bluuebunny/crossref_metadata_2025 huggingface dataset:
A Cohort Study of Mortality in Two Clinic Populations of Patients with Diabetes Mellitus
Authors: Zwaag Roger V , Runyan John W , Davidson John K , Delcher Harry K , Mainzer Ilse , Baggett Henry W
Published: March 2007

Mortality rates of two cohorts of patients with diabetes mellitus are estimated and compared. The Atlanta cohort is defined as all black patients receiving care at the diabetes clinic of Grady Memorial Hospital for the first time during calendar year 1971. The Memphis cohort is defined as all black patients referred from the City of Memphis Hospital outpatient clinic to a decentralized neighborhood clinic operated by the Memphis and Shelby County Health Department during September 1969 through August 1970. The Atlanta program discontinued all prescriptions of oral hypoglycemic drugs and emphasized instead an aggressive diet therapy. The Memphis program has used diet therapy but also insulin and/or oral hypoglycemic agents according to current guidelines. The ratios of observed to expected deaths (standardized mortality ratios) were remarkably similar for the two cohorts. In both cohorts the standardized mortality ratios were greatest for the youngest patients and for those patients whose duration of illness was longest. Nine-year survival rates, estimated by the life-table method and adjusted for differences in frequency distributions of entry age and duration of diabetes, were also similar for the two cohorts.
Clinician Communication Associated with Diabetic Patients' Comprehension of Their Therapeutic Regimen
Authors: Mazzuca Steven A , Weinberger Morris , Kurpius DeWayne J , Froehle Thomas C , Heister Marianna
Published: March 2007

The purpose of this study was to identify the types of statements used by medical and nursing clinicians in encounters with diabetic outpatients that are associated with accurate comprehension of their therapeutic regimen. Encounters between 19 clinicians and 29 patients followed in an urban diabetes clinic were examined. Statements made by clinicians were classified by trained observers according to an 11-category observation scheme. Immediately after the encounters, each patient was interviewed and asked to recall his or her regimen as just discussed. Recall was verified by review of a videotape of the encounter. By use of multiple discriminant analysis, a combination of three types of statements by clinicians was found to predict high (better than 80%) comprehension by patients: demonstrating respect, sharing current clinical data, and acknowledging patient statements (inversely). Insofar as patient comprehension of the diabetic regimen is a prerequisite for compliance with that regimen, this study suggests that the chances for therapeutic success are increased when the interaction of clinician and patient takes a certain tone. Most importantly, the clinician should be informative. Current laboratory and physical findings should be shared with the patient in order to make more obvious the successes and failures of recent attempts at compliance. As suggested in previous research, this information should have its strongest effect when conveyed in a nonthreatening manner.
Glycerol Prevents Insulin Precipitation and Interruption of Flow in an Implantable Insulin Infusion Pump
Authors: Blackshear Perry J , Rohde Thomas D , Palmer John L , Wigness Bruce D , Rupp William M , Buchwald Henry
Published: March 2007

Insulin precipitation is a major obstacle to the use of implantable insulin infusion pumps. In one such pump (Infusaid, Infusaid Corporation, Norwood, Massachusetts), unprotected insulin precipitated and occluded nine pumps implanted in normal dogs within 43 days. In contrast, two similar pumps containing insulin mixed with 80% glycerol functioned normally for more than 250 days. In human studies, a similar mixture allowed insulin to be delivered to nine diabetic subjects for more than 6 mo in each case; total fluid flow rates from the pump were essentially unchanged after 460 patients-weeks of insulin infusion. A possible drawback of the mixture is a time- and temperature-dependent propensity to cause the formation of soluble, higher-molecular-weight insulin polymers, which apparently have lower biologic activity. Formation of such polymers and maintenance of biologic activity were largely prevented by the addition of phosphate buffer at neutral pH.
Coping with Predictable Crises of Diabetes
Authors: Hamburg Beatrix A , Inoff Gale E
Published: March 2007

Although the role of emotional and psychosocial factors in diabetes is generally appreciated, most health care professionals, diabetic patients, and families of patients have no clear model that clarifies the nature of psychosocial variables and provides defined principles for effective treatment and preventative interventions. A multivariate clinical model for coping with predictable crises of diabetes is presented. The model is based on the constructs of crisis, coping, and social support as well as a developmental and life course perspective. The psychosocial tasks to be addressed in coping with crises, in general, as well as strategies of coping are defined and discussed. The specific predictable crises of diabetes are described with reference to the demands and sources of stress inherent in the critical situations and the associated strategies for coping with them. Special attention is given to coping with the initial diagnosis and onset of the disease, the role of health care professionals, and developmental issues in coping with diabetes.
Postprandial Blood Glucose Response to Exercise in Type I Diabetes: Comparison Between Pump and Injection Therapy
Authors: Koivisto Veikko A , Tronier Bente
Published: March 2007

