bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Dose Bedtime NPH Insulin in Treatment of Secondary Failure to Glyburide
Authors: Trischitta Vincenzo , Italia Salvatore , Borzi Vito , Tribulato Antonio , Mazzarino Salvatore , Squatrito Sebastiano , Vigneri Riccardo
Published: March 2007

Secondary failure to oral hypoglycemic agents (OHAs) is a possible outcome for non-insulin-dependent diabetes mellitus (NIDDM) patients and poses a serious therapeutic problem. In this study, we evaluated the effect of adding a single bedtime low-dose NPH insulin injection to the previous ineffective sulfonylurea therapy in 23 NIDDM patients with true secondary failure to OHAs. This treatment schedule was conducted for 3 mo by 18 patients (78%) who completed the study. In these patients, the addition of NPH insulin (0.2 ± 0.01 Ill/kg body wt) greatly decreased fasting and postprandial plasma glucose (P < .001) and glycosylated hemoglobin (P < .005). No weight gain was observed in any of the patients studied. Five patients dropped out: 2 patients (9%) due to insufficient compliance, 2 patients (9%) due to the multiple insulin injections required to achieve good metabolic control, and 1 patient (4%) due to recurrent hypoglycemic episodes. No correlation was observed between glucagon-stimulated C-peptide values and amelioration of metabolic control. In conclusion, mst NIDDM patients with secondary failure to OHAs may be successfully treated with the addition of a single low-dose bedtime NPH insulin injection, and residual (β-cell function evaluation is not able to predict the effectiveness of the combined treatment.
Intracerebral Crises During Treatment of Diabetic Ketoacidosis
Authors: Rosenbloom Arlan L
Published: March 2007

Sixty-nine instances of intracerebral complications of diabetic ketoacidosis (DKA), including 29 unpublished occurrences, were analyzed to determine predictive factors, the frequency of other disorders resembling cerebral edema, the effectiveness of intervention to reduce intracranial pressure, and whether any etiologic considerations appeared valid. The review failed to implicate rate of hydration, tonicity of administered fluids, rate of correction of glycemia, or use of bicarbonate. Infants and young children (<5 yr of age) were disproportionately represented (33%), as were new-onset patients (62%). Approximately 20% of patients were found to have localized basilar edema, hemorrhage, thromboses, or infection by computed tomography scan or on postmortem examination. The histories of 50% of the patients suggested a period of dramatic neurological change preceding respiratory arrest (RA) during which intervention might be effective. Twenty-three patients were treated for increased intracranial pressure before RA; 13 patients survived in an independent functional state, and 3 survived in a severely disabled or vegetative state. Only 3 of the remaining 46 patients survived normally: 2 were untreated and never developed RA, and 1 was given mannitol at the onset of apnea. This review supports close neurological monitoring and intervention to reduce intracranial pressure when there are definite signs of neurological compromise. However, treatment appears to be successful in only 50% of patients who give sufficient warning for such intervention, and they comprised half of the study population. Therefore, prevention of DKA remains the most important goal to avoid intracerebral complications.
Is Menarche Associated With Diabetic Retinopathy?
Authors: Klein Barbara EK , Moss Scot E , Klein Ronald
Published: March 2007

The goal of this study was to evaluate the association between menarchalstatus and diabetic retinopathy. Diabetic retinopathy was present in 51 of 129 females; 7 were premenarchal, and 44 were postmenarchal. The range of severity of retinopathy was greater in the postmenarchal group. In multivariateanalyses, duration of diabetes, menarchal status, and diastolic blood pressure were associated with the prevalence of diabetic retinopathy. After partitioning the duration of diabetes into years before and years after menarche, both were significant, but the number of years of diabetes after menarche was more strongly associated. At a 4-yr follow-up examination, more postmenarchal than premenarchal females had progression of their retinopathy (P = 0.06). These data suggest that stage of sexual development, as reflected by menarchal status, is associated with the presence and possibly the risk of progression of diabetic retinopathy.
Impact of Glucose Self-Monitoring on Non-lnsulin-Treated Patients With Type II Diabetes Mellitus: Randomized Controlled Trial Comparing Blood and Urine Testing
Authors: Allen B Titus , DeLong Elizabeth R , Feussner John R
Published: March 2007

The goal of this study was to compare the relative efficacy and cost of self-monitoring of blood glucose (SMBG) with routine urine testing in the management of patients with type II (non-insulin-dependent) diabetes mellitus not treated with insulin. Fifty-four patients with type II diabetes mellitus, not treated with insulin, who had inadequate glucose control on diet aloneor diet and oral hypoglycemic agents were studied. Patients performed SMBG or urine glucose testing as part of a standardized treatment program that also included diet and exercise counseling. During the 6-mo study, both the urine-testing and SMBG groups showed similar improvement in glycemic control; within each group, there were significant improvements in fasting plasma glucose (reduction of 1.4 ± 3.2 mM, P < 0.03) and glycosylated hemoglobin (reduction of 2.0 ± 3.4%, P < 0.01) levels. Seventeen (31%) of54 patients actually normalized their glycosylated hemoglobin values, 9 in the urine-testing group and 8 in the SMBG group. Comparisons between the urine-testing and SMBG groups showed no significant differences in mean fasting plasma glucose (P > 0.86), glycosylated hemoglobin (P > 0.95), or weight (P < 0.19). In patients with type II diabetes mellitus not treated with insulin, SMBG is no more effective, but is 8–12 times more expensive, thanurine testing in facilitating improved glycemic control. Our results do not support widespread use of SMBG in diabetic patients not treated with insulin.
Effect of Captopril on Glucose Concentration: Possible Role of Augmented Postprandial Forearm Blood Flow
Authors: Kodama Junichi , Katayama Shigehiro , Tanaka Kiyoshi , Itabashi Akira , Kawazu Shyoji , Ishii Jun
Published: March 2007

