bluuebunny/crossref_metadata_2025 huggingface dataset:
Incipient and Overt Diabetic Nephropathy in African Americans With NIDDM
Authors: Dasmahapatra Amita , Bale Asha , Raghuwanshi Maya P , Reddi Alluru , Byrne William , Suarez Sarah , Nash Fred , Varagiannis Evelyn , Skurnick Joan H
Published: March 2007

OBJECTIVE

To determine the prevalence of incipient and overt nephropathy in African- American subjects with non-insulin-dependent diabetes mellitus(NIDDM) attending a hospital clinic. Contributory factors, such as blood pressure (BP), duration and age at onset of diabetes, hyperglycemia, hyperlipidemia, and body mass index (BM1) also were evaluated.

RESEARCH DESIGN AND METHODS

We recruited 116 African-American subjects with NIDDM for this cross-sectional, descriptive, and analytical study. BP, BMI, 24-h urine albumin excretion, creatinine clearance, serum creatinine, lipids, and GHb levels were measured. Albumin excretion rate (AER) was calculated, and subjects were divided into three groups: no nephropathy (AER <20 μg/min), incipient nephropathy (AER 20–200 μg/min), and overt nephropathy (AER >200 μg/min). Frequency of hypertension and nephropathy was analyzed by x2 testing, group means were comparedusing analysis of variance, and linear correlations were performed between AER and other variables. Multiple regression analysis was used to examine theassociation of these variables while controlling for the effects of other variables.

RESULTS

Increased AER was present in 50% of our subjects; 31% had incipient and 19% had overt nephropathy. Hypertension was present in 72.4%; nephropathy, particularly overt nephropathy, was significantly more prevalent in the hypertensive group. Mean BP and diastolic blood pressure (dBP) were higher in the groups with incipient and overt nephropathy, and systolic blood pressure (sBP) was increased in overt nephropathy. Men with either form of nephropathy had higher sBP, dBP, and mean BP, whereas only women with overt nephropathy had increased sBP and mean BP. Subjects with incipient or overt nephropathy had a longer duration of diabetes, and those with overt nephropathyhad a younger age at onset of diabetes. By multiple regression analysis, AER correlated with younger age at diabetes onset, but not with diabetes duration. No correlation with age, lipid levels, or GHb was noted. BMI correlated with AER.

CONCLUSIONS

Incipient and overt nephropathy were observed frequently inthese African-American subjects with NIDDM. Albuminuria correlated with BP, younger age at diabetes onset, and BMI. Association of albuminuria and increased cardiovascular mortality may place 50% of inner-city African-American patients with NIDDM at risk for developing cardiovascular complications.
Hyperosmolar Nonketotic Diabetic Syndrome Following Treatment of Human Immunodeficiency Virus Infection With Didanosine
Authors: Munshi Medha N , Martin Rebecca E , Fonseca Vivian A
Published: March 2007

OBJECTIVE

To determine whether didanosine (DDI), one of the drugs commonly used to treat infection with human immunodeficiency virus (HIV), contributes to the development of diabetes and hyperosmolar nonketotic diabetic syndrome (HNKDS).

CASE SUMMARY

One female patient was treated with DDI for infection with HIV during pregnancy. Soon after starting DDI treatment, she developed diabetes, which progressed to HNKDS.

CONCLUSIONS

Although not reported in the literature, hyperglycemia following treatment with DDI has been noted in 82 patients and is usually associated with pancreatitis. DDI should be recognized as one of the drugs known to potentially cause diabetes and HNKDS. With the increasing use of DDI and other drugs that cause hyperglycemia, such as pentamidine and dapsone, blood glucose should be monitored frequently in the HIV-infected patients.
Weight Loss in Severely Obese Subjects Prevents the Progression of Impaired Glucose Tolerance to Type II Diabetes: A longitudinal interventional study
Authors: Long Stuart D , O'brien Kevin , Macdonald Kenneth G , Leggett-Frazier Nancy , Swanson Melvin S , Pories Walter J , Caro José F
Published: March 2007

OBJECTIVE

To determine if weight loss may prevent conversion of impaired glucose tolerance (IGT) to diabetes, because weight loss reduces insulin resistance. The prevalence of IGT in the U. S. population is estimated at 11.2%, more than twice that of diabetes. Furthermore, because an oral glucose tolerance test is needed for its detection, most of these patients are undiagnosed. Screening for IGT would be meaningful if progression to diabetes could be delayed or prevented.

RESEARCH DESIGN AND METHODS

For an average of 5.8 years (range 2–10 years), 136 individuals with IGT and clinically severe obesity (>45 kg excess body weight) were followed. The experimental group included 109 patients with IGT who underwent bariatric surgery for weight loss. The control group was made up of 27 subjects with IGT who did not have bariatric surgery. The criteria of the World Health Organization was used to detect IGT and diabetes in this population. The main outcome measure of this nonrandomized control trial is the incidence density, or number of events (development of diabetes) divided by the time of exposure to risk.

RESULTS

Of the 27 subjects in the control group, 6 developed diabetes during an average of 4.8 ± 2.5 years of postdiagnosis follow-up, yielding a rate of conversion to diabetes of 4.72 cases per 100 person-years. The 109 individuals of the experimental group were followed for an average of 6.2 ± 2.5 years postbariatric surgery. Based on the 95% confidence interval of the comparison group, we would expect to find that between 22 and 36 subjects in the experimental group developed diabetes over the follow-up period. Only 1 of the 109 experimental-group patients developed diabetes, resulting in a conversion rate of the experimental group of only 0.15 cases per 100 person-years, which is significantly lower (P < 0.0001) than the control group.

