bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Structured Treatment and Teaching Program for Non-Insulin-Treated Type II Diabetic Outpatients in Germany After the Nationwide Introduction of Reimbursement Policy for Physicians
Authors: Gruesser Monika , Bott Uwe , Ellermann Petra , Kronsbein Petra , Joergens Viktor
Published: March 2007

Objective— To evaluate the practicability and efficacy of a structured treatment and teaching program for non-insulin-treated type II diabetic patients in routine primary health care.

Research Design and Methods— All physicians (n = 139) and their office staffs in Hamburg, Germany, who had participated in a special training course from 1 April 1991 to 31 December 1991 were contacted for a standardized interview. A random sample of 17 of these offices was selected for office visits during which the documented data of all patients who had received the standardized treatment and teaching in the same period were collected and evaluated.

Results— The program was well received by the physicians, and the data collected on 179 patients (5.1 mo median after the intervention) demonstrated the efficacy of the program at the treatment level: reduction of body weight (mean 2.8 kg, P < 0.0001) and HbA1c levels (from 8.11 ± 1.68 to 7.47 ± 1.64%, P < 0.0001) was substantial. The individual prescribed volume of oral antidiabetic agents was ∼50% lower after patient attendance of the program (significant decrease from 1.41 ± 1.42 to 0.76 ± 1.11 tablets/patient/day, P < 0.0001). The proportion of patients treated with oral antidiabetic drugs decreased from 63 to 42% (P < 0.0001).

Conclusions— Subsequent to the introduction of nationwide remuneration of outpatient education for type II diabetic patients by office-based physicians, a relevant improvement was observed in the quality of care, comparable with the effects of the program in a previous prospective controlled trial.
Postural Instability in Patients with Diabetic Sensory Neuropathy
Authors: Simoneau Guy G , Ulbrecht Jan S , Derr Janice A , Becker Mary B , Cavanagh Peter R
Published: March 2007

OBJECTIVE

Recent survey evidence suggests that sensory ataxia due to diabetic neuropathy may be a more frequent and serious problem than is commonly recognized. This view is further supported by research that confirms the major contribution of the somatosensory system to the control of posture. We therefore sought to determine the effects of significant diabetic distal symmetrical polyneuropathy on the control of posture.

RESEARCH DESIGN AND METHODS

Fifty-one subjects, divided into three groups, participated in this study. Seventeen had diabetes and significant sensory neuropathy, 17 had diabetes and no neuropathy, and 17 had neither diabetes nor neuropathy. The subjects were matched across groups, and stringent exclusion criteria were applied. Postural stability during quiet standing was measured using a force platform. In addition to electrophysiological and quantitative sensory tests of neuropathy, a number of physical and functional characteristics were measured for all subjects.

RESULTS

Postural instability was found to be significantly associated with sensory neuropathy, but not with diabetes per se. Patients with sensory neuropathy demonstrated between 66 and 117% more instability than did control subjects (depending on the testing condition). Based on multiple linear regression analyses, the most significant correlates of instability were the quantitative sensory measures of neuropathy and age.

CONCLUSIONS

The loss of sensory perception secondary to diabetic distal symmetrical sensory neuropathy has a markedly detrimental effect on postural stability. The deficit is greatest when visual or vestibular cues are absent or degraded. Patients with neuropathy need to be informed of the postural consequences of this condition to limit the potential morbidity caused by falls.
The Incidence of IDDM in Seoul From 1985 to 1988
Authors: Ko Kwang W , Yang Sei W , Cho Nam H
Published: March 2007

OBJECTIVE

To determine insulin-dependent diabetes mellitus (IDDM) incidence rates for the first time in Seoul, Korea, from 1985 to 1988.

RESEARCH DESIGN AND METHODS

A mail survey was conducted among all hospitals, a total of 136, with > 80 beds in the Seoul area. Of these, (15.4%) hospitals reported patients with newly diagnosed IDDM.

RESULTS

The average incidence rate of IDDM from 1985 to 1988 was 0.70/100,000 (95% confidence interval [CI]: 0.55–0.89). When stratified by gender, the average incidence rate in boys was 0.58/100,000 (95% CI: 0.42–0.9), and in girls it was 0.78/100,000 (95% CI: 0.56–1.07). The age at onset was similar to that reported in other countries, i.e., more than 50% of the cases were diagnosed between the ages of 10 and 14. The incidence of IDDM increased in parallel with the age-group (0–4 < 5–9 < 10–14 years). Onset seasonality was also similar to that in other reported countries with the most cases occurring during the winter months and the least number of cases during the summer months.

CONCLUSIONS

The incidence rate of IDDM in Seoul is the lowest reported in the world. This might be effectively considered a baseline incidence rate before exposure to environment or other risk factors. The similar pattern of onset characteristics in Korea to those in other countries suggests that the same etiological factors are operative.
Autonomic Neuropathy Influences Great Toe Blood Pressure
Authors: Uccioli Luigi , Monticone Giovanna , Durola Laura , Russo Francesco , Mormile Flaminio , Mennuni Gioacchino , Menzinger Guido
Published: March 2007

OBJECTIVE

To assess the influence of autonomic neuropathy on toe blood pressure (TBP), a parameter used currently as an ischemic index.

RESEARCH DESIGN AND METHODS

The age-matched study subjects included 20 non-insulin-dependent diabetes mellitus (NIDDM) patients with autonomic neuropathy (DN) and 10 NIDDM patients without autonomic neuropathy (D), assessedby standard cardiovascular tests and galvanic skin response, and 8 control subjects (C). None of the subjects had peripheral vascular disease (PVD) (ankle/brachial index 0.9–1.1.

