bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Levels of Tumor Necrosis Factor and IL-1α and IL-1β in Diabetic Patients
Authors: Mooradian Arshag D , Reed Richard L , Meredith Keith E , Scuderi Philip
Published: March 2007

Objective

To determine whether chronic hyperglycemia causes increased levels of serum tumor necrosis factor (TNF) and interleukin 1 α (IL-1 α) and IL-1 β.

Research Design and Methods

Sera were obtained from 59 diabetic patients, 44 chronically ill nondiabetic patients, and 34 age-matched healthy control subjects. Mononuclear cells were isolated from a subgroup of diabetic patients and healthy control subjects.

Results

Except for a modest increase in the prevalence of detectable serum TNF levels in diabetic patients, the serum cytokines measured in this study did not appear to be altered in diabetes. In vitro TNF production by mononuclear cells was not altered in diabetic patients. However, in vitro IL-1 β secretion, in response to lipopolysaccharides, was reduced.

Conclusions

Diabetes mellitus is not associated with significant changes in serum levels of TNF, IL-1 α, or IL-1 β. In vitro secretion of IL-1 β in response to lipopolysaccharides may be reduced in diabetes.
Smoking and Diabetes Mellitus: Findings From 1988 Behavioral Risk Factor Surveillance System
Authors: Ford Earl S , Newman Jeffrey
Published: March 2007

Objective

To examine the association between smoking and self-reported diabetes mellitus.

Research Design and Methods

The study was comprised of 3006 people ≥18 yr of age with diabetes and 52,750 without diabetes.

Results

Twenty-six percent (SE 1.8) of the diabetic population were current smokers, 25.9% (SE 1.4) were former smokers, and 48.1% (SE 2) had never smoked. Similar percentages were found among the nondiabetic population. Compared to respondents without diabetes, the prevalence of current smoking was notably higher among respondents with diabetes who were between the ages of 18 and 34 yr (36.1%, SE 4.1), who had not graduated from high school (44.9%, SE 3.7), and who were men of African-American origin (54.8%, SE 5.8).

Conclusions

Despite the excess risks, the overall prevalence of smoking in the diabetic population is comparable to that of the general population. Our finding of a higher prevalence of smoking among young people, people who had not graduated from high school, and African-American men with diabetes suggests that additional educational efforts should be targeted at these groups.
Hand Skin Blood Flow in Diabetic Patients With Autonomic Neuropathy and Microangiopathy
Authors: Hauer Joao L , Boland Oliver M , Ewing David J , Clarke B F
Published: March 2007

Objective

To determine whether changes in hand skin blood flow in diabetic men could be demonstrated with liquid crystal contact thermography and to assess the relative effects of autonomic neuropathy and microangiopathy on these changes.

Research Design and Methods

Thirty-four diabetic and 12 age-matched nondiabetic men comprised the study. The diabetic men were categorized according to standard cardiovascular autonomic function tests and the presence or absence of background or proliferative retinopathy and/or proteinuria. Bilateral hand thermograms were measured at rest and after immersion of the right hand in ice-cold water.

Results

Diabetic men with definite or severe autonomic neuropathy (n = 13) had a high frequency of anisothermal baseline thermograms (77 vs. 25% in nondiabetic subjects, P < 0.05). After ice-cold water immersion, right-hand recovery was abnormally slow (514 ± 157 arbitrary U, area under the curve) compared with nondiabetic men (685 ± 135 arbitrary U, P < 0.01). Diabetic men with proliferative retinopathy (n = 8) all had definite or severe autonomic neuropathy and showed the same abnormalities. Diabetic men with nor or early autonomic changes showed normal thermographic patterns.

Conclusions

These results are consistent with increased palmar arteriovenous shunt blood flow or capillary closure in the hands of diabetic patients with definite or severe autonomic neuropathy. They indicate that thermoregulatory reflex changes in hand skin blood flow are controlled by the autonomic nervous system. It is possible, however, that diabetic microangiopathy, associated with the presence of proliferative retinopathy, also independently affects hand skin blood flow.
Topical Phenytoin in Diabetic Foot Ulcers
Authors: Muthukumarasamy M Govindraj , Sivakumar Gurumurthy , Manoharan Govindan
Published: March 2007

Objective

The efficacy of topical phenytoin in the treatment of diabetic foot ulcers was evaluated in a controlled inpatient study.

Research Design and Methods

Fifty patients were treated with topical phenytoin, and 50 patients matched for age, sex, and ulcer areas, depth, chronicity, and infection were dressed with dry sterile occlusive dressing.

Results

Both groups improved, but the ulcers treated with topical phenytoin healed more rapidly. Mean time to complete healing was 21 days with phenytoin and 45 days with control. The differences seen were statistically significant (P < 0.05) via the chi 2 test.

Conclusions

Phenytoin appears to be useful as a topical agent in promoting the healing of diabetic foot ulcers.
Contact Thermography of Painful Diabetic Neuropathic Foot
Authors: Chan Ah Wah , MacFarlane Ian A , Bowsher David R
Published: March 2007

Objective

To investigate regional differences in skin blood flow (measured by contact thermography) in the diabetic neuropathic foot and to examine the effect of foot temperature on the severity of neuropathic pain.