CONCLUSIONS

Weight loss in patients with clinically severe obesity prevents the progression of IGT to diabetes by >30-fold.
Effects of Long-Term Enalapril Treatment on Persistent Microalbuminuria in Well-Controlled Hypertensive and Normotensive NIDDM Patients
Authors: Sano Takahisa , Kawamura Takahiko , Matsumae Hiromi , Sasaki Hiromitsu , Nakayama Motohiro , Hara Tomohiro , Matsuo Seiichi , Hotta Nigishi , Sakamoto Nobuo
Published: March 2007

OBJECTIVE

To determine whether long-term treatment with an angiotensinconverting enzyme (ACE) inhibitor has a beneficial effect on the urinary microalbumin excretion and renal function in non-insulin-dependent diabetes mellitus (NIDDM) patients, enalapril (5 mg/day) was administered for 48 months.

RESEARCH DESIGN AND METHODS

Fifty-two patients with NIDDM who had persistent microalbuminuria in the range of 20–300 mg/24 h, serum creatinine < 106.1 μM 1.2 mg/dl), supine systolic blood pressure (BP) <150 mmHg, supine diastolic BP <90 mmHg, and HbA1c <10% were divided into four groups. Twenty-six patients with normotension were divided at random into two groups; one group received enalapril (5 mg/day) (NE group), the other did not receive enalapril (NC group). In the same way, 26 other patients who were already well-controlled with nifedipine (30 mg/day) over a long-term period (4–6 years) were divided at random into two groups; one received enalapril (5 mg/day) (HE group), the other did not receive enalapril (HC group).

RESULTS

After 48 months, urinary albumin excretion (UAE) was markedly reduced in group NE from 102.4 ×/÷ 1.3 to 55.5 ×/÷ 1.3 mg/24 h (P < 0.005), whereas no significant change occurred in group NC. In the well-controlled hypertensive groups, a significant reduction in UAE occurred in group HE (P < 0.05), whereas no significant change occurred in group HC. No changes in creatinine clearance, BP, or blood glucose control were seen during the study.

CONCLUSIONS

Treatment with enalapril for 48 months may have a beneficial effect on the decline of microalbumin excretion in NIDDM patients.
Improvement of Basal Hepatic Glucose Production ana Fasting Hyperglycemia of Type I Diabetic Patients Treated With Human Recombinant Ultralente Insulin
Authors: Riccio Antonio , Avogaro Angelo , Valerio Anna , Zappella Anna , Tiengo Antonio , Prato Stefano Del
Published: March 2007

OBJECTIVE

To test whether a suppertime injection of human ultralente insulin in patients with type I diabetes would result in a larger inhibition of basal hepatic glucose production (HGP) and improvement in fasting and mean daily plasma glucose levels.

RESEARCH DESIGN AND METHODS

We studied 16 type I diabetic patients (41 ± 4 years of age; body mass index [BMI] = 23.3 ± 0.3 kg/m2; diabetes duration >3 years) with a crossover protocol of therapy with an intermediate and ultralente insulin. All patients were already treated with three injections per day of regular insulin in addition to intermediate-acting (NPH) insulin at suppertime. After a 14-day run-in period, patients were randomly assigned to treatment with equivalent doses (10.8 ± 0.8 U, at 1900) of intermediate (Humulin 1) or ultralente (Humulin U) insulin. After 1 month of treatment, patients were crossed over. No change of the insulin dosage was performed during the study period. Basal HGP was measured by β-glucose infusion. Plasma glucose concentration was measured in the fasting state and monitored during the day.

RESULTS

Before starting the study period, fasting plasma glucose was 13.4 ±1.1 mM and plasma free-insulin was 48.0 ± 4.8 pM. Daily plasma glucose concentration averaged 10.3 ± 0.3 mM and the area under the curve (AUC) was 1.41 ± 0.05 mol/14 h. NPH insulin, given at suppertime for a month, did not induce significant changes in fasting plasma insulin (40.2 ± 4.8 pM), glucose concentration (14.0 ± 0.9 mM) or HGP (20.2 ± 2.2 jamol · kg–1 · min–1). Accordingly, no change occurred in the average daily plasma glucose (10.3 ± 0.3 mM) or AUC (1.41 ± 0.9 mol/14 h). Glycated hemoglobin also was not affected (8.2 ± 0.4 vs. 8.2 ± 0.3%). On the contrary, a 4-week treatment with ultralente insulin, also given at suppertime, was associated with a decline in the basal HGP (16.0 ±1.3 /Ltmol · kg–1 · min–1), fasting (11.3 ± 0.9 mM) and average daily (9.4 ± 0.3 mM) plasma glucose concentrations, and AUC (1.29 ± 0.07 mol/14 h) of plasma glucose level (all P < 0.05). Glycated hemoglobin was reduced (7.9 ± 0.4%). In each condition, fasting plasma glucose concentration was correlated with the average daily plasma glucose level (basal = 0.78; intermediate = 0.89; ultralente = 0.62; all P < 0.05), which suggests that ultralente insulin likely induces the improvements of metabolic control through reducing fasting plasma glucose.

CONCLUSIONS

Our results suggest that treating type I diabetic patients with ultralente insulin at suppertime provides a better modulation of basal HGP so that lower fasting plasma glucose levels are ensured. The reduction of fasting hyperglycemia is likely to affect positively aily plasma glucose control.
National Diabetes Programs: Application of capture-recapture to count diabetes?
Authors: Bruno Graziella , Laporte Ronald E , Merletti Franco , Biggeri Annibale , McCarty Daniel , Pagano Gianfranco
Published: March 2007

OBJECTIVE

To evaluate the utility of capture-recapture methods using multiple, routinely collected, computerized data sources to estimate the numbers and prevalence of diabetes. Methods employed for regional and national monitoring of diabetes have been too inaccurate or too expensive.

