred in NIDDM patients with AN (1,123 ± 245 mm2) compared with NIDDM patients without AN (460 ± 232 mm2) or normal subjects (429 ± 138 mm2, P < 0.001). The HR increase after all the orthostatic maneuvers was smaller in diabetic patients with AN (P < 0.01) compared with that recorded in other groups. Significant correlations were observed between BP fall after squatting and either the expiration:inspiration ratio at deep breathing (r = -0.77, P < 0.001) or the duration of diabetes (r = 0.76, P < 0.001).

CONCLUSIONS

The intrinsic orthostatic load of the squatting test, which is greater than conventional postural maneuvers, makes the squatting test an easy and useful test to detect early orthostatic dysregulation in NIDDM.
Use of Fetal Ultrasound to Select Metabolic Therapy for Pregnancies Complicated by Mild Gestational Diabetes
Authors: Buchanan Thomas A , Kjos Siri L , Montoro Martin N , Wu Paul Y K , Madrilejo Nelson G , Gonzalez Martha , Nunez Victoria , Pantoja Patricia M , Xiang Anny
Published: March 2007

OBJECTIVE

To determine whether fetal ultrasound early in the third trimester can identify Latina with mild gestational diabetes mellitus (GDM) whose fetuses are at risk for macrosomia and, if so, whether maternal insulin therapy can reduce that risk.

RESEARCH DESIGN AND METHODS

Study subjects included 303 consecutive women with GDM and a fasting serum glucose level <5.8 mM on diet therapy who had a fetal ultrasound between 29 and 33 weeks gestation. Of the women, 98 (32%) had a fetal AC ≥ 75th percentile for gestational age, and 59 women completed a randomized trial of diet therapy (n = 29) or diet plus twice daily insulin (n = 30). Maternal nutrient levels were assessed by meal tolerance testing (MTT) before and during therapy and by capillary glucose monitoring four to seven times a day. Birth weights corrected for gestational age and neonatal glycemia and skin folds were the primary outcome variables compared between treatment groups.

RESULTS

Diet and diet-plus-insulin groups were well matched for maternal age, prepregnancy relative weight, weight gain during pregnancy, and glycemia at entry. Insulin therapy reduced maternal capillary (P < 0.005) and MTT (P < 0.001) glucose levels and prevented a diet-associated rise in MTT triglyceride levels (P < 0.002). Gestational age at delivery was similar in insulin- and diet-treated groups (39.6 ± 0.2 vs. 39.5 ± 0.2 weeks). Birth weights (3,647 ± 67 vs. 3,878 ± 84 g; P < 0.02), the prevalence of large-for-gestational age infants (13 vs. 45%, P < 0.02), and neonatal skin-fold measurements at three sites (P < 0.005) were reduced in the insulin-treated group. Rates of transient neonatal hypoglycemia were low in both treatment groups (14 and 18%, respectively) and didnot differ significantly between groups.

CONCLUSIONS

Fetal ultrasound early in the third trimester identified women with mild GDM whose infants were at high risk for fetal macrosomia in the absence of standard glycemic criteria for insulin therapy. Insulin treatment reduced the macrosomia, indicating that fetal ultrasound can be used to guide metabolic therapy in pregnancies complicated by mild GDM.
The Health and Functional Status of Veterans With Diabetes
Authors: Ahroni Jessie H , Boyko Edward J , Davignon Denise R , Pecoraro Roger E
Published: March 2007

OBJECTIVE

To determine the extent of functional impairment among veterans with diabetes and investigate whether such functional impairment is associated with measures of glycemic control, sensory neuropathy, lower extremity macrovascular disease, or other comorbid conditions.

RESEARCH DESIGN AND METHODS

A 20-item general health survey (SF-20) developed by the Medical Outcomes Study (MOS) Group, was administered to 577 subjects participating in a prospective study of risk factors for diabetic foot ulceration. Measures of glycemic control and neurovascular disease included GHb, sensory lower extremity neuropathy assessed by aesthesiometry, and segmental lower extremity doppler blood pressures.

RESULTS

Veterans with diabetes have major decreases in all domains of functional status; 87% were in poor health in terms of physical functioning and 86% in terms of health perceptions. Those with advancing age, symptoms of neuropathy and claudication, and a medical history of complications associated with diabetes had significantly more impairment of health status than those without. GHb values did not correlate with functional status measures. Subjects with neuropathy had statistically significant functional impairment. Subjects with vasculopathy had only two significantly low health status measures.

CONCLUSIONS

In summary, the findings from this survey reveal that veterans with diabetes have low functional status scores. The presence of symptoms and complications accounts for only part of the impairments experienced by this group.
Testosterone Concentrations in Women and Men With NIDDM
Authors: Andersson Björn , Märin Per , Lissner Lauren , Vermeulen Alex , Björntorp Per
Published: March 2007

OBJECTIVE

To evaluate androgen concentrations in relation to insulin resistance in men and women with and without NIDDM. Recent studies have indicated the potential importance of the regulation of insulin sensitivity by androgens in both women and men. Low sex hormone binding globulin (SHBG) concentration is an independent risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM) in women and is strongly associated statistically with signs of insulin resistance.

RESEARCH DESIGN AND METHODS

We compared measurements of anthropometric variables and SHBG, steroid hormone, and insulin concentrations of women and men who have NIDDM with those of control subjects.

