bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis of Ni3C Nano-whisker from NiSO4 and Sucrose by Means of Spray Pyrolysis
Authors: Kashiwagi Takeshi , Suzuki Naohisa , Niina Masashi , Nishiguchi Hiroyasu , Nagaoka Katsutoshi , Takita Yusaku
Published: March 2007

Ni particles and Ni3C whiskers with a novel morphology, grew on the Ni–carbon composite by heat treatment at 1073 K in Ar. Ni–carbon composites were prepared by spray pyrolysis of a solution of sucrose and NiSO4 in Ar at 1073 K.
Setup and Open-Stacks Minimization in One-Dimensional Stock Cutting
Authors: Belov Gleb , Scheithauer Guntram
Published: March 2007

The primary objective in cutting and packing problems is trim loss or material input minimization (in stock cutting) or value maximization (in knapsack-type problems). However, in real-life production we usually have many other objectives (costs) and constraints. Probably the most complex auxiliary criteria in one-dimensional stock cutting are the number of different cutting patterns (setups) and the maximum number of open stacks during the cutting process. There are applications where the number of stacks is restricted to two. We design a sequential heuristic to minimize material input and show its high effectiveness for this purpose. Then we extend it to restrict the number of open stacks to any given limit. Then, the heuristic is simplified and integrated into a setup-minimization approach in order to combine setup and open-stacks minimization. To get a smaller number of open stacks, we may split up the problem into several parts of smaller sizes. Different solutions are evaluated in relation to the multiple objectives using the Pareto criterion.
Enhancing Lagrangian Dual Optimization for Linear Programs by Obviating Nondifferentiability
Authors: Sherali Hanif D. , Lim Churlzu
Published: March 2007

We consider nondifferentiable optimization problems that arise when solving Lagrangian duals of large-scale linear programs. Different from traditional subgradient-based approaches, we design two new methods that attempt to circumvent or obviate the nondifferentiability of the objective function, so that standard differentiable optimization techniques could be used. These methods, called the perturbation technique and the barrier-Lagrangian reformulation, are implemented as initialization procedures to provide a warm start to a theoretically convergent nondifferentiable optimization algorithm. Our computational study reveals that this two-phase strategy produces much better solutions with less computation in comparison with both the stand-alone nondifferentiable optimization procedure employed, and the popular Held-Wolfe-Crowder subgradient heuristic. Furthermore, the best version of this composite algorithm is shown to consume only about 3.19% of the CPU time required by the commercial linear programming solver CPLEX 8.1 (using the dual simplex option) to produce the same quality solutions. We also demonstrate that this initialization technique greatly facilitates quick convergence in the primal space when used as a warm start for ergodic-type primal recovery schemes.
Schmidt's Syndrome in a Child with Diabetes Mellitus
Authors: Nelson Richard P , Traisman Howard S , Deddish Ruth B , Green Orville C
Published: March 2007

Schmidt's syndrome (thyroid and adrenal insufficiency) and concurrent diabetes mellitus represent an intriguing multiple endocrinopathy in children. This report describes an eleven-year-old girl with diabetes of eight years' duration presenting in adrenal crisis. Serum thyroxine was undetectable, and antibodies to both thyroglobulin and adrenal tissue were found in high titer. The child's condition stabilized with hormonal replacement therapy, except for persistent growth failure. Approximately two years later she succumbed during a rapidly fulminant episode of ketoacidosis. The natural history of her illness supports recent speculation based on serologic data that juvenile diabetes mellitus may be an immunologic disorder in some children.
Influence of Indigestible Fibers on Glucose Tolerance
Authors: Monnier L , Pham T C , Aguirre L , Orsetti A , Mirouze J
Published: March 2007

In eight patients exhibiting chemical diabetes mellitus with a poststimulative hypoglycemia, we observed that the pattern of the oral glucose tolerance test (OGTT) was improved when indigestible fiber was added to the oral glucose load. As compared with a standard OGTT, the peak blood glucose, expressed as per cent change from baseline, was particularly blunted by pectin or by cellulose phosphate but remained unchanged with cellulose supplementation. The time interval required to reach the blood glucose peak was significantly prolonged with pectin. The rate of blood glucose rise was reduced to a greater extent by pectin than by cellulose phosphate, which in turn was more efficient than cellulose. The blood glucose nadir expressed as per cent change from baseline was blunted by pectin, while the results were not significantly different after addition of either cellulose phosphate or cellulose. On the other hand, the plasma immunoreactive insulin did not show any significant change whether the glucose was given with or without one of the aforementioned types of fiber. From these results, it is concluded that an additional fiber intake may be of interest in the management of chemical diabetes. The use of pectin may diminish the poststimulative hypoglycemia.
Decreased Serum Cholesterol-binding Reserve in Diabetes Mellitus
Authors: Hsia S L , Fishman Lawrence M , Briese Franklin W , Christakis George , Burr Janice , Bricker Lee Alan
Published: March 2007