Research Design and Methods

Thirty-five diabetic patients with painful polyneuropathy (PPN) and 33 healthy age- and sex-matched control subjects comprised the study. Mean foot temperature (MFT) in PPN (mean ± SE 28.3 ± 0.3 ° C) was significantly higher (P < 0.001) than in the control subjects (25.9 ± 0.5 ° C), with the highest temperatures over the metatarsal areas and heel. Visual analogue scale pain score (mean ± SD 5.3 ± 1.9 cm) did not correlate with MFT (r = −0.14, P = 0.52). In 10 patients with PPN followed for 2–8 mo (mean 4.6), MFT fell by 1.6 ° C (P = 0.05), but pain scores did not alter.

Conclusions

Neuropathic pain is unaffected by alterations in skin temperature. Elevated skin temperatures at recognized sites of weight bearing (metatarsal heads and heels) are common in the diabetic neuropathic foot and may indicate tissue injury or inflammation induced by pressure trauma or increased arteriovenous shunting. Follow-up studies will determine whether thermographic hot spots are more susceptible to ulceration.
Effect of Puberty on Insulinlike Growth Factor I and HbA1 in Type I Diabetes
Authors: Rogers Douglas G , Sherman Lori D , Gabbay Kenneth H
Published: March 2007

Objective

To assess the effect of puberty on the relationship between glycemic control and insulinlike growth factor I (IGF-I) levels in children with insulin-dependent (type I) diabetes mellitus.

Research Design and Methods

Simultaneous HbA1 and plasma IGF-I levels were determined in 71 prepubertal (Tanner stage I) and 112 pubertal (Tanner stages II-V) subjects aged 2.7–17.8 yr.

Results

Overall, IGF-I levels were positively correlated with both age (r = 0.31, P < 0.001) and Tanner stage (r = 0.32, P < 0.001) but only weakly associated with HbA1 values (r = −0.16, P = 0.025). A strong negative association existed between IGF-I and HbA1 levels (r = −0.45, P < 0.001) in the pubertal subjects, but no such association was apparent in the prepubertal subjects. Multiple regression analyses disclosed a significant independent negative association between IGF-I and HbA1 levels in the pubertal group (P < 0.001) but not in the prepubertal group.

Conclusions

Glycemic control appears to strongly influence IGF-I levels only after the onset of puberty.
Copper, Zinc, Manganese, and Magnesium Status and Complications of Diabetes Mellitus
Authors: Walter Rober M , Uriu-Hare Janet Y , Olin Katherine Lewis , Oster Michelle H , Anawalt Bradley D , Critchfield James W , Keen Carl L
Published: March 2007

Objective

To evaluate copper, zinc, manganese, magnesium, and other indices of peroxidative status in diabetic and nondiabetic human subjects.

Research Design and Methods

Convenience sample of 57 insulin-dependent or non-insulin-dependent diabetic subjects recruited from the diabetes clinic of the University of California, Davis, Medical Center and 28 nondiabetic subjects recruited from the staffs of the Departments of Internal Medicine and Nutrition. Individuals conducting laboratory analyses were blind to subject group. A fasting blood sample was collected from all subjects and appropriately processed for future analyses. A 24-h urine collection was obtained in a subset of subjects.

Results

Hyperzincuria and hypermagnesuria were evident in diabetic subjects compared with control subjects. There were no differences in plasma magnesium or whole-blood manganese between groups. Plasma copper was higher and plasma zinc was lower in diabetic than in control subjects. When data were viewed with respect to specific diabetes-associated complications, diabetic subjects with retinopathy, hypertension, or microvascular disease had higher plasma copper concentrations compared with both diabetic subjects without complications and with control subjects. There were no significant differences between control and diabetic subjects in erythrocyte copper-zinc superoxide dismutase activity or whole-blood glutathione peroxidase or glutathione reductase activities. Plasma peroxide concentrations were higher in diabetic than control subjects.

Conclusions

Diabetes can alter copper, zinc, magnesium, and lipid peroxidation status. Perturbations in mineral metabolism are more pronounced in diabetic populations with specific complications. It is not known whether differences in trace element status are a consequence of diabetes, or alternatively, whether they contribute to the expression of the disease.
Receiver Operating Characteristic Analysis on Fasting Plasma Glucose, HbA1c, and Fructosamine on Diabetes Screening
Authors: Tsuji Ichiro , Nakamoto Kazuya , Hasegawa Toshihiko , Hisashige Akinori , Inawashiro Hiroshi , Fukao Akira , Hisamichi Shigeru
Published: March 2007

Objective

To determine the efficacy of HbA1c and fructosamine as alternatives to fasting plasma glucose (FPG) for diabetes screening.

Research Design and Methods

Receiver operating characteristic (ROC) analysis was conducted on the above tests. Comparison among tests was based on the area under ROC curve of a test. World Health Organization criteria for classifying glucose tolerance status of the subjects was used. The study consisted of subjects (n = 583) who visited the clinic from September to October 1989 and all diabetic cases (n = 36) from November 1989 to March 1990, after excluding those < 40 yr of age or with hypoglycemic therapies (469 were normal, 88 with impaired glucose tolerance [IGT], and 62 with diabetes).

Results

Area under ROC curve of HbA1c was not different from that of FPG. Area under curve of fructosamine was significantly smaller than that of FPG. For all tests, overall efficacy of a test to detect IGT and diabetes was considerably diminished compared with detection of diabetes alone.

Conclusions

The discriminating ability of HbA1c is almost the same as that of FPG, therefore HbA1c is a good alternative to FPG. Fructosamine is not suitable for diabetes screening.
Altering Triglyceride Concentrations Changes Insulin-Glucose Relationships in Hypertriglyceridemic Patients: Double-Blind Study With Gemfibrozil With Implications for Atherosclerosis
Authors: Steiner George
Published: March 2007

Objective

To determine whether reducing triglyceride concentrations in humans reduces serum insulin levels and consider the implications of this for the insulin resistance of hypertriglyceridemia.