The goal of this study was to evaluate the effects of captopril on plasma glucose concentration. The daily profiles of the plasma glucose levels were determined in 12 non-insulin-dependent diabetic normotensive subjects, treated with or without captopril at a dose of 25 mg 3 times/day. Forearm blood flow was also measured by strain-gauge plethysmography. Administration of captopril improved the daily profile of the plasma glucose level. Postprandial forearm blood flow was also augmented 2 h after a meal. These results suggest that angiotensin-converting enzyme inhibitors may improve glucose metabolism in diabetic subjects, possibly through enhancement of blood flow to skeletal muscle.
Analysis of Metabolic Progression to Type I Diabetes in ICA+ Relatives of Patients With Type I Diabetes
Authors: Bleich David , Jackson Richard A , Soeldner J Stuart , Eisenbarth George S
Published: March 2007

We intensively studied 5 islet cell-antibody-positive (ICA+) first-degree relatives of type I (insulin-dependent) diabetic patients before overt diabetes. In total, 55 intravenous glucose tolerance tests (IVGTTs) and 83 fasting plasma glucose determinations were made over a maximum 4-yr period before diabetes. The 5 prediabetic relatives (not diabetic when initially studied but subsequently progressed to overt diabetes) as a group showed a progressive rise in fasting glucose (r = 0.58, P < 0.001, slope = 23.1 mg · dl1 yr1) and glucose at 60 min in IVGTT (r = 0.46, P = 0.01, slope = 47.5 mg · dl-1) beginning 1.5 yr before diabetes. During the 4.0- to 1.5-yr period before overt diabetes, no change was observed in fasting glucose or glucose at 60 min on IVGTT (fasting glucose: r = 0.21, P = 0.18, slope = 2.1 mg · dl-1 · yr-1; 60-min glucose: r = 0.08, P = 0.72, slope = 2.9 mg · dl-1 · yr-1). The positive predictive value for a fasting glucose >;108 mg/dl to be within 1.5 yr of diabetes was 100% (11 of 11 values). The negative predictive value of a stimulated insulin (1-min + 3-min insulin - 2 × basal insulin) level >24 μU/ml to be >1.5 yr from diabetes was 90% (9 of 10 values) and 100% (10 of 10 values) at >1 yr from overt diabetes. We tested these predictive values by applying fasting glucose >108 mg/dl and stimulated insulin >24 μU/ml to another prediabetic group (n = 14) not included in the original analysis because each individual had fewer measurements. Once again, the positive predictive value that diabetes would develop within 1.5 yr from the time of fasting glucose >108 mg/dl was 100% (5 of 5 values), and the negative predictive value of stimulated insulin >24 μU/ml was 63% (5 of 8 values) for 1.5 yr and 89% (6 of 7 values) for 1 yr. Finally, 16 ICA+ relatives who had not yet become diabetic lacked raised fasting glucose levels (14 of 16 patients) and had stimulated insulin levels >24 μU/ml.
Management of Dyslipidemia in NIDDM
Authors: Garg Abhimanyu , Grundy Scott M
Published: March 2007

Coronary heart disease is the leading cause of death among patients with non-insulin-dependent diabetes mellitus (NIDDM). NIDDM patients have a high frequency of dyslipidemia, which along with obesity, hypertension, and hyperglycemia may contribute significantly to accelerated coronary atherosclerosis. Because risk factors for coronary heart disease are additive and perhaps multiplicative, even mild degrees of dyslipidemia may enhance coronary heart disease risk. Therefore, therapeutic strategies for management of NIDDM should give equal emphasis to controlling hyperglycemia and dyslipidemia. The National Cholesterol Education Program recently issued guidelines for treatment of hyperlipidemia in adults including diabetic patients. Because of the unique features of diabetic dyslipidemia, however, we suggest that certain modifications in these guidelines be made to meet specific needs of diabetic patients. For example, therapeutic goals for serum cholesterol reduction should be lower in diabetic patients than in nondiabetic subjects. Particular emphasis should be given to weight reduction in NIDDM patients. In some diabetic patients, monounsaturated fatty acids may be a better replacement for saturated fatty acids than carbohydrates. The target for cholesterol lowering should include both very-low-density lipoprotein and low-density lipoprotein (LDL) (non-high-density lipoprotein) rather than LDL alone. To obtain a substantial reduction of cholesterol levels, drug therapy may be required in many patients. However, first-line drugs for nondiabetic patients (nicotinic acid and bile acid sequestrants) may be less desirable in NIDDM patients than hydroxymethylglutaryl coenzyme A (HMG CoA) reductase inhibitors and even fibric acids. In fact, HMG CoA reductase inhibitors may be the drugs of choice for NIDDM patients with elevated LDL cholesterol and borderline hypertriglyceridemia, whereas gemfibrozil appears preferable for NIDDM patients with severe hypertriglyceridemia.
Blood Glucose Area Under the Curve: Methodological Aspects
Authors: Floch Jean-Pierre Le , Escuyer Philippe , Baudin Eric , Baudon Dominique , Perlemuter Léon
Published: March 2007

