bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of progression from normoalbuminuria to microalbuminuria in NIDDM.
Authors: Forsblom C M , Groop P H , Ekstrand A , Tötterman K J , Sane T , Saloranta C , Groop L
Published: March 2007

OBJECTIVE: Our objective was to establish the clinical, genetic, metabolic, and immunologic risk factors for the progression of the albumin excretion rate (AER) in normoalbuminuric NIDDM patients. RESEARCH DESIGN AND METHODS: We recruited 108 NIDDM patients with normal AER after a diabetes duration of 9 years to participate in a prospective 9-year follow-up. In addition to conventional clinical and metabolic variables, we assessed microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (coronary heart disease, peripheral vascular disease) diabetic complications, genetic markers (HLA genotypes), and organ-specific autoimmune markers, including islet cell antibodies. Multiple logistic regression was used to determine independent predictors of progression of AER. RESULTS: A total of 21 patients (19%) died during the follow-up. There was an overrepresentation of men (61 vs. 39%; P = 0.044) and smokers (55 vs. 27%; P = 0.01) in patients who progressed to micro- or macroalbuminuria versus those who did not progress. In addition, progressors had higher fasting plasma glucose (P = 0.002) and HbA1 (P = 0.0002) concentrations at baseline than did nonprogressors. Neuropathy was more often seen in progressors than in nonprogressors at baseline (53 vs. 16%; P = 0.0004). Frequency of HLA genotypes and autoimmune markers did not differ between progressors and nonprogressors. In a multiple logistic regression analysis, HbA1 (P = 0.0005) and a history of smoking (P = 0.011) were independent predictors of progression of AER. CONCLUSIONS: This study reemphasizes the importance of poor glycemic control and smoking as independent risk factors for progression of AER. Furthermore, development of micro- or macroalbuminuria in NIDDM was associated with neuropathy and male sex.
Hypoglycemia after pancreas transplantation.
Authors: Redmon J B , Teuscher A U , Robertson R P
Published: March 2007

OBJECTIVE: Hypoglycemia is a serious complication of therapy for diabetes. Chronic hypoglycemia and the attendant decrease in quality of life have been rationales for advocating pancreas transplantation as an alternative treatment. However, reports have appeared that suggest that as high as 30-50% of pancreas transplant recipients have occasional symptoms of mild hypoglycemia. Therefore, we studied glucose and hormone levels in transplant recipients and healthy control subjects. RESEARCH DESIGN AND METHODS: We studied glucose and hormone levels in transplant recipients reporting frequent symptoms of hypoglycemia (n = 10), transplant recipients without symptoms of hypoglycemia (n = 9), and healthy control subjects (n = 8) after a mixed meal and during a subsequent 24-h modified fast. All transplant recipients were insulin-independent; were receiving prednisone, cyclosporine, and azothioprine; and had functioning grafts with systemic venous drainage. RESULTS: No significant differences were observed in the fasting glucose, insulin, C-peptide, or glucagon levels when comparing the symptomatic with the asymptomatic groups of patients who had undergone successful pancreas transplantation. Similarly, no significant differences were found in the immediate postprandial period after a mixed meal. However, during the subsequent 24-h fast, glucose levels fell lower in the symptomatic than in the asymptomatic group of patients receiving a transplanted pancreas (71+/-2 vs. 81+/-2 mg/dl, P < 0.002). During the fast, no significant differences were found in insulin, C-peptide, or glucagon levels when comparing asymptomatic to symptomatic groups. Of 10 symptomatic recipients of pancreas transplantation, 5 reported symptoms of hypoglycemia during the study. In four of these five subjects, the onset of symptoms corresponded to nadirs in serum glucose, which occurred at values 2 SD or more below the mean glucose observed for the control and the asymptomatic pancreas recipient groups. The serum glucose levels at the time of symptoms in these four subjects were 55, 66, 51, and 57 mg/dl. In each of these four subjects, symptoms abated and the glucose levels rose spontaneously without intervention. One of these four subjects had elevated insulin binding activity in his serum consistent with endogenous insulin antibodies. This individual had a serum glucose value of 55 mg/dl at the conclusion of the 24-h fast without symptoms. CONCLUSIONS: Among a group of pancreas transplant recipients reporting frequent symptoms of hypoglycemia, some individuals demonstrated transient, symptomatic postprandial hypoglycernia. With the exception of one recipient with insulin antibodies, no evidence was found for hypoglycemia during fasting. Although postprandial hypoglycemia may occur in some pancreas transplant recipients, it does not appear to be a highly significant clinical problem.
Effect of weight change and metformin on fibrinolysis and the von Willebrand factor in obese nondiabetic subjects: the BIGPRO1 Study. Biguanides and the Prevention of the Risk of Obesity.
Authors: Charles M A , Morange P , Eschwège E , André P , Vague P , Juhan-Vague I
Published: March 2007