RESULTS

Women with NIDDM had somewhat higher plasma insulin concentrations, lower SHBG, and higher free testosterone values than did control subjects with similar body mass index (BMI). Women with NIDDM had marginally higher waist-to-hip ratios (WHR). Plasma insulin concentrations correlated positively with BMI, WHR, and free testosterone and negatively with SHBG. In multivariate analyses, insulin concentrations remained positively associated with BMI and free testosterone. Men with NIDDM had higher fasting plasma insulin concentrations than did the nondiabetic control subjects. Testosterone and SHBG were lower in the diabetic men than in both control groups. The derived value of free testosterone was not different between groups. Univariate correlation analyses revealed tight statistical couplings between plasma insulin on the one hand and SHBG and testosterone concentrations (negative) on the other. In multivariate analyses, only the insulin-testosterone association remained.

CONCLUSIONS

Women with NIDDM have high levels of free testosterone and low levels of SHBG. Insulin resistance is closely correlated with these signs of hyperandrogenicity as well as with obesity. Men with NIDDM also have low levels of SHBG and, in contrast to women, low testosterone values. Insulin values correlate negatively with these hormonal factors. Based on the results of experimental work and intervention studies, we suggest that these androgen abnormalities might be causally related to insulin resistance in NIDDM.
Variability of Urinary Albumin Excretion in Patients With Microalbuminuria
Authors: Phillipou George , Phillips Patrick J
Published: March 2007

OBJECTIVE

To estimate the within-person variability (SDi) for the overnight urinary albumin excretion rate (AER) in diabetic patients with persistent microalbuminuria.

RESEARCH DESIGN AND METHODS

Thirteen normotensive diabetic patients in stable medical control, with normal renal function and without any associated cardiovascular or other clinical disorders, collected overnight urines at monthly intervals during one year. AER was determined by radioimmunoassay.

RESULTS

Analysis of individual series of AER showed a significant trend (P ≤ 0.01) in three cases. The remaining patients (eight men, two women; seven with insulin-dependent diabetes mellitus) had a median mean AER 102 μg/min (range 30–238 μg/min). Because the individual mean AERs were significantly associated with their respective SDiS, the data was loge transformed. Log2SDi was estimated as 0.420, and its 90% probability range (0.353–0.490) was calculated using the bootstrap method.

CONCLUSIONS

The high within-person variance for AER means that only people with an initial AER in the range of 53–76 μg/min have a high probability (P ≥ 0.95) of being classified as microalbuminuric (20–200 μg/min) on a subsequent specimen. However, subjects with an initial AER ≥53 or ≥80 μg/min have a 95 and 99% probability of persistent microalbuminuria. The large variability of AER limits its potential as a serial marker to detect any gradual deterioration of established renal dysfunction.
Accuracy of Plasma Glucose Measurements in the Hypoglycemic Range
Authors: Genter Pauline M , Ipp Eli
Published: March 2007

OBJECTIVE

This study was designed to evaluate three different enzymatic methods for glucose measurement in plasma samples with special emphasis on glucose concentrations in the hypoglycemic range.

RESEARCH DESIGN AND METHODS

Glucose dehydrogenase (Hemo- Cue analyzer), glucose oxidase (YSI analyzer), and hexokinase (Abbott analyzer) methods were used to measure plasma samples that were obtained during research studies.

RESULTS

Mean glucose concentrations (n = 240) were 5.3 ± 0.2, 5.4 ± 0.2, and 5.6 ± 0.2 mM (95.6 ± 3.9, 96.7 ± 3.9, and 101.6 ± 4.0 mg/dl) using glucose dehydrogenase, glucose oxidase, and hexokinase, respectively (NS). In the hypoglycemic range, mean glucose concentrations with each method retained the same hierarchy of measurements: 2.7 ± 0.05, 2.8 ± 0.04, and 2.9 ± 0.03 mM (48.4 ± 0.9, 50.6 ± 0.8, and 52.3 ± 0.6 mg/dl) by glucose dehydrogenase, glucose oxidase, and hexokinase, respectively (P < 0.005). Individual glucose dehydrogenase measurements (n = 240) correlated well with glucose oxidase and hexokinase, r = 0.99, and were considerably easier to perform at the bedside. The differences between the glucose measurement methods were consistent and similar in low, normal, and high concentration ranges.

CONCLUSIONS

We conclude that any interpretation or comparison of critical clinical and research measurements of glucose in different settings take into account methodological differences, particularly in the hypoglycemic range.
Increasing Incidence of Type I Diabetes in The Netherlands: The second nationwide study among children under 20 years of age
Authors: Ruwaard Dirk , Hirasing Remy A , Reeser H Maarten , Buuren Stef Van , Bakker Karel , Heine Rob J , Geerdink Rolf A , Bruining G Jan , Vaandrager Gerrit J , Verloove-Vanhorick S Pauline
Published: March 2007

OBJECTIVE

A nationwide retrospective study was conducted to assess the incidence of type I diabetes in The Netherlands among children <20 years of age in 1988–1990. The first study with a similar design covered 1978–1980.

RESEARCH DESIGN AND METHODS

The capture recapture census method was chosen for analysis of the data. A questionnaire was sent to all Dutch pediatricians and internists, and for the ascertainment, a similar questionnaire was sent out separately to members of the Dutch Diabetes Association, which is the national patient association.

RESULTS

The average achieved ascertainment rate was 81%. The ascertainmentadjusted annual incidence was 13.2/100,000 for 0- to 19-year-old children, indicating an increase of 23% compared with the 1978–1980 survey; for 0- to 14-year-olds, the increase amounted to 17%.

