bluuebunny/crossref_metadata_2025 huggingface dataset:
Polyunsaturated Fatty Acids May Impair Blood Glucose Control in Type 2 Diabetic Patients
Authors: Vessby B. , Karlström B. , Boberg M. , Lithell H. , Berne C.
Published: July 2009

Fifteen patients with Type 2 diabetes were given two diets rich in either saturated fat or polyunsaturated fat in alternate order over two consecutive 3‐week periods on a metabolic ward. Both diets contained the same amount of fat, protein, carbohydrates, dietary fibre, and cholesterol. The proportions of saturated, monounsaturated and polyunsaturated fatty acids in the saturated fat diet were 16, 10, and 5%‐energy and in the polyunsaturated fat diet (PUFA) 9, 10, and 12%‐energy. The PUFA diet contained a high proportion of n‐3 fatty acids. Metabolic control improved significantly in both dietary periods, due to both qualitative dietary changes and a negative energy balance. The serum lipoprotein concentrations decreased on both diets but the serum lipids were significantly lower after the PUFA diet (serum triglycerides −20%, p=0.001; serum cholesterol −5%, p=0.03; VLDL‐triglycerides −29%, p < 0.001; and VLDL‐cholesterol −31%, p=0.001) than after the saturated fat diet. Average blood glucose concentrations during the third week were significantly higher fasting (+ 15%, p < 0.01), and during the day at 1100 h (+18%, p < 0.001) and 1500 h (+ 17%, p=0.002) on PUFA than on the saturated fat diet. Significantly higher blood glucose levels were also recorded with a standard breakfast, while the sum of the insulin values was lower (‐19%, p=0.01). HbA1c did not differ significantly between the two dietary periods. The present study suggests that an increased content of polyunsaturated fatty acids, especially long‐chain n‐3 fatty acids, in a low fat diet may have beneficial as well as adverse effects in the management of Type 2 diabetes.
Glomerular Volume in Kidneys Transplanted into Diabetic and Nondiabetic Patients
Authors: Østerby Ruth , Nyberg G. , Karlberg I. , Svalander C.
Published: July 2009

Biopsies taken at the time of renal transplantation in 12 non‐diabetic and 23 diabetic patients were studied by quantitative light‐ and electron‐microscopy. Repeat biopsies were taken at 6 months and/or after 2–3 years in patients who had acceptable graft function. All patients except two received cyclosporin as part of the immunosuppression. Glomerular volume was significantly increased, + 36(95% CI +6 to +65)% (p = 0.03), in the diabetic patients at 6 months which differed from the change of −20 (‐50 to +10)% in the non‐diabetic patients (p = 0.03). After 2–3 years glomerular volume was equal to the baseline value in the diabetic patients, while the change from baseline in the non‐diabetic patients was −21 (‐42 to −1)%. Substantial glomerular occlusion was seen in only three diabetic patients after 2–3 years. Total structural volumes per glomerulus in the 2–3‐year biopsies showed an increase in basement membrane material of 0.09 times 106 μm3 in the diabetic patients, significantly different from the change in non‐diabetic patients (‐0.10 times 106 μm3, p = 0.003). No correlation was obtained between the 6‐month increase in glomerular volume and the development of diabetic glomerulopathy at 2–3 years. The fact that glomerular hypertrophy was not present in the entire series may be due to the cyclosporin and to rejection. Nevertheless the diabetic group did show an early hypertrophy which did not seem to play a major role in the ensuing development of diabetic glomerulopathy.
Assessment of Cardiovascular Autonomic Function: Age‐related Normal Ranges and Reproducibility of Spectral Analysis, Vector Analysis, and Standard Tests of Heart Rate Variation and Blood Pressure Responses
Authors: Ziegler Dan , Laux G. , Dannehl K. , Spüler M. , Mühlen H. , Mayer P. , Gries F.A.
Published: July 2009

To establish normal ranges for assessment of autonomic dysfunction, a battery of cardiovascular reflex tests was performed in 120 healthy subjects aged 15–67 years using a computer‐based technique. Tests of heart rate variation (HRV) included 8 measures at rest: coefficient of variation (CV), root mean squared successive difference (RMSSD), spectral analysis of HRV in the low frequency, mid frequency, and high frequency bands in the supine and standing postures; 5 measures during deep breathing: CVb, RMSSDb, Expiration‐Inspiration (E‐I) difference, E/I ratio, and mean circular resultant of vector analysis; Valsalva ratio, and max/min 30:15 ratio. In addition, the change in systolic and diastolic blood pressure in response to standing and the diastolic blood pressure response to sustained handgrip were determined. The results of all measures, the blood pressure tests excepted, declined significantly with increasing age (r = −0.16 to −0.59; p < 0.05). Moreover, RMSSD, RMSSDb, and E‐I difference decreased considerably with increasing heart rate (r = −0.37 to −0.52; p < 0.001). The longest and shortest R‐R intervals in response to standing were distributed within beats 21–39 and 6–24, respectively. All tests were independent of sex. Log transformation was used to define the age‐related lower limits of normal at the 2.3 centile for all tests of HRV, except for the E/I, Valsalva, and max/min 30:15 ratios. The results of these tests had to be analysed using a log(y‐1) transformation. The intra‐individual reproducibility determined on two consecutive days in 20 healthy subjects and 21 diabetic patients indicated that there were no major differences between the two groups regarding the day‐to‐day variation of test results, which was highest for the Valsalva ratio. We conclude that: (1) all indices of spectral and vector analyses of HRV are age‐dependent and have the advantage of being independent of heart rate; (2) RMSSD, E‐I difference, and the 30:15 ratio as it was used previously are not suitable for evaluation of autonomic dysfunction in diabetes; (3) log(y‐1) transformation is required to determine age‐dependent normal ranges and reproducibility for the three ratios.
Improved Diabetes Care in a UK Health District
Authors: Jones J.N. , Marsden P.
Published: July 2009