OBJECTIVE: Insulin resistance is associated with hypofibrinolysis. Metformin has been shown to improve insulin sensitivity and fibrinolysis. Its action on fibrinolysis and the von Willebrand factor was evaluated in the Biguanides and the Prevention of the Risk of Obesity (BIGPRO)1 trial in nondiabetic men (n = 151) and women (n = 306) aged between 34 and 65 years with a central fat distribution and a mean BMI of 32.5 kg/m2. RESEARCH DESIGN AND METHODS: The subjects were randomly allocated to a 1-year treatment with metformin (850 mg b.i.d.) or placebo, in addition to diet and exercise recommendations. RESULTS: Plasminogen activator inhibitor 1 (PAI-1) activity and antigen decreased significantly but similarly by 30 and 40%, respectively, in both the placebo and the metformin groups. This decrease occurred mainly in subjects who lost weight. Metformin did not have any significant additional effect on PAI-1. In contrast to the results for PAI-1, there was a significantly greater decrease in tissue-type plasminogen activator (tPA) antigen in the metformin than in the placebo group (mean+/-SD: -1.1+/-3.1 vs. 0.2+/-3.2 ng/ml, P < 0.02). The von Willebrand factor (vWF) also decreased significantly more in the metformin group (-0.17+/-0.42 vs. -0.05+/-0.38 U/I, P < 0.02). CONCLUSIONS: Weight loss was the main factor associated with the decrease in PAI-1, in accordance with the recent demonstration of production of PAI-1 by adipocytes. Metformin had a significant effect on two factors, tPA antigen and vWF, mainly secreted by the endothelial cells, which suggests an effect of the drug on the production or the metabolism of these two hemostatic proteins.
Blue-on-yellow and achromatic perimetry in diabetic children without retinopathy.
Authors: Lobefalo L , Verrotti A , Mastropasqua L , Della Loggia G , Cherubini V , Morgese G , Gallenga P E , Chiarelli F
Published: March 2007

OBJECTIVE: We compared blue-on-yellow perimetry with achromatic perimetry to determine whether the first was more sensitive in detecting visual field defects. RESEARCH DESIGN AND METHODS: We studied 50 children and adolescents (22 male, 28 female) with IDDM, ranging in age from 10.1 to 16.3 years (mean 13.3+/-2.1 years), with a disease duration of 5.2-10.0 years (mean 7.1+/-1.9 years). Patients were divided into subgroups according to the presence of persistent microalbuminuria. No one had signs of diabetic retinopathy when studied with fluorescein angiography. RESULTS: By achromatic perimetry, the analysis of subareas of the central 30 degrees of the visual field (0-9 degrees; 10-18 degrees; out of 18 degrees) showed no differences between diabetic subgroups in the central 18 degrees of the visual field, while a significant difference between the same subgroups was found outside the 18 degrees of the 24-2 program of the Humphrey perimeter (P = 0.027). By blue-on-yellow perimetry, in all three of the perimetric subareas evaluated, the sensitivity was lower in microalbuminuric patients than in normoalbuminuric ones. The differential sensitivity between the perimetric tests performed with blue-on-yellow and with achromatic stimuli showed statistically significant data, with a higher level of significance in the central 18 degrees (P < 0.0001) than outside the 18 degrees (P = 0.033). CONCLUSIONS: Our study suggests that blue-on-yellow perimetry is more useful and more sensitive than achromatic perimetry in the detection of preclinical visual field defects in diabetic children with microalbuminuria but without clinically detectable retinopathy.
Genes Versus Environment: The relationship between dietary fat and total and central abdominal fat
Authors: Samaras Katherine , Kelly Paul J , Chiano Mathias N , Arden Nigel , Spector Timothy D , Campbell Lesley V
Published: March 2007