To specify the influence of methods used in estimating area under the curve (AUC) and the meaning of total and incremental AUC, 75 glycemic responses to a mixed meal were studied in 75 diabetic patients, 39 with insulin-dependent diabetes mellitus and 36 with non-insulin-dependent diabetes mellitus. AUC was integrated with five computerized methods: polynomial interpolation of third and fourth degree, trapezoidal rule, Simpson's integration, and cubic interpolatory splines. Although these methods gave significantly different results (P < 0.001), a strong correlation was found between estimations of AUC with different methods (r > 0.99, P < 0.001). In addition, variation between methods was ≤2%, whereas the coefficient of variation between subjects was 38%. Total AUC was strongly correlated with basal blood glucose value (r = 0.90, P < 0.001), whereas incremental and positive AUC were not (r = 0.12 and 0.07, respectively, NS). Incremental and positive AUC were strongly correlated with glycemic rise (r = 0.89 and 0.93, respectively, P < 0.001), whereas total AUC was only slightly so (r = 0.31, P < 0.01). Incremental and positive AUC gave slightly but significantly different information on glucose response. These results suggest that variations related to the method used in estimating AUC are not clinically relevant and that a simple method such as trapezoidal rule can be used. Total AUC is a descriptive factor related to basal blood glucose value, whereas incremental and positive AUC more accurately describe glycemic response to foods.
Hemostatic Alterations With Exercise Conditioning in NIDDM
Authors: Hornsby W Guyto , Boggess Karen A , Lyons Timothy J , Barnwell William H , Lazarchick John , Colwell John A
Published: March 2007

Various parameters of coagulation and fibrinolysis were measured in 13 men (aged 54 ± 3 yr) with non-insulindependent diabetes mellitus (NIDDM) before and after 12-14 wk of exercise training. Subjects exercised for 30 min 3 times/wk at 70% of maximum O2 consumption (Vo2max). Training increased Vo2max by 12.5% but did not alter body weight, relative body fat, blood pressure, cholesterol, triglycerides, or high-density lipoprotein cholesterol. Slight downward trends were apparent for fasting glucose and insulin, but glycosylated hemoglobin was unchanged. There were no changes in coagulation parameters of plasminogen, hematocrit, or α2-antiplasmin. Plasma fibrinogen (303 ± 24.2 vs. 256 ± 12.3 mg/dl) and fibronectin (380 ± 41.9 vs. 301 ± 22.2 μg/ml) were significantly reduced (P < 0.02) by exercise conditioning. Three assays of fibrinolytic activity (tissue plasminogen activator, euglobulin lysis time, and an isotopic measure of fibrinolysis) confirmed that neither basal fibrinolysis nor the fibrinolytic responses to venous occlusion and maximal exercise were significantly altered. Exercise conditioning may have antithrombotic effects in NIDDM by reducing plasma fibrinogen and fibronectin. Although the significance of the fall in fibronectin awaits further studies, the reduction in plasma fibrinogen gives a rationale for the use of exercise training in men with NIDDM.
PEPCK Gene as Model of Inhibitory Effects of Insulin on Gene Transcription
Authors: O'Brien Richard M , Granner Daryl K
Published: March 2007

Regulation of gene transcription is a major action of insulin. Most of the >20 examples of this effect involve the stimulation of transcription, but a few involve an inhibition. The inhibition of transcription of the phosphoenolpyruvate carboxykinase (PEPCK) gene has been studied in detail. Most of this effect is exerted at the level of transcription initiation. Hormone effects on transcription are thought to be mediated through cisacting DNA sequences located in the 5'-flanking sequence adjacent to the transcription initiation site. The techniques of transient and stable transfection of fusion genes containing various segments of the PEPCKgene promoter are being used to locate the insulinresponsive sequences.
Randomized Prospective Study of Self-Management Training With Newly Diagnosed Diabetic Children
Authors: Delamater Alan M , Bubb Jeanne , Davis Susan G , Smith Jeffrey A , Schmidt Lois , White Neil H , Santiago Julio V
Published: March 2007

This study was designed to evaluate the effects of a self-management training (SMT) program on metabolic control of children with insulin-dependent diabetes mellitus (IDDM) in the first 2 yr after diagnosis. After standard in-hospital diabetes education, 36 children (mean age 9.3 yr, range 3–16 yr) were randomized to conventional follow-up, conventional and supportive counseling (SC), or conventional and SMT, which emphasized use of data obtained from self-monitoring of blood glucose. SC and SMT interventions consisted of seven outpatient sessions with a medical social worker during the first 4 mo after diagnosis and booster sessions at 6 and 12 mo postdiagnosis. Groups were similar with respect to age, sex, body mass index, socioeconomic status, C-peptide, and severity of illness at diagnosis. Metabolic control, measured quarterly by glycosylated hemoglobin (HbA1), improved substantially in all three treatment groups during the first 6 mo. SMT patients had significantly lower HbA1 levels than conventional patients at 1 yr (P < 0.01) and 2 yr (P < 0.05) postdiagnosis. SMT patients also had lower HbA1 levels than SC patients, but this did not reach statistical significance. The lower HbA1 levels of SMT patients were not explained by severity of illness at diagnosis, or insulin dose, body mass index, and C-peptide levels at 2 yr. These results suggest that an SMT program during the first few months after diagnosis helps avoid the deterioration in metabolic control often seen in children with IDDM between 6 and 24 mo after diagnosis.
Predicting Type I Diabetes
Authors: Ziegler Anette G , Herskowitz Raymonde Dumont , Jackson Richard A , Soeldner J Stuart , Eisenbarth George S
Published: March 2007