The present study reports an analysis of diabetes care in general practice in a London Health District. A specialist nurse facilitator used various techniques to obtain practice information building up individual practice profiles. Four groups of constraints were identified as affecting the provision of GP diabetes care. Individual practice plans were formulated, working with key staff, to apply various interventions to ameliorate identified constraints. Using a non‐prescriptive approach, GPs were encouraged to become involved in diabetes care in the way they felt most appropriate for their practice. Using this method, GP involvement in diabetes care has increased from 17 to 53% during the three years of the study.
Diabetic Neuropathic Cachexia Associated with Malabsorption
Authors: D'Costa D.F. , Price D.E. , Burden A.C.
Published: July 2009

Diabetic neuropathic cachexia is characterized by neuropathic pain and severe weight loss of unknown aetiology. We describe four patients with diabetic neuropathic cachexia who were found to have malabsorption. Four diabetic patients presented with neuropathic pain, anorexia, depression and weight loss of 16 (range 10–21) kg. None complained of diarrhoea. There were three males and one female, median age 54 (46–67) years. A butterfat test showed a serum turbidity difference of 9 (6–10) light scattering units (normal > 60 units). The median serum xylose was low and there was delayed urinary xylose excretion. Urinary indicans, small bowel histology, liver function tests, and thyroid and renal function were normal. Ultrasound scans of liver, gall bladder and pancreas, and endoscopic retrograde cholangiopancreatogram were normal. The patients were treated with pancreatic supplements and a high calorie diet. Three have completely recovered and the other patient is improving. Thus these cases of diabetic neuropathic cachexia appeared to be associated with malabsorption which may be due to pancreatic dysfunction. It is suggested that the management of diabetic neuropathic cachexia should include the investigation and treatment of malabsorption.
Genetic, Immunological, and Metabolic Determinants of Risk for Type 1 Diabetes Mellitus in Families
Authors: Lipton R. B. , Atchison J. , Dorman J. S. , Duquesnoy R. J. , Eckenrode K. , Orchard T. J. , LaPorte R. E. , Riley W. J. , Kuller L. H. , Drash A. L. , Becker D. J.
Published: July 2009

Prospective studies of the relatives of people with Type 1 diabetes can provide insights into risk factors for processes leading to the ultimate destruction of the pancreatic islet 8‐cells. Relatives ascertained through the Children's Hospital of Pittsburgh diabetes registry were followed and rates of conversion to diabetes were determined. We studied the role of genetic and immunological markers, and used the oral glucose tolerance test (OGTT) to study metabolic disturbances among first‐degree relatives. A group of siblings was serotyped for the HLA‐A and ‐B antigens, and the degree of HLA haplotype sharing with the diabetic sibling was established. Later, islet cell antibody (ICA) assays were performed, and subjects were followed to determine the predictive value of ICA testing for the subsequent development of diabetes. The rate of conversion to diabetes among the siblings was 14 times greater than the rate observed in the general population from which they come. This is comparable to rates observed by other centres following relatives of people with Type 1 diabetes. Impaired glucose tolerance (by National Diabetes Data Group (USA) criteria) carried a three‐fold greater risk for subsequent Type 1 diabetes than did a normal OGTT. Those relatives with detectable ICA were about 50 times more likely to convert to diabetes than were those without ICA. In a group of siblings in whom HLA haplotype sharing was determined, the prevalence of detectable ICA was greater among those who were HLA‐identical to the diabetic sibling (9.9 %) than among those who were haplo‐identical (5.3 %) or completely dissimilar (2.4 %) at the HLA‐A and ‐B regions. Similarly, the incidence of Type 1 diabetes was greater among those who were HLA‐identical (8.4 per 103 sibling‐years), than among those who were not HLA‐identical to the proband (4.2 per 103). The greatest risk for subsequent diabetes was found among HLA‐identical siblings who were ICA‐positive. Approximately 7 % of those who were HLA non‐identical or haplo‐identical and ICA‐positive became diabetic within 5 years, while more than 30 % of HLA‐identical siblings who were ICA‐positive became diabetic during the 5 years after ICA were detected.
Ethnic Differences in Insulin Secretion in Women at Risk of Future Diabetes
Authors: Dornhorst A. , Chan S. P. , Gelding S. V. , Nicholls J. S. D. , Baynes C. , Elkeles R. S. , Beard R. W. , Anyaoku V. , Johnston D. G.
Published: July 2009