RESULTS

The TBP and toe/brachial index (TBI) were significantly lower in DN than in C and D (P < 0.01). The saturation index (SI), the ratiobetween foot venous and arterial partial pressure of oxygen (PO2), was significantly higher in DN than in C and D (P < 0.05). An inverse relationship was found between TBI and SI (r = 0.554, P = 0.001).

CONCLUSIONS

The autonomic nervous system directly influences peripheral circulation. In diabetic patients without PVD, a failure of sympathetic fibers caused by autonomic neuropathy could lead to a reduction of TBP. Therefore, TBP cannot be used as an ischemic index in diabetic patients.
Increasing Prevalence of NIDDM in the Pacific Island Population of Western Samoa Over a 13-Year Period
Authors: Collins Veronica R , Dowse Gary K , Toelupe Palanitina M , Imo Tofaeono T , Aloaina Faalii L , Spark Raymond A , Zimmet Paul Z
Published: March 2007

OBJECTIVE

A survey of noncommunicable diseases (NCD) in the Pacific island population of Western Samoa in 1978 (n = 1,206) documented a relatively high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) and obesity. A follow- up survey was performed in 1991 (n = 1,776) to assess changes in NCD prevalence and risk factor distribution over 13 years.

RESEARCH DESIGN AND METHODS

In both surveys, the same representative villages from one urban and two rural areas were studied, and the survey procedure included an oral glucose tolerance test, anthropometric and blood pressure measurements, and physical activity assessment (1991 only).

RESULTS

The age-standardized prevalence of NIDDM in 1991 was 9.5 and 13.4% in Apia (urban) for men and women, respectively. In Poutasi (rural), 5.3% of men and 5.6% of women had NIDDM, and in Tuasivi (rural) the prevalence was 7.0 and 7.5% for men and women, respectively. Age, body mass index (BMI), waist-to-hip circumference ratio, physical inactivity, and family history of diabetes all showed independent association with NIDDM and impaired glucose tolerance. Living in Apia (compared with Poutasi) was also associated with NIDDM. Between 1978 and 1991, the age-standardized prevalence of NIDDM in Apia increased from 8.1 to 9.5% in men and 8.2 to 13.4% in women. In Poutasi, a dramatic increase occurred in prevalence from 0.1 to 5.3% in men, but little change in women was noted (5.4 to 5.6%). In Tuasivi, the increases were 2.3 to 7.0% in men and 4.4 to 7.5% in women. In combined survey areas, increases were observed in the agestandardized prevalence of obesity and mean levels of total cholesterol, fasting triglycerides, and uric acid between surveys as well as a reduction in the prevalence of smoking.

CONCLUSIONS

This is the first study using standardized methods to show a dramatic increase in the prevalence of NIDDM in a developing Pacific island population, and it indicates the importance of maintaining and expanding preventive programs for NIDDM and related lifestyle diseases in these populations.
Incidence of IDDM in the Marche Region, Italy
Authors: Cherubini Valentino , Cantarini Maurizio , Ravaglia Elsa , Bartolotta Edoardo
Published: March 2007

OBJECTIVE

To provide reliable data concerning the incidence of insulindependent diabetes mellitus (IDDM) in children from the Marche Region in Italy and contribute to a better understanding of its geographical variability throughout Italy and Europe.

RESEARCH DESIGN AND METHODS

All newly diagnosed cases of IDDM in children 0–14 years of age in the Marche Region between 1 January 1990 and 31 December 1992 were recorded. The primary source of ascertainment was clinical records from the 59 hospitals of the region. Secondary and tertiary independent sources included local and national associations for diabetic children and local district centers of the National Health System.

RESULTS

Over the 3-year study period, the overall IDDM incidence rate was 8.1 per 100,000/year. No significant sex-related difference in incidence was noted, with a male:female ratio of 0.9. The completeness of ascertainment was estimated at 100%.

CONCLUSIONS

The Marche Region appears to have a slightly elevated incidence of IDDM among noninsular Italian regions.
A Cost-Benefit Comparison of Intensive Diabetes Management With Implantable Pumps Versus Multiple Subcutaneous Injections in Patients With Type I Diabetes
Authors: Haardt Marie-Joelle , Selam Jean-Louis , Slama Gerard , Bethoux Jean-Pierre , Dorange Catherine , Mace Brigitte , Ramaniche Marie-Lou , Bruzzo Françoise
Published: March 2007

OBJECTIVE

To investigate if intraperitoneal (IP) insulin infusion via programmable implantable pumps is a potential alternative to subcutaneous (SC) insulin via multiple injections.

RESEARCH DESIGN AND METHODS

We compared the cost-benefits of the two methods using a randomized, prospective, 6-month, crossover design in 10 adult type I diabetic patients.

RESULTS

When judged on the last month of IP versus SC periods in the nine patients who completed the study, metabolic data showed better glycemie control (HbA1c: 7.2 ± 0.2 IP vs. 8.5 ± 0.7% SC, mean ± SE, P = 0.02), reduced glycemie fluctuations (SD of capillary glucose values: 3.4 ± 0.2 IP vs. 4.6 ± 0.2 mM SC, P > 0.01), and fewer mild hypoglycemie events (5.7±2.0 IP vs. 10.0 ± 3.1 events/month SC, P = 0.02). Quality of life, judged by Diabetes Control and Complications Trial questionnaires, was unaffected by pump therapy. Direct costs, including pump acquisition, implantation, and follow-up, were 2.6-fold higher with IP than with SC delivery.