Serum cholesterol-binding reserve (SCBR), the capacity of a serum sample to solubilize additional cholesterol in excess of its cholesterol content, was measured in 43 white male patients with maturityonset diabetes in the age range of 35–59 years who were under treatment with insulin. The values were compared with those of 194 nondiabetic controls of the same race, sex, and age range. The mean ±S. D. of SCBR of patients (71.9 ± 29.3 mg./dl.) was lower than that of controls (88.9 ± 30.9mg./dl.) (p < 0.001). Age in the range of 35 to 59 years had no correlation with SCBR in either patients or controls. SCBR was positively correlated with serum levels of cholesterol (SC) and triglycerides (TG) in both patients and controls. After adjustment for SC and TG, the difference in SCBR between patients and controls persisted (p < 0.001). In 15 of 20 (75 per cent) patient-control pairs matched for SC and TG to within 5 per cent, the patient had lower SCBR (paired t-test, p < 0.002). In 16 patients without elevation of serum lipid levels (SC below 250 and TG below 150 mg./dl.), the mean ± S.D. of SCBR (59.1 ± 17.7 mg./dl.) was lower than that of 49 controls having serum lipids in the same range (77.4 ±31.7 mg./dl.) (p < 0.03). These results indicate an association of decreased SCBR with diabetes and are consistent with the hypothesis that low SCBR is associated with accelerated atherosclerosis and enhanced risk for coronary heart disease.
Growth and Maturation of Children with Insulin-dependent Diabetes Mellitus
Authors: Jackson Robert L , Holland Edward , Chatman Ira D , Guthrie Diana , Hewett John E
Published: March 2007

The purpose of this paper is to define criteria used for classifying patients into varying degrees of diabetic control and to verify that children with diabetes maintained in higher degrees of metabolic control do not have delayed growth and maturation. Growth records of 252 children with insulin-dependent diabetes who have been under continuous observation in our clinic at three- to five-month intervals for at least three years and up to 16 years have been individually reviewed and analyzed. All children received two daily injections of a mixture of two parts of an intermediate to one part of regular insulin and were instructed to eat structured meals of high-quality selected foods. An over-all rating for diabetic control based primarily on the frequency and degree of glycosuria was made for the time period between clinic visits. The over-all diabetic control rating and the size of the subgroups were “good” — 20 per cent, “fair to good” — 64 per cent, and “fair”—16 per cent. All children maintained in “good” and “air to good” control (84 per cent), grew and matured at a normal rate regardless of the age at onset or duration of diabetes. All children in lower degrees of control coming under care for greater than 24 months after diagnosis had accelerated growth during the early months after attaining a higher degree of control.
The Saccharin Controversy
Authors: Kalkhoff Ronald K , Levin Marvin E
Published: March 2007

Saccharin and its salts are the most extensively consumed artificial sweeteners in the United States today. The current controversy about the risks of their use to human health has surfaced from research findings that report an increased incidence of cancer, primarily of the urinary bladder, in certain animal species and man chronically exposed to these agents. The April 1977 proposal by the Food and Drug Administration to restrict use of saccharin was based on these investigations. The intense public response against any ban has led to Congressional deliberations over the fate of saccharin during the present moratorium and information-gathering period. Since diabetic patients are among the principal users of this compound, it appears timely to review the evidence for and against its carcinogenic potential.
Use of Fructose, Xylitol, or Sorbitol as a Sweetener in Diabetes Mellitus
Authors: Brunzell John D
Published: March 2007

Nonnutritive sweeteners have been utilized in the diet of diabetic patients an an agent to replace glucose and sucrose. Since saccharin might be removed from the marketplace, the nutritive sweeteners fructose, xylitol, and sorbitol are being considered as possible alternatives for glucose and sucrose. This review considers the effects of these nutritive sweeteners on the main dietary concerns in the diabetic diet—control of blood glucose levels, obesity, and hyperlipidemia. The potential side effects of these agents are also reviewed.
Is There a Role for Dietetic Foods in the Management of Diabetes and/or obesity?
Authors: Wunschel Irene M , Sheikholislam Bagher M
Published: March 2007

The cost and nutritional value (calorie, carbohydrate, protein, and fat content) of 108 regular products were compared with 101 dietetic products. The cost of dietetic candies, cookies, fruits, preserves/syrups, and puddings/gelatins was significantly greater (p < 0.005, p < 0.005, p < 0.005, and p < 0.025, respectively). Dietetic candies and cookies contained more calories than the regular ones. These differences were significant only for candies (p < 0.005). In contrast, dietetic fruits and preserves/syrups had significantly fewer calories than the regular ones (p < 0.005 and p < 0.005 respectively). Dietetic puddings/gelatins were significantly less expensive and contained fewer calories than the regular products (p < 0.005 and p < 0.005, respectively). Dietetic ice creams were generally more expensive with varying amounts of carbohydrate content. Most dietetic products contained higher amounts of protein than regular food products. Since the dietetic products constitute only a fraction of total food intake, the differences in their composition have little or no effect on the relationship of nutrients consumed within a 24-hour period. Thus, in most cases the consumer receives little or no nutritional benefit from the higher cost of dietetic products.
Composition of Foods Commonly Used in Diets for Persons with Diabetes
Authors: Anderson James W , Lin Wen-Ju , Ward Kyleen
Published: March 2007

Information on the carbohydrate, protein, fat, kilocalorie, and plant fiber content of 152 common foods has been collated. These data are based on information currently available and will need to be modified and updated as more information emerges. These data are presented in six tables that follow the format of the commonly used Exchange Lists for Meal Planning for patients with diabetes mellitus.
On Diabetic Osteopathy: A Radiographic Study of 21 Patients
Authors: Whitehouse Fried W , Weckstein Malcolm
Published: March 2007