The effect of 40 min ergometer exercise on glucose homeostasis was studied 90 min after morning insulin and a breakfast meal in 11 insulin-dependent diabetic subjects treated with conventional injection therapy or with continuous subcutaneous insulin infusion with a portable pump. During conventional therapy plasma free insulin levels rose slowly (7 ± 2 μU/ml) after the morning injection, allowing an excessive postprandial rise in blood glucose levels (6.4 ± 0 . 4 mmol/L). Physical exercise was able to reverse this increase of blood glucose. With insulin infusion therapy, the initial rise in plasma free insulin after a preprandial bolus was 3.5-fold higher (25 ± 4 μU/ml, P < 0.01) and postprandial hyperglycemia was reduced by 70% as compared with conventional therapy (P < 0.02). During exercise blood glucose fell 60% more in pump than in conventionally treated patients (P < 0.02). However, the decline continued during the recovery period in conventionally treated but not in pump patients, resulting in a comparable total fall in blood glucose in both groups. Fluctuations in blood glucose were avoided when exercise was performed in the fasting state with basal insulin infusion. In conclusion, when exercise was performed after breakfast, the total fall in blood glucose was similar during pump and conventional therapy, although the fall was faster on the pump. This can be explained, at least in part, by greater peak insulin levels obtained by the pump. Since postprandial glucose levels are lower in pump than in conventionally treated patients, a risk for hypoglycemia induced by postmeal exercise may be greater in pump than in conventionally treated patients.
The Oral Glucose Tolerance Test (OGTT): Effect of Rate of Ingestion of Carbohydrate and Different Carbohydrate Preparations
Authors: Heine Robert J , Hanning Ian , Morgan Linda , Alberti K George M M
Published: March 2007

The glucose load of the oral glucose tolerance test (OGTT) is well standardized. However, recommendations on rate of ingestion and nature of the load are vague. In this study the effect on blood glucose, serum insulin, C-peptide, and plasma gastric inhibitory polypeptide (GIP) of giving 75 g glucose in 300 ml over 1 and 10 min (Gl and G10) was investigated in six subjects. In five an isocaloric amount of partially hydrolyzed starch (Hycal) was also used (HI and H10). The fast glucose intake, compared with the slow ingestion, resulted in an earlier rise in blood glucose levels, accompanied by a faster serum insulin and C-peptide response. Between 90 and 135 min blood glucose concentrations were significantly higher after the 10-min glucose intake. At 120 min blood glucose levels were 5.5 ± 0.5 and 4–7 ± 0.5 mmol/L, respectively, for G10 and Gl (P < 0.05). In the first half hour after slow and fast Hycal intake no differences were seen in blood glucose, serum insulin, and C-peptide levels. Between 45 and 120 min blood glucose levels were significantly higher after the 10-min Hycal intake. At 120 min blood glucose levels were 5.3 ±0.2 and 4–4 ± 0.1 mmol/L, respectively, for H10 and HI (P < 0.01). Except for a faster rise in glucose and insulin levels after glucose loading in 1 min, no further differences were found, when compared with Hycal. No significant differences were seen in the GIP responses. Thus differences in rates of ingestion can cause significant differences in later results. A standard time for glucose ingestion should be specified.
Diarrhea and Metformin in a Diabetic Clinic
Authors: Dandona Paresh , Fonseca Vivien , Mier Anne , Beckett Arthur G
Published: March 2007

In a questionnaire-based survey of 285 randomly selected diabetic patients, diarrhea was found to occur in 8%; this was found to be similar to that in 150 nondiabetic control patients attending other medical clinics (8%). When the diabetic patients were divided into separate therapeutic groups, metformintreated (with or without sulfonylureas) patients had a markedly greater prevalence of diarrhea (20%) than those not on this drug (6%). A majority of patients with metformin-associated diarrhea had soiling of clothes as a problem, while at least two complained of frank loss of control over their anal sphincter. These patients did not have autonomic neuropathy, and in all who stopped this drug, diarrhea settled within 2–5 days. Only 6% of insulin-dependent diabetic individuals (IDD) had diarrhea, one of whom had explosive nocturnal stools with incontinence and features diagnostic of autonomic neuropathy. Metformin is by far the commonest cause of diarrhea and incontinence in our diabetic clinic, where it is used routinely. In contrast, diarrhea due to autonomic neuropathy is rare.
A New Approach to the Treatment of Nocturnal Hypoglycemia Using Alpha-Glucosidase Inhibition
Authors: McCulloch David K , Kurtz Anthony B , Tattersall Robert B
Published: March 2007

Nocturnal hypoglycemia is common in the diabetic patient on twice-daily regular and intermediate (NPH or lente) insulin regimens because intermediate-acting insulins before the main evening meal produce “unopposed” free insulin peaks around 0300 h, food absorption having been completed much earlier. Fourteen insulin-dependent diabetic patients were treated for 6 wk with the alpha-glucosidase inhibitor, acarbose, in a double-blind crossover study to see whether the drug would delay absorption of the evening meal sufficiently to correct the mismatch and prevent nocturnal hypoglycemia. On 200 mg acarbose (six patients), inhibition of carbohydrate digestion was so profound as to lead to midevening hypoglycemia with severe flatulence and abdominal colic. With a smaller dose of 100 mg before the evening meal (eight patients) there was a significant reduction in MAGE and MBG coupled with a clinically significant reduction in midevening and nocturnal hypoglycemic reactions. Alpha-glucosidase inhibition therefore provides a promising new approach to the problem of nocturnal hypoglycemia although a preparation that is safe for long-term clinical use remains to be found.
Interference of New Penicillins and Cephalosporins with Urine Glucose Monitoring Tests
Authors: McCue Jack D , Gal Peter , Pearson Robert C
Published: March 2007

