bluuebunny/crossref_metadata_2025 huggingface dataset:
Flattening Postprandial Blood Glucose Responses with Guar Gum: Acute Effects
Authors: McIvor Michael E , Cummings Charles C , Leo Theresa A , Mendeloff Albert I
Published: March 2007

It has been proposed that high-carbohydrate, high-fiber (HCF) diets might serve as useful therapeutic modality in non-insulin-dependent diabetes mellitus (NIDDM). One problem in evaluating clinical trials of this therapy is that, by their very nature, the trials cannot be double blinded. We have developed HCF and placebo granola-type bars using complex absorbable carbohydrate and guar gum fiber to circumvent this methodologic problem. The HCF bars, when consumed with an ad lib. diet, assure an HCF intake without imposing other dietary restrictions. To test the short-term efficacy of the bars, 9 normal adult volunteers, 2 women with impaired glucose tolerance, and 20 patients with NIDDM consumed the bars alone or with meals. Blood glucose responses when HCF bars were consumed alone were blunted when compared with the placebo response (P < 0.0005 to P < 0.002), with the most marked suppression occurring in the early postprandial period. In contrast, when the bars were consumed along with breakfast, HCF and placebo responses were virtually identical in the early postprandial period, but showed a progressively greater difference from 90 to 240 min (P < 0.02 to P < 0.0005). When consumed with lunch as well as breakfast, the HCF bars caused flattening of blood glucose responses during the late postprandial period after breakfast and maintained flattened responses during the early and late postprandial periods after lunch (P < 0.05 to P < 0.005). It is concluded that these HCF bars can be used to blunt postprandial blood glucose responses, in subjects with either normal or abnormal carbohydrate metabolism.
Absorption of Subcutaneously Infused Insulin: Influence of the Basal Rate Pulse Interval
Authors: Hildebrandt Per , Birch Kjeld , Jensen Bente M , Kühl Claus , Brange Jens
Published: March 2007

Eight insulin-dependent diabetic patients were given two constant infusions (each 1 IU/h) of 125I-labeled insulin into the abdominal subcutaneous tissue for about 12 h. Insulin was infused in pulses into one side of the abdomen in 6-min intervals (by means of an Auto-Syringe pump) and in the other side of the abdomen, insulin was infused in 1-h intervals (by means of a Medix pump). The size of the subcutaneous depots was continuously measured by counting the radioactivity at the infusion sites. After starting the infusions, the two depots were built up to steady-state levels at the same time and of the same size (approximately 3 IU) and with similar absorption rates. Thus, during basal rate insulin infusion, identical insulin absorption kinetics was achieved, irrespective of a 10-fold difference in the pulse rate.
Incidence of Diabetic Retinopathy and Blindness: A Population-based Study in Rochester, Minnesota
Authors: Dwyer Mark S , Melton L Joseph , Ballard David J , Palumbo Pasquale J , Trautmann James C , Chu Chu-Pin
Published: March 2007

Among the 1135 Rochester residents discovered to have diabetes in the period 1945–69, the prevalence of retinopathy was 2.6% at the time of initial diagnosis. Among those free of retinopathy at diagnosis of diabetes, the subsequent incidence of any retinopathy was 17.4 per 1000 person-years and for proliferative retinopathy alone was 1.6 per 1000 person-years, based on 12,000 person-years of follow-up. The incidence rate of retinopathy was almost three times greater among residents with insulin-dependent (IDDM) than with non-insulin-dependent diabetes (NIDDM); however, the actual number of retinopathy cases was over four times greater among the more numerous residents with NIDDM. By 20 yr after diagnosis of diabetes, the cumulative incidence of retinopathy approached 70% among IDDM subjects and was 30% and 36%, respectively, among the obese and nonobese NIDDM residents. The epidemiologic patterns for proliferative retinopathy were qualitatively similar to those for nonproliferative retinopathy. The risk of blindness was greater among those with proliferative than with nonproliferative retinopathy but was substantial even for those without retinopathy. Most blindness was caused by factors other than isolated diabetic retinopathy.
Accommodating Planned Exercise in Type I Diabetic Patients on Intensive Treatment
Authors: Schiffrin A , Parikh Sagar
Published: March 2007

To achieve optimal metabolic control in type I diabetic patients treated with continuous subcutaneous insulin infusion (CSII) and multiple subcutaneous injections of insulin (MSI) appropriate adjustments of the insulin prescription should be made for exercise, which is a normal component of everyday life. The present study describes the responses of seven type I diabetic adolescents treated with CSII and six patients treated with MSI to specific insulin dose changes in anticipation of postprandial exercise. The effect of 45 min of cycle ergometer exercise at 55% VO2 on glucose regulation was studied 2 h after morning insulin and a breakfast meal. To quantify the potential benefit of modifying the insulin dose before exercise, the subjects were studied on five different days in a random order: (1) resting control day, (2) postprandial exercise preceded by the usual dose of insulin, (3) postprandial exercise preceded by one-half of the usual dose of insulin, (4) postprandial exercise preceded by two-thirds of the usual dose of insulin, and (5) postprandial exercise without the usual dose of insulin. In all cases insulin was injected or infused subcutaneously in the anterior abdominal wall. When exercise was performed without changing the usual insulin dose, there was a significant fall in glycemia in both groups, with the nadir occurring after 45 min. In the CSII group, the ± SEM plasma glucose was 57 ± 5 mg/dl (P < 0.05 versus rest) with hypoglycemia occurring in four patients. In the MSI group, the mean ± SEM plasma glucose fell to 65 ± 10 mg/dl (P < 0.05 versus rest) and hypoglycemia occurred in three patients. This was corrected with the administration of approximately 25 g of glucose by mouth. When exercise was performed after one-half and two-thirds of the usual insulin dose, the plasma glucose profile observed during exercise in both groups was not statistically different from that observed during the rest day. Postprandial exercise without prior insulin resulted in significant hyperglycemia in both groups (P < 0.01). Plasma free insulin levels remained unchanged throughout the exercise period in all protocols. A 50–66% reduction of the insulin dose in anticipation of postprandial exercise of moderate intensity resulted in near-normal glycemic values and prevented hypoglycemia. Alternatively, in the case of unplanned postprandial exercise of 45 min duration, the intake of 25–30 g of glucose may prevent hypoglycemia in the CSII- and MSI-treated type I diabetic patients.
Pancreatic Polypeptide: A Marker for Lean Non-insulin-dependent Diabetes Mellitus?
Authors: Service F John , Koch Mark B , Jay Joan M , Rizza Robert A , Go Vay L W
Published: March 2007