CONCLUSIONS

The implantable pump is more effective in the short term, equally accepted, but more costly than multiple injections and should be limited to patients with unsatisfactory glycemie control despite intensive diabetes management with SC insulin. In addition, longer-term, larger-scale, and comparative evaluation is required.
Subcutaneous Injection of the Incretin Hormone Glucagon-Like Peptide 1 Abolishes Postprandial Glycemia in NIDDM
Authors: Gutniak Mark K , Linde Birgitta , Holst Jens J , Efendić Suad
Published: March 2007

OBJECTIVE

To investigate the effect of subcutaneously injected glucagon-like peptide 1 (GLP-1) (7–36)amide on postprandial plasma glucose, insulin, and C-peptide levels in patients with non-insulin-dependent diabetes mellitus (NIDDM) and a secondary failure to sulfonylureas.

RESEARCH DESIGN AND METHODS

GLP-1 (25 nmol) was injected subcutaneously into either the abdominal wall or the gluteal region at a standardized depth and speed. The injection device was guided by the ultrasound determination of the depth of the fat layer. The peptide was given 5 min before a standard meal. Plasma concentrations of glucose, C-peptide, insulin, glucagon, and GLP-1 were followed during 240 min after the injection.

RESULTS

In control experiments, a significant hyperglycemia was attained after the meal. GLP-1 given into the abdominal wall not only virtually abolished the postprandial blood glucose rise but significantly decreased glucose concentrations, with a nadir at ∼25 min after the injection. A rapid rise of C-peptide and insulin levels was observed 10-15 min after the injection of GLP-1. The stimulatory effect of GLP-1 was transient, and, at 45 min after the meal, both insulin and C-peptide levels were almost identical in GLP-1 and control experiments. Significantly lower glucagon concentrations were observed 35-65 min after the peptide injection. GLP-1 concentration in plasma increased from 10 pM to a peak concentration (Cmax) of 70 pM at Tmax 30 min after injection. Then GLP-1 levels rapidly decreased to 25 pM at 95 min and returned to basal at 215 min. The gluteal injection of GLP-1 had similar effects compared with the abdominal administration on plasma levels of glucose, insulin, C-peptide, and glucagon.

CONCLUSIONS

GLP-1 is promptly absorbed from the subcutaneous tissue. It exerts a significant blood glucose lowering effect when administered before meals in overweight patients with NIDDM.
Independent Correlation Between Plasma Lipoprotein(a) and Angiographie Coronary Artery Disease in NIDDM
Authors: Watts Gerald F , Gwilym Rhiannon M Ap , Mazurkiewicz Janina , Coltart John
Published: March 2007

OBJECTIVE

To examine the correlation between angiographie coronary artery disease (CAD) and plasma lipoprotein(a) [Lp(a)] concentration in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

In this cross-sectional study of 36 patients with NIDDM who underwent coronary angiography, CAD was assessed visually using a coronary artery score (CAS), and plasma Lp(a) was measured immunotur-bidimetrically.

RESULTS

Lp(a) concentration was significantly higher in patients in the middle and upper tenues of CASs (>4) compared with those in the lower tenue (≤4); geometric mean 0.30 g/l(95% confidence interval [CI] 0.22–0.40) vs. 0.12 g/l (0.08–0.17, P = 0.002). Lp(a) was significantly and positively correlated with the CAS (R2 23%, P = 0.006), independent of other cardiovascular risk factors, including lipoprotein related variables and glycated hemoglobin.

CONCLUSIONS

Plasma Lp(a) is a strong and independent correlate of the extent of angiographie CAD in symptomatic patients with NIDDM.
Relationship Between Habitual Physical Activity and Insulin Area Among Individuals With Impaired Glucose Tolerance: The San Luis Valley Diabetes Study
Authors: Regensteiner Judith G , Shetterly Susan M , Mayer Elizabeth J , Eckel Robert H , Haskell William L , Baxter Judith , Hamman Richard F
Published: March 2007

OBJECTIVE

To determine whether higher levels of physical activity are associated with lower fasting insulin levels and lower insulin areas under the oral glucose tolerance curve in individuals with impaired glucose tolerance (IGT) in a community setting.

RESEARCH DESIGN AND METHODS

Data from a cross-sectional study of a population consisting of 219 Hispanic and non-Hispanic white men and women with IGT (by World Health Organization criteria) in two rural Colorado counties were analyzed. Total physical activity was assessed by a 7-day physical activity recall, from which metabolic equivalents (METs) were estimated (expressed as MET h/week). Relationships of MET h/week with fasting insulin levels and insulin areas were assessed while considering obesity, age, and other risk factors known to influence fasting insulin level and insulin area.

RESULTS

Among all subjects, univariate analyses showed that higher physical activity levels were associated with lower mean insulin areas and fasting insulin levels (both P ≤ 0.05). Multiple linear regression showed that higher levels of physical activity were significantly associated with lower values of of the insulin area (P < 0.001) but not with fasting insulin levels. The relationship between insulin area and habitual physical activity was independent of obesity, fat distribution, and age.

CONCLUSIONS

On the basis of cross-sectional data, we conclude that higher levels of habitual physical activity are associated with lower insulin areas in a population of individuals with IGT. Understanding the impact of physical activity on markers of insulin action in individuals with IGT is important because of the greatly enhanced risk of non-insulin-dependent diabetes mellitus and, hence, cardiovascular disease in this population.
A Longitudinal Study of Plasma Insulin and Glucagon in Women With Previous Gestational Diabetes
Authors: Damm Peter , Kühl Claus , Hornnes Peter , Mølsted-Pedersen Lars
Published: March 2007

OBJECTIVE

To investigate whether plasma insulin or glucagon predicts later development of diabetes in women with gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

The subjects studied were 91 women with diet-treated GDM and 33 healthy women. Plasma insulin and glucagon during a 50-g oral glucose tolerance test (OGTT) were measured during pregnancy, postpartum, and at follow-up 5-11 years later. At follow-up, the women were also examined with a 75-g OGTT or an intravenous glucagon test.