OBJECTIVE

The influence of diet on body fat has not been quantified independently of genetic influences, although both are held to contribute to regulation of body fat stores. This study examined 1) the relationship between recent diet and total body and central abdominal fat inmiddle-aged female twins independent of genetic and important environmental factors and 2) evidence of interaction between diet and genetic predisposition

RESEARCH DESIGN AND METHODS

Measurements in 436 healthy female twins (aged 58 ± 10 years) included dietary intake by food frequency questionnaire (validated against a 7-day food diary, n = 162), BM1, total body and central abdominal fat by dual-energy X-ray absorptiometry and environmental covariates (smoking habit, hormone replacement, and physical activity) by standardized questionnaire. Dietary energy underreporters were excluded.

RESULTS

Intake of dietary fat (total and subtype) and carbohydrates was not related to BM1 or to total or central fat, confirmed in quintile analysis. With genetic and environmental factors controlled in 90 monozygotic pairs, differences in the intake of energy, fat, or protein were not related to intrapair differences in total and central body fat. However, a minor inverse relationship between carbohydrate intake and total adiposity was confirmed (r = −0.25, P = 0.02). In paired analyses, the twin with the higher intake of total sugars had significantly lower total body and central abdominal adiposity. There was no evidence of a gene-environment interaction between intake of fat or carbohydrates contributing to greater body fat mass in subjects genetically predisposed to obesity.

CONCLUSIONS

Using validated dietary measures and direct measures of body fat and excluding underreporters, no relationship between dietary fat and body fat was found in middle-aged women, particularly after controlling for genetic and some environmental factors. The role of dietary factors in determining total body and central abdominal fat appears to have been overestimated in past cross-sectional studies
Randomized Study of Two Different Target Levels of Glycemic Control Within the Acceptable Range in Type 2 Diabetes: Effects on well-being at 1 year
Authors: Does Ferdinand E E Van Der , Neeling J Nico D De , Snoek Frank J , Grootenhuis Peter A , Kostense Pieter J , Bouter Lex M , Heine Robert J
Published: March 2007

OBJECTIVE

A randomized trial with 1-year follow-up was conducted in 23 general practices to study the relationship between target values for glycemic control and well-being in type 2 diabetes

RESEARCH DESIGN AND METHODS

A total of 176 patients with type 2 diabetes, aged 40–75 years, were included. General practitioners were encouraged to make decisions according to a standardized step-up regimen until the target levelof glycemic control was reached. The random allocation to a strict or a less strict target level of glycemic control (fasting capillary glucose <6.5 or <8.5 mmol/;1), change in HbAlc and fasting glucose, and initiating insulin or treatment with oral hypoglycemic agents were studied as putative determinants of scores on a type 2 diabetes symptom checklist, a profile ofmood states, an affect balance scale, and general well-being. Adjustments were made for baseline scores on the outcome at issue.

RESULTS

Positive affect (an odds ratio [OR] [95% CI] of 0.39 [0.19–0.83]) and perceived treatment burden (OR 0.48[0.23–0.98]) were unfavorably altered in the group randomly allocated to stricter target levels (fasting capillary glucose <6.5 mmol/l). Patients who had a decrease in HbA1c of 1% or more tended to have comparatively favorable mood (OR displeasure score 0.35 [0.13–0.94]) and general well-being scores at 1 year (ORs of having unfavorable scores ranged from 0.4 to 0.5, NS).