Research Design and Methods

Insulin and glucose levels were determined during an oral glucose tolerance test (OGTT) in 14 volunteers who had a range of basal triglyceride levels. A double-blind crossover design was used to study active and placebo gemfibrozil and relate triglyceride changes to insulin and glucose levels. Diet and weight were kept constant.

Results

Glucose concentrations during OGTT were the same in both treatment periods. Insulin concentrations were reduced in proportion to reductions in triglyceride.

Conclusions

Triglyceride reduction in hypertriglyceridemic patients is associated with a decrease in serum insulin. This does not appear to be a direct effect of gemfibrozil, because it does not occur without a sufficient fall in triglyceride levels. Because glucose concentration remains the same despite the reduced insulin, the triglyceride reduction may result in greater sensitivity to insulin. Treatment of hypertriglyceridemia may break a vicious and potentially atherogenic cycle of hypertriglyceridemia and hyperinsulinemia.
Inverse Association Between Fish Intake and Risk of Glucose Intolerance in Normoglycemic Elderly Men and Women
Authors: Feskens Edith JM , Bowles Carel H , Kromhout Daan
Published: March 2007

Objective

To examine the association of fish intake with the subsequent risk of impaired glucose tolerance and diabetes mellitus (glucose intolerance).

Research Design and Methods

In 1971, information about food intake was obtained by the cross-check dietary history method on 175 men and women aged 64-87 yr who were normoglycemic and free of clinical diabetes. During the follow-up period from 1972 to 1975, an oral glucose tolerance test was performed annually, and in 59 of 175 elderly people a diagnosis of glucose intolerance was made at least once.

Results

In 1971, ~ 60% of the subjects usually ate fish, with a mean daily intake of 24.2 g. In fish eaters, the incidence of glucose intolerance was significantly lower compared with nonfish eaters (odds ratio [OR] 0.40, 95% confidence interval [CI] 0.21-0.77). With logistic regression analysis, this inverse association could not be explained by taking into account age and sex or possible confounding baseline characteristics, such as the prevalence of myocardial infarction, body mass index, energy intake per kilogram body weight, or intake of carbohydrates (OR 0.47, 95% CI 0.23-0.93). Baseline characteristics of the oral glucose tolerance test and serum triglyceride levels could also not account for this result.

Conclusions

These results suggest that, in an elderly population, the habitual consumption of a small amount of fish may protect against the development of impaired glucose tolerance and diabetes mellitus.
Effects of Combination Therapy With Glyburide and Insulin on Serum Lipid Levels in NIDDM Patients With Secondary Sulfonylurea Failure
Authors: Karlander Sven G , Gutniak Mark KM , Efendic Suad
Published: March 2007

Objective

To compare the long-term effect of combined treatment with insulin and glyburide versus insulin alone on serum lipid levels in non-insulin-dependent diabetic (NIDDM) patients with secondary failure to sulfonylurea therapy.

Research Design and Methods

The study was a randomized double-blind placebo-controlled parallel trial with a duration of 325 days. The study was conducted at a referral-based endocrinology clinic. Subjects were a sequential sample of 20 patients with NIDDM with failure to respond to glyburide treatment after at least 1 yr of adequate glucose control with this therapy. The patients were randomized to treatment with insulin and glyburide (IG) or insulin and placebo (IP). Insulin was given twice daily to all patients as a mixture of NPH and regular insulins in dosages aiming at optimal glucose control. Glyburide or placebo was taken before breakfast (7 mg) and dinner (3.5 mg).

Results

Mean HbA1c decreased from 11.1% (range 9.8–12.9%) before insulin to 9.1% (range 6.8–11.4%) on day 325 (P < 0.001) in IG patients and from 10.3% (range 8.4–13.3%) to 9.0% (range 6.3–11.8%) (P < 0.05) in IP patients. In both groups, there was an increase in high-density lipoprotein cholesterol of ~ 20% lasting throughout the study (P < 0.01). During the first 83 days of the study, there was a decrease in serum cholesterol (P < 0.01) and serum triglycerides (P < 0.05) in both groups. All changes in lipid variables were comparable in magnitude and duration in both treatment with insulin and glyburide in NIDDM patients with secondary sulfonylurea failure improves lipid metabolism to a similar degree as insulin therapy alone.
Evaluation of Fasting Plasma Glucose as Screening Test for NIDDM in Older Adults: Rancho Bernardo Study
Authors: Blunt Barbara A , Barrett-Connor Elizabeth , Wingard Deborah L
Published: March 2007

Objective

To examine the efficiency of fasting plasma glucose (FPG) as a screening test for non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH AND METHODS DESIGN: A population-based evaluation was made of FPG as screening test for NIDDM in an upper middle-class white community of Rancho Bernardo, California. NIDDM was defined by 2-h postchallenge plasma glucose (PCPG) level ≥ 11.1 mM, the cutoff point recommended by the World Health Organization. Participants comprised a population-based sample of 1851 men and women 50–79 yr of age that represented 80% of surviving participants surveyed between 1972 and 1974 for the Lipid Research Clinic Prevalence Study. Those with insulin-dependent diabetes were excluded.

