bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of Paper-strip Test for 3-Hydroxybutyrate and its Clinical Application
Authors: Harano Yutaka , Suzuki Masaaki , Kojima Hideto , Kashiwagi Atsunori , Hidaka Hideki , Shigeta Yukio
Published: March 2007

A rapid paper-strip test for the semiquantitating 3-hydroxybutyrate (3-OHBA) has been developed. The color develops within 5 min after applying the serum to the paper strip, and the purple color was read either visually or by reflectance meter. This can detect 3-OHBA levels as low as 0.1 mmol/L up to 2.0 mmol/L. The more concentrated sample can be measured on serial dilution. Clinical usefulness has been tested in a summer camp for insulin-dependent diabetic children as well as in a routine diabetes clinic. Serum 3-OHBA levels ranged from > 100 µumol/L to 4 mmol/L in all the subjects before breakfast in a summer camp. In four subjects, 3-OHBA was elevated to the level of 2–4 mmol/L, and only one of these four subjects exhibited ketonuria by nitroprusside test. In a diabetes clinic, a new paper-strip test for 3-OHBA has revealed ketonemia in 34 (74%) of 46 diabetic subjects, while nitro-prusside test revealed ketonemia in only 4 (13%). The present paper-strip test for 3-OHBA is sensitive enough to detect levels as low as 0.1 mmol/L and is clinically useful for rapid detection of ketosis proneness as well as for monitoring of diabetes control.
Normalization of Insulin Sensitivity in Type I Diabetic Subjects by Physical Training During Insulin Pump Therapy
Authors: Yki-Järvinen Hannele , DeFronzo Ralph A , Koivisto Veikko A
Published: March 2007

Seven type I (insulin-dependent) diabetic patients previously treated with continuous subcutaneous insulin infusion therapy participated in a 6-wk training program consisting of cycle ergometer exercise 1 h/day 4 times a week. Six nontraining pump-treated type I diabetic patients and 19 healthy subjects were studied as controls. The training improved maximal aerobic power (VO2 max) by 8% (P < 0.05). Hemoglobin A1 was in the high normal range before training (8.6 ± 0.4%) and remained unchanged. The ratio of HDL cholesterol to total cholesterol rose by 16% in the training group (P < 0.01) but remained unchanged in the sedentary diabetic patients. Mean daily insulin requirements fell by 6< in the training group (P < 0.01). This reduction occurred in the lunch and dinner boluses whereas the basal infusion rate remained unchanged. Insulin sensitivity as determined by the euglycemic clamp technique was 25–40% lower in the training group (5.24 ± 0.48 mg/kg/min) and sedentary diabetic group (6.55 ± 0.82 mg/kg/min) as compared with controls (8.69 ± 0.77 mg/kg/min, P < 0.025). After the training, the rate of glucose uptake rose by 60% (P < 0.001) to 8.48 ± 0.77 mg/kg/min, which was comparable to that in the controls, but remained unaltered in the sedentary diabetic group. Insulin binding to erythrocytes was comparable in the diabetic and healthy subjects, and remained unchanged. Basal hepatic glucose production was elevated in both groups of diabetic patients (P < 0.05), whereas the suppression by insulin was normal, and both of these were unaltered by training. In conclusion, our data demonstrate that a controlled physical training program in pump-treated diabetic patients (1) does not change an already near-normal glycemic control, (2) improves body sensitivity to insulin and reduces insulin requirements, and (3) increases the HDL cholesterol to total cholesterol ratio.
Plasma Lipids and Lipoprotein Cholesterol in Undernourished Diabetic Subjects and Adults with Protein Energy Malnutrition
Authors: Das Sidhartha , Tripathy Bibhuti B , Samal Kshitish C , Panda Nimai C
Published: March 2007

Estimation of triglycerides (Tg), total cholesterol (Tc), HDLs, LDLc, and VLDLc was carried out in 46 undernourished diabetic subjects (UND); 21 untreated and 25 on insulin; 44 well-nourished diabetic subjects (WND); 22 untreated and 22 on insulin; together with 25 patients with protein energy malnutrition (PEM) and 25 healthy controls <50 yr of age. Compared with controls, in the untreated diabetic subjects Tg, Tc, LDLc, and VLDLc were significantly higher in both classes, while HDLc was lower only in WND. Among the treated diabetic subjects, Tg were higher in WND, LDLc lower in UND, and VLDLc higher in both. With regard to relative distribution of cholesterol in the untreated patients, HDLc/Tc was lower in WND, but this was not so in UND. HDLc/Tc was higher in treated UND. Between undernourished and well-nourished groups of diabetic subjects in the untreated patients, HDLc was significantly higher and LDLc lower in the former. Both Tc and LDLc were lower in UND on insulin compared with WND. HDLc/Tc was higher and LDLc/Tc lower in both untreated and treated UND. In adults with PEM, mean values of Tg, Tc, and LDLc were much lower than in controls, as well as in both groups of UND. On the other hand, values of HDLc/Tc were higher and LDLc/Tc lower in PEM compared with controls, but this was not so for treated UND. It is evident from the results of this study that the undernourished have lower levels of plasma lipids and a favorable distribution of cholesterol among the lipid fractions from the point of view of vulnerability to development of atherosclerosis.
The Role of Self-Monitoring of Blood Glucose in the Routine Management of Children with Insulin-dependent Diabetes Mellitus
Authors: Daneman Denis , Siminerio Linda , Transue David , Betschart Jean , Drash Allan , Becker Dorothy
Published: March 2007