RESEARCH DESIGN AND METHODS

A survey was undertaken that used four sources of ascertainment to identify prevalent cases of known diabetes in a community of Northern Italy: diabetic clinic and family physicians, hospital discharges, prescriptions, and reagent strips and insulin syringes. Capture-recapture methods were employed to estimate the number of missing cases and to adjust for undercount to accurately estimate the number of people who had diabetes.

RESULTS

We identified 2,069 unique prevalent cases of known diabetes with the intensive case-finding procedure. The diabetic clinic and family physicians data source identified the largest number of cases. The evaluation of the two sample capture-recapture estimates showed that they were all biased downward because of dependencies between sources. Log-linear modeling was employed to take into account the dependence among all data sources and the heterogeneity of diabetic patients. This method estimated that 2,586 cases existed, resulting in an ascertainment-adjusted prevalence of 2.77% (95% confidence interval, 2.44–3.10). Thus, despite the active case identification, ∼20% could not be identified. However, the number of cases and rates could easily be adjusted using capture-recapture.

CONCLUSIONS

The study shows that a two-sample capture-recapture estimate could be very biased if the investigator is not assured that the sources are independent. However, if at least three data sources are employed, log-linear models allow estimation of the number and prevalence rate adjusted for the degree of undercount (in spite of both the dependence of data sources and the heterogeneity of the diabetic population). The critical factor, however, is that the application of multiple sources with capture-recapture methods could be applied across broad geographical areas and across time to have cost-effective monitoring of diabetes at local and national level.
The Prediction of Diabetic Neuropathic Foot Ulceration Using Vibration Perception Thresholds: A prospective study
Authors: Young Matthew J , Breddy John L , Veves Aristidis , Boulton Andrew J M
Published: March 2007

OBJECTIVE

To assess the ability of vibration perception threshold (VPT) to predict the development of diabetic foot ulceration.

RESEARCH DESIGN AND METHODS

A prospective follow-up study of consecutive patients with vibration perception measured by biothesiometry from April 1988 to March 1989. Patients were stratified in various risk groups.

RESULTS

Patients with a VPT <15 V had a cumulative incidence of foot ulceration of 2.9% compared with 19.8% in patients with a VPT >25 V, odds ratio (OR) 7.99 (3.65–17.5, 95% confidence intervals), P < 0.01. The incidence of ulceration increased with duration of diabetes, but even with this effect removed, the excess of ulceration persisted, OR 6.82 (2.75–16.92), P < 0.01.

CONCLUSIONS

VPT is an effective predictor of the risk of foot ulceration in diabetes and therefore could be used to target foot-care education to those patients most likely to benefit and, thereby, possibly improve its effectiveness.
Prevalence of Isthmic Lumbar Spondylolisthesis in Nondiabetic Subjects and NIDDM Patients
Authors: Virta Lauri , Rönnemaa Tapani , Laakso Markku
Published: March 2007

OBJECTIVE

To compare the prevalence of lumbar spondylolytic spondylolisthesis (LSS) in nondiabetic and diabetic subjects.

RESEARCH DESIGN AND METHODS

A cross sectional study of 1,147 randomly selected nondiabetic subjects and 892 non-insulin-dependent diabetes mellitus (NIDDM) patients, 45–64 years of age. LSS was diagnosed radiographically using a lateral view of the lumbosacral spine.

RESULTS

No significant difference was seen in the prevalence of LSS between nondiabetic (6.0%) and diabetic (5.7%) subjects. LSS was more frequent in nondiabetic men (7.7%) than in nondiabetic women (4.6%; P = 0.026), whereas diabetic patients showed no significant sex difference in the prevalence of LSS (men 5.6% and women 5.9%).

CONCLUSIONS

NIDDM does not predispose one to lumbar spondylolisthesis. However, diabetes seems to abolish the sex difference in the prevalence of LSS observed in nondiabetic populations.
Hyperinsulinemia and Macrosomia in the Fetus of the Diabetic Mother
Authors: Schwartz Robert , Gruppuso Philip A , Petzold Kathleen , Brambilla Donald , Hiilesmaa Vilho , Teramo Kari A
Published: March 2007

OBJECTIVE

To determine 1) whether macrosomia in the fetus of the diabetic mother is related to fetal hyperinsulinemia and 2) whether hyperinsulinemia and macrosomia are related to maternal metabolic control.

RESEARCH DESIGN AND METHODS

Normal pregnant women (n = 95) were compared with insulin-treated pregnant women (n = 155), who were subdivided according to White's class, hypertension, and mode of delivery. All women were treated to achieve optimal metabolic control. HbA1c was determined at each visit. At delivery, umbilical plasma was analyzed for glucose, insulin antibodies, total insulin, free insulin, C-peptide, proinsulin components, and total and individual amino acids.

RESULTS

Macrosomia, defined as <2 standard deviation units (97.75%), was found in 10–27% of the diabetic groups. It was not related to maternal mass or size, but was significantly correlated with umbilical total insulin, free insulin, and C-peptide. Proinsulin components were not different among groups. Amino acids also were not different. Glycosylated hemoglobin was a weak predictor of birth weight and fetal hyperinsulinism.

CONCLUSIONS

Macrosomia in the fetus of the diabetic mother remains inadequately explained. In a large population of pregnant women with strict metabolic control, macrosomia was mainly independent of glycosylated hemoglobin. Nevertheless, fetal hyperinsulinism remains the driving force for excessive fetal growth. The stimulus for fetal insulin excess in humans remains to be defined.
Diabetes Mellitus and Cigarette Smoking: Findings from the 1989 National Health Interview Survey
Authors: Ford Earl S , Malarcher Ann M , Herman William H , Aubert Ron E
Published: March 2007

OBJECTIVE

To compare the prevalence of current smoking in the U. S. diabetic population with that of the nondiabetic population.

RESEARCH DESIGN AND METHODS

Using data from the 1989 National Health Interview Survey—a nationally representative sample—we calculated the prevalence of current smoking for 2,405 people with self-reported diabetes and 20,131 people without this condition.