RESULTS

Twenty-seven (30%) of the women with previous GDM had abnormal glucose tolerance at follow-up (2 had insulin-dependent diabetes mellitus, 13 had non-insulin-dependent diabetes mellitus, and 12 had impaired glucose tolerance). Compared with the control subjects, women with previous GDM had relatively impaired insulin secretion (decreased insulinogenic index and delayed peak insulin response) at all time points investigated; this was also found when only nonobese glucose-tolerant women were examined. Low insulin secretion during pregnancy together with a high fasting plasma glucose level at the diagnostic OGTT in pregnancy and hyperglycemia during the postpartum OGTT were predictive for subsequent development of overt diabetes (logistic regression analysis).

CONCLUSIONS

Women who develop GDM have a relative insulin secretion deficiency, the severity of which is predictive for later development of diabetes. Furthermore, our data indicate that their relatively reduced β-cell function may be a significant pathogenic factor in relation to the high incidence of subsequent diabetes in women with GDM. This could be important in the design of follow-up programs for women with previous GDM.
Physician and Patient Prevention Practices in NIDDM in a Large Urban Managed-Care Organization
Authors: Martin Toni L , Selby Joe V , Zhang Danya
Published: March 2007

OBJECTIVE

To examine physician and patient adherence to prevention guidelines in non-insulin-dependent diabetes mellitus (NIDDM) with attention to possible differences in adherence by patient race or ethnicity.

RESEARCH DESIGN AND METHODS

We performed a cross-sectional chart review study of prevention practices, complications, and risk factors in 378 NIDDM patients (at least 5 years known duration) who were Permanente Medical Care Program, Oakland, CA. There were 232 blacks, 81 whites, 29 Hispanics, and 36 members of other races/ethnicities.

RESULTS

Age- and duration-adjusted prevalence of 14 complications was low and, with the exception of diabetic retinopathy, did not differ significantly by race. An eight-point prevention score that reflected recommended use of glucose, HbA1c, high-density lipoprotein/total cholesterol, blood pressure and proteinuria testing, ophthalmology a and foot examinations, and diabetes education during a 2-year period did not differ by race/ethnicity (P = 0.36). The mean score (4.9 ± 1.6) indicated that on average, five of eight guidelines were performed appropriately. Compliance was poorest for annual proteinuria checks (32.2%). No differences were noted by race/ethnicity in referrals to ophthalmology, weight reduction, or smoking cessation or in missed appointments or failure to keep referral visits.

CONCLUSIONS

The absence of racial differences in either prevention practices or complication rates in this insured prepaid setting suggests that improved access to preventive services may be effective in reducing such differences nationally. However, adherence to several guidelines was ≤ 50%, indicating that physicians are not sufficiently convinced of the necessity for these prevention measures.
Effects of Alprazolam on Glucose Regulation in Diabetes: Results of double-blind, placebo-controlled trial
Authors: Lustman Patrick J , Griffith Linda S , Clouse Ray E , Freedland Kenneth E , Eisen Seth A , Rubin Eugene H , Carney Robert M , McGill Janet B
Published: March 2007

OBJECTIVE

To determine the effects of alprazolam on glucose regulation in anxious and nonanxious patients with poor glycemic control and establish whether regulatory benefits are related to anxiolytic effects of the medication.

RESEARCH DESIGN AND METHODS

Fifty-eight patients with poor glycemic control, 16 (27.6%) of whom had a symptomatic generalized anxiety disorder, were entered into a randomized, double-blind, placebo-controlled, 8-week trial using alprazolam (up to 2 mg/day) as the active agent. Generalized anxiety disorder was determined in accordance with Diagnostic and Statistical Manual of Mental Disorders criteria, and anxiety symptoms were measured using the Hopkins Symptom Checklist. Glycated hemoglobin levels were used to determine glucose regulation. Compliance behavior was assessed using glucometers and medication monitors equipped with electronic memory.

RESULTS

A statistically significant reduction in glycated hemoglobin level was observed in patients treated with alprazolam compared with those receiving placebo (−1.1 vs. −0.3%, P = 0.04). This treatment effect was not a function of differences in compliance behaviors. Anxiety symptoms decreased in both alprazolam- and placebo-treated patients with generalized anxiety disorder, but reduction in glycated hemoglobin level was not dependent on alleviation of anxiety.

CONCLUSIONS

A short course of alprazolam improved glucose regulation in patients with a history of poor diabetes control. This effect was not directly related to concomitant changes in anxiety. Alprazolam treatment of anxious patients with poorly controlled diabetes may result in decreased anxiety and improved glucose regulation through independent mechanisms.
Reproducibility of the First-Phase Insulin Response to Intravenous Glucose Is Not Improved by Retrograde Cannulation and Arterialization or the Use of a Lower Glucose Dose
Authors: McNair Peter D , Colman Peter G , Alford Frank P , Harrison Leonard C
Published: March 2007

OBJECTIVE

To determine whether the reproducibility of the first-phase insulin response (FPIR) measured during an intravenous glucose tolerance test is improved by the use of a lower glucose dose or retrograde sampling from an arterialized hand vein.