We report a double-crossover study to assess the impact of self-monitoring of blood glucose (SMBG) on the glycemic control of children with insulin-dependent diabetes mellitus (IDDM) on a conventional therapeutic regimen. Sixteen children were assigned to one of two groups—group A, period 1 (wk 1–13): urine testing plus SMBG; period 2 (wk 14–26): urine testing only; group B, period 1: urine only; period 2: urine testing plus SMBG. Frequent telephone contact was maintained throughout to help optimize insulin dose adjustment. At the outset, the two groups were similar in age, diabetes duration, and glycosylated hemoglobin levels (10.5 ± 0.6% and 9.5 ± 0.3% in groups A and B, respectively). No significant differences could be detected between the two groups at any stage of the study. There was, however, a trend toward lower mean blood glucose (MBG) concentration in both groups toward the end of the SMBG period. No complications of SMBG were noted, but compliance was a major problem in three children. SMBG confirmed symptoms of hypoglycemia in all children, and detected asymptomatic hypoglycemia (BG ≤ 40 mg/dl) in 11. Sixty-nine percent preferred SMBG to urine testing. We conclude that SMBG is an acceptable part of routine diabetes care in children. It is associated with very few complications and helps to confirm symptomatic hypoglycemia and detect asymptomatic hypoglycemia. However, the addition of SMBG to routine diabetes care does not necessarily lead to improved metabolic control.
Continuous Peritoneal Insulin Infusion with Portable Pumps: Factors Affecting the Operating Life of the Chronic Catheter
Authors: Selam J L , Giraud P , Mirouze J , Saeidi S , Hedon B , Slingeneyer A , Lapinski H , Humeau C
Published: March 2007

Fifty-nine chronic peritoneal catheters made of polyethylene covered with silastic were used to treat 43 IDDM patients peritoneally for 3–34 mo (mean 14 mo) with portable peristaltic pumps and U40 acidic insulin. The operative life of the catheters was determined by actuarial analysis. The mechanisms of catheter failure were determined by preremoval x-ray opacification, removal under laparoscopie examination, and electron microscopic analysis of the catheter. Factors such as age, sex, duration of diabetes, implantation and tunnelization procedures, length of the catheter, and rate of infusion were analyzed. The 50% survival rate of the catheters was 16 mo. Six catheters were irreversibly obstructed by intraluminal fibrin formation and/or extraluminal adhesions, although insulin precipitation was never encountered. Seven catheters had to be removed because of a persisting local infection. Other causes were negligible (misinsertion, irreparable break). The only factor significantly related to incidence of catheter failure was gender with respect to obstruction (1 obstruction among 24 women versus 5 among 19 men, P < 0.03).
Use of Health Services by Diabetic Persons. II. Hospital Admissions
Authors: Scott Russell S , Brown Laurie J , Clifford Penelope
Published: March 2007

Over a 10-mo period, a computerized admission discharge system was scrutinized to identify all persons with diabetes mellitus admitted to a general hospital in Christchurch, North Canterbury (population 342,000), New Zealand. The 274 admissions by 197 diabetic persons (42% were insulin treated, 14% were newly diagnosed, 44% were non-insulin-dependent) contributed to 3.6% of the total hospital admissions, with duration of stay being longer than for nondiabetic persons (13.6 versus 11.3 days, P = 0.05). Patients admitted were aged 11–91 yr (mean 59 yr); those over 50 yr of age were numerically the largest admission group. Although cardiovascular illnesses were the most frequent events precipi-tating admission (34%), potentially preventable admissions for reasons of infection, poor glycemic control, or hypoglycemia were found in all age groups. Just under half of the 902 registered insulin-treated diabetic patients living in this health region had at some stage participated in diabetes education programs at the time this admission survey was undertaken. Of these, only nine were admitted. The other 70 insulin-treated patients admitted who lived in this region had never had diabetes education. Overall, only 11.7% of patients admitted had received diabetes education. These data show that, for insulin-treated diabetic individuals at least, admission rates were substantially lower among those who were sufficiently motivated to attend diabetes education programs.
A Clinical Algorithm to Determine the Etiology of Brittle Diabetes
Authors: Schade David S , Philip Eaton R , Drumm Denise A , Duckworth William C
Published: March 2007

Brittle diabetes is a subset of insulin-dependent diabetes mellitus for which multiple causes have been suggested. In its most severe form, brittle diabetes is incapacitating, preventing gainful employment and a normal lifestyle. Although some brittle diabetic individuals will significantly improve by intensive insulin therapy and education, many others remain unable to function normally because of recurrent episodes of hyperglycemia and hypoglycemia. We studied 30 incapacitated brittle diabetic subjects and developed an efficient algorithmic approach to determine the etiology of brittleness. Central to our diagnostic algorithm was the glucose response to 0.1 U/kg insulin administered subcutaneously and intravenously. If this response was normal, then psychosocial evaluations were completed, including psycholinguistic and health psychological testing. Other parameters affecting blood glucose concentration were also assessed, such as gastric motility, counterregulatory hormones, and, most important, patient compliance with prescribed regimens. However, if an “abnormal” glucose response to the insulin challenge tests was observed, the location of the insulin resistance was identified as being subcutaneous, intravascular, or at the peripheral tissue. Using our diagnostic algorithm, the identification of the etiology of brittleness in 29 of the 30 referred patients was possible. Thus, the purpose of an algorithmic approach to diagnosis is not only to avoid unnecessary testing, but also to determine the correct etiology of the brittle diabetes to determine appropriate therapy.
The Young Adult with Diabetes: Impact of the Disease on Marriage and Having Children
Authors: Ahlfield Janet E , Soler Norman G , Marcus Spencer D
Published: March 2007