Twenty-one diabetic patients with anesthetic peripheral neuropathy who never suffered a foot infection or local ulceration had roentgenograms of both feet to seek whether osseous changes characteristic of diabetic osteopathy were present. We found nine patients with vascular calcification (all 21 patients had palpable pedal pulses); four patients with ancient fractures; one patient with two phalangeal erosions; and two patients with equivocal osseous cystic lesions. No patient had findings typical of diabetic osteopathy. From this study, plus experience with other diabetic patients who had infected, ulcerated feet, we conclude that diabetic osteopathy represents healing or healed lesions of local osteomyelitis.
Spontaneous Hypoglycemia Associated With Autoimmunity Specific to Human Insulin
Authors: Sklenar Ivo , Wilkin Terence J , Diaz Jose-Luis , Erb Peter , Keller Ulrich
Published: March 2007

A 55-yr-old woman with a history of Graves'; disease experienced attacks of postprandial hypoglycemia for 6 yr. An insulinoma could not be confirmed by repeated fasting tests and by surgical pancreas revision. Extracted pancreatic insulin was chemically normal. Fasting plasma total insulin (1.22 nM = 183 μU/ml) and proinsulin (0.48 nM) were elevated and greatly increased after oral glucose. Glucoseclamp studies revealed delayed insulin clearance. Plasma free-insulin levels were normal. Insulin-binding antibodies were detected by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay with human insulin as ligand but not with pork or beef insulins. Analysis with a modified ELISA suggested a monotypic and monoclonal human insulin autoantibody, which showed a restriction to the λ-light chain. T-lymphocytes (predominantly helper) demonstrated increased responsiveness to beef, pork, and human insulins by proliferation assay. A T-lymphocyte line showed exclusively human insulin specificity. All this indicated cellular and humoral anti-human insulin autoimmunities. Clinically, the cause of hypoglycemia associated with elevated total insulin and proinsulin was misdiagnosed as atypical insulinoma. The study of total and free plasma insulin levels and sensitive antibody assays specific to human insulin were necessary to correctly diagnose autoimmune hypoglycemia.
Relationship of Muscle Capillary Basement Membrane Thickness and Diabetic Retinopathy
Authors: Klein Robert F , Feingold Kenneth R , Morgan Craig , Stern Walter H , Siperstein Marvin P
Published: March 2007

We examined the relationship between the thickness of the quadriceps muscle capillary basement membrane and diabetic retinopathy. Basement membrane thickness was measured in two groups of patients with long-standing type II diabetes mellitus. One group of patients (N = 13) had no evidence of diabetic retinopathy on fluorescein angiography, whereas the other (N = 12) had proliferative microvascular disease. All the patients were male, and both groups were of similar ages, duration of diabetes, serum creatinines, and glycemic control as reflected by HbA1 levels. Mean muscle capillary basement membrane width (±SE) of the patients with proliferative retinopathy (3346 ± 262) was significantly greater (P < .05) than that observed in the patients without retinopathy(2660 ± 177). The results of this study suggest that there is a relationship between capillary basement membrane thickness in skeletal muscle and the severity of microangiopathy in the eye. However, there was a substantial overlap between the two groups, indicating that for any individual patient the measurement of muscle capillary basement width will probably not be useful in identifying the presence or absence of retinopathy.
Biphasic Patterns of Peripheral Insulin and Glucose Levels After Lunch in Normal Subjects
Authors: Robbins David C , Jaspan Jonathan , Vasquez Barbara , Cauter Eve Van
Published: March 2007

The dynamic relationship of glucose concentrations and insulin secretion during the postabsorptive state is complex and has been associated with a variety of cyclic rhythms. To study the pattern of insulin and glucose response immediately after a mixed meal, we collected blood every 15 min from 0730 to 1645 h from eight normal resting men (age 24.9 ± 2 . 1 yr). They took identically constituted mixed meals at 0800 and 1145 h. Concentrations of glucose and insulin were measured in samples taken throughout the study, whereas levels of C-peptide, glucagon, and a-NH2 were determined in samples taken after 1130 h only. Computer-assisted analysis was used to identify significant increments and declines in concentrations and to quantify the coincidence of peaks of glucose, C-peptide, glucagon, and α-NH2 with peaks of insulin. Coefficients of correlation between data points were calculated for each individual.

The patterns of blood insulin and glucose after breakfast and lunch were different. After breakfast, a single simultaneous peak in insulin and glucose occurred ∼60 min after starting the meal. In contrast, the pattern after lunch in seven of the eight subjects was clearly biphasic. There were secondary, significant coincident peaks in serum insulin, glucose, and C-peptide occurring 1.75—2.25 h after the meal was served. The secondary peak appeared unrelated to the late absorption of protein because it was not associated with consistent changes in serum a-NH2 concentration. Erratic variations characterized the postlunch pattern of glucagon levels, excluding a role for this counterregulatory hormone in the control of the biphasic insulin and glucose response. Of the measured substances, only glucose, insulin, and C-peptide demonstrated significant cross-correlations. These data indicate that in this well-defined group of healthy volunteers, the response of plasma glucose, serum insulin, and C-peptide to lunch is biphasic.
Psychosocial Aspects of Diabetic Retinopathy
Authors: Wulsin Lawson R , Jacobson Alan M , Rand Lawrence I
Published: March 2007

Diabetic retinopathy, particularly in the more advanced stages, poses many difficult psychosocial problems and demands major adjustments by the patient. Our review of this literature has identified specific problems relevant to patient care, future research, and public policy. For example, proliferative retinopathy often leads to at least partial visual impairment, psychiatric symptoms, and difficulties with glycemic control. Partial visual impairment appears to cause as much psychosocial disruption as severe blindness. This suggests that most rehabilitation programs that serve the legally blind may come too late in the course of this illness. This review emphasizes the paucity of past research on psychosocial aspects of diabetic retinopathy and raises some questions for future research.
Glycemic Effects of Spaghetti and Potato Consumed as Part of Mixed Meal on IDDM Patients
Authors: Hermansen Kjeld , Rasmussen Ole , Arnfred Jon , Winther Eva , Schmitz Ole
Published: March 2007

