bluuebunny/crossref_metadata_2025 huggingface dataset:
Accurate Estimation of Glomerular Filtration Rate in Diabetic Nephropathy From Age, Body Weight, and Serum Creatinine
Authors: Sampson Michael J , Drury Paul L
Published: March 2007

Objective

To assess, in diabetic nephropathy, the accuracy of a method that estimates glomerular function with age, body weight, and serum creatinine as parameters.

Research Desihn and Methods

Glomerular filtration rate (GFR) was measured 57 times in 20 subjects with insulin-dependent diabetes mellitus and nephropathy with a single injection of 51Cr-EDTA. At the same time, the estimated creatinine clearance (ml/min) was calculated with the Cockroft-Gault formula

These values were then corrected for body surface area (1.73 m2).

Results

For GFR measurements <100 ml · min−1 · 1.73 m−2 (n = 41), there was a strong positive correlation with the estimated creatinine clearance corrected for body surface area (r = 0.94, P <0.0001). The slope of this regression line did not differ significantly from identity or the y-intercept from zero. On average, the Cockroft-Gault formula (corrected for body surface area) underestimated the GFR by only 3.1 ml·min−1·1.73 m−2 (9.7 SD).

Conclusions

This formula, corrected for body surface area, gives accurate estimates of GFR when GFR <100 ml·min−1·1.73 m–2. This formula could be used with an acceptable degree of confidence when repeated isotope assessments of renal function in diabetic nephropathy are impracticable.
Early Infant Diet and Risk of IDDM in Blacks and Whites: A Matched Case-Control Study
Authors: Kostraba Jill N , Dorman Janice S , LaPorte Ronald E , Scott Fraser W , Steenkiste Ann R , Gloninger Margaret , Drash Allan L
Published: March 2007

Objective

To investigate the role of early infant feeding in the development of insulin-dependent diabetes mellitus (IDDM) and to determine whether an association exists in both blacks and whites.

Resarch Design and Methods

Black and white diabetic subjects were recruited from the Allegheny County and Children's Hospital of Pittsburgh IDDM Registries. Extensive infant diet histories were obtained from the diabetic subjects and their nondiabetic siblings, who were used as nondiabetic control subjects. Each diabetic subject was matched outside his/her family to an unrelated nondiabetic control subject on birth order, birth year (± 2 yr), and race, which resulted in 211 case-control pairs with a mean birth year of 1967.

Results

In whites, diabetic subjects were less likely to have been breast-fed than control subjects (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.3, 0.9). Breast-feeding prevalence did not differ between black diabetic subjects and control subjects. Duration of overall and exclusive breast-feeding did not differ between diabetic and control subjects in the black and white cohorts. The following analyses, which examined whether the timing of the first breast milk substitute to which the infant was exposed differed between diabetic and control subjects, were conducted for exposure to any breast milk substitute and to breast milk substitutes that were cow's milk based. In whites, age at exposure to any breast milk substitutes and cow's milk-based substitutes were similar between diabetic and control subjects. In blacks, the first exposure to breast milk substitutes occurred significantly earlier for any substitute (5.1 vs. 11.9 wk, P = 0.02) and marginally earlier for cow's milk-based substitutes (3.9 vs. 8.5 wk, P = 0.07) in diabetic subjects compared with control subjects. The first exposure to breast milk substitutes was more likely to occur by 3 mo of age in black diabetic subjects compared with black control subjects (OR 3.3, 95% CI 1.1–10.0) after adjusting for maternal age at birth. The addition of breast-feeding status to the model only slightly weakened this association in blacks.

Conclusions

The analyses of this study cohort suggest that the observed protective effect of breast-feeding on the risk of IDDM may be related to differences in the age at exposure to breast milk substitutes in blacks but not in whites.
Elevated Proinsulin Levels Related to Islet Cell Antibodies in First-Degree Relatives of IDDM Patients
Authors: Spinas Giatgen A , Snorgaard Ole , Hartling Svend G , Oberholzer Martin , Berger Willi
Published: March 2007

Objective

To assess whether proinsulin levels are elevated in first-degree relatives of insulin-dependent diabetes mellitus (IDDM) patients and whether there is a relationship between proinsulin levels and the occurrence of immunological markers.

Research Design and Methods

Fasting proinsulin concentrations were measured in 85 first-degree relatives (54 siblings, 20 parents, 11 children) of IDDM patients and in 90 age- and weight-matched control subjects with no family history of diabetes mellitus.

Results

Fasting proinsulin levels (median, 25th, and 75th percentiles) were 8 pM (range 3.2–14 pM) in first-degree relatives and 1.7 pM (range 1.7–4 pM) in control subjects (P <0.0001). Proinsulin was significantly elevated in siblings (7.2 pM, range 3.8–15 pM; P <0.0001), parents (9.8 pM, range 6.4–13 pM; P <0.0001), and children (6.6 pM, range 1.8–12 pM, P = 0.04) compared with control subjects but without differences between these groups. Islet cell antibody positive (ICA+) IDDM relatives had significantly higher proinsulin levels than ICA- (16 pM; range 7.2–25 vs. 6.9 pM, range 3.1–12 pM; P = 0.02). There was no difference between individuals with and without insulin autoantibodies. No difference in proinsulin levels was observed if the relatives were subdivided according to HLA-DR sharing with the diabetic proband.