Both basal and postprandial pancreatic polypeptide (PP) concentrations were exaggerated twofold in lean NIDDM patients, whereas they were normal in lean IDDM and obese NIDDM patients who were hyperglycemic as a result of partial insulin withdrawal. Insulin infusion from an artificial endocrine pancreas, which resulted in fasting euglycemia and near-normoglycemia postprandially, had no effect on PP responses in any of the diabetic patients. No postprandial PP responses were observed in totally pancreatectomized (TPX) patients. Excessive basal and postprandial concentrations of PP in diabetes appear to be related to both leanness and residual beta cell function and, therefore, potential markers for lean NIDDM.
Self-Monitoring of Blood Glucose: How Accurate Are Children with Diabetes at Reading Chemstrip bG?
Authors: Clarson Cheril , Daneman Denis , Frank Marcia , Link Judy , Perlman Kusiel , Ehrlich Robert M
Published: March 2007

Accuracy of self-monitoring of blood glucose (SMBG) using Chemstrip bG (Bio-Dynamics, Indianapolis, Indiana) was studied in 90 randomly selected children with insulin-dependent diabetes mellitus (IDDM). For 28 children (mean age 8.3 ± 3.6 yr) a parent routinely read the Chemstrip at home. The remaining 62 children (mean age 13.7 ± 2.8 yr) read the Chemstrip themselves. Each child or parent analyzed 20 capillary blood samples using Chemstrips and answered a questionnaire on SMBG. The accuracy of SMBG of the group was high (mean correlation coefficient = 0.89 ± 0.05), but consistency of measurement was variable (mean standard deviation = 1.90 ± 0.57) and there was a general tendency to underread Chemstrips (mean y-intercept = 1.05 ± 1.48; mean slope = 0.80 ± 0.17). For each subject, 0–65% (mean of 34%) of readings were within 10% of the laboratory measurement, and 17–100% (mean 68%) within 20%. These results indicate that most subjects were fairly accurate in reading Chemstrips; however, analysis of accuracy is useful in identifying individuals who are inaccurate or inconsistent in SMBG. Continuing supervision of SMBG is necessary in children with IDDM.
Glucose Tolerance in Granuloma Annulare
Authors: Kidd Gerald S , Graff Gene E , Davies Bernard F , McDermott Michael T , Aeling John L , Hofeldt Fred D
Published: March 2007

Granuloma annulare (GA) may be associated with glucose intolerance. Twenty-one patients with GA were evaluated. Four patients were found to have frank diabetes mellitus and 2 were excluded from the data analysis because of obesity. The remaining patients and 14 age- and weight-matched controls had oral and intravenous glucose tolerance tests (GTT). During the oral GTT the fasting plasma glucose, the 2-h plasma glucose, the area of the glucose curve, the 1-h serum insulin, and the area of the insulin curve were all significantly greater in the GA patients than in the controls. During the intravenous GTT the immediately releasable insulin pool was intact, while the fasting plasma glucose and the area of the glucose curve were greater in the GA patients than in the controls. The data taken together suggest that glucose tolerance may be reduced in GA and that insulin resistance may exist.
Aspartame Use By Persons with Diabetes
Authors: Nehrling Jeanine Kullessa , Kobe Peter , McLane McLane P , Olson Ronald E , Kamath Savitri , Horwitz David L
Published: March 2007

Sixty-two subjects having either insulin-dependent or non-insulin-dependent diabetes completed a randomized, double-blind study comparing effects of aspartame or a placebo on blood glucose control. Twenty-nine subjects consumed 2.7 g aspartame per day for 18 wk, given as aspartame-containing capsules with meals, while 33 subjects took identical appearing placebo capsules. After 18 wk, no changes were seen in fasting or 2-h postprandial blood glucose levels or glycohemoglobin levels in either the aspartame- or placebo-treated groups. Adverse reactions were no more common in the group taking aspartame. We conclude that use of aspartame as a low-calorie sweetener does not adversely affect glycemic control of persons with diabetes.
Prediction of the Relative Blood Glucose Response of Mixed Meals Using the White Bread Glycemic Index
Authors: Wolever Thomas M , Nuttall Frank Q , Lee Randolph , Wong Gerald S , Josse Robert G , Csima Adele , Jenkins David J
Published: March 2007