RESULTS

Overall, the age-adjusted prevalence of smoking was 27.3% among people with diabetes and 25.9% among people without diabetes. The prevalence of smoking did not differ significantly between participants with and without diabetes when they were stratified by age, sex, race, or education. Black and Hispanic men with diabetes had a higher prevalence of smoking than did white men with diabetes and black and Hispanic men without diabetes, but none of these differences were statistically significant. Among people with diabetes, age, race, sex, and educational status were independent predictors of current smoking in a multiple-logistic regression model. Duration of diabetes was not related to smoking.

CONCLUSIONS

These data again emphasize the need to prevent and reduce smoking in the diabetic population. Smoking cessation programs should particularly target people with diabetes who are ≤44 years of age. Black and Hispanic men are also prime targets for intervention efforts.
Mechanism of Glomerular Hyperfiltration After a Protein Meal in Humans: Role of hormones and amino acids
Authors: Sreekumaran Nair K , Pabico Rufino C , Truglia Joseph A , McKenna Barbara A , Statt Marcia , Lockwood Dean H
Published: March 2007

OBJECTIVES

Previous studies demonstrated that protein meals and amino acid (AA) infusions increase glomerular nitration rate (GFR) and renal plasma flow (RPF) and that somatostatin (SRIH) infusion inhibits these increments. We tested whether a single AA such as alanine could increase GFR and RPF and whether the changes in GFR and RPF could be explained on the basis of changes in glucagon, growth hormone (GH), and insulin.

RESEARCH DESIGN AND METHODS

In the first experiment, alanine was infused with or without SRIH in five normal subjects. In the second experiment, five other subjects were infused with SRIH on three separate occasions. In a control study, insulin, glucagon, and GH were given at replacement doses; in a hyperglucagonemia study, glucagon was given at a rate of 0.2 μ · kg−1 · h−1 (hypoglucagonemia); and in a high GH study, GH was given at a rate of 2 /μg · kg−1· h−1. GFR and RPF were measured using inulin and para-aminohippurate, respectively.

RESULTS

Alanine increased GFR and RPF, whereas SRIH inhibited these changes (P < 0.05). Hyperglucagonemia or high GH with or without insulin failed to increase RPF or GFR.

CONCLUSIONS

A single AA such as alanine increases GFR and RPF, and this increase is dependent on a factor inhibited by SRIH. Although GH, glucagon, and insulin are factors inhibited by SRIH, none of these factors explains the changes in RPF and GFR in our acute studies.
A Treatable Cause of Recurrent Severe Hypoglycemia
Authors: Hardy Kevin J , Burge Mark R , Boyle Patrick J , Scarpello John H B
Published: March 2007

OBJECTIVE

To see if glucocorticoid deficiency might explain increased insulin sensitivity causing severe brittle diabetes in two type 1 diabetic patients.

CASES

We describe two patients who developed brittle diabetes characterized by recurrent severe hypoglycemia on small daily insulin doses with severe hyperglycemia on further insulin dose reduction. In both patients, insulin requirements had fallen markedly.

RESULTS

Both patients were found to have glucocorticoid deficiency. In one patient, this was a result of hypopituitarism, in which hypoglycemia was aggravated by growth hormone deficiency. In the other patient, glucocorticoid deficiency was the result of primary adrenal failure. Resolution of brittle diabetes and restoration of normal insulin doses followed steroid replacement therapy in both patients.

CONCLUSIONS

These patients emphasize the importance of seeking an organic cause for recurrent severe hypoglycemia. Increasing insulin sensitivity in type I diabetic patients should alert clinicians to the possibility of glucocorticoid deficiency.
Apolipoprotein A-IV Levels and Phenotype Distribution in NIDDM
Authors: Vergès Bruno L , Vaillant Genevieve , Goux Alain , Lagrost Laurent , Brun Jean M , Gambert Philippe
Published: March 2007

OBJECTIVE

To determine plasma apolipoprotein A-IV (apoA-IV) levels and phenotype distribution in non-insulin-dependent diabetes mellitus (NIDDM) patients and to analyze the influence of apoA-IV phenotype on lipid profiles in NIDDM.

RESEARCH DESIGN AND METHODS

Total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, HDL2 cholesterol, HDL3 cholesterol, free fatty acid, and apoA-IV levels were measured in 83 NIDDM patients and 100 normal control subjects. The apoA-IV phenotype was determined in each individual.

RESULTS

In both sexes, NIDDM patients had significantly higher levels of triglycéride and free fatty acid and significantly lower levels of HDL cholesterol and HDL2 cholesterol than control subjects. In men and women, apoA-IV levels were significantly higher in diabetic patients than in control subjects (men: 17.1 ± 7.9 vs. 12.3 ± 3.6 mg/dl, P < 0.001; women: 18.9 ± 9.9 vs. 11.9 ± 3.5 mg/dl, P < 0.001). The multiple regression analysis showed that the apoA-IV level in NIDDM patients was significantly and independently related to log triglyceride (P = 0.0001) and HDL cholesterol (P = 0.01) levels. The apoA-IV phenotype distribution was not significantly different between NIDDM patients and control subjects. In the control subjects, the apoA-IV-1–2 phenotype was associated with significantly higher levels of HDL cholesterol (69 ±12 vs. 56 ± 11 mg/dl, P < 0.01) and of HDL2 cholesterol (36 ± 15 vs. 25 ± 12 mg/dl, P < 0.05) compared with the apoA-IV-1–-1 phenotype; on the other hand, HDL cholesterol and HDL2 cholesterol levels were not different between the two apoA-IV pheno-types in NIDDM patients.