Conclusions

Fasting proinsulin concentrations were raised not only in siblings but also in parents and children of IDDM patients. Because proinsulin is more elevated in ICA+ than in ICA− subjects, increased proinsulin levels could reflect minor β-cell damage due to previous immunological attack.
Evaluation of Capillary Collection System for HbA1c Specimens
Authors: Voss Ellen M , Cembrowski George S , Clasen Becky L , Spencer Martha L , Ainslie Michael B , Haig Broatch
Published: March 2007

Objective

We evaluated the accuracy and stability of a capillary HbA1c collection system for use with a high-performance liquid chromatography analyzer.

Research Design and Methods

The collection system requires that 5 ul blood is drawn into a calibrated capillary tube, which is then placed into a vial of stabilizing solution and sent for analysis. The study was conducted on simultaneously drawn capillary and venous blood specimens from 47 pediatric diabetes patients. Accuracy was determined by comparing the capillary to the venous HbA1c values. Stability was measured by analyzing 17 capillary specimens over 3 wk.

Results

There was excellent agreement between the capillary and venous HbA1c values (capillary 0.959, venous +0.494, R2 = 98.7%). The capillary HbA1c values were 0.2% higher than the venous HbA1c values and decreased gradually over time (0.1% HbA1c/week) when stored at room temperature.

Conclusions

The Bio-Rad (Richmond, CA) collection system is accurate, stable, and simple to use.
Immunological and Metabolic Responses of Patients with History of Antibody-Induced Beef Insulin Resistance to Treatment With Beef, Pork, Human, and Sulfated Beef Insulin
Authors: Davidson John K , Fineberg S Edwin , Meyts Pierre De , Fineberg Naomi S , Galloway John A
Published: March 2007

Objective

We evaluated immunological and metabolic responses during therapy with beef (B), pork (P), human (H, rDNA), and sulfated beef (SB) insulins in patients with insulin-antibody-mediated insulin resistance.

Research Design and Methods

A randomized double-blind sequential crossover study was performed with each insulin administered for 56 days unless dose reached 200 U/day or allergy developed. Participants were 26 individuals with history of B-P insulin dosage ≥200 U/day and insulin binding capacities >0.216 nM (30 mU/ml serum). Twenty-one participants completed the study. Insulin dosage/day, fasting plasma glucose, percentage HbA1, insulin antibody binding capacity (IABC), bound insulin (BI), percentage binding of 125I-labeled B, P, and H insulins, and receptor inhibition factor (RIF) were assessed.

Results

Mean insulin dosage (U/day) was significantly greater on B (88.9) than on P (29.2), H (29.4), or SB (29.6). On B, dosage increased in 12 individuals and reached 200 U/day in 6 individuals. Mean fasting plasma glucose (12.1 mM) and HbA1 (11%) were significantly higher on B than on P, H, and SB. Mean IABC, bound insulin, RIF, and percentage of B, P, and H bound were significantly higher on B than on P, H, and SB. Prolonged treatment with SB before entry into the study (>5 wk) resulted in a blunted anamnestic response to B insulin.

Conclusions

Rechallenge with B results in anamnestic immunological response and deterioration of metabolic control. SB, H, and P insulins have equivalent effects in patients with insulin antibody-mediated immunologic resistance.
Use of Health Maintenance Organization Data Bases to Study Pharmacy Resource Usage in Diabetes Mellitus
Authors: Glauber Harry S , Brown Jonathan B
Published: March 2007

Objective

To evaluate use of medications by patients with diabetes.

Research Design and Methods

We analyzed the computerized pharmacy data base of a large health maintenance organization to evaluate cost impact and patterns of usage for all pharmacy products by a defined population of diabetic patients.

Results

Diabetic patients received 31.2 dispenses/yr compared with 11.5 for control patients. Total pharmacy costs were threefold higher for diabetic patients ($621 vs. 207/yr) and accounted for ∼ 17% of their total health-care costs. Products specifically for the care of diabetes averaged $175/yr or ∼ 4.5% of their total health-care costs: 57% received an oral hypoglycemic agent, 34% received insulin, and 6% received both. Cardiovascular drugs accounted for 29% of total costs. There was increased use of most classes of medication by patients with diabetes.

Conclusions

Health maintenance organization management data bases, particularly those storing pharmacy dispensing data, provide useful information on the impact of chronic disease. People with diabetes receive a greater number of most types of medication with a greater overall cost than do nondiabetic people. Previous studies have underestimated the contribution of pharmacy purchases to the costs of caring for a diabetic population.
Clinical Trial of Programmable Implantable Insulin Pump For Type I Diabetes
Authors: Selam Jean-Louis , Micossi Piero , Dunn Frederick L , Nathan David M ,   Implantable Insulin Pump Trial Study Group
Published: March 2007

Objective

The first step in the evolution of an artificial pancreas is the development of a reliable implantable pump for insulin delivery. Despite recent advances, significant issues remain, including small size of studies and frequent irreversible catheter obstructions. We report safety, feasibility, and efficacy results from 56 patients, representing 73 patient-yr of pump experience, entered into a multicenter trial with a new implantable programmable pump.

Research Design and Methods

All patients had insulin-dependent (type 1) diabetes, were 38 ± 8 yr old, and were not prone to severe hypoglycemia. The pump (Infusaid 1000) has a pulsatile mechanism powered by freon-vapor pressure. Its rate is regulated by battery-powered valves, operated via a hand-held programmer. The pump is refilled transcutaneously with 25 ml U100 insulin (Hoechst 21PH) on a monthly basis and has a second septum (side port) proximal to the catheter, which allows flushing the catheter or lavaging the pump unit. The pumps were implanted after 3 mo intensive subcutaneous insulin therapy and catheters were positioned either in the peritoneum (i.p., n = 38) or the superior vena cava (i.v., n = 18).