CONCLUSIONS

This study suggests a sustained increase of type I diabetes in The Netherlands because the cumulative incidence studied previously in the 1960–1970 birth cohorts of male army conscripts 18 years of age was also found to rise. In contrast to Northern European countries, an increase in incidence for the age category 0–4 years could not be found.
Which Left Ventricular Function Is Impaired Earlier in the Evolution of Diabetic Cardiomyopathy?: An echocardiographic study of young type I diabetic patients
Authors: Raev Dimitar C
Published: March 2007

OBJECTIVE

To determine whether diastolic dysfunction preceded systolic dysfunction in the evolution of diabetic cardiopathy.

RESEARCH DESIGN AND METHODS

A total of 157 young (mean age 26.6 years) cardiac asymptomatic type 1 diabetic patients and 54 age- and sex-matched healthy (nondiabetic) subjects were studied. The severity of diabetic complications (retinopathy, nephropathy, and cardiac autonomic neuropathy) was evaluated by the diabetic complication index (DCl), a sum of individual scores for each complication. Left ventricular (LV) function was studied by M-mode echocardiography. Impaired systolic and diastolic functions were presumed if at least two echocardiographic variables for systolic function (fractional shortening [FS], mean velocity of circumference fiber shortening, and stroke index) and for diastolic function (slope of anterior mitral leaflet in early diastole, isovolumic relaxation time [IRT], and left atrium emptying index) were out of the control range (mean ± 2 SD).

RESULTS

Diastolic dysfunction was twice as common as systolic dysfunction (27% and 12%, respectively, P < 0.001). Of diabetic patients with systolic dysfunction, 83% had impaired diastolic function, whereas only 30% of diabetic patients with diastolic dysfunction had systolic damage (P < 0.001). On the other hand, only 3 of 157 diabetic patients (1.9%) had systolic dysfunction with preserved diastolic function (P > 0.05). Diastolic dysfunction, represented by the interval from minimal LV dimension to mitral valve opening, was seen in diabetic patients ∼8 years after onset of diabetes and systolic dysfunction represented by FS after ∼18 years. Diastolic dysfunction, represente by 1RT, was found in the presence of mild complications (DCl = 2), and systolic dysfunction, represented by FS, was found in the presence of more severe complications (DCl = 4).

CONCLUSIONS

Our findings indicate that myocardial damage in patients with diabetes affects diastolic function before systolic function. The intentional assessment of diastolic function is advisable for early detection of LV dysfunction before clinical symptoms appear, with follow-up to detect further deterioration of cardiac status.
Differences in Survival Between Black and White Patients With Diabetic End-Stage Renal Disease
Authors: Cowie Catherine C , Port Friedrich K , Rust Keith F , Harris Maureen I
Published: March 2007

OBJECTIVE

To evaluate whether the longer survival of blacks with diabetic end-stage renal disease (ESRD) relative to whites is due to racial differences in type of diabetes, comorbidity at ESRD onset, and ESRD treatment modality and to examine whether survival differences between blacks and whites occur only in certain population subgroups.

RESEARCH DESIGN AND METHODS

The Michigan Kidney Registry was used to ascertain all blacks and whites (n = 594) with diabetic ESRD in southeastern Michigan, with ESRD onset at age <65 years during 1974–1983. Patients were followed through 1988. Medical records were abstracted for type of diabetes, comorbidity at ESRD onset, and other factors.

RESULTS

Median survival among insulin-dependent diabetes mellitus patients was 27 months in blacks and 17 months in whites, and among non-insulin-dependent diabetes mellitus patients was 30 months in blacks and 16 months in whites. After adjustment for confounding factors by Cox proportional hazards analysis, the death rate was 45% lower in blacks than in whites on dialysis (relative death rate [RDR] = 0.55,95% confidence interval [CI] = 0.44–0.69), but was similar in blacks and whites with a renal transplant (RDR = 0.99, 95% CI = 0.64–1.52). Compared with dialysis, transplantation was associated with lower mortality in both races (whites, RDR = 0.50, 95% CI = 0.36–0.70; blacks, RDR = 0.89, 95% CI = 0.60–1.34), although the effect was not statistically significant in blacks. Racial differences in survival did not vary by type of diabetes or any additional factor.

CONCLUSIONS

Survival after ESRD onset is longer in blacks than in whites treated with dialysis, even after adjusting for comorbidity and other factors that affect survival. Survival does not differ by race among transplant patients.
The Incidence of Childhood IDDM in New South Wales, Australia
Authors: Verge Charles F , Silink Martin , Howard Neville J
Published: March 2007

OBJECTIVE

To determine the incidence of insulin-dependent diabetes mellitus (IDDM) in children 0–14 years of age in the state of New South Wales, Australia, which has a total population of 5.73 million.

RESEARCH DESIGN AND METHODS

We established a prospective register, identifying 361 incident cases over a 2-year period (1990–1991) with two independent sources of case ascertainment. The primary source was the reporting of newly diagnosed patients by physicians and diabetes educators. The secondary source was a subsidized syringe scheme.

RESULTS

Using the capture-recapture method, ascertainment was estimated to be 99.4% complete. The age-standardized incidence rate was 14.5 per 100,000 person-years (95% confidence interval: 13.0–16.0). No significant differences were found when comparing the first and second years of the register, boys and girls, geographical areas, or Aboriginal and non-Aboriginal children. There was seasonal variation in the onset (with more cases in winter), which was evident in the 10- to 14-year age-group (P = 0.01), but not in younger age-groups. A first-degree relative was already affected in 6.9% of the cases. No significant difference was noted in the age at onset when comparing cases with and without an affected first-degree relative.