The plasma glucose and insulin responses to oral glucose were studied in 44 women who had previously had gestational diabetes, but had reverted to normal glucose tolerance. Twenty were White, 14 Black, and 10 Asian. A group of race‐, age‐ and weight‐matched controls was also studied. Fasting values of glucose and insulin did not differ significantly between the study group and controls. During the 2 h 75‐g OGTT the White and Black previously gestational‐diabetic women had similar plasma glucose values to their controls, while the Asian previously gestational‐diabetic women had significantly higher glucose values at 30 min (9.2 ± 0.6 (± SE) vs 7.1 ± 0.3 mmol I−1, p < 0.02) and at 60 min (8.6 ± 0.8 vs 6.2 ± 0.4 mmol I−1, p < 0.02). Compared with their race‐matched controls, the White previously gestational‐diabetic women had significantly lower insulin values at 60 min (median 41 range 2–91) vs 56 (15–118) mU I−1, p < 0.05), and the Black previously gestational‐diabetic women had lower values at both 30 min (17 (4–116) vs 53 (22–197) mU I−1) and 60 min (36 (4–148) vs 99 (12–169) mU I−1, p < 0.05). The insulin values were similar during the OGTT in the Asian previously gestational‐diabetic women and their controls. The ratio of the insulin area:glucose area during the OGTT was significantly lower in the White and Black previously gestational‐diabetic women compared with controls (White 5.0 ± 0.7 vs 7.3 ± 0.9 mU mmol−1, p < 0.05; Black 5.0 ± 1.0 vs 8.9 ± 1.2 mU mmol−1, p < 0.02) while similar area ratios were observed for the Asian previously gestational‐diabetic women and their controls (7.6 ± 1.7 vs 8.7 ± 0.9 mU mmol−1).

The results suggest that there are ethnic differences in insulin secretion following oral glucose in previously gestational‐diabetic women.
Near Visual Acuity: A Simple Measure of Practical Significance in Insulintreated Diabetic Patients
Authors: Caldwell G.
Published: July 2009

The value of measuring near visual acuity as a predictor of loss of independence in administering insulin and monitoring blood or urine glucose has been assessed in 110 insulin‐treated diabetic patients. Near visual acuity was simple to measure in the clinic setting, and correlated well with 6 m acuity. Fourteen patients depended on an assistant either to draw up the correct dose of insulin (n = 12), inject the insulin (n = 7) or to monitor blood or urine glucose (n = 12). Of these 14 patients only one, who was demented, had near visual acuity better than N.12. Two other patients had near visual acuity N.12 or worse and yet were independent of help. One had severe visual impairment and used a pen‐injector and a meter with speech synthesizer, and the other had near visual acuity of N.12. Impairment of near visual acuity to N.12 or worse is associated with loss of independence in insulin‐treated diabetes. Measurement of near visual acuity could be useful in predicting independence of insulin‐treated patients.
Work‐load and Outcomes of Diabetes Care in General Practice
Authors: Bradshaw C. , Eccles M.P. , Steen I.N. , Choi H.Y.
Published: July 2009

The effect of starting a general practice diabetes clinic on practice work‐load and intermediate outcome measures was studied retrospectively using patient records. The 35 diabetic patients included had been diagnosed > 4 years before the diabetes clinic started and were followed for 6 years in the clinic, together with a group of age‐ and sex‐matched controls. There was a significant rise in the consultation rates of the diabetic patients, due to an increase in diabetes‐related consultations, from 3.9 consultations yr−1 to 6.7 consultations yr−1 (p < 0.001). There was a fall in HbA1c level of 0.22 (99 % CI 0.13, 0.32) %Hb yr−1 over the 6 years and in body mass index of 0.37 (99 % CI 0.22, 0.52) kg m−2 yr−1, suggesting an improvement in diabetes management.
New Insights on Non‐enzymatic Glycosylation May Lead to Therapeutic Approaches for the Prevention of Diabetic Complications
Authors: Ceriello A. , Quatraro A. , Giugliano D.
Published: July 2009

It is generally accepted that chronic hyperglycaemia is responsible for most of the long‐term complications of diabetes. Several studies suggest that accelerated non‐enzymatic glycosylation may be the underlying mechanism by which hyperglycaemia causes complications. More recently, glucose auto‐oxidation has been linked to non‐enzymatic glycosylation, and glycosylated proteins have been shown to be a source of free radicals. These findings suggest the possibility that oxidative stress may be related to the development of diabetic complications. Anti‐oxidants such as vitamins C and E have recently been demonstrated to reduce protein glycosylation both in vivo and in vitro. In addition they also act as scavengers of free radicals generated by non‐enzymatic glycosylation of protein. These findings may lead to new therapeutic approaches for the prevention of complications by limiting the damage caused by non‐enzymatic glycosylation and oxidant stress. Such therapies may also be useful in complementing existing treatment in those with the long‐term complications of diabetes.
The Prevalence of Diabetic Distal Sensory Neuropathy in an English Community
Authors: Walters D.P. , Catling W. , Mullee M.A. , Hill R.D.
Published: July 2009

The prevalence of lower limb neuropathy was determined in a known diabetic population. From a general population of 97034 subjects, a total of 1150 diabetic patients were identified of whom 1077 (93.7%) were reviewed. Neuropathy was defined as symptoms plus one abnormal physical finding, or two abnormal physical findings. An age‐ and sex‐matched non‐diabetic control group of 480 individuals was also examined by the same single observer. The prevalence of neuropathy was 16.3 (95% CI 14.6–19.0)% in diabetic patients and 2.9 (95% CI 1.4–4.4)% in non‐diabetic subjects, yielding a prevalence odds of 6.75 (95% CI 3.87–11.79), p < 0.001. In Type 1 diabetes, the prevalence was 12.7 (95% CI 8.0–17.6)% and in Type 2 diabetes 17.2 (95% CI 15.9–18.5)%. After adjusting for age, the difference was not significant (odds ratio (OR) 1.60 (95% CI 0.95–2.76)). The prevalence of neuropathy increased with age in diabetic and non‐diabetic subjects. Multiple logistic regression analysis of selected (variables revealed that height (OR per cm 1.06 (95% CI 1.00–1.13), p < 0.05) and retinopathy (OR 9.00 (95% CI 7.72–10.30), p < 0.001) in Type 1 diabetes and age (OR per year 1.02 (95% CI 1.00–1.05)), height (OR per cm 1.06 (95% CI 1.03–1.08), p < 0.001),) alcohol intake (OR per unit of alcohol consumed per week 1.03 (95% CI 1.00–1.05), p = 0.005), HbA1 (OR per 1% 1.21 (95% CI 1.08–1.35), p = 0.005), and any retinopathy (OR 2.14 (95% CI 1.67–2.62), p = 0.002) in Type 2 diabetes were significant predictors of neuropathy. The prevalence of neuropathy increased with the duration of diabetes but an independent association was not found for either type of diabetes.
Serum and Urinary Concentrations of Type IV Collagen and Laminin as a Marker of Microangiopathy in Diabetes
Authors: Haiyashi Yoshikazu , Makino H. , Ota Z.
Published: July 2009