Results

All implanted pumps have functioned safely with no instance of overdelivery or stoppage. The most frequent complications were flow slow downs, presumably due to insulin precipitation within the pump, which occurred in 86% of pumps and were resolved in all but one case by lavaging the pump in situ with alkaline solution. Flow slow downs due to catheter obstruction occurred in 52% of the intravenous catheters but only 21% of the intraperitoneal catheters (P < 0.05) and were resolved in all but two cases by diluent flushing through the sideport. Incidence of severe hypoglycemia decreased from 0.47 before implant to 0.05 episodes/patient-yr after pump implantation (P < 0.001). Mean HbA1c fell from 7.4 ± 1.2% after intensive subcutaneous therapy to 7.1 ± 1.0% 12 mo after implantation. Only 2 patients withdrew from study after recurrent catheter problems, and quality-of-life questionnaires showed improvement in satisfaction with diabetes-specific quality of life when on implantable pump therapy.

Conclusions

Insulin therapy with implantable pumps is effective and safe for periods up to 1.7 yr with a decreased risk of severe hypoglycemia than with intensive subcutaneous insulin therapy.
Lipid and Lipoprotein Levels in Patients With IDDM: Diabetes Control and Complication Trial Experience
Authors:   The DCCT Research Group
Published: March 2007

Objective

To compare lipid and lipoprotein levels in patients with insulin-dependent diabetes mellitus (IDDM) with values in similarly aged nondiabetic subjects and analyze the effects of demographic variables, metabolic control, and other factors on the lipid and lipoprotein levels in the diabetic population.

Research Design and Methods

Fasting total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol levels measured during screening for the Diabetes Control and Complications Trial (DCCT) in 1569 generally healthy IDDM patients, between the ages of 13 and 40 yr and with 1–15 yr diabetes duration, were compared with values obtained with similar methods in the Lipid Research Clinics (LRC) prevalence study of nondiabetic individuals.

Results

When similarly aged groups of IDDM and nondiabetic subjects were compared, higher total and LDL cholesterol and lower HDL cholesterol lipid profiles were restricted to younger (13–24 yr) female diabetic subjects. In general, IDDM males and older IDDM females had similar or slightly less atherogenic profiles than similarly aged nondiabetic subjects. Metabolic control, measured by HbA1c, and body weight (% of ideal body wt) correlated positively with total cholesterol, LDL cholesterol, and triglyceride levels.

Conclusions

Lipid and lipoprotein levels in the generally healthy IDDM volunteers for the DCCT are similar to those in the nondiabetic population. More atherogenic profiles were present only in younger IDDM women compared with nondiabetic women. The differences between the DCCT data and older studies that demonstrated more profound abnormalities in lipid levels in IDDM populations may reflect patient selection and/or changes in dietary patterns (higher-carbohydrate and lower-fat content) and in glucose control that has occurred in recent years.
Association of Waist-Hip Ratio With Diabetes Mellitus: Strength and Possible Modifiers
Authors: Schmidt Maria Inês , Duncan Bruce B , Canani Luis Henrique , Karohl Cristina , Chambless Lloyd
Published: March 2007

Objectives

To characterize the association between central obesity, as measured by the waist-hip ratio (WHR), and non-insulin-dependent diabetes mellitus (NIDDM), considering the effects of sex, age, overall obesity, and family history of diabetes.

Research Design and Methods

Case-control study nested within a community-based survey. We selected 151 subjects with NIDDM and 301 nondiabetic control subjects as a systematic sample of survey screening negative individuals.

Results

Odds ratios for NIDDM, comparing a high WHR (≥ 0.926 for men, ≥ 0.83 for women) to a low WHR were 4.72 with a 95% confidence interval of 2.39–9.34, and 2.17 with a 95% confidence interval of 1.03–4.58, for women and men, respectively, controlling for age, overall obesity, and a family history of diabetes. Women with high WHRs in the presence of these risk factors are notably at risk for diabetes.

Conclusions

Central obesity, as measured by the WHR, is importantly and independently associated with NIDDM.
MPO Activity and Generation of Active O2 Species in Leukocytes From Poorly Controlled Diabetic Patients
Authors: Sato Noriyuki , Shimizu Hiroyuki , Suwa Kunihiko , Shimomura Yohnosuke , Kobayashi Isao , Mori Masatomo
Published: March 2007

OBJECTIVE

This study was undertaken to determine which part of ROI generation is reduced in the neutrophils from patients with NIDDM.

RESEARCH DESIGN AND METHODS

Superoxide anion (O2−) production, LDCL activity in response to opsonized zymosan, and MPO activity were measured in leukocytes of poorly controlled NIDDM patients (FBG >8.89 mM, HbA1 >10%).

RESULTS

In diabetic subjects, both O2− production and LDCL activity assessed with initial slope gradient and peak value were significantly reduced. MPO activity was also decreased in diabetic subjects, and there was a significant correlation between HbA1 levels and MPO activity of diabetic subjects.

CONCLUSIONS

This study demonstrated that every step in leukocyte ROI generation should be reduced in the leukocytes from poorly controlled diabetic patients.
Trends in Diabetes and Diabetic Complications, 1980–1987
Authors: Wetterhall Scott F , Olson David R , DeStefano Frank , Stevenson John M , Ford Earl S , German Robert R , Will Julie C , Newman Jeffrey M , Sepe Stephen J , Vinicor Frank
Published: March 2007

OBJECTIVE

Although diabetes is a major source of morbidity and mortality in the United States, only recently has a unified national surveillance system begun to monitor trends in diabetes and diabetic complications.