CONCLUSIONS

The incidence of childhood IDDM in New South Wales is similar to rates found in other predominantly Anglo-Saxon populations. IDDM occurs in Aboriginal children with a frequency comparable to that in the rest of the population.
Sodium-lithium Transport in Adolescents With IDDM: Relationship to incipient nephropathy and glycemic control
Authors: Crompton Charles H , Balfe J Williamson , Balfe Judith A , Chatzilias Alice , Daneman Denis
Published: March 2007

OBJECTIVE

The aims of this study were to examine genetic and environmental influences in the development of early diabetic nephropathy and to assess the value of measuring membrane sodium transport as a marker for early nephropathy.

RESEARCH DESIGN AND METHODS

We measured erythrocyte sodium- lithium (Na-Li) countertransport, blood pressure (BP), HbA1c, and microalbuminuria (MA) in 84 adolescents with insulin-dependent diabetes mellitus (IDDM), 29 of whom had MA. Twenty-nine non-MA patients were selected and matched for age, sex, and IDDM duration with the 29 diabetic subjects with MA. The 84 diabetic adolescents were also compared with 85 nondiabetic siblings.

RESULTS

The erythrocyte Na-Li countertransport was significantly greater in the IDDM group than in the sibling group (mean ± SD, 0.41 ± 0.14 vs. 0.30 ±0.11 mmol Li · liters of erythrocytes–1 · h–1, respectively, P < 0.0001), but a significant correlation was noted between the results in IDDM subjects and their siblings (r = 0.42, P < 0.0008). Na-Li countertransport was not different in the diabetic subjects with or without MA (0.43 ± 0.13 vs. 0.37 ± 0.13 mmol Li · liters of erythrocytes–1 · h–1, respectively). There was a significant correlation in the IDDM group between recent diabetic control (HbA1c) and Na-Li countertransport (r = 0.37, P < 0.003). Diastolic BP was significantly higher in the IDDM group with MA than in those without MA (60 ± 6 vs. 55 ± 6 mmHg, respectively, P < 0.03).

CONCLUSIONS

These results suggest that erythrocyte Na-Li countertransport is influenced by the diabetic milieu. However, there was also evidence in our subjects of a genetic contribution to Na-Li countertransport as seen by the correlation between levels in the IDDM subjects and their siblings. Using Na-Li countertransport, we were not able to segregate those IDDM adolescents with and without early nephropathy.
Metabolic Control Is Not Altered When Using Indwelling Catheters for Insulin Inactions
Authors: Ragnar Hanas S , Ludvigsson Johnny
Published: March 2007

OBJECTIVE

To determine if the use of indwelling catheters for insulin injections affects the long- and short-term metabolic control of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Sixteen children and adolescents 9–20 years of age were included in a randomized 10-week crossover study using indwelling catheters (Insuflon, Pharma-Plast, Lynge, Denmark; CHRONIMED, Minnetonka, Minnesota) for insulin injections. Their diabetes duration was 7.5 ± 3.3 years (range 2–14), and they used multiple injection therapy with 4–5 doses/day. C-peptide was <0.15 nM fasting and ≤0.30 nM postprandial.

RESULTS

We found no significant difference between those with and without Insuflon in degree of metabolic control reflected by HbA1c (with Insuflon, 7.3 ± 2.6%; without, 7.1 ± 2.2%), 24-h profiles of blood glucose and free insulin, 24-h samples of glucosuria, or ketonuria. Weight, insulin doses per kilogram per 24 h, and insulin antibodies were all the same in the two groups.

CONCLUSIONS

The long- and short-term metabolic control of IDDM was not altered by the use of indwelling catheters for insulin injections. Insuflon can be offered as an alternative to patients with IDDM who find regular injections uncomfortable.
Frequency and Determinants of Diabetes Patient Education Among Adults in the U.S.Population
Authors: Coonrod Beth Ann , Betschart Jean , Harris Maureen I
Published: March 2007

OBJECTIVE

To determine the proportion of adults with diabetesin the U.S. who have received diabetes patient education and to assess factors that determine whether patients receive this education.

RESEARCH DESIGN AND METHODS

A questionnaire on diabetes was administered to a representative sample of 2,405 diabetic individual≥18 years of age in the U.S. population. The questionnaire inquired about whether these individuals had ever attended a diabetes education class or program. Sociodemographic and clinical factors that may influence participation in patient education were also determined.

RESULTS

Of all people with diabetes, 35.1% had attended a class or program about diabetes at some time during the course of their disease,including 58.6% of individuals with insulin-dependent diabetes mellitus, 48.9% of insulin-treated individuals with non-insulin-dependent diabetes mellitus (NIDDM), and 23.7% of NIDDM individuals not treated with insulin. Younger age, black race, residence in the midwest region of the U.S., higher level of education, and presence of diabetes complications were consistentlyassociated with having had diabetes education for people with NIDDM. Although increasing income was associated with patient education for NIDDM individuals not treated with insulin, it was not an independent determinant for insulin-treated NIDDM individuals. NIDDM individuals not treated with insulin who lived alone were more likely to have had patient education than those who did not live alone. Not having a diabetes physician or not visiting onein the past year was associated with a higher likelihood of patient education for non-insulin-treated NIDDM individuals.