CONCLUSIONS

Perceived treatment burden and positive effect are unfavorably affected by random allocation to a strict target level for glycemic control. Improved glycemic control is associated with favorable mood and possibly general well-being in type 2 diabetes.
Multiple Metabolic Syndrome Is Associated With Lower Heart Rate Variability: The Atherosclerosis Risk in Communities Study
Authors: Liao Duanping , Sloan Richard P , Cascio Wayne E , Folsom Aaron R , Liese Angela D , Evans Gregory W , Cai Jianwen , Sharrett A Richey
Published: March 2007

OBJECTIVE

To test at the population level whether people with multiple metabolic syndrome (MMS) disorders have reduced cardiac autonomic activity (CAA).

RESEARCH DESIGN AND METHODS

We examined the association between the level of CAA and MMS disorders, at the degree of clustering and the segregate combination levels, using a random sample of 2,359 men and women aged 45–64 years from the biracial, population-based Atherosclerosis Risk in Communities (AR1C) Study. Supine resting 2-min beat-to-beat heart rate data were collected. High-frequency (HF) (0.15–0.35 Hz) and low-frequency (LF) (0.025–0.15 Hz) spectral powers, the ratio of LF to HF, and the SD of all normal R-R intervals (SDNN) were used as the conventional indices of heart rate variability (HRV) to measure CAA. The MMS disorders included hypertension, type 2 diabetes, and dyslipidemia.

RESULTS

HRV indices were significantly lower in individuals with MMS disorders. The multivariable adjusted mean HF was 0.85 (beat/min)2 in subjects with all three MMS disorders, in contrast to 1.31 beat/min)2 in subjects without any MMS disorder. At the segregated combination level, the multivariable adjusted means ± SEM of HF were 1.34 ± 0.05, 1.16 ± 0.05, 1.01 ± 0.17, and 1.34 ± 0.05 (beat/min)2, respectively, for subjects without any MMS disorder, with hypertension only, with diabetes only, and with dyslipidemia only, and the means ± SEM of HF were 0.93 ± 0.04,0.70 ± 0.15, and 1.20 ± 0.05 eat/min)2, respectively, for subjects with diabetes and hypertension, diabetes and dyslipidemia, and hypertension and dyslipidemia. An increase in fasting insulin of 1 SD was associated with 88% higher odds of having a lower HF The pattern of associations was similar for LF and SDNN.

CONCLUSIONS

These findings suggest that MMS disorders adversely affect cardiac autonomic control and a reduced cardiac autonomic control may contribute to the increased risk of subsequent cardiovascular events in individuals who exhibit MMS disorders.
Slicing the Pie: Correlating HbA1c values with average blood glucose values in a pie chart form
Authors: Brewer Karl W , Chase H Peter , Owen Susie , Garg Satish K
Published: March 2007

OBJECTIVE

The purpose of this study was to define the correlation between HbA1c values and the percentage of home blood glucose (HBG) measurements within given ranges in a pie chart in three age-groups of subjects with type 1 diabetes.

RESEARCH DESIGN AND METHODS

HbA1c values were compared with HBG measurements in subjects who did at least three blood glucose tests per day over 30 days in three age-groups: 5–11, 12–16, and 17–35 years. The blood glucose values were arbitrarily divided into three groups, defined as the percentage of HBG measurements within, above, and below target range. Each range was then compared with the corresponding HbA1c value. Longitudinal data were also collected for 279 of the subjects after a mean of 139 days.

RESULTS

A strong correlation (P = 0.001) was found between HbA1c values and the average blood glucose, and also with the percentage of HBG measurements within, above, and below target range in each of the three age-groups (P < 0.001). Analyses of longitudinal data showed a strong correlation of the changes in HbA1c values to the changes in blood glucose values.