Results

Analyses were stratified by age after logistic regression indicated that FPG and age (but not gender) were significantly related to probability of disease. As FPG cutoff points increased, sensitivity and percentage of the population to be recalled for confirmation decreased, whereas specificity and positive predictive value increased. Negative predictive value was consistently in the 90% range. Specificity did not change with age. In contrast, at virtually every FPG cutoff point, sensitivity decreased with increasing age. For example, at FPG ≥ 6.7 mM, sensitivity was 65.6% for those 50–64 yr of age and 40.0% for those 65–79 yr of age. At FPG ≥ 7.2 mM, these sensitivities were 46.9 and 28.5%, respectively. Positive predictive value increased with increasing age, reflecting the increasing prevalence of NIDDM with age.

Conclusions

Poorer sensitivity with increasing age reflects the fact that the numerator of the sensitivity equation is not affected by age (mean FPG did not vary significantly between age-groups), whereas the denominator increases with age (mean PCPG increased from 6.6 mM for subjects 50–64 yr of age to 8.2 mM for subjects 65–79 yr of age). Nevertheless, because the clinical significance of increasing PCPG with age in older adults is unknown, age-specific screening criteria probably are not warranted.
Dietary Fiber—An Overview
Authors: Anderson James W , Akanji Abayoml O
Published: March 2007

Diabetes diets should aim at ensuring an ideal body weight with normoglycemia and normolipidemia. The consensus recommendations of various diabetes associations suggest that these goals are most likely to be achieved by diets high in complex carbohydrates and fiber and low in fat. A typical diabetes diet containing 55–60% energy as carbohydrate (at least 66% complex), <30% energy as fat, 0.8 g.kg−1 desirable body wt.day−1 protein, and ∼40 g fiber/day, improves glycemic control, reduces levels of serum atherogenic lipids, decreases blood pressure in those with hypertension, and reduces body weight in the obese. This diet also reduces insulin requirements in the insulin-treated patient and can promote discontinuation of insulin therapy in those with non-insulin-dependent diabetes mellitus. This article presents our experience with high-fiber high-carbohydrate diets and reviews knowledge on the likely mechanisms of action of fiber, its long-term effectiveness, and the concerns about its long-term safety. We suggest that reports on the risk of hypertriglyceridemia from on the risk of hypertriglyceridemia from high-carbohydrate diets are inconsistent and invalidated if those diets are also high in fiber content. Similarly, we urge some caution in prescribing high-monounsaturated fat diets as an alternative to high-carbohydrate diets, at least until the long-term implications of the former are clearer. We believe that there is no compelling reason to change the current diabetes diets, which should continue to be high in carbohydrate and fiber content.
Telematic Transmission of Computerized Blood Glucose Profiles for IDDM Patients
Authors: Billiard Alain , Rohmer Vincent , Roques Marie-Agnès , Joseph Marie-Geneviève , Suraniti Sylvestro , Giraud Philippe , Limal Jean-Marie , Fressinaud Philippe , Marre Michel
Published: March 2007

Objective

To improve the analysis of self-monitoring of blood glucose (SMBG) and its communication between patients and physicians by a telematic transmission of computerized SMBG and to study the consequences of its use on glucose control of insulin-dependent diabetic (IDDM) patients.

Research Design and Methods

A prospective randomized crossover trial with two 3-mo periods, one with SMBG recorded on traditional booklets (booklet period) and another with computerized SMBG transmitted to a central data base through a telematic network (telematic period), comprised the study. During the latter phase, patients could receive computerized SMBG analysis on individual terminals connected to the telephone network (Minitel system). Blood glucose recordings and HbA1c were measured at inclusion and end of each period. Eleven pairs of IDDM patients on intensified insulin therapy were randomized within each pair to start with the telematic period (group A) or the booklet period (group B).

Results

Telematic transmissions were successful (<1% failure rate). Although initial HbA1c was low (6.7%), it declined during the telematic period (Δ = -0.41%) compared with the booklet period (Δ = + 0.37%, P = 0.05). The percentage of low (<3.3 mM) blood glucose values correlated with HbA1c changes during the telematic period (r = 0.714, P= 0.0014) but not the booklet period. The patients favored the telematic tool to analyze SMBG.

Conclusions

Telematic transmission of SMBG is feasible. It can improve SMBG analysis and perhaps glucose control, therefore offering a new way of communication between diabetic patients and their physicians.
Role of Peptide Growth Factors in Development of Macrovascular Complications of Diabetes
Authors: Clemmons David R
Published: March 2007

Peptide growth factors provide an important means of coordinating the growth of cells within tissues and organs. Although their role in controlling cell growth is not well understood, they have been implicated in derangements of cellular proliferation that occur in diabetes, e.g., mesangial cell hyperplasia and atherosclerosis. Because several growth factors have been structurally characterized and the cell types on which they act identified, research is focusing on developing model systems to determine whether they are involved in the pathogenesis of specific disease states. New techniques, i.e., in situ hybridization, gene transfection, and detailed structural analysis of proteins, have made it possible to define both changes in the relative abundance of specific growth factors and potential changes in their actions in specific disease states. These techniques are being applied in diabetes research and will make it possible to determine the alterations that have occurred in growth factor synthesis and growth factor-matrix protein interaction and cell-type-specific alterations in cell growth that occur after loss of normal glucose homeostasis. The findings from these types of analyses should lead to a better understanding of how the complications of diabetes develop and rational strategies to control their effects.
Low-Glycemic Index Foods Improve Long-Term Glycemic Control in NIDDM
Authors: Brand Janette C , Colagiuri Stephen , Crossman Shirley , Allen Annette , Roberts David CK , Truswell A Stewart
Published: March 2007

Objective

To compare high- and low-glycemic index (GI) diets in the treatment of non-insulin-dependent diabetes mellitus (NIDDM).