CONCLUSIONS

Plasma apoA-IV levels are increased in NIDDM patients. This increase in apoA-IV is related mainly to hypertriglyceridemia and, to a lesser extent, to HDL cholesterol level. The apoA-IV phenotype distribution is not different between NIDDM patients and nondiabetic control subjects. The potential protective lipid profile (characterized by increased HDL and HDL2 cholesterol levels) linked with apoA-IV-1–2 phenotype in control subjects is no longer found in NIDDM patients. We suggest that the metabolic state of NIDDM has erased the potential protective lipid profile associated with the apoA-IV-1–2 phenotype.
Maternal Glucose Tolerance and Obstetric Complications in Pregnancies in Which the Offspring Developed Type I Diabetes
Authors: Beischer Norman A , Wein Peter , Sheedy Mary T , Werther George A , Gold Hugo
Published: March 2007

OBJECTIVE

To identify possible in utero risk factors in children who develop type I diabetes and to determine the risk of development of type I diabetes in the children of women with gestational diabetes.

RESEARCH DESIGN AND METHODS

All known children with type I diabetes born at the Mercy Hospital for Women whose mothers had glucose tolerance tests (GTTs) performed during pregnancy were identified. The results of the mothers' GTTs were compared with those of the hospital population, as were their obstetric complications.

RESULTS

We identified 38 children with type I diabetes born at this hospital whose mothers had GTTs performed during pregnancy. Only one of these mothers had gestational diabetes, compared with 5.6% in the overall hospital population (adjusted odds ratio 0.69, 95% confidence interval 0.12–3.84, P = 0.99). There were no differences in the blood glucose levels between the mothers of the children who developed diabetes and the general hospital population. The birth weights of the children destined to develop diabetes also showed no deviation from the expected distribution, and there were no outstanding features of the mothers' obstetric histories.

CONCLUSIONS

Maternal blood glucose level is not an important determinant of the child's risk of developing type I diabetes.
The Effects of Enalapril and Nifedipine on Carbohydrate and Lipid Metabolism in NIDDM
Authors: Chan Juliana CN , Yeung Vincent T F , Leung Denis H Y , Tomlinson Brian , Nicholls M G , Cockram Clive S
Published: March 2007

OBJECTIVE

To compare the effects of nifedipine and enalapril oncarbohydrate and lipoprotein metabolism in Chinese non-insulin-dependent diabetes mellitus (NIDDM) patients with hypertension.

RESEARCH DESIGN AND METHODS

A 12-week, double blind, ran domized study of plasma lipid levels and glycemie control in patients treated with nifedipine (n = 52) or enalapril (n = 50) was conducted. None of the patients were treated with insulin. Diet and dosages of oral hypoglycemie agents remained unchanged during the 12-week treatment period.

RESULTS

Mean arterial pressure was reduced more by nifedipine than by enalapril (23.1 vs. 11.1 mmHg, P < 0.001). Similar reductions in body mass index and plasma triglycerides and increases in apolipoprotein A-I were seen with both treatments, but HbA1 was reduced more during treatment with enalapril than with nifedipine (0.49 vs. 0.20%, P = 0.035) and serum apolipoprotein B (apoB) also declined more with enalapril than with nifedipine (8.2 vs. 2.3 mg/dl, P = 0.009).

CONCLUSIONS

Twelve weeks of treatment with enalapril in hypertensive NIDDM patients was associated with greater improvement in glycemie control and greater reduction in serum apoB concentration, although the reduction in blood pressure was less than with nifedipine. These changes in cardiovascular risk profile warrant investigation for a longer term.
Rate of Progression of Albuminuria in Type II Diabetes: Five-year prospective study from South India
Authors: John Lily , Sunder P S S , Kanagasabapathy AS
Published: March 2007

OBJECTIVE

To evaluate the potential risk factors for the progression of albuminuria in type II diabetes.

RESEARCH DESIGN AND METHODS

A cohort of 481 type II diabetic patients were followed prospectively for 5 years. Blood glucose (BG) and blood pressure (BP) were checkedat 2 monthly intervals, and urinary albumin excretion (UAE) was checked at yearly intervals. Progression of albuminuria was recognized by the development of microalbuminuria and macroalbuminuria and a significant increase in albuminuria within the microalbuminuric range.

RESULTS

UAE was normal in 349 patients, 93 patients were microalbuminuric, and the rest (39) were macroalbuminuric. Sixty-two patients with normal UAE developed microalbuminuria. Ten patients with normoalbuminuria and 23 with microalbuminuria developed macroalbuminuria during the 5-year observation period with overall incidence of 46.9/1,000 person-years for normoalbuminuria and 58.7/1,000 person-years for microalbuminuria.

Baseline UAE was significantly higher in those patients who progressed compared with those patients who did not (normoalbuminuria: 8.5 ± 6 vs. 5.3 ± 4 μg/min, P < 0.001; microalbuminuria: 68.5 ± 57 vs. 47.4 ± 34 μg/min, P < 0.01). Multiple regression analysis revealed initial UAE and diabetes durationto be predictors of albuminuria progression.

CONCLUSIONS

Initial UAE is a strong predictor of albuminuria progression intype II diabetic patients.
Combination of Nicotinamide and Steroid Versus Nicotinamide in Recent-Onset IDDM: The IMDIAB II Study
Authors: Pozzilli P , Visalli N , Boccuni M L , Baroni M G , Buzzetti R , Fioriti E , Signore A , Cavallo MG , Andreani D , Lucentini L , Matteoli M C , Crinò A , Cicconetti C A , Teodonio C , Amoretti R , Pisano L , Pennafina M G , Santopadre G , Marozzi G , Multari G , Campea L , Suppa M A , Mattia G C De , Faldetta M Cassone , Marietti G , Perrone F , Greco A V , Ghirlanda G
Published: March 2007

OBJECTIVE

The aim of this study was to compare the effect of nicotinamide (NCT) alone or in combination with a cortisone-like substance, deflazacort (DFL), on the integrated parameters of metabolic control in patients with the recent-onset of insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

Thirty-six patients who were diagnosed with diabetes between 5 and 35 years of age entered a randomized, double-blind, 1-year prospective study. Group A (n = 18) received NCT for 1 year (25 mg· kg–1 · day–1) plus DFL for 3 months (0.6 mg · kg–1 · day–1 in the first month, 0.3 mg · kg–1 · day–1 in the other 2 months). Group B (n = 18) received NCT for 1 year (25 mg · kg–1 · day–1) plus placebo forthe first 3 months. All patients were treated with intensified insulin therapy.