Recently, we demonstrated that spaghetti caused a significantly lower glycemic response in isoinsulinemic insulin-dependent diabetic (IDDM) subjects than an exchangeable amount of potato. The question is, however, whether the difference of the glucose response in IDDM patients is preserved if these carbohydrate-rich foods are taken as part of a mixed meal. To answer this question, we evaluated blood glucose, free-insulin, and glucagon responses to exchangeable amounts of spaghetti and potato when ingested together with bolognese sauce in seven IDDM patients who had attained euglycemia with the artificial pancreas before meal intake. The potato (200 g raw wt) with bolognese sauce (167 g) and spaghetti (50 g raw wt) with bolognese sauce (167 g) had ∼ identical caloric content (435 and 447 kcal, respectively), fat (18 g each), protein (23 and 26 g, respectively), and carbohydrate (47 and 48 g, respectively). Blood glucose increment after white spaghetti and bolognese sauce was only ∼ 50% of that seen in response to potato and bolognese sauce. Similar constant insulin levels and increments in glucagon were seen. A major determinant of the postmeal glucose rise in IDDM patients seems to be dependent on the kind of carbohydrate in the meal. The approach by which the insulinemia was kept constant by the artificial pancreas seems to be a valuable tool for studying glycemic responses to different meals in IDDM patients who otherwise show great variations in circulating insulin and glucose levels when treated by subcutaneously administered insulin.
Single-Void Urine Samples Can Be Used To Estimate Quantitative Microalbuminuria
Authors: Nathan David M , Rosenbaum Carol , Protasowicki V Daniel
Published: March 2007

The excretion of small quantities of urinary albumin (microalbuminuria) may predict renal failure in diabetes. The measurement of microalbuminuria with radioimmunoassays has been based on 24-h, overnight, and 3- to 4-h collections. To determine whether single-void urine samples can be used to estimate 24-h excretion, we compared the results of 24-h outpatient urine collections with single-void samples corrected for creatinine from diabetic and nondiabetic subjects.

The overall correlation of single-void sample results expressed as microgram albumin per milligram creatinine with 24-h excretion (mg/24 h) was excellent (r = .82, P < .001). More important, in the diabetic patients the sensitivity and specificity of detecting 24-h microalbuminuria in the abnormal range were at least 94 and 96%, respectively. Single-void urine specimens adjusted for creatinine discriminate between normal and abnormal levels of microalbuminuria, as determined in 24-h urine collection, with high specificity and sensitivity.
Renal Excretion of Prostaglandin E2 and Plasma Renin Activity in Type I Diabetes Mellitus: Relationship to Normoglycemia Achieved With Artificial Pancreas
Authors: Esmatjes Enrique , Levy Isaac , Gaya Juan , Rivera Francisca
Published: March 2007

To determine the effect of normoglycemia on renal prostaglandin synthesis and renin-angiotensin system activity, prostaglandin E2 (PGE2) urinary excretion, plasma renin activity (PRA), and glomerular filtration rate (GFR) were studied in seven patients with insulin-dependent diabetes mellitus (IDDM) without complications, both in basal conditions and after a 20-h treatment with an artificial pancreas. Normoglycemia induced a significant reduction in PGE2 excretion (88 ± 23 vs. 55 ± 25 ng/12 h, P < .05) and GFR (138 ± 34 vs. 105 ± 20 ml · min−1 · 1.73 m−2, P < .05) and a nonsignificant increment of PRA (0.52 ± 0.48 vs. 0.83 ± 0.92 ng · ml−1 · h−1). The results enhance the hypothesis that renal prostaglandins play a role in the renal functional alterations observed in IDDM during hyperglycemia.
Controlled Crossover Study of Subcutaneous and Intravenous Insulin Infusion in Type I Diabetes
Authors: Gulan Mirjana , Perlman Kusiel , Albisser A Michael , Pyper Jane , Zinman Bernard
Published: March 2007

Various routes of insulin infusion have been utilized to improve metabolic control in type I (insulin-dependent) diabetes. To determine the relative effectiveness of subcutaneous (SC) and intravenous (IV) systems of insulin-pump therapy, we studied five type I diabetic subjects aged 20–39 yr who were randomly assigned to a 3-mo period of either SC or IV insulin infusion and then crossed over to the alternate route for a similar period. After an initial 7- to 14-day period of in-hospital insulin-dose adjustment, all subjects were similarly followed as outpatients during both infusion periods, with a minimum of four daily preprandial self-measurements of blood glucose. Although the overall mean levels of blood glucose and HbA1c (116 ± 6 vs. 114 ± 5 mg/dl and 6.1 ± 0.2 vs. 5.9 ± 0.1% for the SC and IV systems, respectively) were similar, there was a greater incidence of low (< 50 mg/dl) and high (> 180 mg/dl) preprandial blood glucose readings during SC- than during IV-pump therapy (P < .05). Furthermore, the frequency of nocturnal and preprandial hypoglycemia was greater during SC-pump therapy (P < .05 and P < .02, respectively). Eight documented technical problems related to the pump and catheter occurred with the SC system, whereas 17 episodes occurred with the IV system. The number of episodes of ketosis (4 vs. 5 for SC and IV, respectively) was similar with both systems. The number of episodes of ketosis (4 vs. 5 for SC and IV, respectively) was similar with both systems. In summary, although similar degrees of near normalization of mean blood glucose levels can be achieved with both SC and IV insulin-pump therapy, less glycemic variability, in particular less hypoglycemia, occurs with the external IV infusion system. These observations provide continued rationale for the development of implantable insulin-delivery devices for insulin replacement in type I diabetes mellitus.
Dawn Phenomenon: Its Frequency in Non-Insulin-Dependent Diabetic Patients on Conventional Therapy
Authors: Atiea Jameel A , Ryder Robert R J , Vora Jiten , Owens David R , Luzio Stephen D , Williams Sheila , Hayes Tom M
Published: March 2007