RESEARCH DESIGN AND METHODS

We established a diabetes surveillance system using data for 1980–1987 from vital records, the National Health Interview Survey, the National Hospital Discharge Survey, and the Health Care Financing Administration's records to examine trends in the prevalence and incidence of diabetes, diabetes mortality, hospitalizations, and diabetic complications.

RESULTS

From 1980 through 1987, the number of individuals known to have diabetes increased by 1 million—to 6.82 million. Age-standardized prevalence for diabetes increased 9% during this period, from 25.4 to 27.6/1000 U.S. residents (P = 0.03). The incidence of diabetes increased among women (P = 0.003), particularly among those > 65 yr old (P = 0.02). Age-standardized mortality rates (for diabetes as either an underlying or contributing cause) per 100,000 individuals with diabetes declined 12%, from 2350 to 2066. Annual mortality rates from stroke (as an underlying cause and diabetes as a contributing cause) and diabetic ketoacidosis declined 29% (P = 0.003) and 22% (P < 0.001), respectively. During these 8 yr, hospitalization rates for major CVD and stroke (as the primary diagnoses and diabetes as a secondary diagnosis) increased 34% (P = 0.006) and 38% (P = 0.01), respectively. Also during this period, hospitalization rates increased 21% for diabetic ketoacidosis (P = 0.01) and 29% for lower-extremity amputations (P = 0.06). From 1982 through 1986, treatment for end-stage renal disease related to diabetes increased > 10% each year (P < 0.001). The prevalence of diagnosed diabetes was nearly twice as high in blacks as in whites (P = 0.04). Blacks also had increased rates of lower-extremity amputation (P = 0.02), diabetic ketoacidosis (P < 0.001), and end-stage renal disease (P = 0.01).

CONCLUSIONS

Diabetes surveillance data will be useful in planning, targeting, and evaluating public health efforts designed to prevent and control diabetes and its complications.
Glycemic Control in Early IDDM
Authors: Allen Catherine , Zaccaro Daniel J , Palta Mari , Klein Ronald , Duck Stephen C , D'Alessio Donn J
Published: March 2007

OBJECTIVE

A cohort (n = 277) was followed from diabetes diagnosis to evaluate longitudinal glycemic control, urinary C-peptide levels, and certain features of diabetes self-management.

RESEARCH DESIGN AND METHODS

Unselected cases with IDDM, who were < 30 yr of age, were identified at diagnosis from a 28-county area in Wisconsin. Subjects were asked to submit blood every 4 mo for GHb testing, to report aspects of diabetes self-management every 6 mo, and to collect a 24-h urine specimen 4 mo after diagnosis.

RESULTS

In the 1st yr of diabetes, the rate of increase (0.23%/mo) in GHb was significant for the cohort (P < 0.001) and for almost all age and sex subgroups. In the 2nd yr, there was no significant rate of increase for the cohort as a whole (P > 0.10). Adolescent males (10–19 yr of age) had a mean GHb level for year 2 higher than males of other age-groups and higher than female adolescents (P < 0.001). Adolescent males had a significant rate of increase in GHb for year 2 (P = 0.02), unlike all other age and sex subgroups. Adolescents had higher initial 24-h urine C-peptide levels than children < 10 yr of age (P < 0.01). During the 2nd yr of diabetes, the percentage of adolescent males reporting three or more insulin injections/day was lower than any other subgroup.

CONCLUSIONS

These data-suggest that glycemic control stabilizes during the 2nd yr of IDDM, except in adolescent males, and that this may be due partly to aspects of self-management.
Pathogenesis of the Atherosclerotic Lesion: Implications for diabetes mellitus
Authors: Schwartz Colin J , Valente Anthony J , Sprague Eugene A , Kelley Jim L , Cayatte Antonio J , Rozek Marius M
Published: March 2007

In this review, we have highlighted pivotal cellular and molecular events in the initiation and progression of atherosclerosis. Key components of lesion initiation are an enhanced focal intimal influx and accumulation of lipoproteins, including LDL in hemodynamically determined lesion-prone areas, focal monocyte-macrophage recruitment, intimal generation of ROS, and oxidative modification of lipoproteins (including LDL [Ox-LDL]). Modified lipoproteins are taken up by the non-downregulating macrophage scavenger receptor, with foam cell formation and the development of the so-called fatty streak. One transitional event in lesion progression is foam cell necrosis, likely attributable to the cytotoxicity of both intimal free radicals and Ox-LDL, with development of an extracellular metabolically inert lipid core. Another is the migration to and proliferation within the intima of medial SMCs, leading to the synthesis of plaque collagens, elastin, and proteoglycans. Mural thrombosis plays a significant role in the late-stage progression of lesions. Regression of lesions is considered a function of the dynamic balance among components of initiation, progression, plaque stabilization, and removal of plaque constituents—the so-called regression quartet. Here, we critically examine how components of diabetes mellitus might impact not only lesion development, but also lesion regression. It is concluded that some components of diabetes mellitus augment key mechanisms in lesion initiation and progression and will likely retard the processes of plaque regression. Specifically, we focus on the various influences of diabetes mellitus on lipoprotein influx and accumulation, free radical generation and Ox-LDL, monocyte-macrophage recruitment, thrombosis and impaired fibrinolysis, and the reverse cholesterol transport system. The importance of nonenzymatic protein glycosylation in modifying a number of these processes is emphasized.
Diabetic Nephropathy: Management of the end-stage patient
Authors: Markell Mariana S , Friedman Eli A
Published: March 2007