Currently, there are three markers that are being studied with the potential to give a high positive predictive value for the development of type I diabetes (insulin-dependent diabetes caused by autoimmune β-cell destruction) and that can be utilized to predict the disease in susceptible relatives: 1) high-titer cytoplasmic islet cell antibodies, 2) insulin autoantibodies detected with fluid-phase radiobinding assays, and 3) first-phase insulin release after intravenous glucose <1st percentile. With the combination of these assays, it seems to be possible to identify first-degree relatives with a high probability of developing type I diabetes within a limited time span (i.e., <10 yr). The ability to predict type I diabetes with selected assays will allow trials for prevention of diabetes and trials to assess whether prediction will decrease morbidity and mortality at onset of diabetes.
Periodontal Disease and NIDDM in Pima Indians
Authors: Nelson Robert G , Shlossman Marc , Budding Lynn M , Pettitt David J , Saad Mohammed F , Genco Robert J , Knowler William C
Published: March 2007

The goal of this study was to determine the prevalence and incidence of periodontal disease and its relationship with non-insulin-dependent diabetesmellitus (NIDDM). Two thousand two hundred seventy-three Pima Indians (949 men, 1324 women) aged ≥15 yr from the Gila River Indian Community in Arizonawere examined between 1983 and 1989. Periodontal disease was diagnosed by tooth loss and by percentage of interproximal crestal alveolar bone loss ascertained from panoramic radiography. Subjects with little or no evidence of periodontal disease were classified as nondiseased. Thus, the incidence of advanced periodontal disease was determined. The age- and sex-adjusted prevalence of periodontal disease at first dental examination was 60% in subjects with NIDDM and 36% in those without. Twenty-two new cases developed in a subset of 701 subjects (272 men, 429 women) aged 15–54 yr who initially had little or no evidence of periodontal disease and had at least one additional dental examination. The incidence of periodontal disease in this group was similar in men and women (incidence-rate ratio 1.0, 95% confidence interval [Cl] 0.5-1.9, controlled for age and diabetes). Higher age predicted a greater incidence of periodontal disease (χ2 = 30.6, df = 3, P < 0.001, controlled for sex and diabetes). The rate of periodontal disease in subjects with diabetes was 2.6 times (95% Cl 1.0–6.6, controlled for age and sex) that observed in those without. Although periodontal disease was common in nondiabetic Pima Indians, in whom most of the incident cases occurred, diabetes clearly conferred a substantially increased risk. Thus, periodontal disease should be considered a nonspecific complication of NIDDM.
Impact of Intensive Educational Approach to Dietary Change in NIDDM
Authors: Campbell Lesley V , Barth Renate , Gosper Jill K , Jupp Jim J , Simons Leon A , Chisholm Donald J
Published: March 2007

The aim of this study was to compare the effects of an intensive educational approach incorporating longer time, greater simplicity, repetition, andcognitive motivational techniques with a conventional one in subjects with established non-insulin-dependent diabetes mellitus (NIDDM) whose weight, glycemic control, and diet were not optimal. Subjects were randomly allocated to intensive or conventional education. Of 350 subjects, 70 met the study criteria, which included established NIDDM (≥3 mo), suboptimal recent glycemic control, dietary fat intake ≥35% of total energy intake, and body massindex ≥25 kg/m2. The intensive approach was associated with significantly greater improvements in dietary compliance, dietary intake (complex carbohydrate, [P = 0.013], legumes [P < 0.0001], fiber [P < 0.0001], total fat [P < 0.004], saturated fat [P < 0.004]), and total cholesterol level (P = 0.007). The transient improvement in glycemic control was similar in both groups. An intensive education program can improve dietary compliance in established NIDDM subjects more than a conventional one. These recommended dietary improvements achieve better improvement in total cholesterol but do not necessarily improve glycemic control.
Lowering of Plasma Glucose Concentrations With Bezafibrate in Patients With Moderately Controlled NIDDM
Authors: Jones Ian R , Swai Andrew , Taylor Roy , Miller Margaret , Laker Michael F , Alberti K George MM
Published: March 2007

The goal of this study was to investigate whether treatment with bezafibrate improves glucose tolerance in non-insulin-dependent diabetes mellitus (NIDDM). The study included 37 NIDDM patients with HbA1 concentrations >8.5% and normal kidney and liver function who were being treated with diet alone or diet together with a sulfonylurea drug. One patient withdrew because of constipation. At randomization and after 3 mo of treatment, patients were given a standard mixed-test-meal tolerance test (MTT; 500 cal) after an overnight fast, and plasma glucose, insulin, C-peptide, metabolite, nonesterified fatty acid (NEFA), and triglyceride concentrations were measured at 15- to 30-min intervals. Serum lipid, HbA1, and fructosamineconcentrations were measured at monthly intervals. Glucose, NEFA, and triglyceride concentrations were significantly lower throughout the second MTT in bezafibrate patients (P < 0.01–0.001) but not in the placebo group. Fasting serum insulin and C-peptide levels, but not postprandial concentrations, were reduced only in bezafibrate patients (P < 0.05). After 3 mo, mean fasting serum triglyceride concentrations fell from 2.2 to 1.4 mM (P < 0.001), total serum cholesterol concentrations from 6.3 to 5.5 mM (P < 0.001), and lowdensity lipoprotein cholesterol concentrations from 4.2 to 3.5 mM (P < 0.001) in bezafibrate patients. There were no changes in serum lipid concentrations in the placebo group. Treatment of patients with moderately controlled NIDDM with bezafibrate improves glucose tolerance and the serum lipid profile. Bezafibrate treatment may be a useful adjunct to hypoglycemic therapy in patients with NIDDM.
Insulin Use in NIDDM: Rationale Based on Pathophysiology of Disease
Authors: Turner Robert C , Holman Rury R
Published: March 2007