To investigate the impact of insulin-dependent diabetes mellitus on marriage and having children we studied 50 young adults (aged 20–35 yr) with onset of the disease less than 20 yr. The subjects studied (37 women and 13 men) included 17 single, 26 married, and 7 divorced/separated diabetic patients. Twenty-two spouses of the 26 married diabetic patients also participated in the study. A 35-item questionnaire was developed with a 4-point Likert scale format for responses and administered separately to the patients and their spouses. None of the young adults in this study had made a conscious decision to remain unmarried, but 14 of 50 had decided not to have children. Onset of diabetes before 9 yr was associated with a significantly higher marriage rate than later onset of diabetes. Although onset of the disease after age 13 yr was more often associated with a decision to remain childless compared with earlier onset, this difference was not significant. Both men and women with diabetes found that the disease had an impact on certain aspects of their marital life, at times leading to friction and causing a financial burden. Whereas spouses were perceived to be very supportive, there was disagreement between young diabetic subjects and their spouses as to the impact of the disease on family activities and finances, the partners with diabetes perceiving a greater effect on these aspects of their lives than did their spouses.
Diabetes, Parental Diabetes, and Obesity in Oklahoma Indians
Authors: Lee Elisa , Anderson Paul S , Bryan John , Bahr Carman , Coniglione Thomas , Cleves Mario
Published: March 2007

The relationship between diabetes and parental diabetes status and obesity in Oklahoma Indians was studied. Data from 2095 adult Oklahoma Indians (1085 type II diabetic subjects and 1010 nondiabetic subjects) through a complete physical examination and personal interview showed a strong association between diabetes and parental diabetes status. Frequency of diabetes among siblings was significantly higher in families with affected parents than those without diabetic parents. No significant difference was found between families with one diabetic parent and those with two diabetic parents. The diabetic individuals were more obese than the nondiabetic individuals at age 18 and at interview. Obesity was defined as percent body mass index >120. After adjusting for possible age and sex effects, the risk of diabetes for the obese was estimated as almost twice that for the nonobese.
Incidence of Hypoglycemic Episodes in Diabetic Patients Under Continuous Subcutaneous Insulin Infusion and Intensified Conventional Insulin Treatment: Assessment by Means of Semiambulatory 24-hour Continuous Blood Glucose Monitoring
Authors: Arias Pablo , Kerner Wolfgang , Zier Horst , Navascués Ignacio , Pfeiffer Ernst F
Published: March 2007

The incidence and magnitude of hypoglycemia (i.e., blood glucose values < 50 mg/dl) were assessed by continuous blood glucose monitoring over 24 h in 10 insulin-dependent diabetic (IDD) patients treated with continuous subcutaneous insulin infusion (CSII) and 9 IDD patients under intensified conventional treatment (ICT). A newly developed, battery-powered blood glucose monitor was employed. Patients were thus enabled to move freely in the hospital premises. Despite similar quality of previous blood glucose control (HbA1: 8.0 ± 0.05% CSII versus 8.0 ± 0.3% ICT, x¯ ± SEM), the obtained profiles showed better regulation under CSII treatment (mean blood glucose [MBG], 99.6 ± 10.0 versus 133.1 ± 7.4 mg/dl; M-value, 12.3 ± 3.5 versus 26.2 ± 4.1; mean amplitude of glycemic excursion [MAGE], 71.9 ± 8.7 versus 132.9 ± 14.2 mg/dl; CSII versus ICT, x¯ ± SEM). The incidence of blood glucose values < 50 mg/dl was 9/10 patients (CSII) and 5/9 patients (ICT). In both groups, hypoglycemia was most frequent at noon and was related to elevated pre- and postprandial free insulin levels. Patients became aware of hypoglycemia only in 6/23 episodes (CSII) and 6/8 episodes (ICT). Our data indicate that CSII as well as ICT may result in postprandial hyperinsulinemia leading to frequent hypoglycemic episodes of variable length, reassessing the traditional experience of close correlation between aggressive insulin therapy and enhanced hypoglycemic risk.
Severe Hypoglycemia in Diabetic Patients: Frequency, Causes, Prevention
Authors: Casparie Anton F , Elving Lammy D
Published: March 2007

Over a 12-mo period, the frequency of severe hypoglycemic episodes was measured in a population of approximately 400 (50% type I) diabetic patients treated with insulin. There were 32 severe insulin reactions in 26 patients, a patient-yr incidence of 8%. The major precipitating causes were patients' errors (nine), and too much insulin or a wrong combination (six). In seven cases no cause could be found. For the group as a whole there was clear evidence of overtreatment as measured by insulin doses (0.89 ± 0.43 U/kg/day versus 0.65 ± 0.34 U/kg/day in a convenience group of 100 patients from the same diabetic population [P < 0.05]). Furthermore, 6–12 mo after the event the mean insulin dose had decreased from 0.82 ± 0.25 to 0.69 ± 0.27 U/kg/day in the subgroup of 20 hypoglycemic patients that could be followed (P < 0.001). The mean HbAlc levels of the hypoglycemic group and the control group differed significantly (8.1 ± 1.3% versus 8.7 ± 1.7%, P < 0.05). Six to 12 mo after the reaction, the mean HbA1C level in the follow-up subgroup rose from 8.1 ± 1.3% to 9.1 ± 1.1% (P < 0.05). Patients' errors as a cause of the insulin reaction were not only the result of the patients' deficient knowledge but more often of lack of alertness and carelessness. We conclude that it is not possible to prevent all the severe hypoglycemic reactions in diabetic patients. However, besides avoiding overtreatment by the physician, teaching patients to respond more adequately to changing circumstances in daily life or to warning signs could also reduce the incidence of hypoglycemia.
Diabetic Microangiopathic Hemolytic Anemia: Beneficial Effect of an Antiplatelet Agent?
Authors: Dupont Alain G , Van Der Niepen Patricia , Sennesael Jacques , Somers Guido
Published: March 2007