Diabetic nephropathy is currently the leading cause of new patients requiring dialysis in the United States. Management of the diabetic patient with ESRD is complicated by the frequent coexistence of complications affecting other organ systems, including retinopathy, cardiovascular disease, peripheral neuropathy, or autonomic neuropathy, manifested as gastroparesis, diarrhea or obstipation, cystopathy, or orthostatic hypotension. Associated clinical syndromes must be followed and treated, if possible, while preparing the patient to receive renal replacement therapy. Both the clinical condition and the psychosocial environment are key factors in choice of ESRD therapy for an individual patient. Rehabilitation data are best for patients who undergo kidney transplantation, but these data are confounded by the fact that the healthiest patients are referred for this treatment modality. Living, related kidney transplant is the preferred initial choice for the diabetic patient with kidney disease. At most centers, both in the United States and abroad, the cadaveric transplant is the second choice for uremia therapy. At the appropriate institution, the patient with type I diabetes may also be considered for a simultaneous cadaveric pancreas transplant.

While awaiting cadaveric transplantation, or if contraindication to transplantation is present (chronic infection, recent malignancy, or severe cardiac disease), diabetic patients with severe impairment of the glomerular filtration rate (< 10–15 ml/min) are referred for vascular access placement and/or insertion of a peritoneal catheter. The decision regarding the choice of CAPD vs. hemodialysis must be made on an individual basis. Rehabilitation and survival data for these therapies are similar, although technique survival rates for CAPD decline dramatically as time progresses because of infectious complications. In-center hemodialysis has the worst survival and rehabilitation profile, but the sickest, most debilitated patients with the highest number of comorbid conditions tend to be referred for that therapeutic modality. Most studies of rehabilitation were performed before use of recombinant human erythropoietin, and comparison between ESRD treatment modalities will have to be reevaluated now that the drug is routinely used.
Global Estimates for Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Adults
Authors: King Hilary , Rewers Marian ,   Who Ad Hoc Diabetes Reporting Group
Published: March 2007

Objective— To assemble standardized estimates of abnormal glucose tolerance in adults in diverse communities worldwide and provide guidelines for the derivation of comparable estimates in future epidemiological studies.

Research Design and Methods— The project was limited to population-based investigations that had used current WHO criteria for diagnosis and classification of abnormal glucose tolerance. Raw data were obtained by WHO from surveys conducted during 1976–1991 of over 150,000 persons from 75 communities in 32 countries. Data within the truncated age range of 30–64 yr were adjusted to the standard world population of Segi. Age-specific prevalences also are reported for selected populations.

Results— Within the chosen age range, diabetes was absent or rare (<3%) in some traditional communities in developing countries. In European populations, age-standardized prevalence varied from 3 to 10%. Some Arab, migrant Asian Indian, Chinese, and Hispanic American populations were at higher risk with prevalences of 14–20%. The highest prevalences were found in the Nauruans (41%) and the Pima/Papago Indians (50%). Age-standardized prevalence of IGT was low (<3%) in some Chinese, traditional American Indian, and Pacific island populations. Moderate (3–10%) or high (11–20%) prevalences of IGT were observed in many populations worldwide. The highest estimates for prevalence of IGT were seen in female Muslim Asian Indians in Tanzania (32%) and in urban male Micronesians in Kiribati (28%). Prevalence of diabetes rose with age in all populations in which age-specific data were examined. This trend was most pronounced in those at moderate to high risk. The ratio of prevalence of diabetes in men versus women varied markedly between populations with little discernable trend, although IGT was generally more common in women. In most communities, at least 20% of diabetes cases were unknown before the survey, and in many communities, >50% were previously undiagnosed. In both Chinese and Indian migrant populations, relative prevalence was high when compared with indigenous communities.

Conclusions— Diabetes in adults is now a global health problem, and populations of developing countries, minority groups, and disadvantaged communities in industrialized countries now face the greatest risk.
Diabetes Prevalence, Incidence, and Complications Among Alaska Natives, 1987
Authors: Schraer Cynthia D , Bulkow Lisa R , Murphy Neil J , Lanier Anne P
Published: March 2007

Objective— To provide descriptive epidemiological data on diabetes mellitus among Alaska Natives, including incidence, updated prevalence, and incidence rates of ESRD, LEA, MI, and stroke in the diabetic population.

Research Design and Methods— In IHS and tribal contract hospitals and clinics throughout Alaska, Alaskan Indians, Eskimos, and Aleuts living in Alaska with documented diabetes mellitus were studied from 1986 to 1987.

Results— The number of diabetic patients increased from 610 to 708, and the prevalence changed from 15.7 to 17.4/1000 (not a statistically significant increase). Incidence rates per 10,000 diabetic person-yr for complications were 38 for ESRD, 69 for LEA, 92 for MI, and 92 for stroke.

Conclusions— The prevalence of diabetes mellitus increased during the period of observation, but not to a statistically significant degree. Incidence rates for diabetes are lower than for the U.S. general population, but complications rates are as high as those in other diabetic populations.
Diabetes in St. Regis Mohawk Indians
Authors: Martinez Charlene B , Strauss Karen
Published: March 2007

Objective— To establish a registry of diabetes patients and to determine the point prevalence of diabetes in the St. Regis Mohawk New York community at the end of August 1989.