Because basal hyperglycemia is a major feature in non-insulin-dependent diabetes mellitus, diabetes control can be monitored by the fasting blood glucose concentration. A hierarchical sequence of therapies is proposed in which the major aim is to maintain nearnormal fasting blood glucose concentrations, in the expectation that this will help prevent development of long-term complications. When diet and tablet therapy are no longer effective in keeping the fasting blood glucose level <6 mM, a basal insulin supplement from a long-acting insulin such as ultralente can be added. When monitored by fasting blood glucose concentration, there is little risk of hypoglycemia, and the patient can continue a normal life-style without restrictions concerning exercise or the size of individual meals. A basal insulin supplement does not induce marked weight gain. The dose of insulin required can be predicted from the level of the fasting blood glucose and the degree of obesity, which provides an index of the accompanying insulin resistance. Based on current evidence, insulin therapy is equally appropriate in patients with insulin deficiency and insulin resistance, because the benefit from maintaining near-normal glucose concentrations probably outweighs a putative risk of hyperinsulinemia. In more severely affected patients, additional regular insulin to cover meals is needed. Lowering fasting blood glucose to normal with a basal insulin supplement reduces endogenous insulin production, and this may be advantageous if accompanying production of islet amyloid polypeptide and islet amyloid formation are also reduced.
Enhancing Blood Glucose Awareness in Adolescents and Young Adults With IDDM
Authors: Nurick Michael A , Johnson Suzanne Bennett
Published: March 2007

Objective

To determine the effectiveness of an intervention program designed to improve blood glucose awareness.

Research Design and Methods

Eight young-adult outpatients (mean age 22 yr) and six adolescent inpatients (mean age 14.5 yr) with insulin-dependent diabetes mellitus participated in the intervention program. Nine adolescent inpatients (mean age 13.9 yr) served as an untreated comparison group. One adult outpatient with unreliable data was removed. Before treatment, each patient completed a minimum of 40 blood glucose estimations, blood glucose tests, and symptom-rating checklists. Symptoms of hypo- or hyperglycemia were identified for each patient. The three-session intervention focused on internal (e.g., personal symptoms) and external (e.g., timing and amount of insulin, food, and exercise) cues that could be used to enhance blood glucose awareness. At postintervention, patients completed a minimum of 40 additional blood glucose estimates and tests. Comparison subjects completed the pre-postassessments but did not receive the intervention.

Results

Blood glucose estimation accuracy was evaluated with error grid analysis. All estimated-actual blood glucose values were plotted into one of five zones: accurate estimates (zone A), benign errors (zone B), and clinically dangerous errors (zones C, D, and E). An overall accuracy index (AI) was calculated by subtracting the summed percentage of clinically dangerous estimates (zones C, D, and E) from the percentage of accurate estimates (zone A). At study entry, the adolescent inpatients' mean AI of 7% was significantly poorer than the 32% mean AI exhibited by the outpatient young-adult sample (P < 0.02). At postintervention, the adolescents' mean AI improved to 30% (P < 0.02) and the young adults' mean outpatient AI improved to 45% (P < 0.06). The treated sample as a whole exhibited increased sensitivity to both hypo- (P < 0.005) and hyperglycemia (P < 0.05). Similar improvements did not occur in the untreated comparison sample.

Conclusions

Adolescents may exhibit poorer blood glucose awareness than adults. Although this intervention program improved blood glucose awareness in both adolescent and adult patients, postintervention blood glucose estimation accuracy remained far from ideal.
Relationship of Limited Joint Mobility to Abnormal Foot Pressures and Diabetic Foot Ulceration
Authors: Fernando Devaka JS , Masson Ewan A , Veves Aristidis , Boulton Andrew JM
Published: March 2007

Objective

To investigate the role of limited joint mobility (LJM) in causing abnormal foot pressures and foot ulceration.

Research Design and Methods

The subjects were recruited from a general diabetes clinic where patients were screened for neuropathy, retinopathy, and elevated plantar foot pressure. Sixty-four patients in five groups were matched by age and sex in the following groups: group 1, patients with LJM and neuropathy; group 2, nonneuropathic diabetic patients with LJM; group 3, patients with neuropathy and no LJM; group 4, diabetic control subjects; and group 5, nondiabetic control subjects. Joint mobility was assessed in the foot at subtalar and metatarsophalangeal joints; plantar foot pressures were assessed by optical pedobarography and neuropathic status by a Biothesiometer and electrophysiology.