RESULTS

At 3 months after diagnosis, the insulin dose was significantly higher in group A compared with group B (P < 0.03) with similar HbA1 levels. Basal and stimulated C-peptide levels in group A of both adults and children were significantly higher compared with patients of group B (P < 0.05 and P <0.03, respectively). At the end of a 1-year follow-up, basal C-peptide did not differ between the two groups, although stimulated C-peptide was still significantly higher in patients of group A compared with group B (P < 0.05). Finally, insulin requirement did not differ between the two groups.

CONCLUSIONS

A short-term course of DFL therapy at diagnosis in addition to NCT slightly increases glucagon-stimulated but not basal β-cell function after 1 year.
New-Onset IDDM Presenting With Diabetic Ketoacidosis in a Pregnant Adolescent
Authors: Sills Irene N , Rapaport Robert
Published: March 2007

OBJECTIVE

To describe the presentation of insulin-dependent diabetes mellitus(IDDM) as ketoacidosis during pregnancy in a teenager.

CASE

A 14-year-old pregnant girl presented with ketoacidosis (bicarbonate 14 nM, 14 meq/l, pH 7.27, glucose 67 mM, 1,208 mg/dl) during the last month of pregnancy with a fetal demise. Two years of follow-up has confirmed that she has IDDM.

CONCLUSIONS

Diabetes presenting in pregnant adolescents is likely due to IDDM. Immediate insulin therapy and proper education about managing diabetes should be initiated to hopefully prevent the outcome described in this patient.
Preventive Eye Care in People With Diabetes Is Cost-Saving to the Federal Government: Implications for health-care reform
Authors: Javitt Jonathan C , Aiello Lloyd Paul , Chiang Yenpin , Ferris Frederick L , Canner Joseph K , Greenfield Sheldon
Published: March 2007

OBJECTIVE

Diabetic retinopathy, which leads to macular edema and retinal neovascularization, is the leading cause of blindness among working-age Americans. Previous research has demonstrated significant cost savings associated with detection of eye disease in Americans with type 1 diabetes. However, detection and treatment of eye disease among those with type II diabetes was previously thought not to be cost-saving. Our purpose was to estimate the current and potential federal savings resulting from the screening and treatment of retinopathy in patients with type II diabetes, based on recently availabledata concerning efficacy of treating both macular edema and neovascularization along withnew data on federal budgetary costs of blindness.

RESEARCH DESIGN AND METHODS

We used computer modeling, incorporating data from population-based epidemiological studies and multicenter clinical trials. Monte Ciarlosimulation was used, combined with sensitivity analysis and present value analysis of cost savings.

RESULTS

Screening and treatment for eye disease in patients with type II diabetes generates annual savings of $247.9 million to the federal budget and 53,986 person-years of sight, even at current suboptimal (60%) levels of care. If all patients with type II diabetes receive recommended care, the predicted net savings (discounted at 5%) exceeds $472.1 million and 94,304 person-years of sight. Nearly all savings areassociated with detection and treatment of diabetic macular edema. Enrolling each additional person with type II diabetes into currently recommended ophthalmological care resultsin an average net savings of $975/person, even if all costs of care are borne by the federal government.

CONCLUSIONS

Our analysis indicates that prevention programs aimed at improving eye care for patients with diabetes not only reduce needless vision loss but also willprovide a financial return on the investment of public funds.
Arginine-Induced Insulin Release in Glucokinase-Deficient Subjects
Authors: Pueyo Maria E , Clement Karine , Vaxillaire Martine , Passa Philippe , Froguel Philippe , Robert Jean-Jacques , Velho Gilberto
Published: March 2007

OBJECTIVE

In eight glucokinase (GCK)-deficient subjects, we have investigated insulin secretion rates (ISRs) in response to intravenous arginine. Impairment in the enzymatic activity of mutant GCK leads to a reduced glycolytic flux in β-cells. This defect translates in vivo as a right shift in the glucose/ISR dose-response curve. Insulin secretion in response to other secretagogues has not been reported.

RESEARCH DESIGN AND METHODS

The arginine test was performed immediately after a 2-h hyperglycémie (10 mM) clamp. ISR was computed by decon-volution of peripheral C-peptide levels. Linear regression analyses were performed to assess correlations between the /3-cell secretory responses to the arginine test, an intravenous glucose tolerance test (IVGTT), and a hyperglycemie clamp (areas under the C-peptide curves), and between these parameters and the glucose tolerance status (area under the glucose curve during an oral glucose tolerance test).

RESULTS

Two minutes after the injection of arginine, the increment in ISR was 30.17 ± 10.01 pmol insulin · kg−1 · min−1 in patients and 36.25 ± 15.46 pmol insulin · kg−1 · min−1 in control subjects (P = 0.38). Throughout the experiment, increments in ISR were comparable in both groups. The amount of insulin secreted in response to arginine (0-5 min) was similar in patients and control subjects: 81 ± 28 vs. 119 ± 55 pmol/kg (P = 0.16), respectively. The arginine test C-peptide response was not correlated with the IVGTT or hyperglycémie clamp responses. The arginine test and hyperglycemie clamp responses were not correlated to the glucose tolerance status. The best predictor of the glucose tolerance was the C-peptide response to the IVGTT (r2 = 0.78; P = 0.002).