A 66-yr-old man with non-insulin-dependent diabetes mellitus complicated by retinopathy and nephropathy presented with shortened red cell survival associated with prominent fragmentation of erythrocytes and leading to severe hemolytic anemia. Neither abnormal carbohydrate tolerance per se nor renal failure was related to the red cell fragmentation syndrome. Also, a marked platelet hyperaggregability, which disappeared under treatment with ticlopidine, was demonstrated. Furthermore, during treatment with this potent platelet inhibitor, red cell survival normalized and all signs of hemolysis, as well as the schistocytes present in the peripheral blood smears, disappeared. Two weeks after stopping ticlopidine administration, microangiopathic hemolytic anemia relapsed. We suggest that the fragmentation hemolysis in this patient was related to diabetic microangiopathy, and that the beneficial effects of ticlopidine are related to its platelet-inhibiting activities. This case further reaffirms that antiplatelet agents may have a beneficial effect on the vascular disease of diabetes mellitus.
Group Therapy in the Treatment of Diabetes
Authors: Tattersall Robert B , McCulloch David K , Aveline Mark
Published: March 2007

The psychological burden imposed by diabetes is large but is often ignored by health care professionals who concentrate on its technical aspects. In this article we review the need for psychosocial support in the treatment of diabetes. Group psychotherapy, although most widely used in psychiatry, was in fact started by a physician almost 80 yr ago and has been used as an adjunct to the management of many medical conditions. Limited experience of group psychotherapy among diabetic patients has given encouraging results. Issues remain, however, as to which groups of patients might benefit most, who should act as group leader, and how one can best assess outcome.
Self-Monitoring of Capillary Blood Glucose: Changing the Performance of Individuals with Diabetes
Authors: Mazze Roger S , Pasmantier Rosemarie , Ann Murphy Jo , Shamoon Harry
Published: March 2007

Standard reflectance meters were modified by the addition of memory chips capable of storing 440 glucose determinations with corresponding time and date. These modified reflectance meters (MR) were given to 20 individuals with type I diabetes in an effort to determine the level of reliability and accuracy they could achieve on a self-monitoring regimen. During a 6-wk period these subjects measured their capillary blood glucose and recorded the results in a logbook (LB). At 2-wk intervals they visited the clinic. Data from the MR was offloaded onto an Apple IIe microcomputer (Apple Computer, Inc., Cupertino, California) and presented to the subjects in a graphic format, depicting the level of metabolic control over the previous 2 wk. The performance of subjects for the 6-wk period showed that they averaged 7 omissions from the LB for every 100 MR recordings; 1 added value in the LB for every 200 MR recordings; and 1 error in accurately copying the test value for every 100 determinations. In comparison with subjects who participated in an earlier study in which they were unaware of the memory function of the reflectance meter, performance during the current study improved in all categories. It was also observed that consistency in reliable and accurate record keeping did not diminish throughout the study period. Despite these positive changes in performance, no alteration in glycemic control was found.
Frequency and Accuracy of Self-Monitoring of Blood Glucose in Children: Relationship to Glycemic Control
Authors: Wing Rena R , Lamparski Danuta M , Zaslow Sarah , Betschart Jean , Siminerio Linda , Becker Dorothy
Published: March 2007

We evaluated the long-term effects of self-monitoring of blood glucose (SMBG) on glycemic control in a large unselected group of insulin-dependent diabetic (IDD) children and adolescents (N = 282) treated at a diabetes clinic. Among those who had been taught SMBG techniques (N = 229) and reported frequency of use (N = 209), only 26% reported monitoring three or more times per day. HbA1 levels of patients who monitored their blood most frequently did not differ from those who monitored blood less frequently or those who monitored only urine. Likewise, HbA1 levels of patients who monitored with machines did not differ from Chemstrip bG users. Accuracy was assessed in a subsample of 100 randomly selected Chemstrip bG users by comparing their Chemstrip reading with a laboratory value. Fifty-eight percent of the readings were within 20% of the laboratory value. Accuracy did not relate to frequency of monitoring or to HbA1 levels. These data suggest that frequency and accuracy of SMBG are independent and that neither ensures good glycemic control.
Prevalence and Mortality of Acute Myocardial Infarction in Patients with Diabetes
Authors: Rytter Lene , Troelsen Svend , Beck-Nielsen Henning
Published: March 2007