The possibility that three new penicillins (mezlocillin, pipericillin, and azlocillin) and two new cephalosporins (ceftazidime and cefoperazone) might give false positive urine glucose testing results was studied. High and low concentrations of antibiotics were dissolved in urine and tested with Clinitest (Ames Division, Miles Laboratories, El.khart, Indiana) and Tes-Tape (Eli Lilly and Company, Indianapolis, Indiana) at four different concentrations of glucose. None of the antibiotics interfered with the accuracy of Tes-Tape readings. All antibiotics interfered with Clinitest readings; the greatest interference was noted at high concentrations of antibiotics and low concentrations of glucose, and with the two cephalosporins. A summary of all reported cephalosporin interactions with Clinitest urine glucose testing is included.
Impotence as a Presenting Symptom of Presumed Prolactinoma in a Patient with Diabetes Mellitus
Authors: Shakir K M Mohamed
Published: March 2007

Impotence in diabetic men is usually considered to be due to neuropathic factors or vascular insufficiency. However, factors unrelated to diabetes may occasionally produce sexual dysfunction in these patients. Recently, a diabetic patient presented to our clinic with the complaint of impotence. In this patient, macroprolactinemia was discovered. With appropriate therapy, the sexual dysfunction improved and this case is reported here.
Comparative Study of Home Blood Glucose Monitoring Devices: Visidex, Chemstrip bG, Glucometer, and Accu-Chek bG
Authors: Aziz Shahid , Hsiang Ying Hui
Published: March 2007

Visidex (Ames Company, Elkhart, Indiana) and Accu-Chek bG (Bio-Dynamics, Boehringer Mannheim, Indianapolis, Indiana), two new devices for determining blood glucose at home, were compared with two older devices, Chemstrip bG (Bio-Dynamics) and Glucometer (Ames Company), and the standard laboratory glucose-oxidase method (Beckman autoanalyzer, Beckman Instruments, Fullerton, California). Laboratory serum glucose values up to 400 mg/dl had excellent overall correlation with Accu-Chek bG (r = 0.974), Glucometer (r = 0.974), Chemstrip bG (r = 0.963), and Visidex (r = 0.955). For glucose values ≤180 mg/dl, Glucometer had the best correlation (r = 0.921). For glucose values of 181–400 mg/dl, Accu-Chek bG had better correlation (r = 0.907) although Glucometer had closer mean value. Visidex was just as accurate as Chemstrip bG. Although the four devices tested tended to give lower values than the lab method, they are sufficiently accurate to be of clinical use in home monitoring of blood glucose. Meticulous care in running the tests is mandatory for accuracy. Individual differences among the four methods are discussed.
Accuracy of Two Systems for Blood Glucose Monitoring without a Meter (Chemstrip/Visidex)
Authors: Silverstein Janet H , Rosenbloom Arlan L , Clarke Derrel W , Spillar Rebecca , Pendergast Jane F
Published: March 2007

Blood specimens collected from 159 campers were tested using Visidex (VD) (Ames Company, Elkhart, Indiana) and Chemstrip (CS) (Bio-Dynamics, Boehringer Mannheim, Indianapolis, Indiana) compared with glucose analyzer (GA) results. Readers were physicians, two with no prior experience using either strip and two with some experience using CS. Subsequently, 30 clinic patients and 4 staff contributed random specimens that were read by a trained novice as 68 discrete samples and compared with GA results. In both studies readers did not place blood on the strips and were thus blinded as to source and the possible previous reading with the other strip. Correlations of VD and CS with GA for camp and clinic data were calculated. Data were compared for reliability and errors greater than 20% of reference values (GA) were compared for VD and CS. CS correlated better with GA than did VD estimates. Reliability was also significantly greater for CS than for VD readings. Both of these visually read methods provided clinically useful estimates of glycemia.
Insulin Resistance in Fat Cells From Insulin-Treated Type I Diabetic Individuals
Authors: Lönnroth P , Blohmé G , Lager I , Tisell L E , Smith U
Published: March 2007

Fat biopsies from the lower abdominal wall were obtained from 13 insulin-treated type I diabetic subjects and from 12 age-, weight-, and sex-matched control subjects. Insulin binding and the antilipolytic effect of insulin were studied. Insulin binding was significantly reduced in the diabetic subjects (34% reduction at tracer binding, P < 0.05) due to a decreased number of binding sites. In agreement with this, the dose-response curve for the antilipolytic effect of insulin was shifted to the right in the diabetic subjects. Furthermore, the maximal antilipolytic effect of insulin was also reduced (64%, P < 0.05). Thus, fat cells from conventionally treated type I diabetic individuals are resistant to insulin. This resistance is due to a combination of a decreased number of insulin binding sites and an unspecified intracellular (postreceptor) defect involving the antilipolytic effect of insulin. These findings are in accord with recent in vivo studies showing that type I diabetic patients are also resistant to the stimulating effect of insulin on glucose disposal.
Development of the Diabetes Knowledge (DKN) Scales: Forms DKNA, DKNB, and DKNC
Authors: Dunn Stewart M , Bryson Janet M , Hoskins Penelope L , Alford Jan B , Handelsman David J , Turtle John R
Published: March 2007