CONCLUSIONS

These data showed that a pie-shaped graph of the HBG data can be useful as a clinical parameter in helping patients and families attain desired HbA1c values.
Gender, Autoantibodies, and Obesity in Newly Diagnosed Diabetic Patients Aged 40–75 Years
Authors: Wroblewski Marek , Gottsater Anders , Lindgarde Folke , Fernlund Per , Sundkvist Goran
Published: March 2007

OBJECTIVE

To evaluate the frequency of autoimmune markers (islet cell antibodies [ICA] and glutamic acid decarboxylase antibodies [GADA]) and clinical features in newly diagnosed people with diabetes aged 40–75 years.

RESEARCH DESIGN AND METHODS

Two hundred fifty-nine consecutive patients (aged 40–75 years) with newly suspected diabetes diagnosed during a 2-year period were studied. The diagnosis of newly discovered diabetes was confirmed in 203 patients. Gender, BMI, HbAic, fasting C-peptide, ICA, and GADA were evaluated. The frequency of obesity was estimated using two different sets of criteria: 1) National Diabetes Data Group (NDDG) criteria, and 2) criteria based on a Swedish reference population.

RESULTS

The annual incidence of diabetes was 106 per 100,000 people. The incidence of diabetes in those patients who were 40–54 years old was significantly higher in men than in women (odds ratio: 2.16; P = 0.001). ICA were detected in 16 of 203 patients (8%), whereas 17 of 203 patients (8%) were GADA+; 10 of 203 (5%) patients were positive for both ICA and GADA. Among the 203 diabetic patients, 19 (9.4%) were classified as having IDDM, giving an IDDM incidence of 10 per 100,000 people aged 40–75 years. The frequency of obesity in NIDDM was high but varied with its definition; the frequency of obesity was highest (P < 0.001) when NDDG criteria, and not Swedish reference values, were used (57 of 75 [76%] vs. 40 of 75 [53%] for women and 66 of 109 [61%] vs. 45 of 109 [41%] for men).

CONCLUSIONS

A striking male preponderance was found among incident cases of diabetes in people aged 40–54 years. Autoimmune markers were detected in 10% of incident cases of diabetes in people aged 40–75 years. Using a conservative estimation, as many as 10 of 100,000 middle-aged and elderly subjects developed IDDM. The frequency of obesity in NIDDM was high but this was also the case in the reference population.
Effects of Voglibose on Glycemic Excursions, Insulin Secretion, and Insulin Sensitivity in Non-lnsulin-ireated NIDDM Patients
Authors: Matsumoto Kazunari , Yano Mayumi , Miyake Seibei , Ueki Yukitaka , Yamaguchi Yoshihiko , Akazawa Shoichi , Tominaga Yuko
Published: March 2007

OBJECTIVE

To investigate the effects of voglibose, an α-glucosidase inhibitor, on daily glycemic excursions, insulin secretion, and insulin sensitivity in non-insulin-treated NIDDM patients.

RESEARCH DESIGN AND METHODS

An open prospective study was conducted in 27 NIDDM patients receiving diet therapy alone or treatment with a sulfonylurea drug. Of the study subjects, 14 patients were treated with voglibose; the remaining 13 patients served as the control group. The metabolic parameters were evaluated before treatment and at week 4 of treatment as follows: glycemic excursions by M-value and 1,5-anhydro-D-glucitol (1,5-AG), insulin secretion by area under the curve of daily serum insulin (AUCinsulin), and insulin sensitivity by the K index of the insulin tolerance test (KITT).