Serum and urinary concentrations of type IV collagen and laminin were measured by enzyme‐linked immunosorbent assay (ELISA) in diabetic patients and compared with normal control subjects. In diabetic patients with proteinuria or with renal insufficiency, serum and urinary concentrations of type IV collagen were higher than those of control subjects (p < 0.005). Furthermore urinary concentrations of type IV collagen and laminin were significantly higher in diabetes, even in the absence of nephropathy, than in normal controls (p < 0.05). Urinary concentrations of type IV collagen in patients with diabetes and microalbuminuria (0.73 ± 0.11 mg mmol−1) were significantly higher than in diabetic patients without nephropathy (0.40 ± 0.060 mg mmol−1) (p < 0.025). Urinary concentrations of type IV collagen may have a role as an indicator of early diabetic nephropathy. Serum concentrations of type IV collagen in diabetic patients with retinopathy were significantly higher than in normal controls (p < 0.025). However, urinary concentrations of type IV collagen (p < 0.05) and serum concentrations of laminin (p < 0.025) were significantly higher in diabetic patients than normal controls and the difference between patients with and without retinopathy was not significant.
Sex Hormone Binding Globulin Levels in Adolescent Subjects with Diabetes Mellitus
Authors: Holly J.M.P. , Dunger D.B. , AI‐Othman S.A. , Savage M.O. , Wass J.A.H.
Published: July 2009

In normal adolescents there is a pubertal fall in circulating levels of sex hormone binding globulin (SHBG) in both sexes which is not explained by classically accepted mechanisms of control of SHBG. Recent in vitro and in vivo evidence has suggested that SHBG is inversely regulated by insulin. In view of this we have compared SHBG levels in 80 adolescent subjects with Type 1 diabetes to those in 61 normal adolescents. In both normals and in Type 1 diabetic subjects there was a pubertal fall in SHBG levels. Contrary to expectations, SHBG levels were not elevated in those with diabetes, but prepubertally were significantly lower in both sexes (boys mean ± SD, 70 ± 28 nmol I−1, normals 130 ± 52 nmol I−1 p < 0.001; girls, 61 ± 17 nmol I−1, normals 110 ± 23 nmol I−1, p = 0.01). In pubertal subjects no differences in SHBG levels were seen between the two groups, or between either sex within any group. In subjects with Type 1 diabetes SHBG levels were unrelated to metabolic control as reflected by HbA1 but were inversely related to pubertal stage (r = 0.55, p < 0.001). In prepubertal subjects with diabetes, in whom abnormal SHBG levels were found, these levels were weakly related to insulin dose (r = 0.33, p < 0.05); no such relationship was found in the other groups. The significance of the abnormal SHBG levels in prepubertal children with diabetes and its relationship to any irregularities of their sexual development is unclear.
Quality of Life in Young Adults with Type 1 Diabetes in Relation to Demographic and Disease Variables
Authors: Eiser Christine , Flynn M. , Green E. , Havermans T. , Kirby R. , Sandeman D. , Tooke J. E.
Published: July 2009

Sixty‐nine young adults (mean age 21 (range 15–25) years) with Type 1 diabetes completed measures of diabetes knowledge and quality of life. Factor analysis of the quality of life scale resulted in the identification of three subscales (social relationships, diabetes concerns, and impact). There was no relation between any of the quality of life subscales with knowledge, or with multiple versus twice‐daily insulin injection regimens. Higher self‐rated diabetes satisfaction was related to lower fructosamine levels and better clinic attendance (p < 0.05). Females reported a more negative impact of diabetes on their lives compared with males (p < 0.05).
Use of the Accident and Emergency Department by Patients with Diabetes
Authors: Holmwood K.I. , Williams Rhys , Roland J.M.
Published: July 2009

As part of a District‐based audit of diabetes care all attendances (of diabetic and non‐diabetic patients) at a local Accident and Emergency department were monitored over a 3‐month period. A total of 9505 attendances took place of which 62 (0.7%) were by people with diabetes. This was no different from the expected number of attendances (61.5) based on the rates seen in non‐diabetic individuals. Of these 62 attendances, 20 (by 15 individuals) were directly related to diabetes (hypoglycaemia 17, hyperglycaemia 1, for supplies of insulin or equipment 2). When these diabetes‐specific attendances were removed from the total, the number of attendances (42) was significantly (p = 0.004) less than that expected. Diabetic males aged 0–19 years attended significantly more often than non‐diabetic individuals of the same age but this excess was solely attributable to diabetes.
The Diabetes Annual Review as an Educational Tool: Assessment and Learning Integrated with Care, Screening, and Audit
Authors:   The North Tyneside Diabetes Team
Published: July 2009