The Diabetes Knowledge Assessment (DKN) scales were developed to meet a specific need for rapid and reliable knowledge assessment in diabetic patients. Item format and item selection from an initial pool of 89 items were determined by pilot-testing over 300 diabetic subjects. Reliability analysis of the resulting 40 multiple-choice items, with a further sample of 56 subjects, gave a Cronbach's alpha coefficient of 0.92. Parallel forms DKNA, DKNB, and DKNC, each of 15 items selected from the parent set, had alpha coefficients above 0.82 and correlated 0.90 with each other. A full clinical trial, using DKNA, DKNB, and DKNC in randomized order of presentation, was conducted with 219 subjects attending a 2-day diabetes education program. Overall DKN scores improved from 7.6 (51%) to 11.3 (75%). Analysis of variance confirmed that DKNA, DKNB, and DKNC were equivalent forms at pretest. Mean posttest scores on DKNB were lower than the other scales (P < 0.001), but variances were equivalent for all three. A specific local change in the education program format was found to account for this discrepancy in the DKNB posttest mean. In situations where comprehensive assessment of diabetes knowledge would be time-consuming and unnecessary, these results indicate that rapid and reliable assessment is possible with a scale of only 15 validated items. The development of parallel forms of the scale extends the range of retesting possibilities for diagnosis and research.
Reduction of Abnormal Foot Pressures in Diabetic Neuropathy Using a New Polymer Insole Material
Authors: Boulton Andrew J M , Franks Christopher I , Betts Roderic P , Duckworth Thomas , Ward John D
Published: March 2007

The precise pressures and loads under 69 neuropathic feet have been measured during walking using a modified microprocessor-controlled optical system. Abnormally high pressures were demonstrated in 94% of feet with a history of foot ulceration, with pressures as high as 20–30 kg × cm−2 under the forefoot. All subjects were also studied using a new visco-elastic polymer material recently used for insole manufacture. A reduction in pressure was demonstrated that was proportional to peak pressure (linear regression line correlation coefficient of 0.91; P < 0.001). We conclude that this material causes a significant reduction in the abnormally high pressures recorded under neuropathic feet, and should provide a useful insole for the management of patients at risk of neuropathic foot ulceration.
Effects of a Physical Activity Program on Metabolic Control and Cardiovascular Fitness in Children with Insulin-dependent Diabetes Mellitus
Authors: Campaigne Barbara N , Gilliam Thomas B , Spencer Martha L , Lampman Richard M , Schork M Anthony
Published: March 2007

The purpose of this investigation was to determine the effects of a regular vigorous physical activity program on children aged 5–11 yr with insulin-dependent diabetes mellitus (IDDM). The experimental group of children (N = 9) took part in a 30-min vigorous exercise program three times a week for 12 wk; the control group (N = 10) did not. Hemoglobin A1 (HbA1) and fasting blood glucose (FBG) were used to determine metabolic control. Oxygen consumption was evaluated by treadmill testing and analyses of expired air. The experimental group significantly (P < 0.05) decreased their HbA1 and FBG while the control group showed no change. The experimental group significantly (P < 0.05) increased their peak aerobic capacity (ml/kg min) when compared with baseline values (47.14 ± 1.94 versus 50.69 ± 1.30). It was concluded that a carefully applied program of regular vigorous physical activity can beneficially influence metabolic control and cardiovascular fitness in young children with IDDM.
The Clinical Pattern of Diabetes Mellitus in Ethiopians
Authors: Lester Frances T
Published: March 2007

Records of 849 consecutive diabetic Ethiopians revealed that 171 had type I diabetes, 462 type II nonobese, 210 type II obese, and 4 drug-induced. Undernutrition (BMI < 18 kg/m2) was present in 12.9% of patients. Forty percent of all patients require insulin; ketoacidosis has occurred in 7.8%. Diabetes was present 10 yr or less in 73%, only 11% have been diabetic more than 15 yr, and none more than 32 yr. During 7 yr, 66 (7.8%) are known to have died. Renal failure caused 30.3% of known deaths, and ketoacidosis 3%. About 4% of those diabetic 6–10 yr have a clinically significant complication. The incidence of “diabetic triopathy” rose rapidly after 10 yr. Of those diabetic 16–20 yr, 27.7% had nephropathy, 27.7% neuropathy, and 33.3% retinopathy. Hypertension was seen in 12.1% of patients without nephropathy. Cataracts were seen in 1.4% of new diabetic patients, rising to 40.7% in those diabetic more than 20 yr. Peripheral vascular disease was uncommon and myocardial infarctions occurred in eight patients. Thus, “diabetic triopathy,” hypertension, and cataracts are frequent in and after the second decade of diabetes in Ethiopians.
High-Carbohydrate, High-Fiber Diet in Children with Type I Diabetes Mellitus
Authors: Lindsay Alan N , Hardy Sherie , Jarrett Lucie , Rallison Marvin L
Published: March 2007

The effects of a high-carbohydrate, high-fiber (HCHF) diet on glucose control was evaluated in 12 children with type I diabetes mellitus. The children had had diabetes for an average of 5.25 yr; their mean glycosylated hemoglobin was 12.4% (normal 5–9%), and C-peptide was virtually undetectable in all but one. They were followed on a regular diabetic diet for 10 days at home and in the hospital and then were studied on a HCHF diet for 14 days. The HCHF diet contained 60% carbohydrate and 30 g of fiber per 1000 cal provided through grains, fruits, vegetables, and high-fiber crackers. Capillary blood glucose levels were monitored at home before meals and at bedtime, and venous plasma glucose levels were measured in the hospital before and after each meal and during the night. Plasma glucose was measured serially after test meals with each diet. There was no significant difference in blood glucose levels preprandially, postprandially, and while fasting on the two diets. The 24-h glucose profiles and posttest meal profiles obtained during both diets were remarkably similar. We conclude that a diet high in fiber and carbohydrate has limited application in children with type I diabetes mellitus who have no residual beta-cell function.
Hypoglycemia in a Diabetes Nurse Care Coordinator
Authors: Bauman William A , Merkle Larry N , Rachman Raymond A , Mitsuto Sumi M
Published: March 2007