RESULTS

After the study treatment, HbA1c and plasma glucose in the patients who had received voglibose were comparable to those of patients in the control group. M-value was lower in the patients treated with voglibose than in the control subjects (5.7 ± 0.9 vs. 9.8 ± 1.2, P < 0.05). 1,5-AG was higher in the patients treated with voglibose than in the control subjects (12.2 ± 1.0 vs. 8.2 ± 0.7 μg/ml, P < 0.01). A statistically significant decrease in AUCinsuiin occurred after treatment with voglibose (2,223.5 ± 390.6 to 1,546.7 ± 303.4 pmol · l−1 · h, P < 0.05), but no change occurred in the control group (2,364.5 ± 315.4 to 2,464.2 ± 269.3 pmol · l−1 · h, P = 0.60). Insulin sensitivity (KITT) was improved to a statistically significant level in both the patients treated with voglibose and the patients in the control group. KITT in the patients after voglibose treatment was comparable to that of the control group (3.18 ± 0.30 vs. 3.21 ± 0.23%/min, P = 0.94).

CONCLUSIONS

The results suggest that voglibose lowers the daily glycemic excursions and inhibits overwork of the pancreatic β-cells but has little effect on insulin sensitivity in NIDDM patients.
Evaluation of GHb Assays in France by National Quality Control Surveys
Authors: Gillery Philippe , Dumont Gilles , Vassault Anne
Published: March 2007

OBJECTIVE

To evaluate the state of the art concerning GHb assays through analysis of a large-scale quality control survey and to compare the results with those of previous surveys.

RESEARCH DESIGN AND METHODS

A lyophilized hemolyzate prepared from human erythrocytes containing a physiological HbA1c level (5.5%) was sent to 3,500 French laboratories in February of 1995 and assayed as a patient's sample under routine conditions. Distribution of values was analyzed from the reported results for each method. The results were compared with the assigned value (acceptable range: ± 20%) and with the upper value of the reference range currently used.

RESULTS

Results were obtained from 2,674 laboratories, among which 39% used cationexchange chromatography methods, 37.5% affinity chromatography, 16% immunological methods, and 7.5% electrophoresis. The number of laboratories using immunological methods increased from 100 to 400 between 1993 and 1995. The overall interlaboratory coefficient of variation (CV) was 20.2%, with within-method CVs ranging between 3.2 and 29.5%. Method-to-method accuracy varied dramatically, with mean HbA1c values ranging from 4.4 to 8.2%. Results from 75% of the laboratories were comprised in the acceptable range; 88% of them reported a value within the normal range of the method used.

CONCLUSIONS

The interlaboratory variability of results illustrates the difficulties encountered by diabetologists in the follow-up of diabetic patients using results obtained from different laboratories. It demonstrates the usefulness of the internationally developed standardization process of GHb measurements and points out the need for laboratories to fulfill good practices.
Preserved Endothelial Function in IDDM Patients, but Not in NIDDM Patients, Compared With Healthy Subjects
Authors: Enderle Markus-D , Benda Norbert , Schmuelling Reinhold-M , Haering Hans U , Pfohl Martin
Published: March 2007

OBJECTIVE

To examine endothelial function (EF) noninvasively in IDDM and NIDDM patients with long diabetes duration.

RESEARCH DESIGN AND METHODS

We studied EF in 17 IDDM patients without diabetic complications and in 25 NIDDM patients with comparable glycemic control and with diabetic complications and compared both with nondiabetic control subjects matched for age, sex, and lumen diameter. Using high-resolution ultrasound, we measured the endothelialdependent (FAD%) and independent vasodilation (GTN%); the blood flow at rest, postocclusive, and after application of 400 μg glyceroltrinitrate of the brachial artery; and the intima media thickness (IMT) of the common carotid artery.

RESULTS

In the IDDM patients, neither FAD% (8.2 ± 4.6 vs. 7.6 ± 4.2%), GTN% (16.3 ± 4.9 vs. 18.4 ± 6.4%), nor postocclusive blood flow (40.6 ± 19.1 vs. 39.3 ± 23.6 cm/s) differed from the control subjects. IMT (0.59 ± 0.10 vs. 0.55 ± 0.14 mm) was slightly, but not significantly, elevated. In contrast, the NIDDM patients showed an impaired FAD% (3.8 ± 3.3 vs. 6.9 ± 4.4%, P < 0.01), no difference in GTN%, and a decreased postocclusive blood flow (18.5 ± 13.8 vs. 32.7 ± 20.0 cm/s, P < 0.01). IMT was significantly increased in NIDDM patients (0.77 ± 0.14 vs. 0.62 ± 0.10 mm, P < 0.001).