An integrated diabetes Annual Review is described, suitable for the long‐term care of large numbers of diabetic patients. Equal weight is given to dietary and educational assessment as to medical care and screening. Based on well‐developed team‐work the patient moves through a structured review which culminates in goal setting and planned care for the subsequent year. A structured audit of the review was carried out on a cohort of 123 patients of whom 67 had had two annual reviews. Ten patients failed to attend. Knowledge scores improved by 44% between first and second reviews. In 34% of patients in the first year and in 46% in year two, HbA1c levels were outside a target range set for each treatment group, but only 18% had results outside target in both years. A postal questionnaire was returned by 74/108 (69%) patients. This indicated a high level of patient participation and satisfaction with the review process. The diabetes team set standards, conducted the review, and subsequently changed in‐house working practices and documentation, and developed in‐service training.
Sequential Metabolic Studies of Pancreas Allograft Function in Type 1 Diabetic Recipients
Authors: Cottrell Daryl A. , Henry Mitchell L. , O'Dorisio Thomas M. , Tesi Raymond J. , Ferguson Ronald M. , Osei Kwame
Published: July 2009

We have previously shown that the loss of acute first phase insulin secretion precedes pancreas allograft rejection and development of glucose intolerance in Type 1 diabetic patients. In order to examine whether there is a progressive loss of phases of insulin secretion and beta‐cell function in technically successful pancreas transplants during the first year, we measured glucose, insulin, and C‐peptide responses to physiological (mixed meal) and pharmacological (IV glucose and IV glucagon) stimulation in 27 glucose‐tolerant, insulin‐independent allograft recipients at 3, 6, and 12 months. Mean ± SE fasting serum glucose levels were normalized throughout the study period. Postprandial serum glucose profiles tended to increase by 12 months compared to 3 and 6 months, although peak glucose levels were not statistically different. Following pancreas transplantation, basal serum insulin levels were high at 3 months (163 ± 17 pM), 6 months (165 ± 22 pM), and 12 months (248 ± 54 pM,p= NS) in the Type 1 diabetic pancreas allograft recipients when compared to normal (25 ± 3 pM). We observed slight elevations in postprandial insulin and C‐peptide profiles at 12 months compared to 3 and 6 months. Following IV glucose and glucagon stimulation, serum insulin and C‐peptide levels as well as phases of insulin release did not differ over the 12‐month study period. Similarly, the glucose decay constant (KG) was nearly identical at 3, 6, and 12 months.

In summary, 1 year following successful whole cadaveric, heterotopic pancreas transplantation in Type 1 diabetic recipients, fasting serum glucose remains normalized, while postprandial glucose tends to rise. This alteration in post‐mixed meal glucose tolerance is achieved at the expense of elevated basal and post‐stimulation insulin and C‐peptide levels, suggesting worsening of the insulin‐resistant state in such patients. The upward trend in glucose levels was observed only after mixed meal but not intravenous glucose stimulation. In addition, the acute first and second phase insulin release to both glucose and non‐glucose stimuli, which are more sensitive markers for beta‐cell dysfunction, were preserved 12 months following pancreas transplantation in Type 1 diabetic recipients.
Screening for Diabetic Retinopathy in a Widely Spaced Population using Nonmydriatic Fundus Photography in a Mobile Unit
Authors: Leese G.P. , Newton R.W. , Jung R.T. , Haining W. , Ellingford A. ,   The Tayside Mobile Eye Screening Unit
Published: July 2009

A screening project was established to assess the prevalence and severity of retinopathy in diabetic patients in Tayside (area: 3000 square miles, population: 390 000). A questionnaire was used to examine patient acceptability. Of 2112 patients photographed during the first year, 32% had abnormal photographs; 20.2% had diabetic retinopathy; 7.4% cataracts; 4.6% non‐diabetic eye disease. Among this patient population, 73% were registered at a hospital diabetic clinic. The overall prevalence of diabetic retinopathy was similar between the two groups (hospital 23% vs non‐hospital 20%). The prevalence of severe diabetic retinopathy was also similar (hospital 8.5% vs non‐hospital 10%). This had been previously unrecognized or incorrectly defined in 6.5% of those not attending a hospital diabetic clinic, compared to 3.7% attending the hospital clinic (p < 0.01). A favourable response to the service was indicated by 40% of patients with 7% unfavourable and 41% uncommitted. Non‐mydriatic fundal photography housed in a mobile unit is a practical and effective method of assessing diabetic retinopathy. It is particularly suitable for screening in a widely spread population.
A 12‐Month Randomized Controlled Study of the Aldose Reductase Inhibitor Ponalrestat in Patients with Chronic Symptomatic Diabetic Neuropathy
Authors: Krentz A.J. , Honigsberger L. , Ellis S.H. , Hardman M. , Nattrass M.
Published: July 2009

The effects of the aldose reductase inhibitor ponalrestat (600 mg day−1) on sensory, electrophysiological, and autonomic function were examined in 50 patients with chronic symptomatic, distal symmetrical diabetic neuropathy in a 52‐week randomized, doubleblind, parallel‐group, placebo‐controlled, single‐centre study. In an endeavour to identify patients with a degree of neuropathy potentially amenable to pharmacological intervention, a minimum conduction velocity of 30 m s−1 was set for the peroneal motor nerve. At 52 weeks, no significant differences were observed between the ponalrestat and placebo groups in motor (ulnar, median, and peroneal) or sensory (ulnar and radial) nerve conduction velocities, vibration perception thresholds, adjectival symptom scores or tests of autonomic function (mean electrocardiographic R‐R interval variability on deep breathing and orthostatic blood pressure response). Ponalrestat was clinically well tolerated and had no significant effect on glycaemic control. The lack of beneficial effects of ponalrestat may in part reflect the advanced stage of the neuropathic process in patients with established symptomatic disease, and the poor reproducibility of current neurophysiological techniques. Firmer knowledge of clinico‐pathological correlates allied to improved non‐invasive neurophysiological measurement techniques should facilitate the selection of patients for future therapeutic trials in diabetic neuropathy.
Problems with Gait and Posture in Neuropathic Patients with Insulin‐Dependent Diabetes Mellitus
Authors: Cavanagh P.R. , Derr J.A. , Ulbrecht J.S. , Maser R.E. , Orchard T.J.
Published: July 2009