RESEARCH DESIGN AND METHODS

Previous studies have suggested that the high within-subject variation of FPIR measurement of up to 110% could be reduced by sampling from a retrograde cannulated and arterialized hand vein opposite to the cubital fossa vein through which the glucose was injected or by the use of a lower dose of glucose. Two low-dose (glucose, 5 g/m2 injected over 30 s) and two standard Islet Cell Antibody Registry Users Study (ICARUS) (glucose, 0.5 g/kg injected over 3 min) tests were performed on seven normal subjects at 2-week intervals. Samples were collected simultaneously from the cubital fossa vein, through which the glucose was injected, and from a retrograde cannulated, contralateral hand vein that was arterialized by heating. FPIR was expressed as the sum of the insulin measurements 1 and 3 min after the completion of the glucose injection and as the area under the insulin curve between 0 and 10 min.

RESULTS

Responses to the mean sum of serum insulin concentrations at 1 and 3 min after intravenous glucose were significantly lower for the low-dose test (mean 94 mU/l) than for the high-dose test (mean 184 mU/l) for samples taken from the arm (P < 0.05); mean 0- to 10-min insulin areas were 367 and 596 mU/l for low- and high-dose tests, respectively (P < 0.05). Within-subject coefficients of variation for samples from the hand or the arm ranged from 0.33 to 17.5% and 1.3 to 38% for successive ICARUS and low-dose tests, respectively. Reproducibility, measured by the coefficient of variation between successive tests for each protocol, was not significantly different using samples taken from the arm or the contralateral hand.

CONCLUSIONS

The intravenous glucose tolerance test is reproducible when performed by the same operator over a short time span. Reproducibility is not significantly improved by sampling from an arterialized, retrograde cannulated, contralateral hand vein. There is no case for changing the present ICARUS protocol to incorporate retrograde cannulation or low-dose (5 g/m2) glucose.
Reduction of Postprandial Hyperglycemia in Subjects With IDDM by Intravenous Infusion of AC137, a Human Amylin Analogue
Authors: Kolterman Orville G , Gottlieb Alan , Moyses Chris , Colburn Wayne
Published: March 2007

OBJECTIVE

To demonstrate that intravenous administration of AC137 (25,28,29 tripro-human amylin), a human amylin analogue, modulates the rate of appearance of glucose derived from a standard oral meal in the peripheral circulation of patients with insulin-dependent diabetes mellitus (IDDM).

RESEARCH DESIGN AND METHODS

After the observation that a 2-h infusion of AC137 at a rate of 150 μg/h, in conjunction with the subjects' usual morning insulin dose, decreased postprandial hyperglycemia in 6 subjects with IDDM, a double-blind placebo-controlled two-period crossover design in an additional 18 IDDM patients was undertaken to confirm and extend the observation. Based on reasoning that an effect to modulate the appearance of orally administered glucose would have no impact on the disposition of an intravenous glucose load, nine patients were challenged with an intravenous glucose loads (300 mg/kg), while another nine patients were challenged with a standardized Sustacal meal (350 kcal) during a 5-h infusion of AC137 (50 μg/h). On each occasion, the subjects received their usual morning doses of insulin subcutaneously. The impact of the AC137 infusion on the plasma glucose responses to these different challenges was assessed.

RESULTS

Intravenous infusion of AC137 yielding steady state plasma concentrations of 225 ± 15 pmol/l (mean ± SE) reduced postprandial plasma glucose concentrations after the standardized Sustacal meal challenge. The mean area under the glucose curve, corrected for baseline, was reduced from −1,869 ± 5,562 mg · dl−1 · min during placebo infusion to −28,872 ± 4,812 mg · dl−1 · min during AC137 infusion, P = 0.0015. In contrast, an AC137 infusion producing steady-state concentrations of 234 ± 16 pmol/l had no effect on the plasma glucose profile after administration of an intravenous glucose load.

CONCLUSIONS

AC137 administration, in these patients with IDDM, reduced postprandial hyperglycemia apparently by affecting the delivery rate of glucose from the gastrointestinal tract. AC137 may prove to be a clinically useful addition to insulin regimens to facilitate the achievement of glycemic control.
Comparison of Bedtime NPH or Preprandial Regular Insulin Combined With Glibenclamide in Secondary Sulfonylurea Failure
Authors: Landstedt-Hallin Lena , Adamson Ulf , Arner Peter , Bolinder Jan , Lins Per-Eric
Published: March 2007

OBJECTIVE

To compare the effect of bedtime NPH insulin or preprandial regular insulin combined with glibenclamide on metabolic control in non-insulin-dependent diabetes mellitus (NIDDM) patients with secondary failure to sulfonylurea therapy.

RESEARCH DESIGN AND METHODS

Eighty NIDDM patients were randomized to treatment with either three preprandial doses of regular insulin (daytime group D) or a bedtime dose of NPH insulin (nocturnal insulinization, group N), both regimens being combined with 10.5 mg of glibenclamide. Metabolic profiles were obtained at 0, 6, 16 weeks.

RESULTS

Glycemic control had improved significantly in both groups after 4 months. Fasting blood glucose was significantly lower compared with baseline in both groups. The mean change ± SD in group D was −2.8 ± 3.5 mmol/l and in group N −6.4 ± 3.0 mmol/L, the reduction being more pronounced in group N compared with group D (P < 0.0001). HbA1c was lowered similarly, from 9.2 ± 1.4 to 7.1 ± 1.2% in group D (P < 0.0001) and from 9.1 to 1.1 to 7.5 ± 1.5% in group N (P < 0.0001). The total daily insulin doses were similar, 29 ± 11 U in group D and 26 ± 9 U in group N, and the circulating insulin levels during daytime were higher in group D than in group N. Total serum cholesterol and triglycerides were similarly and significantly lowered compared with baseline in both groups. Weight gain was more pronounced in group D (3.4 ± 0.3 kg) than in group N (1.9 ± 1.9 kg; D vs. N, P < 0.002), and the change was inversely correlated with initial eight but not with the improvement in HbA1c.