A 26-yr-old registered nurse who is employed as a diabetes nurse care coordinator had episodes of symptomatic fasting hypoglycemia associated with hyperinsulinemia and a relatively suppressed plasma C-peptide concentration, arousing the suspicion of self-induced illness. However, using a species-specific radioimmunoassay, the species of insulin during an episode of hypoglycemia was determined to be human in origin. Once the patient's illness was attributed to endogenous insulin hypersecretion, prompt surgical intervention and the diagnosis of nesidioblastosis in an adult was made.
Semisynthetic Human Insulin: Biologic and Immunologic Activity in Newly Treated Diabetic Subjects During a Six-month Follow-up
Authors: Iavicoli M , Mario U DI , Coronel G A , Dawud A M , Arduini P , Leonardi M
Published: March 2007

Biologic and immunogenic activities of semisynthetic human monocomponent insulins were examined in insulin-dependent diabetic patients (group 1). Patients treated with porcine monocomponent (group 2) and conventional (group 3) insulins were studied for control purposes. The patients were examined before the beginning of insulin treatment and for a 6-mo follow-up period. The data collected during the study show that insulin antibody levels were significantly lower in group 1 than in groups 2 and 3. Furthermore, the prevalence of immune complexes assays with the C1q solid phase technique failed to reveal any differences between the three groups. When the conglutinin binding test was used, the prevalence of immune complexes showed a slight but not significant reduction in group 1 and a significant increase in group 3. The metabolic control was similar in the three groups during follow-up and the insulin requirement was lower, but not significantly, in group 1 than in groups 2 and 3. These data suggest that with human monocomponent insulins equivalent glycemic control may be achieved at similar doses than those required with porcine monocomponent insulins. Furthermore, human insulinis the least immunogenic of the present available insulins.
Personality and Family Profiles of Chronic Insulin-dependentDiabetic Patients Using Portable Insulin Infusion Pump Therapy: A Preliminary Investigation
Authors: Shapiro Johanna , Wigg Duncan , Charles M Arthur , Perley Michael
Published: March 2007

Thirty patients were studied before and after introduction of portable insulin infusion pump therapy to determine the psychological and family impact of this new technological intervention. No negative psychological impactor dysfunction appeared to be associated with introduction of the pump. On the contrary, the postpump group reported significantly less depression, significantly less anxiety, and significantly greater family cohesion than the prepump group. Other nonsignificant trends were in a direction indicatingimproved individual and family psychological status.
Dietary Pectin and Glycemic Control in Diabetes
Authors: Gardner D F , Schwartz L , Krista M , Merimee T J
Published: March 2007

Seventeen diabetic subjects requiring insulin and who exhibited glycemic stability over a 9–12-mo control period received 5 g of pectin with each meal and at bedtime for 3 mo. Hemoglobin A1c (HbA1c) and glycosylated serum protein were measured in each patient on multiple occasions to assess glycemic control. No clear-cut change in these measurements occurred during the period of pectin ingestion. These data are not consistent with a beneficial effect of high-pectin diets in people with diabetes.
Lipid Abnormalities in Insulin-dependent Diabetic Patients with Albuminuria
Authors: Vannini Pietro , Ciavarella Adolfo , Flammini Miranda , Bargossi Alberto M , Forlani Gabriele , Borgnino Luigi C , Orsoni Giorgio
Published: March 2007

The relationship between serum lipid, lipoprotein, and apolipoprotein levels and abnormalities of renal function has been investigated in 112 insulin-dependent (type I) diabetic patients. They were subdivided into three matched groups according to the amount of albuminuria: group A (albuminuria < 20 μg/min), group B (albuminuria between 20 and 150 μg/min; Albustix negative), and group C (albuminuria > 150 μg/min; Albustix positive). Twenty-one nondiabetic subjects with albuminuria above 150 μg/min but without nephrotic syndrome and/or renal failure and 77 healthy subjects were also studied. Mean total and LDL cholesterol, triglycerides, and apo B were higher, while HDL cholesterol and HDL/LDLcholesterol ratio were lower in group C than in groups A and B; the apo A/apo B ratio was lower in group C than in group A. Differences in apo B and in apo A/apo B ratio were found between groups A and B. No correlation between lipid parameters and amount of albuminuria was observed. Significant differences in lipid concentrations were also found in diabetic patients when compared with nondiabetic subjects with albuminuria and with healthy subjects. The present study confirmed previous reports of lipid disorders in insulin-dependent (type I) diabetes; however, the most important observation was the finding of albuminuria-related differences in lipid parameters in diabetic patients without renal failure. We think that the greater lipid abnormalities observed in diabetic patients with larger amounts of albuminuria might be the consequence both of impairment of glomerular permeability and of the diabetic state.
Effect of Propranolol on Delayed Glucose Recovery After Insulin-induced Hypoglycemia in Normal and Diabetic Subjects
Authors: Kleinbaum Jerry , Shamoon Harry
Published: March 2007