Results

Joint mobility was reduced at both sites in groups 1 and 2 compared with groups 3, 4, and 5 (P < 0.001). Plantar foot pressures were significantly higher in groups 1 and 2 compared with groups 3, 4, and 5 (P < 0.001). No differences in plantar foot pressures were observed between groups 1 and 2. There were strong correlations between plantar foot pressures and joint mobility in the foot (r = −0.7, P < 0.001). Previous foot ulceration was present in 65% of patients in group 1, none in group 2, and 5% in group 3.

Conclusions

1) LJM may be a major factor in causing abnormally high plantar foot pressures, 2) abnormal plantar foot pressures alone do not lead to foot ulceration, and 3) LJM contributes to foot ulceration in the susceptible neuropathic foot.
Effects of Cyclosporin A and Low Dosages of Steroid on Posttransplantation Diabetes in Kidney Transplant Recipients
Authors: Yamamoto Hidefumi , Akazawa Shoichi , Yamaguchi Yoshihiko , Yokota Atsushi , Yamasaki Hironori , Nakanishi Toshiaki , Tahara Daigo , Matsuya Fukuzo , Saito Yutaka , Nagataki Shigenobu
Published: March 2007

Objective

To investigate the adverse effects of cyclosporin A (CsA) on pancreatic beta-cell function in kidney transplant recipients.

Research Design and Methods

The study consisted of 73 patients without a history of diabetes mellitus who had undergone kidney transplantation in our clinic.

Results

We experienced a higher incidence of posttransplantation diabetes mellitus (PTDM) in patients receiving CsA and low dosages of methylprednisolone (6/20, 30%, P < 0.05) than in patients receiving conventional therapy of azathioprine methylprednisolone (4/53, 7.5%) since the introduction of CsA. In all 6 patients in the CsA-treated group, PTDM occurred within 3 mo after transplantation. The CsA level during the initial 3 mo posttransplant was significantly higher in diabetic than nondiabetic subjects, and the highest CsA level was observed shortly (1 mo) before the development of PTDM. After an average of 71 days of insulin therapy, there was complete remission of PTDM in 5 of 6 diabetic patients, with a corresponding decrease in CsA level. For the patients who were in remission for > 1 yr, a significant improvement of glucose intolerance was observed in association with a significantly higher insulin response to oral glucose load; however, their glycemic profile still showed a significantly higher plasma glucose concentration and a prolonged continuous elevation without initial peak of the insulin-response curve in contrast to the normal pattern found in nondiabetic subjects in the CsA-treated group.

Conclusions

This study suggests that CsA in combination with low dosages of steroid may have adverse effects on glucose metabolism, which may lead to effects similar to those in non-insulin-dependent diabetes mellitus.
Effect of New Oral Antidiabetic Agent CS-045 on Glucose Tolerance and Insulin Secretion in Patients with NIDDM
Authors: Iwamoto Yasuhiko , Kuzuya Takeshi , Matsuda Ayako , Awata Takuya , Kumakura Shinobu , Inooka Gen , Shiraishi Ikuo
Published: March 2007

Objective

To study the effects of CS-045, a newly developed thiazolidine analogue, on glucose tolerance and insulin response to oral glucose load in patients with non-insulin-dependent diabetes mellitus (NIDDM).

Research Design and Methods

Nineteen NIDDM patients (mean ± SD age 48.9 ± 9.4 yr) whose previous glycemic control on diet and/or sulfonylurea (SU) therapy was judged stable but unsatisfactory (> 7.8 mM) were selected for this study. CS-045 (400 mg/day p.o.) was given alone or together with the previous SU drugs for 12 wk. A 75-g oral glucose tolerance test (OGTT) was performed before and after CS-045 treatment.

Results

The following results were found after CS-045 treatment. 1) Fasting plasma glucose (FPG) and HbA1c decreased (n = 19, FPG, 11.0 ± 2.4 vs. 8.4 ± 2.7 mM [before vs. after], P < 0.001; HbA1c, 8.0 ± 1.1 vs. 7.4 ± 1.3%, P < 0.005), and glucose tolerance markedly improved. 2) Fasting insulin (immunoreactive insulin [IRI]) and insulin response during OGTT decreased (n = 19, fasting IRI, 77.4 ± 49.8 vs. 56.5 ± 24.6 pM [before vs. after], P < 0.05; area under the curve of IRI, 540.3 ± 350.5 vs. 426.4 ± 216.3 pM.h, P < 0.05).

Conclusions

CS-045 is effective in improving glucose tolerance without stimulation of insulin secretion in NIDDM, suggesting an effect in improving insulin sensitivity.
Evidence Against Association Between Parity and NIDDM From Five Population Groups
Authors: Collins Veronica R , Dowse Gary K , Zimmet Paul Z
Published: March 2007

Objective

To determine whether a reported positive association between parity and the development of non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) is reproducible in other populations.

Research Design and Methods

We investigated the relationship in data from population-based surveys in four Pacific and Indian Ocean island nations. Women ≥ 40 yr of age at the time of the survey, excluding those in whom diabetes developed before 40 yr of age, were included in this study of Micronesians from Nauru (n = 204) and Kiribati (n = 562), Fiji Melanesians (n = 390), Fiji Indians (n = 247), and mixed-ethnic Mauritians (n = 1333). Subjects in each survey underwent a 75-g oral glucose tolerance test, and glucose tolerance status was ascertained with 1985 World Health Organization criteria. Obstetric information and family history of diabetes were determined by interview.