CONCLUSIONS

The two insulin regimens exert similar effect on glucose metabolism and serum lipids in NIDDM patients on combination therapy. Weight gain is more pronounced in patients given insulin during the daytime when preprandial doses of short-acting insulin are used.
Demonstration, of Insulin Resistance in Coronary Artery Disease Documented With Angiography
Authors: Shinozaki Kazuya , Suzuki Masaaki , Ikebuchi Motoyoshi , Hara Yasushi , Harano Yutaka
Published: March 2007

OBJECTIVE

To evaluate the relation between insulin resistance and coronary atherosclerosis, insulin sensitivity in lean nondiabetic, normotensive subjects with and without obstructive coronary artery disease (CAD). The correlation between insulin resistance and degree of coronary stenosis was also investigated.

RESEARCH DESIGN AND METHODS

Four groups were studied: 1) nine subjects with normal glucose tolerance(NGT) without CAD, 2) 10 subjects with NGT with CAD, 3) nine subjects withimpaired glucose tolerance (IGT) without CAD, and 4) 10 subjects with IGT with CAD. Insulin sensitivity was determined by the steady-state plasma glucose (SSPG) method using Sandostatin. Coronary angiography was performed in all study subjects, and the severity of coronary artery atherosclerosis wasquantified in a modified Gensini score.

RESULTS

The SSPG (millimoles per liter) levels were significantly higher in the patients with CAD compared with control subjects (control vs. patient group: 4.8 ±0.5 vs. 7.9 ± 0.9 with NGT, P < 0.05; 5.6 ± 0.5 vs. 11.1 ± 0.8 with IGT, P < 0.001), indicating the presence of insulin resistance in patients with CAD. The coronary atherosclerosis score (CAS) was significantly and positively correlated with SSPG (r = 0.74, P < 0.05) and 2-h insulin area (r = 0.78, P < 0.01) in NGT subjects with CAD. On the other hand, the percentage fall of plasma free fatty acid (0–30 min) during an insulin sensitivity test was significantly decreased in the subjects with CAD and was inversely correlated with the CAS (r = −0.43, P < 0.05), especially in NGT subjects with CAD.

CONCLUSIONS

These data suggest that in patients with CAD, insulin-mediated glucose metabolism is significantly impaired, and a significant correlation was noted between insulin resistance and severity of CAD. Therefore, the hyperinsulinemia often observed in patients with CAD is attributable to the compensatory mechanism of the β-cell to the inadequate action of insulin for glucose metabolism. Hyperinsulinemia in the presence of insulin resistance aggravates dyslipidemia and may stimulate the atheromatous process by an as-yet-unknown mechanism.
Subcutaneous or Intramuscular Injections of Insulin in Children: Are we injecting where we think we are?
Authors: Polak Michel , Beregszaszi Marta , Belarbi Nadia , Benali Karim , Hassan Max , Czernichow Paul , Tubiana-Rufi Nadia
Published: March 2007

OBJECTIVE

This study was designed to assess the insulin injection location in a group of children who had their injection according to their daily practice, thought to lead to subcutaneous injections.

RESEARCH DESIGN AND METHODS

The location of the insulin deposit at the injection site was visualized using an ultrasound device.

RESULTS

The exact insulin injection location could be localized, and 18 of 59 injections (30.5%) (one injection for each child) were in the intramuscular tissue. Of the children who had intramuscular injection, 15 of 18 were boys. The children who had an intramuscular injection had a significantly lower percentile of BMI (mean ± SE: 47 ± 8 vs. 72 ± 4, P = 0.004), lower distance from skin surface to muscle fascia without a skinfold (5.6 ± 0.6 vs. 11 ± 0.7 mm, P < 0.0001), and a lower distance from skin surface to muscle fascia with a skinfold (8.1 ± 0.9 vs. 15.9 ± 0.8 mm, P < 0.0001) than children who had a subcutaneous insulin injection.

CONCLUSIONS

We identified a group of children at risk for intramuscular insulin injections and that may deserve specific injection technique and advice.
Capillary Blood on Filter Paper for Determination of HbA1c by Ion Exchange Chromatography
Authors: Jeppsson Jan-Olof , Jerntorp Peter , Almër Lars-Olof , Persson Ruth , Ekberg Göran , Sundkvist Göran
Published: March 2007

OBJECTIVE

To facilitate HbA1c determination, we evaluated an HbA1c filter paper system enabling capillary blood sampling at home by the patients.

RESEARCH DESIGN AND METHODS

Capillary blood (two drops) was applied to a filter paper (HbA1c Via Post) and sent to the laboratory where a small disc was punched out on the filter paper. Hemoglobin was eluted from the disc in a buffer containing cysteine to eliminate the interfering glutathione adduct (HbA3) formed during storage. Analysis was performed by ion-exchange chromatography (Mono S, high-performance liquid chromatography), and the eluate was compared with hemolysate of venous blood from 41 patients. The stability of blood impregnated on filter paper was checked at different temperatures over different periods of time.

RESULTS

There was an excellent agreement (r = 0.99) between HbA1c values from capillary blood on filter paper and HbA1c values from venous blood. HbA1c values were constant when stored on filter paper for 5–7 days at 20–21°C (room temperature) or at 4–6°C (refrigerator) for 10 days as well as at −70°C for several months after blood sampling. A new chromatographic-interfering hemoglobin fraction both from venous and capillary samples was identified as free alpha-chain of hemoglobin.