Peripheral neuropathy secondary to diabetes mellitus is believed to cause postural instability and uncoordinated gait, although this is not well documented. Two groups of patients from the Pittsburgh Epidemiology of Diabetes Complications Study, matched for age and duration of Type 1 diabetes, but with significantly different vibratory sensation thresholds as determined by Vibratron II testing, were therefore surveyed. The mean ages were 32.9 and 31.9 years and durations of diabetes were 22.0 and 18.8 years for the neuropathic and control groups, respectively. Patients provided details of fall injuries, and perception of safety during standing and walking. Multiple linear and logistic regression models were used to account for potentially associated variables such as gender, retinopathy, and duration of diabetes. The neuropathic group had adjusted odds ratios for reported injuries during gait of 15.0 relative to the control group (95% confidence intervals 1.04–216.59). The neuropathic group also reported significantly lower scores (less safe, p = 0.004) than the control group on perceived safety in unusual conditions. It is concluded that peripheral neuropathy has an effect on gait and posture which is clinically significant and that this effect merits further biomechanical study in neuropathic patients.
Diabetes Education: Whose Priorities Are Met?
Authors: Genev N.M. , Flack J.R. , Hoskins P.L. , Overland J.E. , Yue D.K. , Turtle J.R.
Published: July 2009

Two hundred Type 2 diabetic patients newly referred to the diabetes centre at a large university teaching hospital were studied over an 8‐month period. Patients completed a diabetes knowledge questionnaire, and specified their educational priorities by selecting six diabetes‐related topics from a list of 14. After giving 1 h of individual education and using the same list, the educators selected six topics which they considered to be most important for that particular patient to know. Choice of educational priorities differed between the patients and the corresponding educator (p < 0.001). In only 38% of cases did the educators' first three priorities coincide with those of the patients. The major discrepancies were in the selection of ‘sick day management’ and ‘complications’, especially favoured by patients, as against ‘oral hypoglycaemic agents’ and other therapy‐related topics, especially favoured by educators. Diabetes knowledge was a determinant of educational priority for patients (p < 0.001) but not educators. In contrast, only the educators' overall choices were affected by duration of diabetes (p < 0.001). Diabetes treatment type influenced both patients' and educators' selection of priorities (p < 0.001). We conclude that an educational strategy which relies on health professionals' perceptions to determine what diabetic patients need to know may be inadequate.
The Effect of Diabetes Mellitus on the Outcome of Angioplasty for Lower Limb Ischaemia
Authors: Davies A.H. , Cole S.E. , Magee T.R. , Scott D.J.A. , Baird R.N. , Horrocks M.
Published: July 2009

Angioplasty is an important tool in the armamentarium of the clinician dealing with atherosclerotic disease. Diabetic patients with occlusive disease pose special problems. Four hundred and twenty‐five lesions were dilated in 370 patients. No difference in site was found when comparing the diabetic and non‐diabetic groups (p < 0.001), but a significant difference in indication for treatment was observed. Cumulative patency at 5 years for iliac lesions in non‐diabetic patients was 61.2% and in diabetic patients was 35.6% (p < 0.05), for superficial femoral and popliteal artery lesions in non‐diabetic patients it was 49.7% and in diabetic patients it was 38.8% (NS). The need for subsequent surgical intervention (p < 0.01) and risk of death (p < 0.001) are both significantly greater in the diabetic group. This study shows that angioplasty is a technique that can be used with success in diabetic patients and if the indications for intervention are compared, diabetic patients do no worse.
Gastric Inhibitory Polypeptide (GIP) Response in Diabetes Using a Highly Specific Antiserum
Authors: Alam M.J. , Kerr J. I. , Cormican K. , Buchanan K. D.
Published: July 2009

Gastric inhibitory polypeptide (GIP), a hormone secreted from the proximal small gut, is recognized as a major component of the enteroinsular axis. However, circulating levels of GIP in diabetes have been reported to be exaggerated, normal or decreased following glucose ingestion, which may be due to the presence of variable crossreacting immunoreactive GIP forms in the circulation. We have raised an antibody (S705) which recognizes only 5 kDa GIP. Using this antiserum we have measured circulating GIP levels in 18 healthy volunteers, and 13 Type 2 diabetic and 9 Type 1 diabetic patients following ingestion of 75 g glucose. As expected, blood glucose levels and blood insulin levels are significantly abnormal in the diabetic groups. On the other hand, circulating GIP levels at all time‐points and integrated incremental GIP over 120 min were not different from the control group. However, we cannot exclude the possibility that apparently normal immunoreactive GIP levels in diabetes might conceal subtle alterations in biological activity which could play a role in the pathogenesis of the disease.
Thermal Threshold Testing for the Assessment of Small Fibre Dysfunction: Normal Values and Reproducibility
Authors: Bravenboer B. , van Dam P.S. , Hop J. , v.d. Steenhoven J. , Erkelens D.W.
Published: July 2009