CONCLUSIONS

A large proportion of patients with diabetes has never received , diabetes education. Patient education has been recognized for its contributions to reducing the morbidity and mortality of diabetes. Consequently, special attention should be directed to the subgroups of individuals, such as those not taking insulin, those with lower socioeconomic status, and those living outside urban areas, in which the frequency of diabetes patient education is particularly low.
Nurse Practitioner Practice Patterns Based on Standards of Medical Care for Patients With Diabetes
Authors: Fain James A , Melkus Gail D'Eramo
Published: March 2007

OBJECTIVE

To determine to what extent nurse practitioner (NP) practice patterns of diabetes care are consistent with standards of care suggested by the American Diabetes Association (ADA).

RESEARCH DESIGN AND METHODS

A descriptive study was conducted to examine practice patterns. A convenience sample of 78 charts was audited, representing a proportionate number of charts for each of the six masters-prepared, certified NPs employed in an ambulatory primary-care center.

RESULTS

Practice patterns related to diabetes care revealed a discrepancy between established standards of care and the degree to which care was documented. All six NPs acknowledged that they became clinically competent to care for patients with diabeteson the job.

CONCLUSIONS

Results of this small study suggest that NPs are not consistently following standards of care suggested by the ADA.
Complications of the Pump Pocket May Represent a Significant Cause of Incidents With Implanted Systems for Intraperitoneal Insulin Delivery
Authors: Renard Eric , Bringer Jacques , Jacques-Apostol Dominique , Lauton Dominique , Mestre Christéle , Costalat Guy , Jaffiol Claude
Published: March 2007

OBJECTIVE

To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs).

CASES

There were 7 cases of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors.

RESULTS

Seven of 40 type I diabetic patients treated by PIP presented severe complications of the pump-pocket, resulting in five definitive explantations and nine other surgical interventions. The lesions included an exudative reaction in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative staphylococcus was identified in the pump-pocket in four patients, including three cases of skin erosion. No specific risk of local complications could be attributed to age, sex, duration of diabetes, body mass index, presence of retinopathy or peripheral neuropathy, HbA1c level since implantation, depth of implantation in the abdominal wall, or duration of experience with PIP. Usual physical activity corresponding to >2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor.

CONCLUSIONS

From these results, we suggest that physical activity should be limited to moderate exercise and exclude vigorous efforts in diabetic patients treated by PIP to avoid an increased risk of complications at the implantation site.
Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men
Authors: Chan June M , Rimm Eric B , Colditz Graham A , Stampfer Meir J , Willett Walter C
Published: March 2007

OBJECTIVE

To investigate the relation between obesity, fat distribution, and weight gain through adulthood and the risk of non-insulin-dependent diabetes melli-tus (NIDDM).

RESEARCH DESIGN AND METHODS

We analyzed data from a cohort of 51,529 U.S. male health professionals, 40-75 years of age in 1986, who completed biennial questionnaires sent out in 1986, 1988, 1990, and 1992. During 5 years of follow-up (1987-1992), 272 cases of NIDDM were diagnosed among men without a history of diabetes, heart disease, and cancer in 1986 and who provided complete health information. Relative risks (RRs) associated with different anthropometrie measures were calculated controlling for age, and multivariate RRs were calculated controlling for smoking, family history of diabetes, and age.

RESULTS

We found a strong positive association between overall obesity as measured by body mass index (BMI) and risk of diabetes. Men with a BMI of ≥35 kg/m2 had a multivariate RR of 42.1 (95% confidence interval [CI] 22.0-80.6) compared with men with a BMI <23.0 kg/m2. BMI at age 21 and absolute weight gain throughout adulthood were also significant independent risk factors for diabetes. Fat distribution, measured by waist-to-hip ratio (WHR), was a good predictor of diabetes only among the top 5%, while waist circumference was positively associated with the risk of diabetes among the top 20% of the cohort.

CONCLUSIONS

These data suggest that waist circumference may be a better indicator than WHR of the relationship between abdominal adiposity and risk of diabetes. Although early obesity, absolute weight gain throughout adulthood, and waist circumference were good predictors of diabetes, attained BMI was the dominant risk factor for NIDDM; even men of average relative weight had significantly elevated RRs.
Maximizing Foot Salvage by a Combined Approach to Foot Ischemia and Neuropathic Ulceration in Patients With Diabetes: A 5-year experience
Authors: Rosenblum Barry I , Pomposelli Frank B , Giurini John M , Gibbons Gary W , Freeman Dorothy V , Chrzan James S , Campbell David R , Habershaw Geoffrey M , LoGerfo Frank W
Published: March 2007

OBJECTIVE

The combination of peripheral neuropathy and arterial insufficiency in patients with diabetes frequently results in chronic non-healing foot ulcers. These patients often have a protracted course that commonly ends in limb amputation.

RESEARCH DESIGN AND METHODS

Since 1987, 39 diabetic patients presented with 42 neuropathic ulcerations beneath the lesser metatarsal heads, complicated by severe arterial insufficiency. A variety of vascular reconstructions were performed to improve circulation to the foot. After successful vascular reconstruction, 14 patients with deep ulcers underwent resection of the involved bone or joint through a plantar elliptical incision with excision of the ulcer and primary closure (33%). Five patients required a simultaneous panmetatarsal head resection (12%). For fifteen superficial ulcers, metatarsal osteotomy through a dorsal approach was performed (36%). Eight patients underwent a fifth metatarsal head resection through a dorsal approach (19%).