CONCLUSIONS

The HbA1c filter paper system enables capillary blood sampling at home, eliminates the need of vein puncture in children and adults, and provides the diabetologist with an HbA1c value when the patient visits the clinic without a need for a previsit phlebotomy.
Factors Associated With Glucose and Insulin Levels in Healthy Postmenopausal Women
Authors: Barrett-Connor Elizabeth , Schrott Helmut G , Greendale Gail , Kritz-Silverstein Donna , Espeland Mark A , Stern Michael P , Bush Trudy , Perlman Jeffrey A
Published: March 2007

OBJECTIVE

Little is known about the covariates of hyperglycemia and hyperinsulinemia. We examined candidate factors in postmenopausal women.

RESEARCH DESIGN AND METHODS

We determined the cross-sectional associations of sociodemographic, body-size, lifestyle, reproductive, and menopausal factors with pretrial fasting and postchallenge glucose and insulin levels in 869 postmenopausal women aged 45-65 years. Women were participants in the Postmenopausal Estrogen/Progestin Interventions study who were not taking estrogen or insulin.

RESULTS

Plasma glucose levels increased significantly with age; serum insulin levels did not. BMI and waist-to-hip ratio (WHR) each showed graded positive and independent associations with glucose and insulin levels. Alcohol intake, cigarette smoking, physical activity, parity, education, and income were also associated with insulin or glucose in age-adjusted models. In multivariable models, BMI and WHR explained 18% of the variability in fasting glucose, 16% in postchallenge glucose, 28% in fasting insulin, and 17% in postchallenge insulin. Age and all other factors combined accounted for <6% of the variance in glucose or insulin. In multiply adjusted models, African-American and Hispanic women had higher fasting and 2-h insulin levels than non-Hispanic white women.

CONCLUSIONS

Most of the variance in glycemia and insulin is unexplained. Measures of obesity and fat distribution account for nearly all the explained variance.
Raised Serum Sialic Acid Concentration Precedes Onset of Microalbuminuria in IDDM: A 10-year follow-up study
Authors: Yokoyama Hiroki , Jensen Jan Skov , Myrup Bjarne , Mathiesen Elisabeth R , Rønn Birgitte , Deckert Torsten
Published: March 2007

OBJECTIVE

Elevated concentrations of serum sialic acid, a potent cardiovascular risk factor in the general population, have been found in patients with IDDM and microalbuminuria. We investigated whether a coincidence exists between the increase of sialic acid concentrations and albuminuria in the transition from normoalbuminuria to microalbuminuria. Furthermore, the predictability of increased sialic acid as well as von Willebrand factor (vWF) and total and HDL cholesterol concentrations in development of persistent microalbuminuria in IDDM was investigated.

RESEARCH DESIGN AND METHODS

This 10-year prospective study was carried out in a cohort of 209 IDDM patients with normoalbuminuria at baseline.

RESULTS

Of the cohort, 198 patients completed the follow-up period and 27 developed persistent microalbuminuria (urinary albumin excretion rate [UAER] ≥ 30 mg/24 h). A coincident increase of UAER and serum sialic acid concentration was seen before persistent microalbuminuria was diagnosed. Elevation of serum sialic acid concentrations in those who later developed microalbuminuria occurred 3 years before the diagnosis of persistent microalbuminuria. Baseline serum sialic acid concentrations were significantly higher in the group of patients who later developed microalbuminuria than in the group who remained normoalbuminuric (2.02 ± 0.41 vs. 1.85 ± 0.31 mmol/l [means ± SD], P < 0.05). Baseline serum sialic acid concentration correlated significantly with HbA1c, UAER, blood pressure, total cholesterol, HDL cholesterol, and vWF and was significantly predictive for development of microalbuminuria (hazards ratio [95% CI], 3.1 [1.2–8.1]; P = 0.02) after adjustments for sex, duration of diabetes, smoking, blood pressure, vWF, total cholesterol, and HDL cholesterol. Adjustment for the effects of HbA1c and UAER, however, canceled out the predictive effect of serum sialic acid.

CONCLUSIONS

UAER and serum sialic acid concentration increase coincidentally before the onset of persistent microalbuminuria. An increased serum sialic acid concentration is predictive for the onset of microalbuminuria independent of age, sex, diabetes duration, smoking, blood pressure, vWF, and total HDL cholesterol.
Promoting Weight Loss in Type II Diabetes
Authors: Brown Sharon A , Upchurch Sandra , Anding Roberta , Winter Mary , Ramìrez Gilbert
Published: March 2007

OBJECTIVE

To examine strategies—behavioral therapies, exercise, diet, anorectic drugs, surgery, or a combination of strategies—used for promoting weight loss in people with type II diabetes.

RESEARCH DESIGN AND METHODS

Meta-analysis was used to synthesize research of promoting weight loss in the population. Literature search strategies involved reviewing bibliographies, conducting computer searches and surveys of relevant master's degree programs, and contacting representatives of the Centers for Disease Control. The final sample consisted of 89 studies involving 1,800 subjects. Data were extracted on 80 variables characterizing the sample of studies/subjects and on 23 outcome variables, including weight, metabolic control, lipids, and other physiological parameters.