Research Design and Methods

Sixteen subjects with well-controlled NIDDM and normal lipid profile, 10 of whom continued oral hypoglycemic medication, participated in the study. A diet that emphasized low-GI foods (e.g., porridge, pasta) was compared with a high-GI diet (e.g., processed cereals, potatoes). The GI of the low-GI diet was 15% lower than the high-GI diet (77 ± 3 vs. 91 ± 1) but otherwise similar in macronutrient composition and fiber, as determined by a 4-day weighed record. The diets were instituted under instruction from a dietitian who visited subjects at home on a weekly basis. Body weight was maintained within 1–2 kg.

Results

Glycemic control was improved on the low-GI diet compared with the high-GI diet (statistically significant findings, P < 0.05). Mean glycosylated hemoglobin at the end of the low-GI diet was 11% lower (7.0 ± 0.3%) than at the end of the high-GI diet (7.9 ± 0.5%), and the 8-h plasma glucose profile was lower (area under the curve above fasting 128 ± 23 vs. 148 ± 22 mmol.h-1.L-1, respectively). Mean fasting plasma glucose, total cholesterol triglycerides, and lipoproteins did not show important differences.

Conclusions

A low-GI diet gives a modest improvement in long-term glycemic control but not plasma lipids in normolipidemic well-controlled subjects with NIDDM.
Insulin Resistance, Hyperinsulinemia, Hypertriglyceridemia, and Hypertension: Parallels Between Human Disease and Rodent Models
Authors: Reaven Gerald M
Published: March 2007

There is considerable evidence that abnormalities of glucose, insulin, and lipoprotein metabolism occur more frequently in untreated hypertensive patients than in normotensive control subjects. More recently, it has also become apparent that similar metabolic abnormalities occur in rodent models of hypertension. One purpose of this article is to review the experimental data that have led to the above generalizations. The second goal is to address the significance of these findings, which is certainly not clear. For example, it could be argued that the relationship between high blood pressure and the associated metabolic defects is incidental. On the other hand, there is evidence that the changes in glucose, insulin, and lipoprotein metabolism may play a role in the etiology and/or clinical course of patients with high blood pressure. Although it is impossible at this point to definitively choose between these possibilities, an effort is made to marshal the evidence in support of the latter alternative.
Effect of Antihypertensive Drugs on Insulin, Glucose, and Lipid Metabolism
Authors: Lithell Hans O L
Published: March 2007

The close relationship between diabetes and hypertension has been recognized for decades. New information indicates that resistance to insulin action on glucose uptake in peripheral tissues is a common underlying mechanism in hypertension and diabetes. In prospective trials, the effects of antihypertensive agents on insulin sensitivity and lipoprotein metabolism have been evaluated. Both β-blockers and thiazide diuretics worsen insulin resistance and deteriorate lipoprotein metabolism. Angiotensin-converting enzyme (ACE) inhibitors, Ca2+ -channel blockers, and α-blockers are neutral or improve these factors. These data may explain the unexpectedly high incidence of the development of diabetes among treated hypertensives and the poor effect on risk for coronary heart disease in intervention trials.
Insulin-Dependent Diabetes Mellitus and Hypertension
Authors: Nosadini Romano , Fioretto Paola , Trevisan Roberto , Crepaldi Gaetano
Published: March 2007

Contrasting results have been reported regarding the prevalence of hypertension in insulin-dependent diabetes mellitus (IDDM), showing a slightly higher or normal percentage of IDDM patients with elevated blood pressure levels than in the general population. Most of the cross-sectional and prospective studies on the prevalence of hypertension in IDDM show an association between microalbuminuria and elevated blood pressure levels. However, it is not clear whether hypertension is simply secondary to kidney damage or whether hypertension occurs with or even before the development of impaired kidney function. Patients with IDDM have a higher exchangeable body Na+ pool. Na+ retention in IDDM is accounted for by several metabolic and hormonal abnormalities such as hyperglycemia, hyperketonemia, hyperinsulinemia, altered secretion, and resistance to atrial natriuretic peptide. High blood pressure appears to be dependent, at least at some phase, on expansion of extracellular fluid volume as a consequence of defects in the renal secretion of Na+ and water. On the other hand, a tendency toward Na+ retention characterizes all patients with IDDM, whereas hypertension develops only in a subgroup of diabetic patients. One possible explanation for these findings is that a genetic predisposition plays a role in creating susceptibility to hypertension and perhaps to diabetic nephropathy independent of diabetes, even if Na+ retention can further deteriorate this susceptibility to hypertension. With regard to this issue, it has recently been suggested that the risk of kidney disease in patients with IDDM is associated with a genetic predisposition to hypertension. Furthermore, diabetic nephropathy occurs in familial clusters, because diabetic siblings of nephropathic diabetic patients show a higher frequency of diabetic nephropathy than the diabetic siblings of nonnephropathic diabetic patients. One of the possible genetic markers that could be useful to identify the diabetic patients with susceptibility to hypertension and diabetic nephropathy is the Na+-Li+ countertransport activity in erythrocytes.
Impact of Blood Pressure and Antihypertensive Treatment on Incipient and Overt Nephropathy, Retinopathy, and Endothelial Permeability in Diabetes Mellitus
Authors: Parving Hans-Henrik
Published: March 2007