RESULTS

In follow-up of 2–64 months (mean 21.2 months), 35 extremities with patent bypass grafts achieved and maintained primary healing of their local foot procedure (83%). Two feet required subsequent revision but ultimately healed (5%). Three feet (7%) developed a new plantar ulceration adjacent to the original one. In two extremities, the foot remained healed in spite of thrombosis of their grafts (5%). One patient with a thrombosed graft required a below-knee amputation. One patient died before the foot healed with a patent bypass graft. Overall, 40 of 42 extremities (95%) ultimately healed over the course of the follow-up period.

CONCLUSIONS

We conclude that complex neuropathic ulcers in diabetic patients can be successfully treated by an aggressive surgical approach that removes infected bone and ulcers and corrects underlying structural abnormalities provided arterial insufficiency is corrected first.
Structure and Correlates of Diabetes-Specific Locus of Control
Authors: Peyrot Mark , Rubin Richard R
Published: March 2007

OBJECTIVE

To examine the structure and correlates of diabetes-specific locus of control.

RESEARCH DESIGN AND METHODS

Study participants were 165 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program. The protocol included measures of diabetes locus of control (DLC), glycemie control, self-care behavior, and emotional well-being.

RESULTS

Scales measuring internal and powerful other DLC each had two components. One component of internal DLC, autonomy, was significantly associated with positive outcomes, and the other component, self-blame, was related to negative outcomes. The two components of powerful other DLC were differently correlated with various aspects of strict regimen adherence, and chance DLC was associated with a variety of measures reflecting a pattern of dysfunction.

CONCLUSIONS

The concept of DLC appears to have explanatory power in accounting for health outcomes, especially when internal DLC measures of autonomy and self-blame are differentiated. It is important to find educational interventions that work effectively with patients who believe that health outcomes are controlled by chance, because they seem to be at special risk for health-related problems.
Increased Transcapillary Escape Rate of Albumin in Microalbuminuric Type II Diabetic Patients
Authors: Nannipieri Monica , Rlzzo Loredana , Rapuano Antonella , Pilo Alessandro , Penno Giuseppe , Navalesi Renzo
Published: March 2007

OBJECTIVE

To evaluate microvascular permeability by the transcapillary escape rate of albumin (TERalb) in type II diabetic patients with normo- and microalbuminuria.

RESEARCH DESIGN AND METHODS

The TERalb has been measured following intravenous injection of 125I-labeled human serum albumin in 32 normotensive type II diabetic patients and 9 healthy control subjects matched for sex and age. Type II diabetic subjects were grouped in normoalbuminuric, albumin excretion rate (AER) <20 μg/min (n = 18), and microalbuminuric, AER 20-200 μg/min (n = 14) categories.

RESULTS

In type II diabetic patients, no differences were noted between normo- and microalbuminuric groups for known diabetes duration (8.3 ± 5.9 vs. 11.7 ± 8.0 years), blood pressure (BP) (129/76 ± 16/8 vs. 131/76 ± 14/5 mmHg), current metabolic control (HbA1c: 8.0 ± 1.4 vs. 8.5 ± 1.6%), and serum lipids. However, previous 2-year mean HbA1c levels were significantly higher in microalbuminuric patients (8.7 ± 1.45 vs. 7.6 ± 1.29%; P < 0.05). The TERalb was similar in control subjects and normoalbuminuric patients (5.16 ± 1.09 vs. 5.71 ± 1.66 %/h) and significantly higher in the microalbuminuric group (8.98 ± 1.35 %/h; P < 0.0001). The increased leak of albumin was not explained by differences in diabetes duration, BP, or metabolic control at the time of investigation and was independently related to the presence of microalbuminuria (r = 0.63, percent explained variance ∼40) and mean “historical” HbA1c (multiple r = 0.705; total explained variance ∼50%).

CONCLUSIONS

Type II diabetic patients with microalbuminuria show an increased TERalb, i.e., a widespread microvascular damage that may be important in the pathogenesis of long-term complications. Our findings may contribute to the explanation of why albuminuria seems to be an independent cardiovascular risk factor in type II diabetes.
Why Do Low-Fat High-Carbohydrate Diets Accentuate Postprandial Lipemia in Patients With NIDDM?
Authors: Chen Y-D Ida , Coulston Ann M , Zhou Ming-Yue , Hollenbeck Clarie B , Reaven Gerald M
Published: March 2007

OBJECTIVE

To understand why low-fat high-carbohydrate (CHO) diets lead to higher fasting and postprandial concentrations of triglyceride (TG)-rich lipoproteins in patients with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Patients with NIDDM were placed randomly on diets containing either 55% CHO, 30% fat, and 15% protein or 40% CHO, 45% fat, and 15% protein for 6 weeks, followed by crossover to the other diet. Test meals at the end of each diet period were consumed at 8:00 A.M. and 12:00 P.M. (noon) and contained 20 and 40% of daily calories, respectively. Vitamin A was also given at noon, and TG-rich lipoproteins of intestinal origin were identified by the presence of vitamin A esters. Frequent measurements were made throughout the 24-h study period of plasma glucose, insulin, and TG concentrations. Plasma samples obtained from 12:00 P.M. (noon) until 12 A.M. (midnight) were subjected to ultracentrifugation, and measurements were made of TG and vitamin A ester concentrations in plasma and in both the Svedberg flotation constant (Sf) >400 (chylomicron) and Sf 20-400 (chylomicron remnant) lipoprotein fractions. In addition, very-low-density lipoprotein (VLDL)-TG turnover rate was estimated by following the decay of [3H]VLDL-TG. Finally, postheparin lipoprotein lipase and hepatic lipase activities were measured at the end of each dietary period.