Results

Age and body mass index (BMI)-adjusted mean parity increased slightly with worsening glucose tolerance in only two groups, decreased in one group, and was inconsistent in the other two (none were statistically significant). We also found an inconsistent relationship between the number of full-term pregnancies and the prevalence of IGT and NIDDM, although in each population, there was a higher prevalence of NIDDM in the highest parity group (≥ 10 pregnancies) compared with the lowest parity group (1-3 pregnancies). In logistic regression analyses accounting for age, BMI, and family history of diabetes, odds ratio estimates for NIDDM and IGT associated with each pregnancy were not significantly greater than unity.

Conclusions

The results indicate that there is little if any independent association between parity and the development of abnormal glucose tolerance in these populations.
Effects of Dietary Fiber and Carbohydrate on Glucose and Lipoprotein Metabolism in Diabetic Patients
Authors: Riccardi Gabriele , Rivellese Angela A
Published: March 2007

Dietary recommendations for the treatment of diabetic patients issued by national and international diabetes associations consistently emphasize the need to increase carbohydrate consumption. However, these recommendations have been questioned on the basis of growing evidence that, in both insulin-dependent and non-insulin-dependent diabetic patients, a high-carbohydrate diet does not offer any advantage in terms of blood glucose and plasma lipid concentrations compared with a high-fat (mainly unsaturated) diet. It has been shown repeatedly that a high-carbohydrate diet increases plasma insulin and triglyceride levels and can deteriorate blood glucose control in the postprandial period. However, much of the controversy between advocates and detractors of dietary carbohydrate can be settled by taking into account dietary fiber. Several studies have shown that the adverse metabolic effects of high-carbohydrate diets are neutralized when fiber and carbohydrate are increased simultaneously in the diet for diabetic patients. In particular, these studies demonstrated that a high-carbohydrate/high-fiber diet significantly improves blood glucose control and reduces plasma cholesterol levels in diabetic patients compared with a low-carbohydrate/low-fiber diet. In addition, a high-carbohydrate/high-fiber diet does not increase plasma insulin and triglyceride concentrations, despite the higher consumption of carbohydrates. Unfortunately, dietary fiber represents a heterogenous category, and there is still much to understand as to which foods should be preferred to maximize the metabolic effects of fiber. There are indications that only water-soluble fiber is active on plasma glucose and lipoprotein metabolism in humans. Therefore, in practice, the consumption of legumes, vegetables, and fruits–rich in water-soluble fiber–should be particularly encouraged. The mechanisms by which dietary fiber exerts its hypoglycemic and hypolipidemic activities are unknown. However, the ability of dietary fiber to retard food digestion and nutrient absorption certainly has an important influence on lipid and carbohydrate metabolism. The beneficial effects of high-fiber foods are also exerted by some foods not particularly rich in fiber. The fiber content and physical form of the food can influence the accessibility of nutrients by digestive enzymes, thus delaying digestion and absorption. The identification of these foods with a low-glycemic response would help enlarge the list of foods particularly suitable for diabetic patients. In conclusion, a diet low in cholesterol and saturated fat should be recommended to all diabetic patients to prevent cardiovascular disease. A balanced increase in consumption of fiber-rich foods and unsaturated fat is the most rational way to replace foods rich in saturated fat and cholesterol in the diabetic diet.
Biological Effects of ω-3 Fatty Acids in Diabetes Mellitus
Authors: Malasanos Toree H , Stacpoole Peter W
Published: March 2007

Fish oils exert important biological effects on several pathways predisposing to atherosclerosis. Epidemiological studies provided the initial evidence that omega-3 fatty acids may be the principal factor in fish oils responsible for these effects and have led to several short-term clinical trials in which fish-oil concentrates have been administered to various populations at risk for coronary heart disease, including patients with diabetes mellitus. omega-3 Fatty acids reduce serum lipids and lipoproteins, impair platelet aggregation, increase cell membrane fluidity, and lower blood pressure in humans. In this review, we highlight these and other potentially antiatherogenic properties of marine lipids in diabetic subjects.
Increased Incidence of Type II Diabetes Mellitus in Mexican Americans
Authors: Haffner Steven M , Hazuda Helen P , Mitchell Braxton D , Patterson Judith K , Stern Michael P
Published: March 2007

Objective

To determine whether Mexican Americans have an increased incidence of non-insulin-dependent (type II) diabetes mellitus relative to non-Hispanic whites. Currently, no study has reported on the incidence of this disorder in Mexican Americans.

Research Design and Methods

We determined the 8-yr incidence of type II diabetes in 617 Mexican Americans and 306 non-Hispanic whites who participated in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Forty Mexican Americans (6.5%) and 6 non-Hispanic whites (2%) developed type II diabetes, as defined by World Health Organization criteria. The age-adjusted ethnic odds ratio (OR; Mexican Americans/non-Hispanic whites) for diabetes incidence was 8.13 (95% confidence interval [C1] 1.10–59.9) in men and 3.62 (95% CI 1.37–9.55) in women. We adjusted for age, sex, ethnicity, body mass index, and level of educational attainment with multiple logistic regression analyses.

Results

Mexican Americans continued to show a statistically significant increase in diabetes incidence (OR 2.72, 95% CI 1.02–7.28). Obesity and age were also positively related to diabetes incidence in this analysis (P < 0.001). In addition, subjects with at least some college education had a lower incidence of diabetes than those with less than a high school education (OR 0.51, 95% CI 0.26–0.99).