Small and large fibre neuropathy are common findings in patients with long‐standing diabetes mellitus. The Thermal Threshold Tester was tested to obtain normal values for thermal perception threshold for warmth and cold. This device produces thermal stimuli by means of a Peltier element placed on the skin. Warm and cold thresholds are measured using a forced choice method with an up‐and‐down‐transform rule and expressed in degrees Celsius (°C). Thresholds were measured at the right wrist and right foot in 80 normal subjects, divided into four age groups; 25–34, 35–44, 45–54, and 55–65 years. The repeatability coefficient was assessed by twice measuring 39 diabetic patients without known neuropathy. Warm thermal threshold in the hand showed a significant increase with age from 0.09 ± 0.5 (mean ± SD) in the youngest age group to 0.17 ± 0.08 °C (p < 0.05) in the oldest age group. Cold thermal threshold in the hand (varying between 0.08 ± 0.04 and 0.14 ± 0.05 °C) and warm thermal threshold in the foot (varying between 2.45 ± 1.93 and 4.06 ± 2.57 °C) did not differ significantly between the four age groups. There was a significant increase in cold thermal threshold in the foot with age, increasing from 0.31 ± 0.24 to 0.56 ± 0.44 °C (p < 0.05). Reproducibility in the diabetic subjects was good for measurements of warm and cold threshold in the hand, but poor for warm threshold in the foot in the normal range and for cold thermal threshold in the abnormal range.
Screening Programme for Microvascular Complications and Hypertension in a Community Diabetic Population
Authors: Higgs E.R. , Kelleher A. , Simpson H.C.R. , Reckless J.P.D.
Published: July 2009

The role of a community‐based screening programme for microvascular complications of diabetes and hypertension was evaluated in the semi‐rural town of Trowbridge (population 31000). Of 405 diabetic patients identified (prevalence 1.31%), 358 (88%) attended for screening, 94 (26%) of whom were under hospital review for diabetes. In only 136 patients (38%) were all aspects of diabetes care found to be satisfactory. The remaining 222 patients included 162 patients with poor metabolic control (HbA1 ≥ 12%), 118 who were hypertensive at screening, 13 with previously undiagnosed diabetic nephropathy, and 29 with undiagnosed potentially sight‐threatening retinopathy. Overall standards of diabetes care in this community population appear inadequate, and might be improved by introduction of a simple screening programme for diabetic complications.
The Prevalence of Hypercholesterolaemia and its Relationship With Albuminuria in Insulin‐dependent Diabetic Patients: An Epidemiological Study
Authors: Haaber A.B. , Kofoed‐Enevoldsen A. , Jensen T.
Published: July 2009

To assess the prevalence of hypercholesterolaemia and its relationship with metabolic control and urinary albumin excretion in Type 1 diabetic patients, all 1577 insulin‐dependent patients attending the outpatient clinic at the Steno Memorial Hospital were studied. None had previously received lipid‐lowering drugs. Hypercholesterolaemia, defined as plasma concentration of cholesterol above 6.4 mmol I−1 was found in 156 patients (10%) (95%) confidence intervals (CI) 8.4–11.5%) compared with 11% in the Danish background population. Compared with the normolipidaemic diabetic patients, the hyperlipidaemic patients were older (42 vs 37 years: p < 0.001, 95% CI for difference in means 3–7 years), they had a higher glycosylated HbA1C (9.2 vs 8.6%, p < 0.001, 95% CI for difference in means 0.4–1.3%) and their urinary albumin excretion was 32 vs 12 mg 24 h−1, p < 0.001. Of the 1577 diabetic patients, 1084 patients (73%) had normal urinary albumin excretion (UAE < 30 mg 24 h−1), 255 (17%) had microalbuminuria (UAE 30–300 mg 24 h−1) and 136 (9%) had overt clinical nephropathy (UAE > 300 mg 24 h−1). The plasma concentration of cholesterol rose significantly with increasing urinary albumin excretion; normoalbuminuric 4.78 mmol I−1 ± 1.06 (mean ± SD); microalbuminuria 5.12 mmol I−1 ± 1.23 and macroalbuminuric: 4.89 mmol I−1 ± 1.38 (p < 0.001). The influence of metabolic control on the plasma level of cholesterol was of only minor clinical importance.

Thus, even though patients with diabetic nephropathy have elevated plasma concentrations of cholesterol, the overall prevalence of hypercholesterolaemia in a large unselected group of insulin‐dependent diabetic patients is not higher than in the background population.
Five Year Audit of Peripartum Blood Glucose Control in Type 1 Diabetic Patients
Authors: Njenga E. , Lind T. , Taylor R.
Published: July 2009

An audit was conducted of the degree of blood glucose control achieved during labour using a simple glucose/insulin infusion regimen. Records were examined of 40 pregnancies in 37 women over a 5‐year period. Mean blood glucose was 5.2 ± 2.2 (SD) mmol−1 7 h before delivery and 4.7 ± 1.8 mmol−1 1 h before delivery. Four women experienced mild symptomatic hypoglycaemia before delivery and two during the 6 h after delivery. Seven neonates had blood glucose levels of 2.2 mmol−1 or less recorded at any time, but there was no relationship between neonatal hypoglycaemia and maternal hyperglycaemia during labour in the range of achieved maternal blood glucose levels. The mean HbA1 at booking was 8.4 ± 1.2% (non‐diabetic range 5.0–7.5%) and fell to a steady plateau from 12 weeks gestation to delivery averaging 7.5% (2SD above the non‐diabetic mean). These data demonstrate the practical applicability of a simple regimen for control of blood glucose during labour in insulin‐dependent diabetic women and suggest that less stringent aims of blood glucose control than originally adopted may be appropriate.
Conventional and Sprinkler Needle Injection of Magnesium Insulin
Authors: Colagiuri S. , Bryson J. , Keating S. , Tan L. , King J. , Eigenmann C. , Jørgensen K. H.
Published: July 2009