Unexpected plasma glucose responses to different mixed meals fed to normal and diabetic volunteers have recently been reported. We have therefore examined in normal volunteers the effect of mixing carbohydrate foods of different glycemic indices (GIs) without the addition of fat and protein. The observed GI of the mixed meal was within 2% of the expected value. In studies in the literature where fat and protein were added to mixed meals, the observed blood glucose responses also related significantly to the meal GIs calculated from the individual foods. Addition of fat and protein in the quantities used did not obscure this relationship. Studies to determine sources of error in comparing glycemic responses showed that type II diabetic patients displayed the least within-individual variation, and type I diabetic patients the most. Expression of results as the GI rather than as absolute glycemic response areas reduced by 50% the between-subject variation. The mean GI values of rice tested in type I and type II patients were similar (82 ± 22 compared with 74 ± 19) and the reproducibility 22 mo later in the same group of subjects was excellent (81 ± 15 compared with 83 ± 15). However, the lack of precise GI values for all foods fed in the test meals indicates a need for GI values to be derived for a wider range of individual foodstuffs. The GI approach to classifying foods according to physiologic effect may play a useful role in planning meals and diets in which specific blood glucose profiles are required.
Gastric Inhibitory Polypeptide (GIP) Responses After Oral Glucose Ingestion in Hyperthyroidism
Authors: Osei Kwame , Falko James M , O'Dorisio Thomas M , Adam David R
Published: March 2007

Gastric inhibitory polypeptide (GIP) is a gastrointestinal hormone stimulated after oral nutrient ingestion, but not after intravenous nutrient administration. GIP stimulates insulin release in the presence of hyperglycemia and as such is considered a major enteroinsular hormone. Since elevated glucose and insulin levels are found in hyperthyroidism, we compared the GIP responses to oral glucose ingestion in 12 hyperthyroid patients and 10 age-matched controls. Seventy-five grams of oral glucose was ingested after overnight fasting and samples were obtained at 0, 30, 60, 90, 120, and 180 min for serum glucose and immunoreactive insulin (IRI) and GIP (IRGIP). The mean serum glucose levels in hyperthyroid subjects were significantly higher (P ≤ 0.05) at every time studied except at 180 min. At 60 min, peak mean glucose was 171 ± 14 mg/dl versus 128 ± 7 mg/dl in controls (P < 0.02). Except for fasting, mean IRI levels were significantly higher (P < 0.001) in hyperthyroid subjects than in controls at all times studied. At 60 min, IRI rose to a peak of 125 ± 11 μU/ml in hyperthyroid subjects versus 50 ± 9 μU/ml in controls (P < 0.001). Mean fasting, stimulated, and incremental IRGIP levels were slightly higher but not statistically different in the hyperthyroid subjects versus controls. Glucose and IRI responses are exaggerated in hyperthyroidism after oral glucose ingestion. Even though GIP has insulinotropic action, its role in the hyperinsulinism found in hyperthyroid subjects appears to be minimal.
Periarthritis: Another Duration-Related Complication of Diabetes Mellitus
Authors: Abdul Sattar Mohammed , Ali Luqman Wijdan
Published: March 2007

The association between periarthritis of the shoulder and diabetes mellitus is well recognized. A study of 100 hospitalized patients with diabetes was performed, comparing them with 100 control subjects. The mean ± SEM age of the subjects was 47 ± 2 yr. Nineteen percent of the patients with diabetes had periarthritis. The afflicted subjects had a higher incidence of retinopathy (P < 0.005) and albuminuria (P < 0.005). The duration of shoulder pain correlated with the duration of the diabetes mellitus (P < 0.001). However, the presence of other complications in subjects with periarthritis was not as well correlated with the duration of the diabetes mellitus. These data emphasize the common occurrence of periarthritis in subjects with diabetes mellitus and its extension to people of diverse backgrounds.
International Criteria for the Diagnosis of Diabetes and Impaired Glucose Tolerance
Authors: Harris Maureen I , Hadden Wilbur C , Knowler William C , Bennett Peter H
Published: March 2007

International agreement on classification and criteria for the diagnosis of diabetes is highly desirable. Two systems promulgated in 1979–80 and widely used today are those of the NIH National Diabetes Data Group (NDDG) and of the World Health Organization (WHO). Although these systems are similar in many ways, certain discrepancies between them result in different classifications of oral glucose tolerance test (OGTT) results and different estimates of prevalence of the various glucose tolerance groups. Analysis of 3704 OGTTs performed during a survey of a national probability sample of U.S. residents without known diabetes and aged 20–74 yr shows that the two systems agreed in classification of 87.7% of OGTTs. For the remainder, the NDDG and WHO classifications differed, primarily because nondiagnostic OGTTs occur in the NDDG system but not in the WHO system. The differences resulted in the prevalence of impaired glucose tolerance (IGT) using WHO criteria (11.6%) being more than twice that using NDDG criteria (4.9%), although prevalence rates of diabetic OGTTs were similar in both systems (3.6%, 3.4%). The WHO system represents a simpler, inclusive classification scheme, and there is insufficient evidence from longitudinal studies of prognostic differences that would justify the more complicated NDDG diagnostic criteria. In situations where multiple venipunctures or retesting are not possible, the venous plasma glucose concentration at 2 h after 75 g glucose appears to be the most appropriate single value to use to designate whether a person has diabetes, IGT, or neither. The use of this value alone placed 97% of diabetic subjects and all other subjects, in the same class they were in when the full WHO criteria were used.
Time as a Risk Factor in Diabetic Nephropathy
Authors: Nyberg Gudrun , Larsson Owe , Attman Per-Ola , Granérus Göran , Nordén Gunnela
Published: March 2007