Research Design and Methods— Participants in this study consisted of residents of the St. Regis Mohawk reservation in New York state, who were registered for health care at the St. Regis Mohawk Clinic. This study was a survey of diabetes cases using the National Diabetes Data Group criteria for diagnosis with comparison with the U.S. rates determined from the 1987–1982 National Health Interview Survey and Canadian Mohawk Indian rates from other studies.

Results— The age-adjusted prevalence of 48.8/1000 Mohawk population was two times (95% CI 1.2–3.2) the U.S. rate. Although precise comparisons with Canadian studies are difficult because of differences in study design, rates for Quebec Mohawks aged 45–64 yr were similar.

Conclusions— A high prevalence (21%) among New York Mohawk Indians <45 yr of age, compared with 17% of diabetic patients in that age-group in the U.S. population, means that complications resulting from diabetes will occur at a relatively young age, placing an increased burden on the health-care system with costs of patient care associated with diabetes increasing accordingly. The registry system is being used to gather information on the prevalence and incidence of diabetic complications and risk factors for developing diabetes. These data will be used to evaluate programs.
Hyperinsulinemia in Macrosomic Infants of Nondiabetic Mothers
Authors: Hoegsberg Bente , Gruppuso Philip A , Coustan Donald R
Published: March 2007

Objective— We tested the hypothesis that macrosomic infants of nondiabetic mothers are more likely to have hyperinsulinemia and increased subcutaneous fat.

Research Design and Methods— Plasma insulin concentrations were measured in cord blood from 50 macrosomic infants and 32 normal-sized (control), term infants. All mothers had had a normal 50-g 1-h GCT. Skin-fold measurements of the triceps and subscapular area were done on 44 macrosomic infants with a Halpern caliper.

Results— No difference was observed in GCT between mothers of macrosomic (5.8 ± 1.0 mM) and normal (5.7 mM) infants. The insulin level in macrosomic infants (18.75 ± 19.08 μU/ml) was significantly higher than in control infants (8.67 ± 6.64 μU/ml). Macrosomia was a predictor of hyperinsulinemia and vice versa (R2 = 0.26). Maternal height, prepregnancy weight, and weight gain were predictors for macrosomia (R2 = 0.26). No differences were noted in anthropometric measurements between hyperinsulinemic and normoinsulinemic infants.

Conclusions— A subset of macrosomic infants have hyperinsulinemia. Maternal anthropometric factors as well as hyperinsulinemia are correlated with macrosomia. The macrosomia may be causally related to the high insulin levels.
Renal Disease Among the Eastern Band of Cherokee Indians
Authors: Quiggins Patricia A , Farrell Mary Anne
Published: March 2007

OBJECTIVE— To ascertain the incidence and prevalence of ESRD in the Eastern Band of Cherokee in the IHS user population from 1978 to 1988 and to determine what proportion of ESRD and chronic renal failure is attributable to diabetes.

RESEARCH DESIGN AND METHODS— Cases were identified from three IHS data sources and from death records obtained from the North Carolina Bureau of Health Statistics. Chronic renal insufficiency was defined as an individual having a serum creatinine of ≥ or = 176.8 μM that remained at that level for a sustained period. An ESRD case was defined as one in which dialysis was required to sustain life, regardless of whether treatment was actually implemented. Data were obtained from chart review and included date of diagnosis, maximum serum creatine level attained, diabetes status, and certain demographic data.

RESULTS— Twenty-two (88%) cases of ESRD were attributable to diabetes. The average annual incidence of ESRD during the study period was much higher than that in the U.S. white population and that of Native Americans. The incidence of ESRD caused by diabetes was 2.5 times higher than that reported in the U.S. Native American population affected by diabetes. Degree of Indian inheritance did not appear to be related to prevalence of diabetic renal disease in individuals having diagnosed diabetes.

CONCLUSIONS— The proportion of ESRD attributable to diabetes indicates that primary prevention of diabetes may be the best method of preventing ESRD in this population.
Diabetic Complications Among American Indians of Washington, Oregon, and Idaho: Prevalence of retinopathy, end-stage renal disease, and amputations
Authors: Freeman William L , Hosey Gwendolyn M
Published: March 2007

OBJECTIVE— To estimate the prevalence of severe diabetic complications.

RESEARCH DESIGN AND METHODS— We surveyed the data systems of the IHS and local care providers to identify all AI/AN people with any of three diabetic complications: retinopathy needing one or more laser treatments, ESRD needing dialysis, and one or more LEAs. We calculated prevalence rates that were sex-age adjusted to the U.S. population for total sample, each community, gender, and culture area.

RESULTS–Of the population-based complete sample with diabetes, 1.7% had retinopathy, 1% ESRD, and 4% LEA. Complication rates among the culture areas were not statistically different. The LEA rate among diabetic men (5.8%) was higher than that among women (2.3%). The odds ratio was 2.2 (95% CI 1.2-4.2). One community had an extraordinarily high LEA rate of 16%.

CONCLUSIONS— This study showed that IHS can use its data systems to estimate prevalence of diabetic complications and identify population groups with higher prevalence rates. The data led the IHS clinic with the high LEA rate to start a program to prevent amputations. We suggest quality assurance activities based on the methods of this study.
Elevated Serum Sialic Acid Concentration in NIDDM and Its Relationship to Blood Pressure and Retinopathy
Authors: Crook Martin A , Tutt Peter , Pickup John C
Published: March 2007

Objective— In view of the possible link between serum sialic acid and cardiovascular disease in the general population, we investigated whether serum total and lipid-associated sialic concentrations are elevated in NIDDM patients compared with normal subjects. We also investigated how sialic acid levels relate to glycemic control, blood pressure, microalbuminuria, retinopathy, and serum lipid levels.