CONCLUSIONS

In contrast to NIDDM patients with cardiovascular complications, IDDM patients with long diabetes duration and good long-term metabolic control do not have impaired EF compared with control subjects.
Well-Being, Cerebral Function, and Physical Fatigue After Nocturnal Hypoglycemia in IDDM
Authors: King Paromita , Kong Marie-France , Parkin Heather , Macdonald Ian A , Tattersall Robert B
Published: March 2007

OBJECTIVE

This study assessed the effect of nocturnal hypoglycemia on well-being cerebral function, and physical fatigue the next day in 10 subjects with IDDM.

RESEARCH DESIGN AND METHODS

After an exercise test to determine work-loads corresponding to 30 and 60% VO2max, volunteers were studied twice, 4 weeks apart. Blood glucose was lowered one night to 2.3–2.7 mmol/l for 1 h, and at the control visit, hypoglycemia was avoided. The next morning, well-being was assessed using the minor symptom evaluation profile (MSEP), and cerebral function was assessed with the paced auditory serial addition test, the digit symbol substitution test, trail making part B, four-choice reaction time, and auditory P300 latency. Subjects then exercised at predetermined workloads corresponding to 30% VO2max for 30 min and 60% VO2max until exhaustion. Fatigue was assessed every 10 min using the Borg scale for rating of perceived exertion.

RESULTS

All three components of the MSEP scored higher (indicating more symptoms) after the hypoglycemic night compared with the control night (P < 0.01 contentment, sleep; P < 0.001 vitality). None of the cerebral function tests performed the next day was affected by hypoglycemia. Exercise capacity was similar at both visits, but subjects were more fatigued after the hypoglycemic night (P < 0.01, analysis of variance). There were no differences in potassium, catecholamine, glucose, or lactate concentrations between visits either before or during exercise.

CONCLUSIONS

One hour of hypoglycemia at night affects a subject's sense of well-being, but not cerebral function, the next day. The greater fatigue after the hypoglycemic night cannot be explained by the biochemical parameters measured.
The Relationship of Menstrual Irregularity to Type 2 Diabetes in Pima Indian Women
Authors: Roumain Janine , Charles M Aline , Courten Maximilian P De , Hanson Robert L , Brodie Todd D , Pettitt David J , Knowler William C
Published: March 2007

OBJECTIVE

Menstrual irregularity is associated with hyperinsulinemia and hyperandrogenemia in nondiabetic Pima Indian women of child-bearing age. In this population-based study, we determined the relationship of menstrual irregularity to type 2 diabetes in Pima Indian women.

RESEARCH DESIGN AND METHODS

Participants for this cross-sectional analysis were 695 nonpregnant Pima Indian women, aged 18–44 years, involved in an ongoing epidemiologic study of diabetes among residents of the Gila River Indian Community of Arizona. Clinical data were collected by questionnaire and an examination that included a 75-g oral glucose tolerance test; diabetes was diagnosed by World Health Organization criteria. Menstrual irregularity was defined as an interval of 3 months or more between menses, when not pregnant, since age 18 years.

RESULTS

History of menstrual irregularity was significantly associated with a high prevalence of diabetes (37 vs. 13%; odds ratio = 4.2, 95% CI = 1.6–10.8) in the least obese women (BMI < 30 kg/m2), adjusted for the effects of age and overall obesity. This association was, in part, because of greater central obesity in women with irregular menses. In more obese women, there was little association with menstrual irregularity, and diabetes was frequent regardless of menstrual history.