Eighteen individuals with IDDM (type I) and diabetic nephropathy in whom the initial glomerular filtration rate (GFR) was reduced but not below 60 ml/min per 1.73 m2 were observed for an average of 3 yr. The rate of further decline of GFR was found to range between −2 and 21 ml/min/yr. The duration of diabetes until the GFR was first found to be reduced varied between 14 and 33 yr and was not correlated to the ensuing rate of decline in GFR (r = −0.13). In 10 individuals who developed uremia 40 yr or more after onset of IDDM, the development of persistent ptoteinuria was followed by hypertension and increased serum creatinine 2 yr later and by terminal uremia after an average of 8 yr. This is also the normal time span for individuals who develop terminal uremia after shorter duration of diabetes. We conclude that the course of clinical diabetic nephropathy is not more favorable in individuals with late onset of this complication and that there is no point at which a person with diabetes can be considered to be spared from developing diabetic nephropathy.
Postsplenectomy Sepsis Caused by Group B Streptococcus (S. agalactiae) in an Adult Patient with Diabetes Mellitus
Authors: Fish Hamilton R , Chia John K S , Shakir K M Mohamed
Published: March 2007

Overwhelming postsplenectomy infection (OPSI) due to group B streptococcus developed in an insulin-dependent diabetic patient. The illness began with nonspecific symptoms, followed rapidly by hypotension and disseminated intravascular coagulation. The early institution of appropriate antibiotics, fluid replacement and pressor agents resulted in a favorable clinical outcome. The association of group B streptococcal infection and diabetes mellitus is discussed. The defects in normal host defenses associated with asplenic state and diabetes mellitus are further emphasized. This is the first case report linking the association of OPSI, diabetes mellitus and group B streptococcal septicemia.
Understanding and Enhancing Patient Compliance with Diabetic Regimens
Authors: Rosenstock Irwin M
Published: March 2007

Behavioral research on patient compliance with regimens to manage diabetes has suffered from lack of conceptual rigor, although a handful of recent studies and reviews are more theoretically oriented. The present review proposes a comprehensive conceptual framework in the context of learning theory to explain patient compliance and to derive approaches for enhancing compliance. The conceptual framework is the health belief model (HBM) expanded to include the concept of perceived self-efficacy. This expanded model may both serve as an agenda for future research as well as a set of guidelines for the education of patients with diabetes. A variety of educational interventions is recommended for use in patient education provided they succeed in reinforcing relevant health beliefs, behavioral skills, and the sense of self-efficacy. The problem of long-term maintenance, of particular significance in chronic disease management, is addressed by the relapse prevention model derived from social learning theory and emphasizing self-efficacy and the learning of coping skills.
Doppler Ultrasound Recognition of Preclinical Changes in Arterial Wall in Diabetic Subjects: Compliance and Pulse-Wave Damping
Authors: Lo C S , Relf I R N , Myers K A , Wahlqvist M L
Published: March 2007

Doppler ultrasound was used to detect early changes in arteries of the legs by two independent techniques. Pulse-wave velocity was measured to calculate arterial wall compliance and Fourier analysis was used to measure damping of the pulse-wave forms. Ten non-insulin-dependent diabetic men with no clinical evidence of peripheral arterial disease had significantly lower compliance and greater pulse-wave damping than 10 matched nondiabetic control subjects. There was a good correlation between the results for the two different techniques.
Abnormalities in Insulin Secretion in Healthy Offspring of Indian Patients with Maturity-Onset Diabetes of the Young
Authors: Mohan Viswanathan , Snehalatha Chamukuttan , Ramachandran Ambady , Viswanathan Moopil
Published: March 2007

Serum C-peptide (CP) and immunoreactive insulin (IRI) responses were studied in 47 euglycemic offspring of patients with maturity-onset diabetes of the young (MODY). Mean IRI responses were not significantly different in nonobese offspring of MODY patients (O-MODY) but they were lower in obese O-MODY than in respective controls. Mean CP responses were low in both groups, the change being more pronounced in obese O-MODY. These findings indicate that alterations of secretion and metabolism of insulin can be detected even before glucose intolerance is seen in O-MODY.
Personal Computer Programs to Assist with Self-Monitoring of Blood Glucose and Self-Adjustment of Insulin Dosage
Authors: Pernick Nat L , Rodbard David
Published: March 2007

We have developed computer programs in compiled BASIC for the IBM-PC and compatible microcomputers for use by physicians, paramedical personnel, and/or patients to assist with self-monitoring of blood glucose (SMBG) and self-adjustment of insulin dosage. The programs can potentially assist with patient education and motivation, and provide: (1) a customized “electronic notebook” for storage and retrieval of information on blood glucose, insulin dosage, hypoglycemic reactions, urinary ketones, diet, activity, weight, illness, apparent explanations for hypoglycemic reactions or glucose values outside target ranges, and comments; (2) graphic displays of glucose and insulin versus date, and of a “glucose profile” versus time of day or versus day of the week; (3) simple and detailed statistical analyses; (4) a legible summary of data; (5) a facility to permit the physician to prepare a “customized treatment plan” for each patient, involving a choice of six regimens, target levels for each of eight time periods, four supplement tables (when well or sick, before meals, or at bedtime), rules to reduce insulin in response to hypoglycemic reactions or documented hypoglycemia, rules to increase routine insulin doses in response to persistent unexplained hyperglycemia, and rules when the patient should call the physician; (6) suggestions regarding compensatory supplements and adjustments of routine insulin dosage; (7) explanations why various insulin dosages should or should not be altered, and why various glucose values should be tested; (8) comparisons of the insulin dosage administered by the patient and the recommendations of the program, together with explanations for discrepancies offered by the patient, to help evaluate compliance. The program is “user-friendly,” easy to learn, and easy to use. A detailed plan for introduction of the program to the patient has been developed. Use of the program is flexible: it could be used several times a day (when monitoring glucose and adjusting insulin dosage), once a day (e.g., to enter the day's data and obtain suggestions for the following day), once every week or two (for data storage, evaluation of the recent degree of control, and analysis of patterns in the daily glucose profile), or once every 1–3 mo (before office visits, to prepare summaries, graphs, statistical analyses, and for retrospective comparison of patient's decisions with the program's recommendations). The advantages and limitations of the present program, approach, and design philosophy are discussed.
Comparison of Five Glucose Meters for Self-Monitoring of Blood Glucose by Diabetic Patients
Authors: Gifford-Jorgensen Rachel A , Borchert Jim , Hassanein Ruth , Tilzer Lowell , Eaks George Ann , Moore Wayne V
Published: March 2007