Conclusions

The incidence of type II diabetes in Mexican Americans is greater than in non-Hispanic whites, a difference that is not explained by ethnic differences in obesity, age, or level of educational attainment.
Association of Cigarette Smoking With Diabetic Retinopathy
Authors: Moss Scot E , Klein Ronald , Klein Barbara EK
Published: March 2007

Objective

To determine whether cigarette smoking is associated with the incidence and progression of diabetic retinopathy.

Research Design and Methods

Younger-onset diabetic subjects who had been diagnosed at >30 yr of age and taking insulin (n = 1210) and a random sample of older-onset diabetic subjects diagnosed at ≥30 yr of age (n = 1780) were selected. Baseline examinations were conducted on 996 youngerand 1370 older-onset subjects. Incidence of retinopathy was based on 138 younger-onset and 154 older-onset insulin-taking subjects and 321 older-onset non-insulintaking subjects who were free of retinopathy at baseline. Progression of retinopathy was based on 530 youngeronset and 418 older-onset insulin-taking subjects and 486 older-onset non-insulin-taking subjects with less than proliferative diabetic retinopathy at baseline.

Results

Baseline smoking history was categorized by status (nonsmoker, ex-smoker, current smoker) and pack-years smoked while diabetic. Retinopathy was documented by stereoscopic fundus photography. In univariate analyses, the only significant association was between pack-years and progression to proliferative diabetic retinopathy in older-onset insulin-taking subjects (P < 0.01). After controlling for known risk factors for the incidence and progression of retinopathy, pack-years smoked was borderline significant (P = 0.052) in predicting incidence of retinopathy in youngeronset subjects. Smoking was not associated with incidence in older-onset subjects or with progression or progression to proliferative diabetic retinopathy in any of the groups.

Conclusions

Smoking is not likely to be an important risk factor for diabetic retinopathy.
Major Role for Arterial Disease in Morbidity and Mortality After Kidney Transplantation in Diabetic Recipients
Authors: Lemmer Michael J , Barry John M
Published: March 2007

Objective

To identify clinical characteristics of diabetic end-stage renal disease patients that place individual transplant candidates at high risk for arterial morbidity and mortality after transplantation.

Research Design and Methods

We studied the course of 101 sequential renal allograft recipients with insulin-dependent diabetes mellitus, transplanted between 10 November 1980 and 1 April 1986. Arterial disorders were tabulated from medical records and interviews with individual patients, their families, and their private physicians. Documentation of discrete arterial events included recorded physical examinations, radiographic studies, laboratory data, electrocardiograms, peripheral vascular flow studies, and operative reports. The prevalence of preoperative arterial disease was compared with the occurrence of new arterial events after kidney transplantation.

Results

Within a mean follow-up period of 47 mo, a 30% absolute mortality rate was observed. Of these deaths, 57% resulted from arterial disorders. Clinical manifestations of arterial disease were recognized in 41% of recipients before transplantation, and 78% of these patients suffered new vascular events after transplantation. Of the entire sample, 57% developed at least one new complication of arterial disease after transplantation, whereas only 34% had no vascular diagnosis before or after transplantation. Cerebral, coronary, and peripheral arterial complications after transplantation occurred in 14, 28, and 36% of the patients, respectively. The corresponding incidences of stroke, myocardial infarction, and amputation were 12, 14, and 25%. Pretransplant coronary artery disease predisposed to new coronary eventsafter transplantation, but only peripheral arterial complications occurred more often after transplantation compared with the preoperative period. The probability of arterial complications or death correlated with patient age at first transplant and duration of diabetes but not with sex or smoking history.

Conclusions

Intrinsic arterial disease in diabetic renal allograft recipients contributes heavily to the long-term morbidity and mortality after transplantation and poses the major threat to survival. Diabetic transplant candidates >35 yr of age or with clincial evidence of arterial disease should undergo an extensive vascular assessment, including stress thallium myocardial imaging and/or coronary arteriography. Such recipients should receive careful preoperative counseling about their excess risk for subsequent arterial disorders.
Hypercholesterolemia in Diabetes and Glucose Intolerance in the U.S. Population
Authors: Harris Maureen I
Published: March 2007

The prevalence of hypercholesterolemia, according to the guidelines of the National Cholesterol Education Program, has been determined in a national survey of diabetes and glucose intolerance. Rates of elevated total cholesterol in people with diabetes in the United States are only slightly greater than in those without diabetes after adjusting for age and sex. Nevertheless, high or borderline high total cholesterol is common in diabetes and is present in 70% of adults with diagnosed diabetes and 77% with undiagnosed diabetes in the U.S. population. Of these individuals, 95% have evidence of coronary heart disease or two or more risk factors for heart disease and should therefore have their low-density lipoprotein (LDL) cholesterol measured. Based on our national data, LDL cholesterol levels warranting dietary treatment for hypercholesterolemia would be expected in 85% of these people. Although elevated LDL cholesterol is uncommon in people with diabetes who have total cholesterol of <200 mg/dl, other risk factors for coronary heart disease are very frequent (100% of men, 73% of women), and low total and LDL cholesterol may mask low high-density lipoprotein cholesterol. Therefore, investigation of blood lipid levels and coronary heart disease risk factors should be routine in all patients with diabetes, and treatment strategies should include management of lipid disorders and the multiple other risk factors for coronary heart disease that are highly prevalent in these patients.