The frequency of the dawn phenomenon has been studied in non-insulin-dependent diabetic (NIDDM) patients while they continued with their conventional therapy. Plasma glucose (PG) and immunoreactive insulin (IRI) were estimated hourly from 0300 to 0900 h in 19 NIDDM patients; 9 patients were treated by diet alone (group 1), and 10 patients were treated by diet and oral hypoglycemic agents (group 2). The dawn rise of plasma glucose was demonstrated in 17 (89.5%) of the 19 patients with mean ± SE plasma glucose at 0300 h of 7.0 ± 0.5 mM and at 0800 h of 8.4 ± 0.6 (P < .01). IRI in all patients rose from 14.7 ± 1.3 μU/ml at 0500 h to 18.1 ± 1.8 μU/ml at 0700 h (P < .05). The changes in IRI levels at any time from 0300 to 0800 h in groups 1 and 2 when considered separately were insignificant. Thus, the dawn phenomenon occurs commonly in NIDDM patients taking their conventional therapy.
Insulin Absorption Accelerated by Alpha-Adrenergic Blockade at Injection Site
Authors: Menon Ram K , Gaylarde Peter M , Hyden Anthony M , Grace Andrew A , Dandona Pares
Published: March 2007

The effect of the addition of phenoxybenzamine to a regular insulin preparation on the absorption of insulin and plasma glucose concentrations was investigated in five normal subjects. The addition of phenoxybenzamine (20 μg) to insulin (0.2 U/kg body wt) resulted in an acceleration of insulin absorption, with a higher and earlier peak insulin concentration at 45 min and higher insulin concentrations throughout the 180 min of investigation. With phenoxybenzamine, plasma glucose concentrations fell more rapidly; nadirs were lower and more rapidly achieved. Two subjects experienced hypoglycemic symptoms when phenoxybenzamine was added to insulin. It is concluded that the addition of phenoxybenzamine to subcutaneously injected insulin increases the bioavailability of insulin for at least 3 h, which leads to a greater fall in plasma glucose concentrations.
Factors Affecting Staphylococcal Colonization Among NIDDM Outpatients
Authors: Lipsky Benjiamin A , Pecoraro Roger E , Chen Mei S , Koepsell Thomas D
Published: March 2007

Because colonization with Staphylococcus aureus probably predisposes to staphylococcal infections, we examined several factors that may be associated with staphylococcal carriage in outpatients with non-insulin-dependent diabetes mellitus and in nondiabetic controls. Nose and skin carrier rates for 59 diabetic patients were significantly greater (30.5%) than for 44 controls (11.4%) (P = .02), but rates did not differ significantly between diabetic patients who injected insulin (31.0%) and those who did not (30.0%). Among the diabetic patients, staphylococcal colonization was not significantly correlated (P > .05) with recent antibiotic treatment, age, race, or clinical duration of diabetes but was inversely correlated (P < .03) with glycemic control, as measured by fasting plasma glucose and glycosylated hemoglobin levels. Hospitalization in the previous year was also associated with staphylococcal colonization, and it was significantly more common among the diabetic patients than the controls; however, this did not account for the increased colonization rates observed. Our results in a well-characterized population confirm an increased rate of staphylococcal colonization among diabetic as compared with nondiabetic outpatients but demonstrate that neither injections of insulin nor various pertinent demographic factors explain this finding.
Psychometric Study of Patient Knowledge Test
Authors: Garrard Judith , Joynes Judy Ostrom , Mullen Lucy , McNeil LeAnn , Mensing Carolé , Feste Catherine , Etzwiler Donnell D
Published: March 2007

The results of a psychometric study of the Test of Patient Knowledge are reported. The 50-item, multiple-choice test, developed by Etzwiler and associates at the International Diabetes Center, consists of a total score and seven subscores based on seven nonoverlapping content categories: nutrition, insulin, general knowledge, methods of control, pattern control, exercise, and complications. The results described herein provide evidence for the validity of the test (content, concurrent, and discriminant validity), a high level of reliability (Cronbach's α = .88), readability for the layperson at the 7th- to 8th-grade level, and sensitivity to instructional gains. The literature on psychometric research with other tests of patient knowledge of diabetes is reviewed and compared with the results of this study.
Intellectual Deficits Associated With Early Onset of Insulin-Dependent Diabetes Mellitus in Children
Authors: Rovet Joanne F , Ehrlich Robert M , Hoppe Marla
Published: March 2007