This study collected data regarding the accuracy of five currently marketed meters for home use of self-monitoring of blood glucose (SMBG). Data regarding ease of operation of each glucose meter as well as cost and availability of meters and necessary materials were compiled. Fasting blood glucose (BG) samples were drawn from patients in the adult and pediatric diabetes clinics at the University of Kansas College of Health Sciences and Hospital. Specimens were tested by a clinical laboratory as well as by each meter. Unadjusted meter readings of whole BG were plotted against laboratory readings of serum glucose and displayed in scattergrams. Scattergrams showed decreased machine accuracy in upper and lower BG ranges. Whole BG values (meter readings) were adjusted to serum glucose levels by multiplication by 1.12. Adjusted values were compared with laboratory serum values using ANOVA for repeated measures and Dunnett's Multiple Comparisons Test: ANOVA and Dunnett's Multiple Comparisons Test showed only Glucochek II (Medistron, Ltd., West Sussex, England; distributed in U.S. by Larken Industries, Lenexa, Indiana) using Dextrostix reagent strips (Ames Division, Miles Laboratories, Elkhart, Indiana) having a statistically significant difference from laboratory values (P < 0.01). This meter was recently revised and may show changed accuracy readings. Each meter exhibited inherent advantages and disadvantages regarding price, calibration, strip utilization, and ease of operation, which must be considered before recommendation by the health care provider.
Preliminary Studies of Diabetic Decompensation Assessed with Bedside Glucose-Monitoring Techniques
Authors: Umpierrez G E , Reed J C , Thacker S V , Phillips L S
Published: March 2007

Blood glucose-monitoring techniques originally developed to aid outpatient management of diabetic patients are now being used to facilitate hospital care. However, applications in hyperglycemic patients have been limited because many glucose-oxidase strips and meters respond only to glucose values ≤ 400 mg/dl. We asked if prior dilution of blood samples would permit reliable estimations. Ten consecutive decompensated diabetic patients (age 35–73, glucose 506–879, HCO3 12–28) had blood glucose determinations done simultaneously by the hospital laboratory and by Chemstrip bG after dilution of heparinized blood 1:2 in saline. Thirty-one samples were obtained before and during insulin therapy. Correlations with laboratory glucose values were 0.95 with strips read by Accu-Chek meter and 0.90 read visually, both P < 0.001. Average deviations from laboratory values were 7.9% with Accu-Chek and 12.9% with visual readings. Accu-Chek deviations averaged 9.6% for glucose > 700 mg/dl, and 6.9% for glucose > 400 mg/dl. Over the first hour of insulin therapy, glucose fell 150 ± 30 mg/dl by Accu-Chek, comparable to 168 ± 29 by laboratory measurement; the decrement by visual reading was 107 ± 32, not significantly different. We conclude that dilution of blood samples with glucose > 400 allows reliable estimation of elevated values by home glucose-monitoring techniques. This approach is cost-effective and provides the rapid feedback needed for the management of critically ill patients.
Use of Beef Ultralente for Basal Insulin Delivery: Plasma Insulin Concentrations After Chronic Ultralente Administration in Patients with IDDM
Authors: Rizza R A , O'Brien P C , Service F J
Published: March 2007

Ultralente has been used as the basal component of intensive insulin therapy programs. To determine the degree to which a single daily subcutaneous injection of beef ultralente provides stable basal insulin concentrations, plasma free insulin concentrations were measured in six insulin-dependent diabetic patients over a 40-h period. All short-acting insulin was withheld during this interval. Each patient had been maintained on a chronic ultralente based program before study. Little if any evidence of a temporal peak in plasma insulin concentrations was observed. Although considerable variation in plasma insulin concentrations was observed in one individual, beef ultralente provided relatively stable plasma insulin concentrations in the group as a whole. Beef ultralente appears to be a reasonable insulin preparation to use as the basal component in an intensive insulin therapy program.
secondary Failure to Treatment with Oral Antidiabetic Agents in Non-insulin-dependent Diabetes
Authors: Groop Leif C , Pelkonen Risto , Koskimies Saija , Bottazzo Gian F , Doniach Deborah
Published: March 2007