The purpose of this study was to investigate if insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) predispose to the development of acute myocardial infarction (AMI) and modify the prognosis. The study includes 832 AMI patients consecutively hospitalized over a 3-yr period. The prevalence of diabetes mellitus among the AMI patients was 9.7% and is significantly higher than in an age-matched population, where it is 6.1% (P < 0.001). The prevalence of diabetes was higher for women than for men (14.9% versus 7.6%). The risk of AMI was found to be twice as high among IDDM than among nondiabetic patients (P < 0.001). Men with NIDDM were not found to have a significantly higher risk of AMI (P > 0.1), but the risk of AMI in women with NIDDM was approximately doubled (P < 0.01). During the first month following AMI the mortality rate for nondiabetic patients was 20.2% compared with 42.0% for diabetic patients (P < 0.001). Insulin treatment in NIDDM was associated with a reduced mortality rate compared with treatment with oral agents (P < 0.05). The mortality rate was significantly higher in patients with poor metabolic control compared with patients in good control, whether before AMI or at the time of hospitalization. Diabetic patients had a higher risk of developing cardiogenic shock and conduction disorders than nondiabetic patients. We conclude that diabetes mellitus disposes to AMI and that the mortality rate of AMI is significantly increased among diabetic patients. Poor metabolic regulation of the diabetes may aggravate the prognosis for AMI.
A Randomized, Controlled Comparison of Instruction by a Diabetes Educator Versus Self-Instruction in Self-Monitoring of Blood Glucose
Authors: Ward W Kenneth , Haas Linda B , Beard James C
Published: March 2007

It is not clear whether diabetic patients can learn accurate self-monitoring of blood glucose (SMBG) by use of written package instructions. In addition, it is unclear whether the improvement in accuracy of monitoring that results from professional training is due to the professional intervention or to a personal practice effect. For these reasons, improvement in accuracy of SMBG (using Chemstrip bG, Biodynamics Division, Boehringer-Mannheim, Indianapolis, Indiana) after a 30-min session of professional instruction in one group of diabetic patients was compared with improvement after 30 min of practice and study of package instructions in another group. After initial reading of package instructions in both groups, and after the practice session in the control group, mean percent error was 22–37%. In contrast, mean percent error declined to 9% after a professional training session. We conclude that learning SMBG solely by reading package instructions leads to unacceptable inaccuracy. However, by use of short, intensive instruction sessions, a diabetes educator can reduce such errors and teach highly accurate monitoring to most diabetic patients.
The Prevalence of Retinopathy Is Similar in Diabetes Mellitus Secondary to Chronic Pancreatitis With or Without Pancreatectomy and in Idiopathic Diabetes Mellitus
Authors: Couet Charles , Genton Pierre , Paul Pointel Jean , Louis Jacques , Gross Patrice , Saudax Etienne , Debry Gerard , Drouin Pierre
Published: March 2007

In a retrospective study, we compared the prevalence of retinopathy in two groups of 88 diabetic patients (84 men, 4 women) with either diabetes mellitus secondary to chronic pancreatitis (CP-DM group) or idiopathic diabetes mellitus (I-DM group). The patients of these two groups were pair-matched according to age (48.7 ± 1.1 versus 48.8 ± 1.0 yr in CP-DM and I-DM groups, respectively; mean ± SEM), sex, duration of diabetes (7.96 ± 0.56 versus 8.08 ± 0.8 yr) and therapy (80 on insulin and 8 on oral hypoglycemic agents in each group). Retinopathy was assessed by bilateral ophthalmoscopic examination of the fundus after pupillary dilation in all 176 patients and by fluorescein angiography in 47 patients with CP-DM and 35 patients with I-DM. Forty-one percent of patients in the CP-DM group and 45.5% of patients in the I-DM group had diabetic retinopathy (P > 0.5). In each group, patients with retinopathy were older than patients without retinopathy (51.6 ± 1.3 versus 46.7 ± 1.8 yr in the CP-DM group, P < 0.01, and 52.1 ± 1.5 versus 46.0 ± 1.2 yr in the ID-M group, P < 0.01). They had diabetes of longer duration (10.9 ± 1.0 versus 5.9 ± 0.6 yr in the CP-DM group, P < 0.001, and 10.5 ± 1.0 versus 6.0 ± 0.6 yr in the ID-M group, P < 0.001). The prevalence of retinopathy increased parallel to the duration of diabetes in a similar way in both groups. The part played in the pathogenesis of retinopathy by the following factors is also discussed: blood glucose control, arterial blood pressure, plasma total cholesterol and triglyceride levels, and family history of diabetes mellitus. Our data suggest that patients with diabetes secondary to chronic pancreatitis are at similar risks of retinopathy.
The Effect of Blood Glucose Concentration on Labile A1c in Diabetic Patients
Authors: Kawahara R , Amemiya T , Komori T , Hirata Y
Published: March 2007

We investigated the magnitude of labile A1c in total A1c measured rapidly by a chromatographic method, and whether or not there was an effect of blood glucose before and after a meal on labile A1c in 94 type I and 178 type II diabetic subjects. There were strong correlations between serum glucose and labile A1c both in type I (r = 0.76, P < 0.001) and in type II diabetic subjects (r = 0.72, P < 0.001). These relationships did not change before and after the meal. As labile A1c increased in proportion to blood glucose, it could be calculated from the blood glucose level in simultaneous blood samples. In type I diabetic subjects, below the 100-mg/dl glucose level labile A1c was negligible, and above 100 mg/dl about 0.35% labile A1c was increased every 50-mg/dl increment of glucose. In type II diabetic subjects, below a 150-mg/dl glucose level labile A1c was in the normal range (0.58 ± 0.15%), and above the 150-mg/dl glucose level every 50-mg/dl increment of glucose increased about 0.3% of labile A1c. If this process is used, stable A1c can be calculated easily from total A1c and coincident serum glucose, even though labile A1c is not removed by incubation.
Diabetic Nephropathy and Proliferative Retinopathy with Normal Glucose Tolerance
Authors: Chan J Y C , Cole E , Hanna A K
Published: March 2007