In order to evaluate the influence of β-adrenergic blockade on recovery from insulin-induced hypoglycemia, we compared the effect of saline or propranolol infusion during concomitant hypoglycemia in normal and type I diabetic persons. The diabetic subjects were initially rendered euglycemic with a basal insulin infusion. Glucose turnover was measured using [3-3H]glucose tracer. Propranolol caused a small but significant delay in glucose recoveryin normal subjects, with plasma glucose only 80% of the values seen during saline infusion 1 h after hypoglycemia (P < 0.005). This delay was caused by a 70% reduction in the rebound glucose output, which was responsible for posthypoglycemic recovery. In the diabetic subjects, glucose recovery was significantly delayed as compared with that in normalpersons, even in the absence of propranolol, and associated with reduced secretion of epinephrine and glucagon. Moreover, the addition of propranolol caused a further 50% reduction in glucose recovery such that plasma glucose remained below 50 mg/dl for 3 h. In contrast to normals, propranolol did not inhibit the already blunted rebound in glucose output. However, propranolol prevented the decline in glucose utilization that occurred when saline alone was infused. During saline infusion, glucose uptake was at basal rates by 60 min whereas, during propranolol administration, glucose uptake remained above baseline until 180 min (P < 0.01). Thus, propranolol may interfere with glucose recovery after insulin-induced hypoglycemia in diabetic patients by blocking epinephrine's inhibition of glucose utilization whereas, in normals, propranolol's effect is largely accounted for by blockade of epinephrineinduced hepatic glucose production.
Scleroderma-like Changes in Insulin-dependent Diabetes Mellitus: Clinical and Biochemical Studies
Authors: Buckingham Bruce A , Uitto Jouni , Sandborg Chrisy , Keens Thomas , Roe Thomas , Costin Gertrude , Kaufman Francine , Bernstein Bram , Landing Benjamin , Castellano Angela
Published: March 2007

Children with insulin-dependent diabetes mellitus (IDDM) were examined for scleroderma-like changes of digital sclerosis and joint contractures. Of the 104 patients, 19 (18%) demonstrated these features; five patients had both multiple joint involvement and skin changes; three were studied in detail. All three had restrictive pulmonary disease. Histopathology of skin in these three patients demonstrated increased accumulation of collagen in the lower dermis. In two of the patients, the extractability of collagen in 0.5 N acetic acid was decreased by about 50% as compared with normal controls, which suggests increased cross-linkage of collagen. In addition, the mean nonenzymatic glycosylation of collagen in these three patients was 13 times that of controls. The results indicate that distinct histopathologic and biochemical changes can be detected in the skin of these patients. The results further support the hypothesis that nonenzymatic glycosylation may alter the turnover of collagen, thus contributing to the development of a scleroderma-like syndrome with skin, joint, and pulmonary findingsin patients with IDDM.
Mumps Infection and Insulin-dependent Diabetes Mellitus (IDDM)
Authors: Ratzmann Klaus P , Strese J , Witt S , Berling H , Keilacker H , Michaelis D
Published: March 2007

In order to select a population at risk for the development of diabetes for a prospective study of the relationship of islet cell antibodies (ICA),islet cell surface antibodies (ICSA), and glucose tolerance after mumps infection, we carried out a screening program for diabetes. A diabetic survey was conducted among 1581 children (< 16 yr of age) with mumps infection 14 mo before the survey, using a brief questionnaire combined with urinary glucose analysis. Responses to the screening program were obtained from 68.4% (N = 1080) of the children. Out of a total of 1080 subjects, 1069 (99%) had no diabetes mellitus, diabetic symptoms, or glucosuria. A “positive urine glucose screen” was obtained in 11 subjects (1%) of the study group. These individuals all had a normal oral glucose tolerance test according to the new WHO definition. A group of 86 children was randomly selected from the total group of 1080 children for follow-up glucose tolerance, ICA, and ICSA. Irrespective of the negative urine glucose screen impaired glucose tolerance was diagnosed in 3.5% (N = 3) of the 86 children. The prevalence of ICA and ICSA was 78% and 36%, respectively. The simultaneous prevalence of ICA and ICSA was 33%. The pathogenetic role of mumps infection and ICA/ICSA and their possible relationship to slow progressive beta cell destruction remain to be elucidated.
Periprandial Blood Glucose and Insulin Values During the Third Trimester of Normal Pregnancies
Authors: de los Monteros Antonio M Espinosa , Duarte Magdalena C , Quijano Jesús V , Casanueva Esther L
Published: March 2007

In order to determine the normal periprandial blood glucose values during gravidity, we studied 17 normal pregnant women, near term of gestation, in their homes using test strips and reflectometers. Results show an initial fasting level not higher than 80 mg/dl and not lower than 45 mg/dl. In all cases but one blood glucose levels were lower than 120 mg/dl, irrespective of when the measurements were taken. Insulin determinations permitted us to recognize low and high responders, although no differences could be found between them.
A High–Wheat Bran Diet in Insulin-treated Diabetes Mellitus: Assessment with the Artificial Pancreas
Authors: McMurry James F , Baumgardner Barbara
Published: March 2007