Currently available short‐acting insulin preparations fail to mimic the postprandial insulin profile of non‐diabetic individuals. The activity of a novel insulin designed for faster absorption has been tested after subcutaneous injection. Magnesium insulin (50 U ml−1) given by sprinkler needle was compared with unmodified human insulin (100 U ml−1) given by conventional needle and unmodified human insulin (50 U ml−1) given by sprinkler needle in normal volunteers using a euglycaemic clamp. Magnesium insulin had a significantly faster onset of action resulting in a higher exogenous insulin level by 15 min, peak level was reached after 60 min compared with 75 min for the unmodified insulins, and duration of action was significantly shorter than both unmodified insulins. No significant differences were observed between the unmodified insulins for the first 5 h after injection, indicating that the observed differences to magnesium insulin could not be attributed to the insulin concentration or the type of needle used for insulin administration. Injection of magnesium insulin prior to a test breakfast in people with Type 2 diabetes resulted in significantly lower total and 0 to 120 min areas under the glucose curve, an earlier rise in exogenous insulin levels and a higher area under the insulin curve from 0 to 120 min compared with unmodified 100 U ml−1human insulin.
The Effect of Insulin Infusion on Capillary Blood Flow in the Diabetic Neuropathic Foot
Authors: Flynn M.D. , Boolell M. , Tooke J.E. , Watkins P.J.
Published: July 2009

The effect of a short‐term improvement in glycaemic control induced by insulin infusion on foot skin capillary blood flow was previously unknown. In seven Type 2 (non‐insulin‐dependent) diabetic subjects with neuropathy capillary blood flow was measured in the great toe nailfold by television microscopy. An estimate of arteriovenous shunt flow was obtained simultaneously in the pulp of the great toe by laser Doppler flowmetry. After omission of oral hypoglycaemic therapy for 24 h mean blood glucose was 15.7 ± 0.7 (SEM) mmol I−1. A priming infusion of 0.1 U kg−1 of insulin was given intravenously over 15 min, followed by a variable rate insulin infusion adjusted to steadily reduce blood glucose avoiding hypoglycaemia. At the end of the study blood glucose was reduced to 6.9 ± 0.7 mmol I−1 (p < 0.001). During the insulin infusion, capillary blood velocity increased by 28.8% (p < 0.05), and the diameter of the capillary erythrocyte column increased from 7.6 ± 0.2 to 9.2 ± 0.3 μm (p < 0.01). Thus during the insulin infusion, the calculated capillary flow increased to 226 ± 36% above basal values (p < 0.01). Laser Doppler flow did not change significantly, suggesting that during insulin infusion skin blood flow is redistributed with an increase in capillary flow relative to arteriovenous shunt flow.
Clinical and Metabolic Characteristics of Type 1 and Type 2 Diabetes: An Epidemiological Study From the Närpes Community in Western Finland
Authors: Eriksson J. , Forsén B. , Häggblom M. , Teppo A‐M. , Groop L.
Published: July 2009

Clinical and metabolic characteristics of all known Type 1 and Type 2 diabetic patients in a well‐defined area in Western Finland are described. Retrospective data from the time of diagnosis and follow‐up data were examined. Overall prevalence of diabetes was 25.4 cases per 1000 population. Patients were defined as having Type 1 or Type 2 diabetes based upon early insulin requirement and C‐peptide levels. Applying these criteria 84% of the patients had Type 2 diabetes. Onset before the age of 40 years was observed in only 3% of Type 2 diabetic patients. This age limit therefore had a sensitivity of 97% and a specificity of 90% in correctly predicting Type 2 diabetes. At diagnosis, hypertension was observed in 2% of Type 1 and in 75% of Type 2 diabetic patients; the corresponding numbers at follow‐up were 6 and 63%. At investigation, 27% of Type 1 and 22% of Type 2 diabetic patients had microalbuminuria. Retinopathy was observed in only 12% of Type 2 compared with 54% of Type 1 diabetic patients. The presence of retinopathy was associated with longer diabetes duration both among Type 1 and Type 2 diabetic patients. A significant decrease in C‐peptide concentration was observed in Type 2 diabetic patients with increasing diabetes duration. The data therefore suggest that Type 2 diabetes is associated with a deterioration of beta‐cell function with time.
Education and Employment Experiences in Young Adults with Type 1 Diabetes Mellitus
Authors: Lloyd C.E. , Robinson N. , Fuller J.H.
Published: July 2009

Educational attainment, employment experiences, and self‐esteem were measured using semi‐structured questionnaires in young adults with Type 1 diabetes mellitus and in a group of age/sex matched healthy controls. Results showed that subjects with diabetes and their matched controls obtained comparable qualifications at all levels. However, subjects with diabetes were less likely to feel competent with regard to their educational performance, and many of this group reported experiencing difficulties at school. There were no differences in the proportion of each group who had experienced unemployment, although this was explained more by social class and educational attainment. Whereas only a minority had decided to withhold information about their condition from their employers, one‐third of those with diabetes had experienced health‐related problems in obtaining employment.

This study suggests that the educational achievements and employment experiences of young adults with diabetes may not differ from those of healthy controls. However subjective reports of difficulties in these areas may be associated with reduced self‐esteem. Confirmation of these findings should be carried out in a larger sample, using a prospective design.