A 61-yr-old man presented with the nephrotic syndrome and normal oral glucose tolerance. Renal biopsy showed the nodular (Kimmelstiel-Wilson) and diffuse glomerulosclerosis lesions characteristic of diabetes. Direct ophthalmoscopy and fluorescein angiography demonstrated a picture of advanced proliferative diabetic retinopathy. The patient had no history of diabetes mellitus and upon testing had normal glucose values in response to an oral glucose tolerance test. Insulin response to an intravenous glucose tolerance test was abnormally low. It is concluded that the nodular glomerulosclerosis lesions and proliferative retinopathy, thought to be specific for diabetes mellitus, may present in the absence of either overt clinical diabetes or impaired glucose tolerance.
Reduced Postprandial Hyperglycemia After Subcutaneous Injection of a Somatostatin-Analogue (SMS 201-995) in Insulin-dependent Diabetes Mellitus
Authors: Spinas Giatgen A , Bock Andreas , Keller Ulrich
Published: March 2007

The effect of a new octapeptide analogue of somatostatin (SMS 201-995) on blood glucose and gut hormone levels was studied in 10 C-peptide-negative, insulin-dependent diabetic (IDDM) subjects. On separate days, either 50 or 100 μg SMS or placebo was s.c. injected simultaneously with an identical insulin dose 30 min before a mixed meal. Postprandial blood glucose decreased after 100 μg SMS s.c. within 30 min from 8.9 ± 0.7 to 7.8 ± 0.6 mmol/L (P < 0.001) and remained at similar levels during 180 min. In contrast, postprandial blood glucose concentration increased after placebo from 9.9 ± 0.8 to 13.8 ± 0.9 mmol/L (SMS versus placebo P < 0.001). Plasma glucagon decreased rapidly after SMS to the limit of detection (P < 0.001) and remained lowered during 180 min; in contrast, glucagon levels increased after the meal during the placebo study (SMS versus placebo P < 0.001). Plasma growth hormone concentrations were significantly lower after SMS than after placebo (P < 0.05). SMS abolished completely the postprandial increase in plasma gastrin and pancreatic polypeptide (PP) concentrations. Plasma free fatty acid (FFA) and triglyceride concentrations decreased after SMS, reaching significantly lower levels than after placebo (P < 0.05 and P < 0.01), respectively). Plasma SMS concentration increased rapidly after s.c. administration of SMS; its appearance preceded that of plasma free insulin after s.c. insulin injection. Fifty micrograms SMS was similarly effective as 100 μg in decreasing blood glucose, triglycerides, glucagon, and gut hormone concentrations. The data demonstrate that in contrast to native somatostatin whose action is known to be relatively weak and shortlived after s.c. administration, this somatostatin analogue results in diminished postprandial blood glucose and plasma triglyceride concentrations and in prolonged suppression of gut hormone levels after s.c. injection.
Effect of Normoglycemia Before Conception on Early Pregnancy Hormone Profiles
Authors: Castracane V Daniel , Jovanovic Lois , Mills James L
Published: March 2007

Insulin-dependent diabetic women have been shown to have subnormal hormone levels in the first trimester of pregnancy. To determine whether these abnormalities were the result of poor diabetes control, testosterone, androstenedione, human chorionic gonadotropin (HCG), and prolactin were studied longitudinally in diabetic women made normoglycemic before conception (N = 11) and normal (N = 6) control subjects beginning at the fifth week of gestation. HCG levels rose normally in all 11 diabetic and six control subjects and then declined as expected, with peak levels between 8 and 12 wk of gestation. Prolactin levels similarly rose significantly (P < 0.00001) during the period studied. Plasma androstenedione did not increase during the course of this study, but testosterone levels increased significantly (P = 0.0001). Androgen levels were consistently higher in diabetic subjects despite the normoglycemic state, although the differences reached statistical significance at only one point. This study demonstrates that when normoglycemia is achieved before conception, HCG and prolactin are normal at 5 wk after the last menstrual period. The possibility that androgen levels may be higher in insulin-requiring diabetic women, perhaps due to peripheral hyperinsulinemia, should be explored.
Progressive Autoimmune Beta Cell Insufficiency: Occurrence in the Absence of High-Risk HLA Alleles DR3, DR4
Authors: Eisenbarth George S , Srikanta S , Fleischnick Ellen , Ganda Om P , Jackson Richard A , Brink Stuart J , Soeldner J Stuart , Yunis Edmond J , Alper Chester
Published: March 2007

In a prospective screening program for type I diabetes mellitus, we identified a unique family in which several members (mother and three siblings) expressed an unusual set of HLA-DR alleles (DR2+, DR3/4−) and were in different phases of immunologically mediated islet beta cell dysfunction. Immunologic and/or clinical manifestations of type I diabetes were absent in all siblings not sharing both HLA haplotypes in common with the proband. This article illustrates: the clinical utility of prospective family screening for predictive markers, such as islet cell antibodies, progressive autoimmune beta cell destruction can occur in the absence of the “high-risk” alleles HLA-DR3 and DR4, and HLA identity with the proband, rather than specific HLA alleles, i.e., presence of DR3, DR4 and absence of DR2, is an essential factor.
The Preparation of an Acceptable Placebo for NPH Insulin
Authors: Johnson Robert G , Godine John E , Hurxthal Katherine , Nathan David M
Published: March 2007