The acute effects of adding a large amount of wheat bran to a mixed meal was examined with the artificial pancreas in seven insulin-dependent diabetic patients. The timing of the peak blood glucose concentration and its magnitude were similar with both low–and high–wheat fiber meals. The total and net areas under the glucose curve were comparable. After adjusting for individual basal needs, the insulin requirements for the test meals were nearly identical. We observed no beneficial effect of added wheat bran from this study. We could not demonstrate any need for diabetic patients to adjust insulin dosage for occasional differences in meal wheat bran content.
Guar and its Effects on Metabolic Control in Type II Diabetic Subjects
Authors: Najemnik C , Kritz H , Irsigler K , Laube H , Knick B , Klimm H D , Wahl P , Vollmar J , Brauning C
Published: March 2007

The effect of guar mini-tablets (5 g t.i.d.) on carbohydrate and lipid metabolism of outpatients with overt diabetes mellitus with glycosuria (> 5 g/24 h) was determined in an open-controlled, randomized, multicenter, crossover study. A 4-wk pretreatment period was followed by a 6-wk treatment period. The treatment period consisted of a 2-wk guar period (treatment period II), which was followed by the wash-out period. The other half of the patients received treatment in the reverse order. Out of 93 patient records, 79 (41 sulfonylurea [SU] and 38 insulin-treated) were suitable for statistical analysis. No relevant weight-reducing effect of guar could be found in both 2-wk treatment periods. At the end of treatment period II, the lowering of the 1-h postprandial values of blood glucose (SU 12%, insulin 10%), cholesterol (SU and insulin 25%) was significant after 2-wk of guar treatment compared with the wash-out period. No clinically relevant changes in the safety laboratory parameters were observed during guar treatment. Side effects were observed in 40 of the 93 patients included in the trial. Treatment had to be discontinued in 11% of the patients due to gastrointestinal side effects. On the basis of our results,guar treatment in combination with sulfonylurea and insulin can be recommended for the improvement of carbohydrate and lipid metabolism.
The Flashlight Test Lacks Validity as a Screen for Nocturnal Hypoglycemia
Authors: Duncan Bruce B , Schmidt Maria I , Skyler Jay S , Ellis George J , Keller Adrienne , Rathjens Michael H
Published: March 2007

Though never validated, the flashlight test is a commonly used screen for nocturnal hypoglycemia. Between 2 a.m. and 4 a.m., we applied the test to 107 children at Eagle's Nest Camp for Children with Diabetes. We validated the test against simultaneously determined capillary blood glucose values (Glucoscan). An eyelid squint in response to the flashlight was considered an intact test. No significant difference existed between mean glucoses for intact and nonintact responses. Both sensitivity and positive predictive value are too low for the flashlight test to be useful in screening for nocturnal hypoglycemia.
The Effects of Physiologic Amounts of Simple Sugars on Lipoprotein, Glucose, and Insulin Levels in Normal Subjects
Authors: Bossetti Brenda M , Kocher Lynn M , Moranz Janice F , Falko James M
Published: March 2007

Using a crossover design, eight healthy volunteers randomly received physiologic amounts (⅓ of each subject's total carbohydrate intake) of either fructose or sucrose as the primary source of simple sugar, incorporated into isocaloric diets comprised of typical American foods. After 7 and 14 days of consuming either of the two sugars, no change occurred in fasting glucose or insulin levels. In addition, total triglyceride, totalcholesterol, low-density-lipoprotein (LDL) cholesterol, and high-density-lipoprotein (HDL) cholesterol concentrations were unaltered. Since our study used conventional foods in normal eating patterns rather than contrived formulas or excessive amounts of simple sugar, our data indicate that there is no difference between sucrose or fructose on various lipid components or glucose and fasting insulin levels in the “real world” innormal subjects.
Abnormal Color Vision and Reliable Self-Monitoring of Blood Glucose
Authors: Lombrail P , Cathelineau G , Gervais P , Thibult N
Published: March 2007

Color vision was assessed in 103 insulin-dependent diabetic patients using the Farnsworth-Münsell 100-Hue Test. All showed color vision impairment. Thirty-four had truedyschromatopsia while 22 suffered from tritanopia or other axial defects. We evaluated how accurately diabetic patients could monitor their own blood glucose by asking them to read a series of 30 precalibrated BM Test Glycemic Strips (Chemstrip, Boehringer, Mannheim,West Germany) without a meter. Patients with axial defects performed least well regardless of 100-Hue scores. Reading accuracy of patients with no axial defects was strongly correlated to 100-Hue scores, although patients having dyschromatopsia were consistently hesitant about their readings. Our results suggest that self-monitoring of blood glucose without a meter is indicated only after color vision has been examined by the 100-Hue Test. Self-monitoring should be voided with patients suffering from axial defects or having unsatisfactory 100-Hue scores.
Relationship of Participation Preference and Health Locus of Control in Diabetes Education
Authors: Ruzicki Dorothy A
Published: March 2007

The relationship between health locus of control type and preference for educational approach was examined in 89 diabetic adults, both hospitalized and ambulatory. In addition, subject personal and demographic variables were examined as they related to health locus of control type and preference for approach. No association was found between hypothesized health locus of control types and preferences for approach. A majority of all health locus of control types (64%) preferred a prescriptive approach. Hospitalized subjects and those who had not attended formal diabetes classes tended to believe that powerful other people had an impact on their health, while subjects who were ambulatory, and those who had previous formal instruction perceived themselves to be more responsible for their health; younger subjects also held high internal beliefs. Participatory approaches were preferred by younger subjects and those who had received formal diabetes instruction. The findings suggested that although educational approaches that maximize participation have been advocated, they did not appear to be the preferred approach. Although participatory approaches might actually be more efficacious in producing behavior change, the finding that people might not prefer them underscores the importance of tailoring educational methodology to individuals; age, place of instruction, and previous diabetes education are factors to be considered in tailoring programs.
Non-insulin-dependent Diabetes (NIDDM) in a Newly Independent Pacific Nation: The Republic of Kiribati
Authors: King Hilary , Taylor Richard , Zimmet Paul , Pargeter Karen , Raper L Robin , Beriki T , Tekanene J
Published: March 2007