To study the etiopathogenesis of secondary drug failure to treatment with oral antidiabetic agents in patients with non-insulin-dependent diabetes (NIDD) we compared 60 “nonresponders” with 60 “responders” to treatment with oral drugs. Secondary drug failure was defined as mean diurnal blood glucose >12 mmol/L after an initial good response of ≥2 yr. The nonresponders were characterized by 50% lower C-peptide concentrations than the responders (P < 0.001). We could not, however, define a critical C-peptide level to discriminate between patients requiring and not requiring insulin therapy. There was a wide overlap of individual C-peptide values between responders and nonresponders that attenuates the clinical value of single C-peptide measurements in predicting therapy. Only by serial measurements over a period of time was it possible to achieve information about changes in beta cell function. The nonresponders showed increased frequency of islet cell (P < 0.01), thyroid antimicrosomal (P < 0.01), and gastric parietal cell antibodies (P < 0.02). In nonresponders, HLA-antigen B8 was increased (P < 0.05) and HLA-B7 decreased (P < 0.01) compared with frequencies of responders. In conclusion, impaired beta cell function is a characteristic feature of many, but not all, NIDD patients who fail on treatment with oral antidiabetic drugs. The presence of islet cell and thyrogastric antibodies can unmask a distinct group of NIDD patients with a high risk of secondary drug failure and subsequent insulin dependency. HLA typing may further help to predict secondary failure in NIDD.
Vitreous Fluorophotometry in Patients with No or Minimal Diabetic Retinopathy
Authors: Chahal Pritpal , Fallon Timothy J , Jennings Stephen J , Chowienczyk Philip J , Kohner Eva M
Published: March 2007

Vitreous fluorophotometry was used to estimate fluorescein leakage into the posterior vitreous of 20 insulin-dependent diabetic patients with no or minimal diabetic retinopathy 60 min after intravenous administration of 14 mg · kg−1 fluorescein. The permeability coefficient (p), a measure of fluorescein penetration through the blood-retinal barrier (BRB) into the vitreous, and the diffusion coefficient (D), a measure of fluorescein dispersion within the vitreous, were obtained by fitting a mathematical model to the vitreous fluorescence scan and plasma free fluorescence curve. A permeability index (PI) was also derived by dividing the area under the fluorescence scan by the area under the plasma free fluorescence time curve. The fluorescence concentrations at discrete distances from the retina were also noted. The mean ± SD for p, D, and PI were 1.95 ± 1.03 cm · s−1 × 10−7, 1.74 ± 1.53 cm2 · s−1 × 10−5, and 2.14 ± 1.21 cm · s−l ± 10−7, respectively, and were not significantly different from values determined in normal subjects. Diabetic patients and normal subjects also had similar fluorescence measurements at corresponding distances from the retina. Quantitative indices of fluorescein leakage did not correlate with either the microaneurysm counts on fluorescein angiograms or the duration of diabetes. Vitreous fluorophotometry did not detect any abnormality of the BRB in diabetic patients with no or minimal retinopathy on fluorescein angiography.
Supportive and Nonsupportive Family Behaviors: Relationships to Adherence and Metabolic Control in Persons with Type I Diabetes
Authors: Schafer Lorraine C , McCaul Kevin D , Glasgow Russell E
Published: March 2007

The Diabetes Family Behavior Checklist (DFBC) was administered to 54 adults and 18 adolescents (<19 yr of age) with insulin-dependent diabetes mellitus (IDDM). Subjects and family members completed parallel forms of the DFBC at initial and 6-mo follow-up home interviews. During each of these periods, adherence was assessed via self-report, 1 wk of self-monitoring, and 24-h dietary recalls. The results showed reliable differences between adolescents and adults. More negative interactions with family members were reported by adolescents and their family members, and adolescents were in poorer metabolic control. For adults but not adolescents, negative DFBC scores were prospectively predictive of poorer regimen adherence over the 6-mo interval for measures of glucose testing, insulin injection, and dietary adherence. In addition, higher negative DFBC scores for adults were marginally associated with higher HbA1 levels (P < 0.10). We conclude that the DFBC is a promising measure of family interaction related specifically to the IDDM regimen and that, for adults, higher levels of nonsupportive family behaviors may be related to reduced regimen adherence and poor control.
Effect of Composition of Mixed Meals—Low-Versus High-Carbohydrate Content—on Insulin, Glucagon, and Somatostatin Release in Healthy Humans and in Patients With NIDDM
Authors: Gutniak Mark , Grill V , Efendlć S
Published: March 2007

Effects of a low-carbohydrate high-fat meal (LCM) versus a high-carbohydrate low-fat meal (HCM) on insulin, glucagon, and somatostatin release in nonobese healthy volunteers and in subjects with mild non-insulin-dependent diabetes mellitus (NIDDM) were compared. The meals were isocaloric. In the LCM, 26% of energy was supplied by carbohydrate, 51% by fat, and 23% by protein, whereas corresponding figures for HCM were 62, 22, and 16%. Hormonal responses were expressed as incremental areas over baseline. In healthy volunteers the HCM had a significantly greater effect on the insulin response than did the LCM. In contrast, in the diabetic group the insulin response to HCM was markedly impaired and was of the same magnitude as that to LCM. Glucagon release was significantly augmented after LCM in the nondiabetic as well as in the diabetic group, despite a pronounced and concomitant hyperglycemia in the latter. Moreover, HCM tended to stimulate glucagon release but only in the diabetic subjects. LCM and HCM induced a significant and sustained elevation of somatostatin levels in both groups; these responses were not significantly influenced by glucose tolerance or composition of meal. In conclusion, the present study suggests that at least two islet dysfunctions—decreased insulin response and enhanced glucagon release—characterize mild NIDDM. With a high-carbohydrate meal, a severe impairment of insulin secretion and a slight pardoxical glucagon release are observed. With a low-carbohydrate fat-rich meal, (β-cell responsiveness seems to be intact, but α-cellsecretion is enhanced.
Development of New Jet Injector for Insulin Therapy
Authors: Lindmayer Istvan , Menassa Karim , Lambert Jean , Moghrabi Albert , Legendre Lise , Legault Claudine , Letendre Michel , Halle Jean-Pierre
Published: March 2007