A suitable placebo for NPH insulin has not previously been available for clinical investigation. A series of organic and inorganic compounds were formulated as insulin placebos and analyzed according to the following criteria: (1) degree of visual similarity to insulin, (2) stability, (3) absence of local side effects, and (4) clinical safety. Dilute suspensions of cortisone acetate (1.25–2.5 mg/ml) were found to fulfill the criteria as acceptable insulin placebos. Placebo-controlled studies with NPH insulin can now be performed.
Assessment of Diabetes Continuing Medical Education
Authors: Adamson T Elaine , Gullion David S
Published: March 2007

A diabetes professional education program was conducted and evaluated with 31 physicians from a rural/suburban community. Treatment guidelines were established by diabetes experts and community practitioners. To document effectiveness, medical record and survey data on 397 patients of the physicians were collected before and after the program. Each participant received a profile of their baseline performance as compared with peers as part of the educational program. A syllabus was designed to complement both the treatment guidelines and the findings from the baseline data. A telephone conference call with a diabetes consultant also occurred. A comparison between data collected before and after the program showed no significant differences in blood glucose levels or hospitalization rates. Physicians were more likely to recommend self-monitoring of blood glucose (SMBG) (7% versus 20%, P < 0.05) and to examine their patients' feet (47% versus 73%, P < 0.05) after the program. More patient education was available in the office (53% versus 73%). Patients using insulin were more likely to test urine for ketones (48% versus 61%, P < 0.05) and know that decreased sensation in the feet could lead to injury (42% versus 53%, P < 0.05). However, no improvements were noted in monitoring other complications, regulating diet, or in most aspects of patient education after the program. The results indicated the need for increased emphasis on the value of brief appropriate examinations for monitoring complications of diabetes and the need for physicians to learn techniques for counseling patients in self-management as well as to refer their patients to educational resources.
Serum Lipids and Lipoproteins in Newly Diagnosed Non-insulin-dependent (Type II) Diabetic Patients, with Special Reference to Factors Influencing HDL-Cholesterol and Triglyceride Levels
Authors: Uusitupa Matti , Siitonen Onni , Voutilainen Erkki , Aro Antti , Hersio Kristiina , Pyörälä Kalevi , Penttilä Ilkka , Ehnholm Christian
Published: March 2007

Serum and lipoprotein lipids were examined in 133 newly diagnosed (type II) diabetic patients (70 men, 63 women), aged 45–64 yr, and in 144 randomly selected nondiabetic control subjects of similar age (62 men, 82 women). The serum total cholesterol levels in diabetic and nondiabetic subjects were similar, but the HDL-cholesterol levels were lower and the serum total triglyceride levels higher in the diabetic than in nondiabetic subjects. No significant differences were found in apoprotein A-I and A-II levels between the diabetic and nondiabetic subjects. After adjustment for age, alcohol intake, obesity, 2-h postglucose serum insulin, and serum triglycerides, male diabetic subjects still had lower HDL-cholesterol levels than corresponding nondiabetic subjects. On the other hand, female diabetic subjects had higher serum triglycerides than their nondiabetic counterparts, even after adjustment for age, alcohol intake, 2-h postglucose serum insulin, and obesity.
Effect of Exchange of Ham for Boiled Egg on Plasma Glucose and Insulin Responses to Breakfast in Normal Subjects
Authors: Villaume Christian , Beck Bernard , Rohr Raymond , Pointel Jean-Paul , Debry Gérard
Published: March 2007

Blood glucose (BG) and plasma insulin (IRI) were measured during two breakfasts different only by the nature of proteins—egg (E) or ham (H)—in eight normal subjects. Compared with H, E led to a flattened BG response at 30, 40, and 50 min and to a sustained BG from 150 to 240 min. Integrated BG response was not significantly different between E and H. After E, the IRI response decreased at 90 min and 120 min (P < 0.05). Integrated IRI response with E was significantly smaller than with H (P < 0.025). The reasons for the effect of E ingestion on BG are not obvious; pancreatic and/or intestinal mechanisms may be involved. It is suggested that greater consideration be given to the protein composition of the test meals when they are used in studies of glucose homeostasis.
Continuous Subcutaneous Insulin Infusion Does Not Provoke Significant Acute-Phase Response
Authors: Sleightholm Marcus A , Gallimore Ruth , Tennent Glenys A , Rowe Ian F , Kohner Eva M , Pepys Mark B
Published: March 2007

C-reactive protein (CRP), the classical acute-phase reactant, and serum amyloid A protein (SAA), the putative precursor of AA-type amyloid fibrils, were measured in 62 diabetic patients. They were all attending their regular clinic appointments and had been asymptomatic during the 2 wk preceding sampling. CRP and SAA levels were similar in 18 patients on continuous subcutaneous insulin infusion (CSII), 27 patients treated by conventional insulin therapy (CIT), nine treated by diet only, and eight treated by diet and oral hypoglycemic agents, and were almost entirely within the normal range. It is concluded that CSII does not provoke an acute-phase reaction in diabetic patients and, while caution should always be exercised with a new form of treatment, it does not seem likely that CSII will predispose to the development of reactive systemic amyloidosis.
Acute Insulin Response to Glucagon, Tolbutamide, and Glucose in Non-insulin-dependent Diabetes of the Young
Authors: Naidoo C , Jialal I , Suleman A , Rajput M C , Joubert S M
Published: March 2007