RESULTS

Mean ± SE hourly concentrations of glucose (8.0 ± 0.8 vs. 7.5 ± 0.7 mmol/1), insulin (184 ± 26 vs. 158 ± 19 pmol/1), and TG (2.8 ± 0.2 vs. 2.1 ± 0.2 mmol/1) were higher (P < 0.05-0.001) after the 55% CHO diet. The 55% CHO diet also led to an increase (P < 0.05-0.01) in the mean ± SE hourly concentrations of vitamin A esters in plasma (2.3 ± 0.3 vs. 1.6 ±0.1 μmol/l) and in both the chylomicron (2.0 ± 0.3 vs. 1.4 ±0.1 μmol/l) and chylomicron remnant fractions (0.36 ± 0.04 vs. 0.14 ± 0.03 μmol;/l). In addition, the VLDL-TG production rate was higher (17.2 ± 1.4 vs. 12.8 ± 1.0 mg · kg−1 · h−1, P < 0.003) and the VLDL-TG fractional catabolic rate lower (0.22 ± 0.02 to 0.28 ± 0.02 l/h, P < 0.005) after the 55% CHO diet. Finally, there was an increase in lipoprotein lipase activity (7.0 ± 0.8 to 8.1 ± 0.7 μmol free fatty acids released · ml−1 · h−1, P < 0.02) in response to the CHO-enriched diet.

CONCLUSIONS

A low-fat high-CHO diet in patients with NIDDM led to 1) higher day-long plasma glucose, insulin, and TG concentrations; 2) postprandial accumulation of TG-rich lipoproteins of intestinal origin; 3) increased production of VLDL-TG; and 4) increased postheparin lipoprotein lipase activity. These data provide a mechanism for the hypertriglycer-idemic effect of CHO-enriched diets in patients with NIDDM and demonstrate that multiple risk factors for coronary heart disease are accentuated when these individuals consume diets recommended to reduce this risk.
Effect of Topical Basic Fibroblast Growth Factor on the Healing of Chronic Diabetic Neuropathic Ulcer of the foot: A pilot, randomized, double-blind, placebo-controlled study
Authors: Richard Jean-Louis , Parer-Richard Claire , Daures Jean-Pierre , Clouet Sophie , Vannereau Denyse , Bringer Jacques , Rodier Michel , Jacob Claudine , Comte-Bardonnet Martine
Published: March 2007

OBJECTIVE

To assess the efficacy and safety of topical human recombinant basic fibroblast growth factor (bFGF) on the healing of diabetic neurotrophic foot ulcers.

RESEARCH DESIGN AND METHODS

Seventeen diabetic patients suffering from chronic neuropathic ulcer of the plantar surface of the foot entered a pilot, randomized, double-blind study comparing local application of bFGF with placebo. Main inclusion criteria were a typical neuropathic ulcer of Wagner grade I-III, more than 0.5 cm in the largest diameter, with an abnormally high vibration perception threshold in the absence of significant peripheral vascular disease or wound infection. bFGF or placebo was applied daily during the 6 weeks as inpatients then twice a week for 12 weeks. Evolution of ulcer size was assessed through weekly clinical examination and computerized photographs.

RESULTS

In the bFGF group, three of nine ulcers healed compared with five of eight in the placebo group (NS). The weekly reduction in ulcer perimeter and area was identical in both groups, as was the rate of linear advance from entry to the 6th week of treatment (bFGF: 0.053 ± 0.048 mm vs. placebo: 0.116 ± 1.129 mm): the same result was obtained at the 11th week. Moreover, percent healed area at the end of the study did not differ significantly. No side effects were observed during bFGF application.

CONCLUSIONS

Topical application of bFGF has no advantage over placebo for healing chronic neuropathic diabetic ulcer of the foot. Because diabetes causes significant wound-healing defects, we hypothesized that using a single growth factor might be insufficient to accelerate wound closure of diabetic ulcers.
Effect of Aging on HbA1c in a Working Male Japanese Population
Authors: Hashimoto Yoshiaki , Futamura Azusa , Ikushima Miharu
Published: March 2007

OBJECTIVE

To evaluate whether there is any change in HbA1c with age and to determine the effects of body mass index (BMI), exercise, and family history of diabetes on this change.

RESEARCH DESIGN AND METHODS

A cross-sectional survey of 7,664 male Japanese workers aged 20–59 years was performed. All subjects received a physical examination that included measurement of HbA1c as an indicator of plasma glucose level. The subjects were classified according to their ages and BMIs, and any relationship with HbA1c levels was evaluated. Information on physical activity and family history of diabetes was obtained by a questionnaire.

RESULTS

In all BMI groups, HbA1c increased with age. The greatest increase in HbA1c was observed in the 40- to 49-year-old age-group in subjects with a BMI ≤26 kg/m2 and in the 30- to 39-year-old age-group in subjects with a BMI >26. HbA1c in the subjects aged 20–29 years did not change with BMI. In contrast, HbA1c in subjects aged 30–59 years was significantly higher in those with a BMI >26 when compared with those with BMI ≤20. The age-dependent increase in HbA1c was greater in subjects with a positive rather than negative family history of diabetes. This age-dependent increase was not affected by active participation in sporting activities of mild to moderate intensity for 3 or more days per week.

CONCLUSIONS

The age-dependent increase in HbA1c may be a consequence of the aging process itself. Furthermore, both BMI and a hereditary predisposition to diabetes, but not active participation in sports, affect this age-dependent increase in HbA1c.
Elevated Serum Total Renin Is Insensitive in Detecting Incipient Diabetic Nephropathy
Authors: Matinlauri Irma H , Rönnemaa Tapani , Koskinen Pertti J , Aalto Maija A , Viikari Jorma S A , Irjala Kwrttu M A
Published: March 2007

OBJECTIVE

To assess the influence of incipient diabetic nephropathy on the levels of total renin in serum.