To improve diabetic patients' compliance to multiple injection protocols, we developed and tested a new insulin jet injector, the Preci-Jet 50. The prototype has the following features: small size (14 × 2 cm) and weight (160 g), capability of mixing two types of insulin, accuracy and reliability of the ejected volume (dose), ease of use and sterilization, simplicity of design, and capacity of adjusting jet pressure to individual skin resistance. The ejected volume, evaluated by gravimetry, was more accurate and more reliable with the injectors (N = 18) than with 0.5-cc disposable plastic syringes (N = 18). The dead space of the injectors (N = 16), as evaluated by isotopic recuperation of radioactive insulin, was minimal, allowing mixed insulin injections. The human-device interface evaluation demonstrated that diabetic patients (N = 13) learned easily to manipulate the injector and that their ability to use it properly improved after 1 mo of use. We conclude that this injector may be a practical tool for insulindependent diabetic patients.
Risk Factors for Diabetic Retinopathy: A Population-Based Study in Rochester, Minnesota
Authors: Ballard D J , Melton L J , Dwyer M S , Trautmann J C , Chu C-P , O'Fallon W M , Palumbo P J
Published: March 2007

Retinopathy is an important sequela of diabetes mellitus, but clinical risk factors for this condition have rarely been assessed in a geographically defined population. In this population-based study, the 1135 Rochester, Minnesota, residents with diabetes mellitus initially diagnosed between 1945 and 1969 (incidence cohort) were followed through their complete medical records in the community to January 1, 1982. Because most of the cases of diabetic retinopathy in Rochester residents developed in patients with non-insulin-dependent diabetes mellitus (NIDDM), risk factors for diabetic retinopathy were examined in this group (N = 1031). A proportional hazards model identified the following risk factors for diabetic retinopathy in NIDDM: elevated initial fasting blood glucose level, marked obesity, and earlier age at onset of diabetes. Stratified analyses indicated that duration of diabetes was also significantly associated with an increased risk of retinopathy. Two secular trends, increasing detection of “mild” NIDDM and decreasing risk of diabetic retinopathy, had a major effect on retinopathy risk assessment. These data also suggest that insulin therapy is not an independent risk factor for diabetic retinopathy.
Incidence, Prevalence, and Mortality of Diabetes Mellitus in Wadena, Marshall, and Grand Rapids, Minnesota: The Three-City Study
Authors: Bender A P , Sprafka J M , Jagger H G , Muckala K H , Martin C P , Edwards T R
Published: March 2007

The Minnesota Department of Health (MDH) in concert with the Centers for Disease Control (CDC) conducted population-based studies of diabetes mellitus in three Minnesota communities. The use of hospital and clinic records alone for case ascertainment purposes would have missed 16% of studyeligible diabetic individuals. Thus, studies that use only hospital or clinic records may present a biased view of the natural history of diabetes. Physician-defined diabetes without additional diagnostic review yielded a prevalence of 1.6% (age standardized to the 1970 US Caucasian population). Diabetes incidence was 117 per 100,000 (age standardized to the same population). These results compare well with those of a Mayo Clinic population-based study in Rochester, Minnesota, and indicate the utility of physiciandefined diabetes as an epidemiologic case definition. Despite differences in population size and structure as well as different medical care systems, diabetes incidence, prevalence, and mortality in these communities was remarkably similar.
Prognostic Significance of Birth of Large Infant for Subsequent Development of Maternal Non-Insuln-Dependent Diabetes Mellitus: A Prospective Study Over 20–27 Years
Authors: Larsson G , Spjuth J , Ranstam J , Vikbladh I , Saxtrup O , Åstedt B
Published: March 2007

In a prospective study, 270 women who gave birth to infants weighing ≥4500 g (large baby, LB) underwent an oral glucose tolerance test (OGTT) within the first week of the puerperium. Of these women, 179 (66.3%) were retested 3–10 yr later, and 236 (87.4%) were also evaluated 20–27 yr later. The frequency of pathologic OGTTs increased with time, but the tests were of little prognostic significance for the individual patient. Women who had borne LBs developed non-insulin-dependent diabetes mellitus (NIDDM) six times more often than did a control group of women matched for age and parity and with the same period of follow-up. However, patients who developed NIDDM were also very obese, of high parity, and had a positive family history for diabetes mellitus in a high percentage of cases. Women with LBs as the only risk factor did not develop NIDDM in our study. We conclude that the birth of one LB is of minor, if any, importance in the subsequent development of NIDDM.
Decreased Exercise Heart Rate and Blood Pressure Response in Diabetic Subjects With Cardiac Autonomic Neuropathy
Authors: Kahn Joel K , Zola Benjamin , Juni Jack E , Vinik Aaron I
Published: March 2007