Acute insulin release in response to maximal intravenous doses of glucose (0.5 g/kg), tolbutamide (1 g), and glucagon (1 mg) was studied in 10 subjects with non-insulin-dependent diabetes of the young (NIDDY) and 10 age-, sex-, and weight-matched controls. Diabetic subjects had attenuated insulinemic responses to all three stimuli, in comparison with control subjects. However, insulin responses to glucagon and tolbutamide were higher than those obtained with intravenous glucose. This study demonstrates that the pancreatic β-cell is more responsive to nonglucose secretagogues than to glucose stimuli in individuals with NIDDY.
Longitudinal Assessment of Glycosylated Blood Protein Concentrations in Normal Pregnancy and Gestational Diabetes
Authors: Morris Mary Ann , Grandis Arnold S , Litton Jean C
Published: March 2007

Longitudinal changes in glycosylated hemoglobin concentration (GlyHb) and glycosylated serum protein concentration (GSP) in both normal pregnancy and pregnancy complicated by gestational diabetes were determined using affinity chromatography, a method in which nonenzymatically glycosylated proteins are specifically measured. At 7–10 wk gestation, GlyHb in women who developed diabetes (N = 21) was higher than GlyHb in normal women (N = 49) (6.7 ± 0.2% versus 5.7 ± 0.2%, respectively, P < 0.001) and remained elevated throughout gestation. In normal pregnancy, GlyHb decreased to a nadir at 23–26 wk and returned to baseline concentration by 31–34 wk. In gestational diabetes, there was an initial increase in GlyHb to 7.1 ± 0.5% at 11–14 wk followed by a steady decrease. At 7–10 wk, GSP in women who developed diabetes was not elevated compared with normal concentration, although at 11–14 wk there was significant difference between the two groups (P < 0.02). In normal women, GSP remained constant throughout gestation. In gestational diabetes, GSP decreased to early pregnancy values (P < 0.02). Glycosylated blood proteins were elevated in early gestation in women who developed gestational diabetes and may have predictive value in identifying women who will develop diabetes in pregnancy.
Preprogrammed Intravenous Insulin Infusion in Diabetic Humans: Metabolic Consequences of Altering Meal Size
Authors: Levy-Marchal Claire , Perlman Kusiel , Zinman Bernard , Albisser A Michael
Published: March 2007

New implantable, variable-rate, intravenous insulin infusion systems offer the possibility of increased dietary flexibility in the treatment of diabetes mellitus. However, the development of insulin infusion algorithms required to maintain near-normal glycemia inthe presence of a nonconstant diet first requires information concerning the metabolic response to meals of varying size when the insulin dose is fixed. With this goal in mind, we studied five type I diabetics aged 16–40 yr who were treated for 3 wk with a portable intravenous insulin infusion system. Initially, the patient's usual prescribed diabetic diet was provided, and an individual waveform of insulin infusion resulting in diurnalnormoglycemia was defined for each meal. Subsequently, small (12% of total daily calories) and large (36% of total daily calories) versions of the regular breakfast (24% of totaldaily calories) were provided without change in the insulin infusion waveforms, and the resulting metabolic profiles were studied. The overall mean fasting plasma glucose levels before the meals of varying size were not significantly different, but the incremental rises in plasma glucose with the small (31 ± 5 mg/dl), regular (48 ± 7 mg/dl), and large (64 ± 5 mg/dl) breakfasts varied directly with the meal size. The subsequent mean plasma glucose levels before the regular lunch were significantlydifferent (P < .05) after the small (50 ± 4 mg/dl) and large breakfasts (131 ± 9 mg/dl), compared with the regular breakfast (81 ± 7 mg/dl). Despite these differences, the plasma glucose levels before dinner were virtually identical.

We conclude that large variations in meal size produce glycemic changes in keeping with the caloric content of the meal. These changes are associated only with the meal in question and do not result in sustained adverse glycemic consequences. Nevertheless, these results suggest the necessity of developing guidelines for changing mealtime insulin infusion profiles to maintain normoglycemia, despite variations in caloric intake. Only in this way will the unique capabilities of implantable intravenous insulin delivery devices be fully exploited.
Malfunction of Continuous Subcutaneous Insulin Infusion Systems: A One-Year Prospective Study of 127 Patients
Authors: Mecklenburg R S , Guinn T S , Sannar C A , Blumenstein B A
Published: March 2007

Malfunction of portable continuous subcutaneous insulin infusion (CSII) systems may result in either ketoacidosis or serious hypoglycemia. To determine the types and frequencies of infusion system failure and the resulting clinical consequences, we recorded their occurrences in a 1-yr prospective study of 127 patients who were using insulin infusion pumps in a clinical practice setting. Of the 127 patients, 109 (86%) experienced at least one infusion system failure during the study. Most of the infusion system failures (96%) occurred in the syringe, infusion tube and connections, or subcutaneous infusion site. Virtually all malfunctions resulted in interruption of insulin flow, and most were associated with temporary loss of diabetes control. Equipment malfunction was documented in 6 of 7 patients who used insulin pumps and were treated in our hospital for diabetic ketoacidosis during the study. Pump “runaway” was not observed. We conclude that infusion system malfunction resulting in interruption of insulin flow is a common occurrence, is often associated with temporary hyperglycemia, and may account for some of the increased incidence of diabetic ketoacidosis previously described in these patients.