Twenty-seven children with early-onset (< 4 yr) diabetes (EOD), 24 children with late-onset (> 4 yr) diabetes (LOD), and 30 sibling controls were compared in their performance on tests of intellectual functioning and school achievement. The results indicated that children with EOD, particularly girls, scored lower than the other groups of diabetic children and siblings on tests of visuospatial (P < .05) but not verbal ability. Many of the girls with EOD were also having difficulty at school, and several were receiving special education. Children with EOD had more hypoglycemic convulsions than those with LOD. Both convulsions and age of onset were associated with poorer performance on spatial tasks. Girls with EOD had lower spatial test scores regardless of convulsion history, whereas boys with EOD scored lower only if they had had a convulsion.
Oral Candidiasis in Patients With Diabetes Mellitus: A Thorough Analysis
Authors: Bartholomew Gary A , Rodu Brad , Bell David S
Published: March 2007

It has generally been assumed that oral candidiasis occurs with increased frequency in patients with diabetes mellitus. To evaluate this, we compared the frequency and severity of oral Candida colonization in 60 patients with insulin-dependent diabetes mellitus (IDDM) admitted to a low-intensity-care diabetes unit with those in 57 age- and sex-matched controls. Swabs taken from the tongue and buccal mucosa were examined by cytology rather than culture because of the discrimination provided by the former. Cytological smears were classified according to the presence and morphology of the Candida organisms. Overall, a significant difference in Candida species colonization was found between patients with diabetes (75.0%) and controls (35.1%) (p < .005). In the diabetic group, no relationship was found to recent use of antibiotics, total or differential white blood cell count, serum glucose, presence of diabetic retinopathy, or glycosylated hemoglobin values. We conclude that in IDDM there is a predisposition to oral candidiasis and that this predisposition is independent of glucose control.
Interaction of Ethanol and Glipizide in Humans
Authors: Hartling Svend G , Faber Ole K , Wegmann Marie-Louise , Wåhlin-Boll Elisabeth , Melander Arne
Published: March 2007

The hypoglycemic effect of 2.5 mg glipizide and the potentiation of this effect by ethanol were studied in 10 normal-weight nondiabetic subjects. The reductions in blood glucose concentrations were similar in time of onset and extent (2 mM) whether glipizide was taken alone or in combination with ethanol. However, the return of blood glucose toward fasting level was delayed by ethanol. Β-Cell secretory activity, evaluated from the concentrations of insulin and C-peptide, was unchanged by ethanol. The serum glipizide concentrations were reproducible within subjects, whereas there was a considerable interindividual variation. This heterogeneity in the rise in glipizide concentration was strongly correlated with blood glucose fall and insulin secretion. Thus, ethanol can prolong but does not augment the hypoglycemia induced by glipizide. The heterogeneity in glipizide concentration seems to be caused by an interindividual variation in kinetics.
Impaired Glucose Tolerance, Hyperinsulinemia, and Hypertriglyceridemia in Australian Aborigines From the Desert
Authors: O'Dea Kerin , Traianedes Kathy , Hopper John L , Larkins Richard G
Published: March 2007

A cross section of adult full-blooded Aborigines from three small isolated communities in the desert region of northwest Australia was surveyed for diabetes, impaired glucose tolerance (IGT), insulin levels, and lipoprotein lipids. Sixty-three men and 86 women from a total adult population of 330 were tested. Of the people tested, 67.6% had normal glucose tolerance, 25% had IGT, and 7.4% had diabetes. Both diabetes and IGT were strongly age related. Fasting insulin levels and insulin responses to oral glucose (elevation above basal) were elevated. Although fasting insulin rose with age, insulin response did not rise after adjustment for body mass index (BMI). Plasma triglyceride levels were high, particularly in men >35 yr old (3.13 ± 0.32 mM), but cholesterol levels were not elevated. Multiple regression analysis of fasting glucose, 2-h glucose, plasma triglyceride, fasting insulin, and insulin response for the nondiabetic subjects revealed 7) BMI was an independent risk factor for elevated 2-h glucose levels in women but not in men and was strongly related to fasting insulin concentrations in both genders; 2) fasting insulin concentration was an independent risk factor for increases in fasting glucose, insulin response, and triglyceride levels; 3) insulin response was related to the 2-h glucose level; 4) fasting and 2-h glucose levels and fasting insulin and triglyceride concentrations all rose with age in both genders, with the rate of increase generally greater in men. The most striking difference between these desert Aborigines and previously studied coastal Aborigines from the same geographical region was the significantly higher insulin response. It is possible that the more severe hyperinsulinemia in the desert Aborigines may indicate a greater degree of susceptibility to type II diabetes than in the coastal Aborigines as the duration of urbanization increases.
Anti-Adrenal Medullary Antibodies in IDDM Subjects and Subjects at High Risk of Developing IDDM
Authors: Brown Florence M , Kamalesh Masoor , Adri M N Sesh , Rabinowe Steven L
Published: March 2007