A population-based survey of 2938 subjects has demonstrated a high prevalence of non-insulin-dependent diabetes (NIDDM) in the Micronesian population of Kiribati (formerly the Gilbert Islands). This finding provides further support for evidence from Nauru, Guam, and the Marshall Islands that Micronesians are particularly susceptible to NIDDM. The age-standardized prevalence was over twice as high in an urban, as compared with a rural, sample (9.1 versus 3.0 in men, 8.7 versus 3.3 in women). To test the a priori hypotheses that obesity, reduced physical activity, and a nontraditional diet are associated with NIDDM, indices of these factors were compared in rural and urban subjects. The rural population was found to be leaner, to have a higher estimate of habitual physical activity, and to have a lower percentage of daily energy intake derived from imported foods. Further analysis demonstrated that obesity alone was insufficient to explain the rural-urban difference in prevalence of NIDDM. The multiple logistic regression model demonstrated a significant association between the prevalence of NIDDM and both obesity and urbanization in men. In women, obesity, physical inactivity, and urbanization were all associated with increased prevalence of NIDDM.
Influence of Physical Training on Blood Glucose Control, Glucose Tolerance, Insulin Secretion, and Insulin Action in Non-insulin-dependent Diabetic Patients
Authors: Trovati Mariella , Carta Quirico , Cavalot Franco , Vitali Sara , Banaudi Carlo , Lucchina Pietro Greco , Fiocchi Franco , Emanuelli Giorgio , Lenti Gianfranco
Published: March 2007

This study has been designed to investigate, in five non-insulin-dependent diabetic patients, the influence of physical training (1 h a day, 7 days a wk for 6 wk, at 50–60% maximum oxygen uptake) on blood glucose control, glucose tolerance, insulin secretion, and insulin action. Physical training resulted in a significant improvement in blood glucose control, glucose tolerance, and insulin action. These results suggest that short-term intense physical training ameliorates the main metabolic derangements of non-insulin-dependent diabetes mellitus.
Association of Differing Dietary, Metabolic, and Clinical Risk Factors with Macrovascular Complications of Diabetes: A Prevalence Study of 503 Mexican Type II Diabetic Subjects. I
Authors: Paisey R B , Arredondo G , Villalobos A , Lozano O , Guevara L , Kelly S
Published: March 2007

Macrovascular and microvascular complications of diabetes may be associated with different environmental factors. To investigate this further, a prevalence study of 503 Mexican type II diabetic subjects was carried out while their patterns of nutrition were constrained by government food subsidies. Average daily dietary intakes were 1866 kcal; 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. With respect to macrovascular disease, 49.3% of patients had evidence of peripheral vascular disease, and 21.6% myocardial ischemia, 6.0% angina, 10.8% EKG evidence of ischemia, 4.8% EKG evidence of myocardial infarction. Only 1.2% (six patients) had a clear history of completed stroke, and all were hypertensive. Six patients had also undergone amputations for diabetic gangrene. Tabulation of the means of clinical characteristics according to presence or absence of myocardial ischemia showed that higher cholesterol, calorie, and fat intake, higher mean blood pressure, higher serum cholesterol, and serum triglyceride levels were found in those with myocardial ischemia. Patients with peripheral vascular disease were more commonly smokers. Stepwise logistic regression revealed significant positive associations between myocardial ischemia and dietary cholesterol, serum cholesterol, and mean blood pressure. In contrast, the presence of peripheral vascular disease was significantly related only to smoking and retinopathy. There were no associations between macrovascular complications and duration of diabetes in the multivariate analysis, and they occurred with equal frequency in men and women. Prospective studies of atherosclerosis in maturity-onset diabetes should assess and seek to modify dietary cholesterol, serum cholesterol, and hypertension.
Improvement of Glucose Homeostasis After Exercise Training in Non-insulin-dependent Diabetes
Authors: Reitman James S , Vasquez Barbara , Klimes Iwar , Nagulesparan Murugasu
Published: March 2007

Six obese patients with recent-onset, non-insulin-dependent diabetes underwent assessment of glucose tolerance, insulin secretory capacity, and insulin-induced glucose disposal before and after 6–10 wk of intensive aerobic training while maintaining body weight. Fasting plasma glucose declined in every subject (average = −33 mg/dl), and oral glucose tolerance (3 h integrated plasma glucose) improved in five of the six (average = −74 mg × 3 h/dl) after training. Individual improvement in control of plasma glucose was directly proportional to degree of hyperglycemia before training and correlated well with an observed improvement in the early (30-min) plasma insulin response to oral glucose (all six subjects). The response of insulin action to training was highly variable; although the observed increase in average insulin-induced glucose disposal rate (M) during the euglycemic clamp did not reach statistical significance in our small cohort, the relative change in M was directly related to reduction in fasting insulin levels after training. Our results show that regular endurance exercise is effective in improving glucose homeostasis and may serve as an adjunct to other modes of treatment in recent-onset, non-insulin-dependent diabetic individuals.