CONCLUSIONS

β-cell secretory increment in response to arginine was found to be in the normal range in GCK-deficient subjects. The arginine test does not seem to reflect either the /3-cell secretory defect or the glucose tolerance status of these subjects. IVGTT seems to be the best predictor of the latter parameter in this population.
Establishment of a Registry and Incidence of IDDM in Avellaneda, Argentina
Authors: Sereday Martha S , Martí Manuel L , Damiano Mónica M , Moser Marcela E C
Published: March 2007

OBJECTIVE

; To provide reliable data on the incidence of insulin-dependent diabetes mellitus (IDDM) in children (<15 years of age) in Avellaneda, Argentina.

RESEARCH DESIGN AND METHODS

A registry was established in Avellaneda, Argentina. The first registry was started in 1989, retrospective data collection was updated from 1985 to 1988, and prospective data was collected from 1989 to the present. The data were collected according to the World Health Organization Diabetes Mondiale (DIAMOND) protocol. Primary ascertainment was based on personal interviews at schools, and secondary sources were pediatrie hospitals and private diabe-tologists.

RESULTS

The IDDM incidence per 10,000 children in the studied population was as follows: for 1985,6.89; for 1986,6.90; for 1987,6.91; for 1988,5.29; for 1989, 6.42; and for 1990, 7.59. Of those children, 51.7% reported previous infection or stress as a possible trigger factor. No sex preference, age incidence peak, or seasonal trend was found.

CONCLUSIONS

The study documents an incidence rate of childhood IDDM in Avellaneda, Argentina, similar to other Occidental countries.
Hypoglycemic Activity of Glyburide (Glibenclamide) Metabolites in Humans
Authors: Rydberg Tony , Jönsson Anders , Røder Michael , Melander Arne
Published: March 2007

OBJECTIVE

To assess the hypoglycemie effect and the insulin-releasing effect of the main glyburide (glibenclamide) metabolites 4-trans-hydroxy-glibenclamide (Ml) and 3-cis-hydroxy-glibenclamide (M2) in humans.

RESEARCH DESIGN AND METHODS

Eight healthy subjects participated in a placebo-controlled, randomized, single-blind crossover study with five single-dose tests, 3 months apart: 3.5 mg glibenclamide (Gb) orally, 3.5 mg Gb intravenously, 3.5 mg Ml intravenously, 3.5 mg M2 intravenously, and placebo intravenously, each in the fasting state. Standardized meals were given 0.5 and 5.5 h after each medication. Blood glucose levels were measured by a glucose oxidase method, and serum insulin concentrations were analyzed by a specific immunoassay.

RESULTS

Blood glucose levels during the first 5 h were significantly lowered not only by Gb but also by Ml and M2. The mean ± SE blood glucose reductions (versus placebo) expressed as percent of area under the curve (AUC) (0-5 h) were 18.2 ± 3.3% for Ml, 12.5 ± 2.3% forM2,19.9 ± 2.1% for intravenous Gb, and 23.8 ± 1.2% for Gb orally. Serum insulin levels were significantly increased by Gb as well as by Ml and M2.

CONCLUSIONS

The two main metabolites of glyburide (glibenclamide) have a hypoglycémie effect in humans, which is due to increased insulin secretion.
Coronary Heart Disease Mortality Is Actually Low in Diabetic Japanese by Direct Comparison With the Joslin Cohort
Authors: Matsumoto Toeko , Ohashi Yasuo , Yamada Nobuhiro , Kikuchi Masatoshi
Published: March 2007

OBJECTIVE

To identify the mortality rate from coronary heart disease (CHD) in diabetic Japanese by directly comparing the Tokyo University Hospital cohort and the Joslin cohort using identical protocols.

RESEARCH DESIGN AND METHODS

Five hundred thirty-eight diabetic patients who were treated at Tokyo University Hospital with a 35- to 62-year age range at entry and with a diabetes duration of <5 years were followed retrospectively for more than 24 years.

RESULTS

The percentage of patients who survived at the end of the 24-year period was higher in the Tokyo University cohort (42%) than in the Joslin cohort (12%). The percentage of patients who died from CHD was remarkably lower in the Tokyo University cohort (11%) than in the Joslin cohort (39%). The CHD mortality rate was lower in the Tokyo University cohort than in the Joslin cohort, regardless of the duration of diabetes.

CONCLUSIONS

Our study confirmed the previous finding that the CHD mortality is lower in diabetic Japanese than in diabetic Caucasians.
Effects of a Traditional Lifestyle on Obesity in Pima Indians
Authors: Ravussin Eric , Valencia Mauro E , Esparza Julian , Bennett Peter H , Schulz Leslie O
Published: March 2007

OBJECTIVE

The Pima Indians of Arizona have the highest reported prevalences of obesity and non-insulin-dependent diabetes mellitus (NIDDM). In parallel with abrupt changes in lifestyle, these prevalences in Arizona Pimas have increased to epidemic proportions during the past decades. To assess the possible impact of the environment on the prevalences of obesity and NIDDM, data were collected on members of a population of Pima ancestry (separation 700–1,000 years ago) living in a remote mountainous location in northwestern Mexico, with a lifestyle contrasting markedly with that in Arizona.

RESEARCH DESIGN AND METHODS

Pima heritage was established by history and by use of Pima language. Measurements of weight, height, body fat (bio-impedance), blood pressure, plasma levels of glucose, cholesterol, and HbA1c were obtained in 19 women (36 ±13 years of age) and 16 men (48 ±14 years of age) and compared with sex-, age- and diabetes status-matched Pimas living in Arizona (10 Arizona Pimas for each Mexican Pima).