Previous reports have noted the presence of antiadrenomedullary antibodies in subjects with insulindependent diabetes mellitus (IDDM). We initiated a study to evaluate the presence of complement-fixing anti-adrenomedullary antibodies (CF-ADM) in the following subjects: group 1 (age 4–60 yr), anti-islet cell antibody-positive (ICA+) subjects at high risk of developing diabetes, in which 9 (32%) of 28 were positive for CF-ADM; group 2 (age 6–41 yr), anti-ICA negative (ICA−) subjects at high risk of developing diabetes, in which 0 (0%) of 15 were positive for CFADM; group 3 (age 1–58 yr), ICA+ diabetic subjects, in which 7 (30%) of 23 were positive for CF-ADM; group 4 (age 5–68 yr), ICA− diabetic subjects, in which 1 (4%) of 24 was positive for CF-ADM; group 5 (age 20–56 yr), volunteer blood bank donor controls, in which 2 (6%) of 32 were positive for CF-ADM; and group 6, known healthy controls, in which 0 (0%) of 14 were positive for CF-ADM. CF-ADM were increased in group 1 compared with group 2 (P < .02) and both control groups (P < .02). CF-ADM were increased in group 3 compared with group 4 (P < .03) and both control groups (P < .03 vs. group 5, P < .05 vs. group 6). Presence of CF-ADM was associated with presence of ICA in group 1 (P < .02) and group 3 (P < .03). In view of these results, adrenomedullary autoimmunity is emerging as a new member of the human organ-specific autoimmune disorders. It occurs before the development of clinically overt diabetes and is associated with the presence of ICAs. The functional significance of adrenomedullary autoimmunity needs to be evaluated.
Hypoglycemic Effect of Opuntia streptacantha Lemaire in NIDDM
Authors: Frati-Munari Alberto C , Gordillo Blanca E , Altamirano Perla , Ariza C Raúl
Published: March 2007

To assess the hypoglycemic effect of the nopal Opuntia streptacantha Lemaire (O. streptacantha Lem.), three groups of patients with non-insulin-dependent diabetes mellitus (NIDDM) were studied. Group one (16 patients) ingested 500 g of broiled nopal stems. Group 2 (10 patients) received only 400 ml of water as a control test. Three tests were performed on group 3 (6 patients): one with nopal, a second with water, and a third with ingestion of 500 g broiled squash. Serum glucose and insulin levels were measured at 0, 60, 120, and 180 min. After the intake of O. streptacantha Lem., serum glucose and serum insulin levels decreased significantly in groups 1 and 3, whereas no similar changes were noticed in group 2. The mean reduction of glucose reached 17.6 ± 2.2% of basal values at 180 min in group 1 and 16.2 ± 1.8% in group 3; the reduction of serum insulin at 180 min reached 50.2 ± 8.0% in group 1 and 40.3 ± 12.4% in group 3. This study shows that the stems of O. streptacantha Lem. cause a hypoglycemic effect in patients with NIDDM. The mechanism of this effect is unknown, but an increased insulin sensitivity is suggested.
Effect of Temperament on Metabolic Control in Children With Diabetes Mellitus
Authors: Rovet Joanne F , Ehrlich Robert M
Published: March 2007

Fifty-one children with insulin-dependent diabetes mellitus (IDDM) and 24 healthy sibling controls were compared on one of two temperament questionnaires completed by parents. Children with IDDM did not provide a characteristic temperament profile or show any problem areas. A regression analysis to predict diabetic control as measured by most recent glycosylated hemoglobin (HbA1c) values revealed that five of the nine temperament scales accounted for a significant 42% of the variance in HbA1c (P < .001). Children with higher activity levels, greater regularity in routines, milder reactions to external stimuli, distractibility, and negative moods were achieving better glycemic control. The results are discussed in terms of how individual differences in behavioral organization, energy consumption, and stress modulation may affect blood glucose levels.
Prevention of Perinatal Morbidity by Tight Metabolic Control in Gestational Diabetes Mellitus
Authors: Drexel Heinz , Bichler Alfred , Sailer Sigurd , Breier Christoph , Lisch Hans-Jörg , Braunsteiner Herbert , Patsch Josef R
Published: March 2007

In a prospective controlled trial, we studied the effect of tight metabolic control on the outcomes of 102 gestational diabetes mellitus (GDM) pregnancies compared with outcomes of 102 matched nondiabetic control pregnancies. Women with GDM were treated to achieve and maintain a blood glucose concentration of <130 mg/dl at 1 h after breakfast. Treatment consisted of a diet low in oligosaccharides and fat and, if necessary, once daily insulin. By the end of gestation, 88 of the 102 women with GDM received insulin at a mean dose of 18 U/day. Duration of insulin therapy ranged from 3 to 32 wk with a median of 11 wk. Perinatal outcome of GDM pregnancies under this management equaled that of control pregnancies. The full spectrum of excess morbidity from GDM was prevented, and normal distribution of birth weight and normal rates of macrosomia, dystrophy, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal acidosis, and low Apgar scores were achieved. No mortality was observed. In addition to the two main study groups, we also studied a third group of 24 women with GDM whose treatment lasted ≤5 wk due to late diagnosis. This suboptimally treated group demonstrated a significant (P < .05) increase of macrosomia and umbilical artery acidosis compared with the well-treated GDM group. The study reported herein demonstrates that excess mortality and morbidity typically observed in GDM can be prevented by early institution of tight metabolic control, which required insulin in 86% of our patients.
Hyperzincuria in IDDM Women: Relationship to Measures of Glycemic Control, Renal Function, and Tissue Catabolism
Authors: Heise Carla C , King Janet C , Costa Francoise M , Kitzmiller John L
Published: March 2007