Diabetic nephropathy is the main cause of the increased morbidity and mortality in insulin-dependent diabetes mellitus (IDDM) patients. Elevated blood pressure accelerates and effective blood pressure reduction with β-blockers and/or angiotensin-converting enzyme (ACE) inhibitors delays the progression of nephropathy and reduces albuminuria. All previous reports dealing with the natural history of diabetic nephropathy demonstrated a cumulative death rate between 50 and 77% 10 yr after onset of nephropathy. Effective antihypertensive treatment reduced the cumulative death rate to 15–20% 10 yr after onset of nephropathy. Recent randomized control studies indicate that ACE inhibition may delay and even prevent the development of diabetic nephropathy in normotensive IDDM patients with persistent microalbuminuria. Several cross-sectional and prospective studies suggest an association between elevated blood pressure and the development and progression of diabetic retinopathy. Furthermore, carotid insufficiency or other causes of unilaterally or bilaterally reduced retinal blood flow (pressure) diminish the development of diabetic retinopathy. Diabetic retinopathy is characterized by abnormal leakage of fluorescein through the blood-retinal barrier, an abnormality that can be reversed during antihypertensive treatment. It is well documented that elevated blood pressure, poor metabolic control, and diabetic microangiopathy independently enhance the endothelial leakage of plasma proteins in diabetes mellitus. A link between capillary hypertension, increased extravasation of plasma proteins, and the development and progression of diabetic microangiopathy has been suggested. Blood pressure reduction diminishes the extravasation of plasma proteins. The above results strongly support the case for early and effective treatment of arterial blood pressure elevation in diabetes.
Effect of Kidney Dysfunction on Lung Volume in Patients With Diabetes
Authors: Gilmour Ian J , Barbosa Jose J
Published: March 2007

Objective

Over several years, one of the authors observed what appeared to be a relationship between a decrease in total lung capacity (TLC) and insulindependent diabetes mellitus (IDDM) in patients who were candidates for kidney transplantation.

Research Design and Methods

In an effort to define this potential relationship, pulmonary function tests (PFTs) were reviewed on all available kidney transplant candidates between 1983 and 1986. The patients were divided into two groups—those with kidney failure caused by IDDM (group 1) and those with kidney failure from other causes (group 2). A third group (control subjects) of volunteers with IDDM but without evidence of kidney failure was evaluated by PFTs in an attempt to determine whether IDDM without kidney failure was also associated with a decrease in TLC.

Results

Demographics of the two groups with kidney failure were similar. However, the duration of IDDM in the volunteers with IDDM was significantly shorter than in group 1 patients (19.6 vs. 25.9 yr). The TLC of group 1 patients was significantly smaller than the TLC of both the group 2 patients and the volunteers with IDDM.

Conclusions

We believe that these data suggest that the association between IDDM and decreased TLC is the result of IDDM and not kidney failure. Because our volunteers with IDDM were significantly younger than the patients with IDDM and kidney failure, we can draw no conclusions about any separate contribution of kidney failure to changes in TLC in people with IDDM.
Controlled Study of Biofeedback-Assisted Relaxation in Type I Diabetes
Authors: McGrady Angele , Bailey Barbara K , Good Marion P
Published: March 2007

Objective

The effect of biofeedback-assisted relaxation was tested in a randomized trial in 18 adults with insulin-dependent (type I) diabetes.

Research Design And Methods

Pretreatment and posttreatment blood glucose values and insulin dosages in the group trained for 10 wk in biofeedback-assisted relaxation were compared with those in the untrained group.

Results

Significantly lower average blood glucose levels, percentage of fasting blood glucose levels at target, and percentage of glucose values < 11.2 mM were observed in the trained group at posttest compared with the untrained group.

Conclusions

These differences could not be explained by increases in insulin. It is suggested that stress management be considered as an adjunct to the medical management of people with type I diabetes.
Infant Feeding in Finnish Children <7 yr of Age With Newly Diagnosed IDDM
Authors: Virtanen Suvi M , Räsänen Leena , Aro Antti , Lindström Jaana , Sippola Henna , Lounamaa Raise , Toivanen Liisa , Tuomilehto Jaakko , Åkerblom Hans K ,   Childhood Diabetes in Finland Study Group
Published: March 2007

Objective

We studied associations between the type of feeding in infancy and the incidence of insulin-dependent diabetes mellitus (IDDM).

Research Design And Methods

We studied 103 newly diagnosed diabetic children <7 yr of age and 103 age- and sex-matched population-based control children in a countrywide study.

Results

The risk of IDDM was decreased (P < 0.05) among children breast-fed for at least 7 mo (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.24–0.85) or exclusively breast-fed for at least 3 (OR 0.33, 95% CI 0.13–0.84) or 4 (OR 0.43, 95% CI 0.22–0.84) mo. Also, children who were ≥4 mo old at the time of introduction of supplementary milk feeding had a lower risk of diabetes (OR 0.48, 95% CI 0.26–0.91).

Conclusions

The protective effects of a long duration of breast-feeding and a late introduction of dairy products on the risk of IDDM remained significant after adjusting for the mother's education.
Trends in Prevalence of Diabetes Mellitus in Patients with Myocardial Infarction and Effect of Diabetes on Survival: The Minnesota Heart Survey
Authors: Sprafka J Michael , Burke Gregory L , Folsom Aaron R , McGovern Paul G , Hahn Lorraine P
Published: March 2007

Objective

The purpose of this study was to document trends in the prevalence of diabetes among men and women hospitalized for myocardial infarction (MI) and to determine the effect of diabetes on in-hospital case fatality rates and long-term survival. Research Design and Methods: The Minnesota Heart Survey is a population-based surveillance system that has monitored trends in coronary heart disease morbidity since 1970. As part of this effort, a 50% random sample of acute Ml discharge records in Minneapolis-St. Paul metropolitan area hospitals was abstracted in 1970,1980, and 1985.