Research Design and Methods— We selected 20 NIDDM patients at random and matched them for age and sex with 20 normal subjects. The patients also had a similar BMI as the control subjects. A first morning blood sample was taken for sialic acid, glucose, fructosamine, and lipid analysis, as was a first morning urine sample for assessment of microalbuminuria. Retinopathy was assessed by fundoscopy.

Results— Both total and lipid-associated sialic acid levels were elevated in the NIDDM patients compared with control subjects (mean ± SD, total: 0.74 ± 0.11 vs. 0.60 ± 0.22 g/L, P < 0.02; lipid-associated: 0.18 ± 0.04 vs 0.12 ± 0.04 g/L, P < 0.001). Total serum sialic acid was correlated with systolic blood pressure (r = 0.58, P < 0.01) and diastolic blood pressure (r = 0.58, P < 0.02). There was no significant relationship of total sialic acid with age, duration of diabetes, BMI, microalbuminuria, serum triglyceride, blood glucose, or serum fructosamine. A relationship of lipid-associated sialic acid levels and systolic blood pressure did not reach significance (P = 0.09). In 9 patients with background retinopathy with or without maculopathy, the total serum sialic acid concentration was higher than in those without retinopathy (0.81 ± 0.09 vs. 0.69 ± 0.10 g/L, P < 0.008). Lipid-associated sialic acid levels were similar in those with and without retinopathy. (The conversion factor for standard units to SI units is 1 gL = 3.2 mM.)

Conclusions— Total serum sialic acid levels were significantly elevated in a relatively small group of NIDDM patients and were correlated with hypertension and retinopathy. A larger study of circulating sialic acid concentrations as a risk factor for the development or marker of diabetic angiopathy is therefore justified.
C-Peptide in NIDDM: Follow-up for 4-6 yr
Authors: Lev-Ran Arye , Hwang David L
Published: March 2007

Objective— To study whether fasting and 1-h postbreakfast C-peptide levels in NIDDM stabilize with time in individual patients.

Research Design and Methods— Within the period of 4–6 yr, 49 NIDDM patients had repeated tests of fasting and 1-h postprandial levels of plasma glucose and C-peptide with the aim of determining their individual qualitative patterns. Throughout the follow-up period, 13 patients were treated with insulin, 21 with oral sulfonylureas, and 15 were switched from oral drugs to insulin, with the tests done in both treatment periods.

Results— The group as a whole demonstrated no changes in mean fasting or postprandial C-peptide within 4–6 yr of observation, irrespective of the mode of therapy or its changes. Glycemic and C-peptide response to breakfast was qualitatively typical for each patient with the correlation between plasma glucose and C-peptide. However, the response was vastly different from patient to patient, and the cross-sectional data showed no correlation between postprandial changes in glycemia and C-peptide, nor between glycemic response to breakfast and fasting plasma glucose or C-peptide. In spite of high fasting glycemia, 25% of the patients showed remarkable tolerance to breakfast with only small increases in plasma glucose. In many other patients, however, in spite of similar increase in C-peptide, plasma glucose rose sharply after the meal.

Conclusions— In our group, no deterioration of the insulin secretory function was observed within 4–6 yr of follow-up. Qualitative patterns of the glycemic and C-peptide responses to breakfast were typical for each patient but vastly different between patients. We see in NIDDM a syndrome with few common characteristics and recommend further work for its subclassification into forms with different pathogenesis.
Familial Hyperproinsulinemia Associated With NIDDM: A case study
Authors: Oohashi Hiroshi , Ohgawara Hisako , Nanjo Kishio , Tasaka Yoshimasa , Cao Qiu-Ping , Chan Shu Jin , Rubenstein Arthur H , Steiner Donald F , Omori Yasue
Published: March 2007

OBJECTIVE

To report studies on an elderly patient with moderate NIDDM associated with marked fasting hyperinsulinemia.

RESEARCH DESIGN AND METHODS

The propositus and several family members were studied by a combination of clinical, biochemical, and molecular genetic approaches to define the underlying genetic defect.

RESULTS

Fasting levels of contrainsulin hormones were normal, and resistance to exogenous insulin was absent. Gel filtration and reverse-phase high-performance liquid chromatography revealed elevated amounts of a structurally abnormal proinsulin intermediate (AC proinsulin). A study of the family of the propositus showed rhe same abnormality in 4 of 5 members in 3 successive generations. Genetic analysis revealed a point mutation affecting residue 65 of human proinsulin (Arg→His) in one allele of the insulin gene in the propositus, a defect similar to that described previously in 3 other apparently unrelated lineages.

CONCLUSIONS

This family exhibits a clear-cut relationship between increasing age and metabolic decompensation in all the hyperproinsulinemic members, suggesting that (inherited) metabolic stress and age both contribute to development of diabetes mellitus.
Improved Insulin Action and Glycemic Control After Long Term Angiotensin-Converting Enzyme Inhibition in Subjects with Arterial Hypertension and Type II Diabetes
Authors: Torlone Elisabetta , Britta Mariella , Rambotti Anna Maria , Perriello Gabriele , Santeusanio Fausto , Brunetti Paolo , Bolli Geremia B
Published: March 2007

OBJECTIVE

To determine the long-term effects of the angiotensin-converting enzyme inhibitor captopril on insulin sensitivity in subjects with type II diabetes and arterial hypertension. The chronic effects of angiotensin-converting enzyme inhibition on insulin-sensitive individuals are presently controversial.