Abnormal hemodynamic responses to exercise have been observed in diabetic subjects, but the pathogenesis and significance remain uncertain. We used maximal treadmill exercise to study 32 subjects with long-term insulin-dependent diabetes without clinical evidence of cardiac disease. Two of the 32 had occult ischemic heart disease revealed by stress electrocardiography and myocardial-perfusion scintigraphy and were excluded from subsequent analysis. In the remaining 30 subjects, we compared the responses to exercise of the 17 subjects with cardiac autonomic neuropathy diagnosed by noninvasive maneuvers (group 1) with the 13 without (group 2). At rest, the pressure-rate product (PRP) was higher in group 1 (114.0 ± 5.7 vs. 95.9 ± 5.3, P < .05). With maximal exercise the increase in heart rate ('44.6 ± 4.8 vs. 79.0 ± 5.4 beats/min, P < .001), systolic blood pressure (36.8 ± 5.9 vs. 55.0 ± 5.8 mmHg, P = .02), and the PRP (102.0 ± 7.3 vs. 182.0 ± 8.2, P < .001) were all lower in group 1 than in group 2, despite similar total treadmill times (631 ± 47 vs. 587 ± 40 s, P > .1). At each stage of exercise, the increase in heart rate and systolic blood pressure was lower in group 1 patients. The severity of cardiac autonomic neuropathy correlated inversely with the maximal increase in heart rate(γ = – .68, P < .001) and the PRP (γ = − .58, P < .005). Age, duration of diabetes, and the presence and severity of microvascular disease did not correlate with any of the hemodynamic parameters. Thus, cardiac autonomic neuropathy is associated with an impairment of the hemodynamic responses to exercise in diabetic subjects without ischemic heart disease.
Wolfram Syndrome: Report of Four New Cases and a Review of Literature
Authors: Fishman L , Ehrlich R M
Published: March 2007

The Wolfram, or DIDMOAD, syndrome consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness. Diabetes mellitus usually occurs as the first manifestation of this syndrome, followed by the development of optic atrophy, neurosensory hearing loss, and finally diabetes insipidus. We report on four cases with a review of the literature. The diabetes mellitus occurring in these patients is clinically indistinguishable rom classic type I diabetes mellitus. Two of three patients continue to have measurable C-peptide secretion 8 yr after onset of diabetes. Two of three patients with Wolfram syndrome had the HLA-DR2 antigen. Combining our cases with those described in the literature, 7 of 11 patients have the HLA-DR2 antigen. The preponderance of the HLA-DR2 antigen in the Wolfram syndrome is different from classic type I diabetes. This is further evidence of the genetic heterogeneity of diabetes mellitus. Although the Wolfram syndrome is rare, it should be considered in diabetic patients with unexplained optic atrophy and hearing loss or with polyuria and polydipsia in the presence of adequate blood sugar control.
Risk of Proliferative Diabetic Retinopathy in Juvenile-Onset Type I Diabetes: A 40-yr Follow-up Study
Authors: Krolewski A S , Warram J H , Rand L I , Christlieb A R , Busick E J , Kahn C R
Published: March 2007

The development of proliferative diabetic retinopathy was studied in three cohorts consisting of 292 patients with recent juvenile-onset, type I (insulin-dependent) diabetes who were followed 20–40 yr beginning in 1939, 1949, and 1959. The risk of this severe eye complication was almost nonexistent during the first 10 yr of diabetes, rose abruptly to its maximum level (∼30/1000 person-years), and remained at that level for the next 25 yr. This pattern did not vary with sex, age at onset of diabetes, or level of glycemic control during the first 5 yr of diabetes. However, the risk of proliferative retinopathy was strongly related to the level of glycemic control during the several years preceding onset of this complication. This was a dose-dependent relationship, with patients in the highest quartile of the distribution of the index of frequency of hyperglycemia having a 10-fold higher risk than individuals in the lowest quartile. A virtually identical pattern was observed in patients who developed diabetes in 1959 as was observed in those who developed diabetes in 1949 or 1939. In contrast, diabetic nephropathy as evidenced by persistent proteinuria showed a lower incidence in the 1959 than in the 1939 cohort. In conclusion, these incidence data do not support the notion that the risk of proliferative retinopathy is mainly a function of duration of diabetes. Instead, the pattern of occurrence of this severe eye complication in type I diabetes suggests that the process leading to the development of proliferative retinopathy consists of two or more stages and that progression through each stage may be governed by different factors.
Children's Self-Reports of Psychologic Adjustment and Coping Strategies During First Year of Insulin-Dependent Diabetes Mellitus
Authors: Kovacs M , Brent D , Steinberg T F , Paulauskas S , Reid J
Published: March 2007

Psychologic adjustment, assessed by self-ratings of anxiety, self-esteem, and depression, and cognitive as well as behavioral coping strategies, elicited by interview, were monitored longitudinally among school-age children with recent-onset insulin-dependent diabetes mellitus (IDDM). Our article documents the findings over the 1st yr of the illness. From the start, the children viewed themselves as self-confident and emotionally comfortable. The diagnosis of IDDM created minimal emotional upheaval (which faded within 6 mo), despite this cohort's consistent report that the diet, insulin injections, and urine tests were difficult. The most prevalent cognitive strategies for coping with IDDM included wishful thinking, thoughts of forbidden foods, and resentful thoughts. Behavioral coping strategies, including information seeking, were evident from the beginning. The frequency of socially oriented coping behaviors (e.g., showing IDDM management to peers) indicated that the young patients actively tried to adapt to the illness and were more comfortable with aspects of home care than previously thought. Selfrated psychologic adjustment, psychiatric diagnosis, and illness-related coping behaviors were unrelated to one another; psychologic variables were similarly unrelated to the use of socially oriented coping strategies. Therefore, in juvenile cohorts, the presumed association between psychologic status and coping behaviors requires further examination.