Research Design and Methods

The Minnesota Heart Survey is a population-based surveillance system that has monitored trends in coronary heart disease morbidity since 1970. As part of this effort, a 50% random sample of acute MI discharge records in Minneapolis-St. Paul metropolitan area hospitals was abstracted in 1970, 1980, and 1985.

Results

The prevalence of diabetes among MI patients was compared over time, and the data indicated a significant increase between 1970 and 1985 in both men (8.2 vs. 16.8%, P = 0.001) and women (16.0 vs. 25.8%, P = 0.01). Diabetic individuals had an odds ratio of in-hospital death after an MI 1.5 times that of nondiabetic individuals (P < 0.01) after controlling for the effects of sex, age, and year of MI. Among discharged MI survivors, the risk of death was 40% higher (P < 0.01) in diabetic individuals than nondiabetic individuals after 6 yr of follow-up. Compared with nondiabetic individuals, diabetic individuals appeared more likely to have cardiac (pump) failure with acute MI.

Conclusions

Our findings suggest that the risk of coronary heart disease morbidity and mortality attributable to diabetes may be increasing over time. Therefore, clinicians need to take extra care in the management of MIs in diabetic individuals, and public health efforts to reduce diabetes prevalence are warranted.
Use of Fructosamine Test in Diabetic Children
Authors: Sobel Douglas O , Abbassi Val
Published: March 2007

Objective

The goal of this study was to assess the effect of glucose and the contribution of the aldimine component on the measurement of fructosamine, the relationship of serum fructosamine with glycosylated plasma proteins, as measured by a new high-performance liquid chromatography methodology (Glyc PP-HPLC) and by an affinity chromatography (Glyc PP), and the ability of serum fructosamine to assess acute, short-term (1–2 wk), and long-term (2–3 mo) glycemic control.

Research Design and Methods

The measurement of fructosamine was unaltered by the addition of up to 27.5 mM glucose or by the elimination of the aldimine component of serum specimens by dialysis. Fructosamine was generated in vitro by incubating serum aliquots. This generation was dependent on time, glucose concentration, and temperature.

Results

Fructosamine (n = 27) correlated well with Glyc PP (r = 0.76, P < 0.01) and significantly less with Glyc PP-HPLC (r = 0.46, P < 0.01). Although oral glucose ingestion increased serum glucose acutely by 200% fructosamine was unchanged at each time interval. Improving glycemic control decreased the mean serum fructosamine concentration from 3.68 (baseline) to 3.28 mM (P < 0.01) at 1 wk and to 3.13 mM (P < 0.01) at 2 wk. HbA1c correlated with fructosamine (r = 0.59) and Glyc PP-HPLC (r = 0.47) but correlated best with Glyc PP (r = 0.83).

Conclusions

These results indicate the fructosamine assay is unaltered by serum glucose, solely measures the ketoamine component, correlates well with glycosylated plasma proteins measured by aminophenylboronic acid column chromatography, is unaffected by acute changes of serum glucose, and may be used to monitor changes in glycemic control over a 1-wk interval.
Evaluation of New Computerized Method for Recording 7-Day Food Intake in IDDM Patients
Authors: Rivellese Angela A , Ventura Mariarosa M , Vespasiani Giacomo , Bruni Mauro , Moriconi Vincenza , Pacioni Vincenza , Sulpini Maria T , Borrelli Renato , Giacco Angela , Cangemi Claudio , Perna Luigi , Brunetti Paolo , Riccardi Gabriele
Published: March 2007

Objective

To evaluate a new computerized method for recording 7-day food intake.

Research Design and Methods

Randomized crossover trial was conducted with patients recording the amount and type of every food and drink consumed during a week by either a computerized device (Food-meter) or recording the data in a diary. Each method was applied twice. Twenty-one insulin-dependent diabetic patients (mean ± SD age 25 ± 9 yr) were studied.

Results

The two methods showed very good agreement in the evaluation of the patients' diets (1792 ± 408 vs. 1764 ± 436 kcal∕day, 84 ± 19 vs. 82 ± 21 g∕day protein, 68 ± 22 vs. 67 ± 23 g∕day fat, 210 ± 60 vs. 207 ± 58 g∕day carbohydrate with the conventional and computerized methods, respectively). The variability between the methods and the variability within each method were of similar magnitude.

Conclusions

The Food-meter represents a useful tool for computerizing the 7-day food record. The method is easy, reliable, and time saving. Moreover, it minimizes the risk of transcriptional errors.
Origins of u.s. Hispanics: Implications for Diabetes
Authors: Hanis Craig L , Hewett-Emmett David , Bertin Terry K , Schull William J
Published: March 2007