RESEARCH DESIGN AND METHODS

Sixteen subjects, with type II diabetes (on diet and/or diet plus oral hypoglycemic agents) and arterial hypertension, were studied. During a 1-mo run-in period no antihypertensive drugs were administered, but oral hypoglycemic agents were continued in subjects already in therapy. The subjects were then randomly assigned to two 3-mo treatment periods, with either captopril or placebo (single blind, cross-over design). At the end of each treatment period, insulin sensitivity was assessed by means of a euglycemic-hyperinsulinemic clamp (2 sequential steps, 2-h each, insulin infusion 0.25 and 1 mU ·kg−1 ·min−1, steps 1 and 2, respectively), combined with infusion of [3-3H]glucose (for calculation of hepatic glucose output and peripheral glucose utilization, rates of glucose disappearance), and indirect calorimetry (for calculation of glucose oxidation, nonoxidative glucose metabolism, and lipid oxidation). The percentage of HbAlc was measured to assess long-term glycemic control.

RESULTS

Comparing data at the end of placebo and captopril treatment, captopril resulted in: lower blood pressure (systolic 154 ± 2 vs. 163 ± 3 mmHg and diastolic 93 ± 2 vs. 101 ± 2 mmHg); greater insulin sensitivity in hyperglycemic conditions (total amount of insulin infused and time of insulin infusion required to reach euglycemia, 1.73 ± 0.54 vs. 2.08 ± 0.60 U and 58 ± 8 vs. 70 ± 11 min, captopril and placebo, respectively, P < 0.05); greater insulin sensitivity in euglycemic conditions at liver level (hepatic glucose output 4.11 ± 0.55 vs. 5.2 ± 0.4 μmol · kg−1 · min−1, step 1 of the clamp), muscle level (rates of glucose disappearance 26.1 ± 2.3 vs. 23.8 ± 2.1 μmol · kg−1 · min−1, step 2 of the clamp), primarily attributable to ∼29% increase in nonoxidative glucose metabolism, and adipose tissue level (plasma free fatty acid 0.185 ± 0.03 vs. 0.24 ± 0.02 mM and lipid oxidation 1.9 ± 0.3 vs. 2.21 ± 0.04 μmol · kg−1 · min−1 in step 1); and lower HbA1c (6.7 ± 0.2 vs. 7.3 ± 0.2%, P < 0.05).

CONCLUSIONS

Long-term captopril administration in type II diabetic subjects improves insulin sensitivity in the postprandial state, not in the fasting state, and improves glycemic control.
Does Familial Hypertriglyceridemia Predispose to NIDDM?
Authors: Sane Timo , Taskinen Marja-Riitta
Published: March 2007

OBJECTIVE

To determine the 10 -yr incidence of impaired glucose tolerance and NIDDM in families with a clustering of endogenous hypertriglyceridemia.

RESEARCH DESIGN AND METHODS

The prospective population study, where the oral glucose tolerance test and the measurement of serum lipids and lipoproteins were performed at the baseline examination and after the 10-yr followup, was conducted on 56 subjects (17–60 yr of age at the baseline). The subjects were from six pedigrees with a clustering of endogenous hypertriglyceridemia, and 47 of these subjects attended the follow-up 10 yr later.

RESULTS

In the study families, the prevalence of glucose intolerance and NIDDM increased from 15 to 49% (P < 0.001) and from 2 to 21% (P < 0.001), respectively, over the 10-yr period. When grouped according to the baseline serum triglyceride tertiles, 76% (P < 0.01) of the family members with highest serum triglycerides were glucose intolerant (29% impaired glucose tolerance, 47% NIDDM) at follow-up compared with 20% of those with lowest serum triglycerides. In discriminant analysis, including age, body mass index, treatment with thiazides and β-blocking agents, and 2-h serum insulin concentration, the baseline serum triglycerides still remained as an independent predictor of development of impaired glucose tolerance and NIDDM.

CONCLUSIONS

Families with a clustering of hypertriglyceridemia are at increased risk of NIDDM, and in these families elevation of serum triglycerides serves as a risk marker of glucose intolerance and NIDDM.
Survey of Physician Practice Behaviors Related to Diabetes Mellitus in the U.S.: Physician adherence to consensus recommendations
Authors: Kenny Susan J , Smith Philip J , Goldschmid Merilyn G , Newman Jeffrey M , Herman William H
Published: March 2007

OBJECTIVE

To summarize the frequency of physician adherence to consensus recommendations for prevention of diabetic complications.

RESEARCH DESIGN AND METHODS

Survey data from a nationwide stratified probability sample of primary-care physicians were analyzed. Adherence to recommendations were reported by physician specialty, age-group, and type of diabetes treated.

RESULTS

Adherence was high for eye exams, blood pressure measurements, neurological and circulatory exams, and laboratory procedures using blood. Adherence was low for examination of the teeth and gums, examination of the feet, and laboratory procedures involving the collection of urine. Internists generally had the highest adherence rates and pediatricians the lowest. Reported adherence decreased with physician age. Adherence was higher for the management of individuals with IDDM than for those with NIDDM.

CONCLUSIONS

Recommendations for the care of diabetic individuals need to be more widely implemented. Recommendations targeted specifically to pediatricians may be necessary.