RESULTS

Mexican Pimas were lighter (64.2 ± 13.9 vs. 90.2 ± 21.1 kg, P < 0.0001; means ± SD) and shorter (160 ± 8 vs. 164 ± 8 cm, P < 0.01) with lower body mass indexes (24.9 ± 4.0 vs. 33.4 ± 7.5 kg/m2, P < 0.0001) and lower plasma total cholesterol levels (146 ± 30 vs. 174 ± 31 mg/dl, P < 0.0001) than Arizona Pimas. Only two women (11%) and one man (6%) had NIDDM, contrasting with the expected prevalences of 37 and 54% in female and male Arizona Pimas, respectively.

CONCLUSIONS

This preliminary investigation shows that obesity, and perhaps NIDDM, is less prevalent among people of Pima heritage living a “traditional” lifestyle than among Pimas living in an “affluent” environment. These findings suggest that, despite a similar potential genetic predisposition to these conditions, a traditional lifestyle, characterized by a diet including less animal fat and more complex carbohydrates and by greater energy expenditure in physical labor, may protect against the development of cardiovascular disease risk factors, obesity, and NIDDM.
A Practical Model of Diabetes Management and Education
Authors: Glasgow Russell E
Published: March 2007

This article discusses an evolving conceptual model of diabetes self-management and patient education. The model contains three primary levels or stages: 1) social environment and contextual factors, which have received little research attention; 2) patient-health care provider interactions, self-management behaviors, and short-term physiological outcomes, which constitute an ongoing cycle of care feedback system; and 3) longer term health and quality-of-life outcomes, which include the major societal costs of treating diabetes complications. The assessment and intervention implications of factors within each of these levels are discussed, with emphasis on both low-cost system-wide activities appropriate for all patients and higher cost activities and resources (e.g., intensive management à la the Diabetes Control and Complications Trial) for appropriately targeted or higher risk patients. I hope that such a systems approach to diabetes management can help reduce victim blaming (whether the victim is the noncompliant patient or the insensitive provider). Such conceptual models, if practically oriented, may help accelerate the development, evaluation, and dissemination of programs that facilitate both patient and health care team adherence to recommended guidelines for diabetes care.
Leisure-Time Physical Activity Patterns in the U.S. Diabetic Population: Findings from the 1990 National Health Interview Survey—Health Promotion and Disease Prevention Supplement
Authors: Ford Earl S , Herman William H
Published: March 2007

OBJECTIVE

Despite the scientific community's recognition of the importance of exercise, little is known about the epidemiology of exercise among persons with diabetes in the U.S. Our goals were to examine whether people with diabetes were more sedentary than people without diabetes, to examine the effect of activity limitations on the prevalence of exercise, and to examine whether the choice of activities differs among people with and without diabetes.

RESEARCH DESIGN AND METHODS

We examined the 1990 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey to describe leisure-time physical activity patterns in a representative sample of the U.S. population with diabetes.

RESULTS

People with diabetes were less likely to report exercising regularly than people without this disease (34.3 ± 2.2% vs. 40.9 ± 0.5%, P < 0.05). When the data were stratified by activity limitation status, no significant differences were observed. People with diabetes were equally likely to have engaged in exercise in the preceding 2 weeks and to have expended ≥2,000 kcal/week as people without diabetes. Walking was the activity of choice for both groups: 49.2 ± 2.1% of people with diabetes reported walking during the previous 2 weeks compared with 44.2 ± 0.5% of people without diabetes (P < 0.05). People with diabetes were less likely to engage in jogging, aerobics, dancing, calisthenics, bicycling, weight lifting, several ball sports, and skiing than people without diabetes.

CONCLUSIONS

After adjusting for activity limitations and age, people with and without diabetes are equally likely to exercise. The majority of people with diabetes, like their nondiabetic counterparts, are not meeting national physical activity goals. Individuals with diabetes should be encouraged to exercise regularly in accordance with their capabilities, physical limitations, and personal interests.
Pentamidine-Induced Derangements of Glucose Homeostasis: Determinant roles of renal failure and drug accumulation: A study of 128 patients
Authors: Assan Roger , Perronne Christian , Assan Dominique , Chotard Laurence , Mayaud Charles , Matheron Sophie , Zucman David
Published: March 2007

OBJECTIVE

To assess the prevalence, presentation, and risk factors of pentami-dine-induced dysglycernia.

RESEARCH DESIGN AND METHODS

Blood glucose values were screened in 244 consecutive immunocompromised patients with Pneumocystis carinii pneumonia: 116 being treated with cotrimoxazole and 128 others with pentamidine.

RESULTS

Two cotrimoxazole patients developed diabetes as a result of necrotiz-ing pancreatitis (1.7%); the others remained euglycemic. Forty-eight pentamidine-treated patients (38.5%) developed severe glucose homeostasis disorders: hypoglyce-mia in 7, hypoglycemia and then diabetes in 18, and diabetes alone in 23 (P < 0.001 vs. the cotrimoxazole group). Hypoglycemia was early, sudden, often recurrent, and life-threatening, associated with inappropriately high insulin levels in plasma; the B-cell response to stimuli was poor. Of the 41 diabetic patients, 26 required insulin therapy; their plasma C-peptide levels were lower than normal, and the B-cell secretory responses to stimuli were poor. Islet cell antibodies, insulin antibodies, and insulitis were not detected. The pentamidine-treated dysglycemic patients differed from their euglycemic counterparts by higher pentamidine doses (P < 0.001), higher plasma creatinine levels (P < 0.001), and more severe anoxia (P < 0.05) and shock (P < 0.001). Most of them had received pentamidine mesylate parenterally (n = 36; 75%); six others received the isethionate salt and six exclusively pentamidine aerosols.

CONCLUSIONS

Pentamidine-induced dysglycemic accidents are primarily due to inappropriate insulin release and toxicity to the islet B-cells. Drug accumulation due to excessive doses, iterative courses, and/or renal impairment is the determining risk factor.