RESULTS

Diet alone had the largest statistically significant impact on weight loss (−20 lb) and metabolic control (−2.7% in glycosylated hemoglobin). All diets significantly improved fasting blood sugar. Behavioral programs alone had a statistically significant impact on weight loss (−6.4 lb) and metabolic control (−1.5%) but effects were < for diet alone. Data from the few exercise studies indicated that weighted average effects for exercise on weight loss (−3.4 lb) and metabolic control (−0.8%) were < diet alone. Behavioral therapy plus diet plus exercise was associated with statistically significant effect size estimates for weight loss (−8.5 lb) and metabolic control (−1.6%). Diet alone achieved better results. Effects of weight promotion strategies, in general, were smaller in experimental studies and for individuals over age 55.

CONCLUSIONS

Dietary strategies are most effective for promoting short-term weight loss in type II diabetes. A number of gaps exist in the extant literature—descriptions of subjects, interventions, or longitudinal outcomes beyond 12 months after intervention.
Comparisons of Studies on Diabetic Complications Hampered by Differences in GHb Measurements
Authors: Kullberg Carin E , Bergström Anders , Dinesen Bo , Larsson Lasse , Little Randie R , Goldstein David E , Arnqvist Hans J
Published: March 2007

OBJECTIVE

To compare glycated hemoglobin (GHb) values of the relationship between glycemic control and complications of diabetes from laboratories involved in long-term studies (Steno, Oslo, Stockholm, Diabetes Control and Complications Trial, and Linköping.)

RESEARCH DESIGN AND METHODS

Blood samples were collected from 25 subjects selected to represent the clinically relevant measurement range. Fresh whole-blood samples were distributed and analyzed within 4 days of sample collection. Pretreatment of samples and analyses of GHb were performed according to the routine method of each study's central or reference laboratory. Results from each laboratory were compared with the group mean, i.e., the mean of all results for each sample.

RESULTS

Regression analyses with the group mean values as independent variables and results from each laboratory as dependent variables showed that Oslo's result had a slope significantly different from the group mean. Laboratories used by the DCCT, Oslo, and Steno studies gave, on average, 0.4, 0.4, and 0.7% higher HbA1c readings than the group mean, respectively, while HbA1c results from Linköping and Stockholm were, on average, 0.6 and 1.0% lower, respectively.

CONCLUSIONS

There were large differences in GHb values among laboratories participating in studies of diabetic complications. The present data offer a guide to the comparison of results from the studies and underscores the need for standardization of GHb measurements.
The Metabolic Syndrome in Hong Kong Chinese. The interrelationships among its components analyzed by structural equation modeling
Authors: Chan Juliana CN , Cheung Jacky CK , Lau Edith MC , Wooà Jean , Chan Albert YW , Swaminathan Ramasmyiyer , Cockrama Clive S
Published: March 2007

OBJECTIVE

To examine the pattern of the metabolic syndrome in Chinese and the causal relationships among its components, including aging, obesity, hyperglycemia, hypertension, hypertriglyceridemia, and hyperinsulinemia in these subjects.

RESEARCH DESIGN AND METHODS

Based on a 75-g oral glucose tolerance test, the World Health Organization criteria were used for the diagnosis of glucose intolerance in a population-based study involving 1.513 Chinese subjects in two work sites. Demographic data including age, family history of diabetes, BMI, waist-to-hip ratio (WHR), and sitting blood pressure (BP) were documented. Fasting plasma glucose, triglyceride (TG) and insulin concentrations, and spot urinary albumin concentration (Ualb) were also measured. Structural equation modeling incorporating factor analysis and path analysis was performed to examine the causal relationships among these variables and their interactions.

RESULTS

Subjects who were treated with antidiabetic and/or antihypertensive drugs or who had a plasma creatinine level ≥ 150 μmol/l were excluded (n = 52). The prevalence of diabetes and impaired glucose tolerance (IGT) were 3.9% (n = 34) and 7.2% (n = 63) in men (n = 881) and 3.1% (n = 18) and 6.7% (n = 39) in women (n = 580), respectively. In both groups, glucose intolerance was associated with increasing age, higher BMI, WHR, BP, Ualb, serum TG, and insulin levels as well as higher prevalence rates of positive family history of diabetes. Structural equation modeling showed that age was a significant determinant for both BMI and WHR. Age and obesity accounted for most of the variance of BP, Ualb, plasma glucose, insulin and TG levels either directly or indirectly. Plasma glucose was determined by a positive family history of diabetes, age, and BMI while TG was dependent on BMI and WHR. Serum insulin was mainly determined by a positive family history of diabetes, obesity, plasma glucose, and TG levels. Apart from age and obesity, BP was also determined by serum insulin, both of which had causal effects on Ualb.

CONCLUSIONS

This model emphasizes the centrality of aging and obesity as well as a positive family history of diabetes as major determinants of the components of the metabolic syndrome. These components in turn had causal effects upon one another. Apart from a familial tendency, a central neurohormonal mechanism may account for these abnormalities mediated primarily through obesity and in close association with aging.
The WHO Multinational Study of Vascular Disease in Diabetes: 3. Microvascular Disease
Authors: Jarrett R J , Keen H
Published: March 2007

A preliminary comparison and analysis of microvascular disease was performed in 14 stratified samples of diabetic subjects. Microvascular disease was assessed by estimating visual disabilities, by standardized examination of the optic fundus by direct ophthalmoscopy, by estimating proteinuria, and by measuring the serum creatinine concentration. Visual impairment by questionnaire positive varied considerably between centers, probably due to cultural differences in interpretation of the questions. Physician-assessed visual disability also yielded considerable differences in frequency; however, the frequency differences were unrelated to those observed for macrovascular disease. Retinopathy—the sum of all components—was related to duration of diabetes in each participating center. The apparent frequency of proteinuria varied considerably between centers. In general, the frequency of retinopathy was related to the level of systolic blood pressure, but there was no systematic association with cigarette smoking.