The purpose of this article was to characterize the origins of the United States Hispanic population and discuss the implications of these origins in the context of diabetes risk. Particular attention was focused on the genetic origins of the three major U.S. Hispanic groups, i.e., Mexican Americans, Puerto Ricans, and Cubans. The U.S. Census figures provided basic demographic information. Genetic marker data for ancestral populations were taken from a review of the literature and compendia. Genetic marker data for the Puerto Rican and Cuban populations were extracted from the literature. Genetic markers determined on ∼ 1000 randomly selected Mexican Americans from Starr County, Texas, were taken as representative of the Mexican-American population. The Hispanic population is the second largest and fastest growing minority in the U.S. Estimates of the Hispanic population in 1988 indicated some 19.4 million residents, of whom 62% were classified as Mexican, 13% as Puerto Rican, and the remaining 25% as Cubans and others. Various lines of evidence can be used to characterize the Hispanic population and its origins. These include ethnohistory, self-assessment of ancestry, surname distributions, speech and cultural characteristics, quantitative traits, and genetic structure. Genetic data were used to estimate the contribution of putative ancestral populations to the contemporary gene pool. For Mexican Americans, 31% of the contemporary gene pool is estimated to be Native American derived, whereas 61 and 8% are Spanish and African derived, respectively. In Puerto Rico, the percentage of contributions of Spanish, Native American, and African admixture to the population are 45, 18, and 37%, respectively. For Cuba, the parallel estimates are 62, 18, and 20%. The high frequency of Native American-derived genes in the contemporary Hispanic population predict a higher frequency of non-insulin-dependent diabetes mellitus (NIDDM) under the assumption that genes are important in NIDDM etiology. Our results are consistent with the finding of the significant role of genes in determining risk.
Genetic and Environmental Determinants of Type II Diabetes in Mexican Americans: Is There a “Descending Limb” to the Modernization/Diabetes Relationship?
Authors: Stern Michael P , Knapp J Ava , Hazuda Helen P , Haffner Steven M , Patterson Judith K , Mitchell Braxton D
Published: March 2007

Evidence from migrant population studies and secular trend data indicates that environmental factors play a role in the etiology of non-insulin-dependent (type II) diabetes. These environmental factors appear to be concomitants of the process whereby traditional populations become “modernized” or “westernized” and include increased intake of total calories, fat, and sucrose, decreased intake of total and complex carbohydrates, including fiber, and decreased physical exercise. There also appears to be a “postmodernization” process, which we have characterized as the “descending limb of the curve.” In Mexican Americans in San Antonio, the prevalence of type II diabetes declines with acculturation to the values, attitudes, and behaviors of “postmodernized” American society. However, examination of the dietary and exercise concomitants of this process revealed a mixed picture. There was some suggestion that Mexican-American women, although not men, had entered onto the descending limb of the curve. However, Native American genetic admixture in Mexican Americans also covaried with affluence and acculturation in such a way that the declining prevalence of diabetes could as easily be due to genetic factors as to environmental factors. The “pancreatic exhaustion” theory holds that resistance to insulin action is a principal lesion leading to hypersecretion of insulin, hyperinsulinemia, and eventual islet cell failure and clinical diabetes. This theory predicts that prediabetic subjects will be hyperinsulinemic. In conformity with this theory, we have shown that subgroups of the Mexican-American population, defined on the basis of family history of diabetes, who would be expected a priori to be enriched with prediabetic subjects, are hyperinsulinemic as predicted.(ABSTRACT TRUNCATED AT 250 WORDS)
Obesity in Hispanic Americans
Authors: Nichaman Milton Z , Garcia Gloria
Published: March 2007

The prevalence of obesity among Hispanic American populations is generally greater than among white populations in the United States. Among Mexican Americans, the prevalence of obesity was higher than among either Cuban Americans or Puerto Ricans. It is well known that the prevalence of diabetes increases with increasing levels of obesity or body mass index. However, it does not appear that the high prevalence of obesity in Mexican Americans completely accounts for the higher prevalence of diabetes seen in this ethnic group. Among Mexican Americans, the association of selected cardiovascular disease risk factors, high-density lipoprotein cholesterol subfractions and systolic blood pressure, was similar to that seen among other U.S. populations. Individuals with diabetes had higher values than seen among those without diabetes. In a comparison of nutrient intake in two Mexican-American populations, one rural and one urban, there were no major differences other than higher calorie intakes in the rural population compared with the urban population. In addition, the diet in the rural population, based on higher levels of the Keys score, was more atherogenic than that of the urban population.
Circadian Rhythm of Blood Pressure in Normotensive NIDDM Subjects: Its Relationship to Microvascular Complications
Authors: Nakano Shigeru , Uchida Kenzo , Kigoshi Toshikazu , Azukizawa Sadahide , Iwasaki Ryoji , Kaneko Mihoko , Morimoto Shinpei
Published: March 2007

Objective

To investigate the relationship between circadian rhythm of mean blood pressure (MBP) and microvascular complications in non-insulin-dependent diabetes mellitus (NIDDM) subjects.

Research Design and Methods

Seventy-six normotensive NIDDM subjects without azotemia were studied under ordinary hospital conditions with a noninvasive ambulatory blood pressure monitoring device. Time series data were analyzed by the cosinor method.

Results

Fifty-four subjects had a circadian MBP rhythm similar to that of 34 age-matched nondiabetic control subjects, with a peak value in the afternoon (group 1). In contrast, 22 had a reversed circadian MBP rhythm, with a peak value during the night (group 2). Obvious complications were found in 65% of group 1 and in all of group 2. The prevalence of retinopathy and somatic neuropathy and the degree of retinopathy were similar in the two groups. The prevalence and degree of autonomic neuropathy (postural hypotension and reduced beat-to-beat heart-rate variation) and nephropathy were greater in group 2 than group 1. Linear discriminant analysis revealed a correlation between the reversed circadian MBP rhythm and postural hypotension (F = 32.2, P < 0.001) and overt nephropathy (F = 5.1, P < 0.05) but not with beat-to-beat heart-rate variation (F = 0.17, NS).

Conclusions

These results suggest that in the hospitalized normotensive NIDDM subjects, there are normal and reversed circadian MBP rhythms and that the reversal of normal circadian MBP rhythm may be related to the degree of postural hypotension and/or nephropathy.