RESEARCH DESIGN AND METHODS

Fifty-five adult patients with insulin-dependent diabetes mellitus (IDDM) were examined in a cross-sectional study. The main outcome measures were serum total renin concentration and urinary albumin excretion rate.

RESULTS

The total renin concentrations in serum were significantly (P < 0.05) higher in 12 patients with microalbuminuria than in 43 patients without albuminuria, but this difference was significant only in men. There was a significant but weak positive correlation between urinary albumin excretion rate and serum total renin concentration in all patients (r = 0.412, P < 0.05, n = 55), but the sensitivity of high serum concentrations of total renin in detecting incipient nephropathy was low (17%). In the study group, two of the three patients suffering from proliferative retinopathy had the highest total renin concentrations in serum.

CONCLUSIONS

Microalbuminuric patients have higher mean serum total renin concentrations than normoalbuminuric patients, but because of low sensitivity, high total renin concentration cannot be used for screening incipient diabetic nephropathy.
Ginseng Therapy in Non-Insulin-Dependent Diabetic Patients: Effects on psychophysical performance, glucose homeostasis, serum lipids, serum aminoterminalpropeptide concentration, and body weight
Authors: Sotaniemi Eero A , Haapakoski Eila , Rautio Arja
Published: March 2007

OBJECTIVE

To investigate the effect of ginseng on newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) patients.

RESEARCH DESIGN AND METHODS

In this double-blind placebo-controlled study, 36 NIDDM patients were treated for 8 weeks with ginseng (100 or 200 mg) or placebo. Efficacy was evaluated with psychophysical tests and measurements of glucose balance, serum lipids, aminoterminalpropeptide (PIIINP) concentration, and body weight.

RESULTS

Ginseng therapy elevated mood, improved psychophysical performance, and reduced fasting blood glucose (FBG) and body weight. The 200-mg dose of ginseng improved glycated hemoglobin, serum PIIINP, and physical activity. Placebo reduced body weight and altered the serum lipid profile but did not alter FBG.

CONCLUSIONS

Ginseng may be a useful therapeutic adjunct in the management of NIDDM.
Albuminuria and 24-h Ambulatory Blood Pressure in Normoalbuminuric and Microalbuminuric NIDDM Patients. A longitudinal study
Authors: Nielsen Søren , Schmitz Anita , Poulsen Per L , Hansen Klavs W , Mogensen Carl E
Published: March 2007

OBJECTIVE

To assess the long-term relationships between 24-h ambulatory blood pressure (AMBP), urinary albumin excretion (UAE) rate, and metabolic control in non-insulin-dependent diabetes mellitus (NIDDM) patients with normo- and microalbuminuria.

RESEARCH DESIGN AND METHODS

We conducted a prospective study of 23 NIDDM patients (11 with normoalbuminuria and 12 with microalbuminuria) receiving standard clinical care, including antihypertensive treatment, attending the outpatient clinic and 8 healthy control subjects. Twenty-four-hour AMBP and UAE were measured synchronously in addition to fasting plasma glucose, HbA1c, and serum creatinine at baseline and after 4.6 (4.2−5.1) years [mean (range)].

RESULTS

Baseline systolic, but not diastolic, 24-h AMBP was significantly higher in diabetic patients compared with control subjects (146/80 [16/11] vs. 133/78 [9/9] mmHg, P < 0.05), but was similar in normoalbuminuric (143/81 [11/11] mmHg) and microalbuminuric (148/80 [20/10] mmHg) patients during strict blood pressure control. The annual increase in 24-h AMBP was equivalent in diabetic patients (0.6/−0.2 [2.6/1.5] mmHg/year) and control subjects (0.7/0.2 [1.2/1.4] mmHg/year, NS) and not significantly different from zero. Overall UAE did not change in control subjects (5.6 [1.6] vs. 4.4 [1.9]) (geometric mean [antilog SD]) or in the normoalbuminuric (8.7 [1.7] vs. 11.3 [3.0] ¼g/min) and microalbuminuric (35.7 [2.1] vs. 34.5 [3.2] μg/min) patients. In diabetic patients, the annual change in UAE correlated significantly with the annual change in the systolic (r = 0.61, P < 0.002) and diastolic (r = 0.54, P < 0.008) 24-h AMBP. In microalbuminuric patients, only the annual increase in systolic 24-h AMBP correlated significantly with the annual change in UAE (r = 0.71, P = 0.010), whereas in the normoalbuminuric patients, only the annual increase in diastolic 24-h AMBP and the annual change in UAE were significantly correlated (r = 0.66, P = 0.026). In a stepwise multiple linear regression analysis, the annual progression in albuminuria in NIDDM patients was significantly determined by increases in systolic (parameter estimate 0.018, SE 0.006, P < 0.008) as well as in diastolic 24-h AMBP (parameter estimate 0.026, SE 0.011, P < 0.033).

CONCLUSIONS

In an outpatient clinical setting, 24-h AMBP is similar in NIDDM patients with normo- and microalbuminuria. Alterations in both 24-h AMBP and UAE are on average moderate and equivalent compared with those in healthy control subjects. Although the average change in albuminuria is small, a progression in albuminuria relates to increments in both systolic and diastolic 24-h AMBP.