Eighteen women with insulin-dependent diabetes mellitus (IDDM) and 15 nondiabetic women participated in a study of the relationship of zincuria to measures of glycemic control, renal function, and tissue catabolism. In the IDDM women, mean ± SE glycosylated hemoglobin was 9.8 ± 0.5%, and fasting plasma glucose was 189 ± 19 mg/dl; duration of diabetes averaged 15 yr. In comparison with control women, the IDDM women excreted four times as much zinc in the urine. However, the total plasma zinc concentration was significantly higher in the IDDM than in the control women (14.7 vs. 13.4 μM). The increased urinary zinc loss in the IDDM women was not related to urine volume, urinary glucose excretion, fasting plasma glucose concentration, percent glycosylated hemoglobin, or an increased glomerular filtration rate. Total urinary protein losses were four times higher in the IDDM women than in the control women, and these urinary protein losses correlated with the urinary zinc losses (P < .007). There was no relationship between urinary zinc and the excretion of any of the amino acids, urea, or ammonia. The results of this study show that hyperzincuria in diabetes is not associated with lower plasma zinc levels. An increased zinc absorption, decreased intestinal zinc excretion, or increased tissue catabolism may support higher plasma zinc levels.
Etiology and Prognostic Significance of Albuminuria in Diabetes
Authors: Viberti Giancarlo
Published: March 2007

Persistent clinical proteinuria (i.e., urinary protein excretion >0.5 g/24 h) is an ominous development in a person with diabetes. It eventually leads to a decline in the glomerular filtration rate and ultimately to end-stage renal failure or premature cardiovascular mortality. Progression of renal disease appears to be related to arterial blood pressure and protein intake and is primarily independent of the metabolic state. More s nsitive immunoassays for detecting low concentration of albumin in urine have led to recognition of subclinic l increases in albumin excretion rates in nonclinically proteinuric diabetic patients, a phenomenon named microalbuminuria. Studies have shown that patients with microalbuminuria have a significantly increased risk for clinical proteinuria and cardiovascular mortality. Microalbuminuria is rarely found during the first 5 yr of a patient's diabetes, suggesting that it is a sign of early glomerular damage rather than a marker for susceptibility to it. In patients with non-insulin-dependent diabetes mellitus (NIDDM), an association has been found between microalbuminuria and coronary heart disease, but this relationship needs further investigation. In pat ents with insulin-dependent diabetes mellitus (IDDM), this subclinical form of proteinuria is associated with poor metabolic control and, more important, with marginal elevation of blood pressure. Correction of hypergly emia by intensified insulin treatment might arrest progression to persistent clinical proteinuria; moreover, restricted protein intake and lowering of blood pressure have been shown to reduce the albumin excretion rate. Recent evidence suggests that the development of nephropathy in IDDM may be linked to a familial, possibly genetically determined, predisposition to hypertension. The identification of genetic components would enable cl nicians to focus therapy on patients at risk for development of diabetic nephropathy.
Postprandial Exercise in Type I Diabetic Patients on Multiple Daily Insulin Injection Regimen
Authors: Trovati Mariella , Anfossi Giovanni , Vitali Sara , Mularoni Elena , Massucco Paola , Facis Roberto De , Carta Quirico , Lucchina Pietro Greco , Emanuelli Giorgio
Published: March 2007

This study shows the influence on plasma glucose concentrations of 45 min of mild exercise (48 ± 4% of maximum aerobic capacity) performed 180 min after breakfast and 195 min after a subcutaneous infection of regular Insulin by six type I (Insulin-dependent) diabetic patients on a three-daily insulin injection regimen (regular insulin before breakfast and lunch, regular + intermediate insulin before supper). It has been observed that such exercise does not induce a large plasma glucose decrease. Actually, plasma glucose concentrations were 99 18 mg/dl before exercise, reached a nadir of 78 ± 17 mg/dl at 35 min, and were 81 ± 15 mg/dl at the end of exercise. During the control study at rest, in the same 45-min time interval, plasma glucose decreased from 146 ± 31 to 128 ± 31 mg/dl. In the exercise study, one patient began exercising while hypoglycemic, and another patient developed asymptomatic hypoglycemia during exercise. In the control study at rest, one patient showed hypoglycemic glucose concentrations. Throughout the exercise study, plasma free-insulin concentrations decreased (from 32 ± 5 to 20 ± 4 μU/ml) as a result of the pharmacokinetics of subcutaneously injected insulin.
Type II Diabetes Mellitus: Interface Between Clinical and Epidemiological Investigation
Authors: Stern Michael P
Published: March 2007

The field of cardiovascular disease and atherosclerosis has been enriched by a fruitful interplay between basic and clinical scientists and epidemiologists. Such interaction has been less highly developed in the field of diabetes. I present an epidemiological perspective on certain problems in type II (non-insulin-dependent) diabetes research and point out some potentially useful directions for future interdisciplinary efforts involving both basic and clinical scientists and epidemiologists. Early research on diabetes has been marred by variable case definitions. The demonstration in numerous epidemiological studies that plasma glucose has a bimodal distribution in populations has contributed to the widely accepted National Diabetes Data Group (NDDG) and the nearly identical World Health Organization (WHO) definitions of diabetes. This development has markedly ameliorated many of the difficulties resulting from variable case definitions. Appreciation of the phenomenon of bimodality has also contributed to a better understanding of impaired glucose tolerance. Many studies on the pathogenesis of type II diabetes take the form of case-control (i.e., cross-sectional) studies. The weaknesses of this research design are well known to epidemiologists. Prospective studies, a much stronger research design for inferring causal relationships, are much less common in the field of diabetes than in the field of cardiovascular disease and atherosclerosis. Recently, however, two prospective studies have helped define the role of serum insulin levels and insulin resistance as diabetes risk factors. These studies were carried out in small, relatively isolated populations, and there is a great need to replicate these findings in larger, more representative populations and to further evaluate the relative role of insulin secretion and insulin resistance as diabetes risk factors. Because characterization of these metabolic parameters by modern techniques is complex and expensive, such studies will probably have to be carried out in high-risk populations in which the sample-size requirements are more modest.