CONCLUSIONS

Prevalence of type 2 diabetes is higher among Pima indian women with a history of menstrual irregularity. The difference is most pronounced among the least obese group of women. This association may be because of insulin resistance and hyperinsulinemia, which predict type 2 diabetes, also causing hyperandrogenism and menstrual irregularity. The findings reinforce the need to evaluate women with menstrual irregularity for hyperglycemia.
Diabetes Prevalence and Hospital and Pharmacy Use in the Veterans Health Administration (1994): Use of an ambulatory care pharmacy-derived database
Authors: Pogach Leonard M , Hawley Gerald , Weinstock Ruth , Sawin Clark , Schiebe Harlan , Cutler Franklin , Zieve Franklin , Bates Mary , Repke Denis
Published: March 2007

OBJECTIVE

To develop a diabetes registry from an outpatient pharmacy database to systematically analyze the prevalence of diabetes, patterns of glycemic medication and glucose monitoring, pharmacy costs, and hospital use related to diabetes care in the Veterans Health Administration (VHA) in fiscal year (FY) 1994.

RESEARCH DESIGN AND METHODS

Veterans with diabetes were identified using a software program that extracted the social security number (SSN) of patients receiving insulin, sulfonylurea agents, or glucose-monitoring supplies. The cumulative FY94 cost for a drug was calculated by multiplying the units dispensed times the unit cost for each fill, using the actual drug cost that was in effect at the time of dispensing. Admission data were obtained by crossmatching the SSN registry with the VHA Austin Mainframe Patient Treatment Files to retrieve associated diagnosis-related groups (DRG), Physicians' Current Procedural Terminology (CPT), and International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes.

RESULTS

From among 1,180,260 unique patients, 139,646 veterans with diabetes receiving insulin, oral agents, or glucose-monitoring strips were identified, accounting for a prevalence of 11.83% from 62 Veterans Administration medical centers. There were 63,078 individuals (52%) who received oral agents, of whom 26.3% also received blood glucose-monitoring supplies; 46,664 individuals (39%) received insulin, of whom 53.2% received blood glucose-monitoring supplies; and 9,440 individuals (8%) received both oral agents and insulin during FY94, with 64.4% receiving blood glucose-monitoring supplies. Only 1,482 (1.2%) individuals received monitoring supplies alone, and 129 patients (0.1%) were provided with an insulin pump. Using an adjusted data set, 12% of veterans accounted for 24% of all outpatient pharmacy costs, with an average expenditure of $622 for veterans with diabetes compared with $276 for veterans without diabetes. There was $454 (73%) for non-diabetes-specific prescriptions and $168 (27%) for prescriptions related to glycemic control. Of pharmacy expenditures for glycemic control, $101 (60.1%) was attributed to insulin, oral agents, and supplies, while $67 (39.9%) was attributable to glucose monitoring. Veterans with diabetes were admitted 1.6 times as frequently as veterans without diabetes.

CONCLUSIONS

This study demonstrates the feasibility of using a pharmacy-based electronic diabetes database in a payor system that can track both claims and individual classes of medication based on a unique identifier number. While the prevalence of diabetes in the VHA is high relative to other health care systems and the general population, patterns of medication usage, pharmacy costs, and relative admission frequency are comparable to results from the private sector.
Cognitive Function in an Elderly Population With Persistent Impaired Glucose Tolerance
Authors: Vanhanen Matti , Koivisto Keijo , Kuusisto Johanna , Mykkänen Leena , Helkala Eeva-Liisa , Hänninen Tuomo , Riekkinen Paavo , Soininen Hilkka , Laakso Markku
Published: March 2007

OBJECTIVE

To study cognitive function in an elderly population with persistent impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS

Fasting and postload 2-h plasma glucose and insulin levels were determined at baseline in a population-based sample of 1,300 people and repeated an average of 3.5 years later in 980 subjects. At follow-up, cognitive function was evaluated in subjects with persistent normal glucose tolerance (NGT; n = 506) and IGT (n = 80) with a brief neuropsychological test battery.

RESULTS

Subjects with persistent IGT scored lower in the Mini-Mental State Examination (MMSE) and in the Buschke Selective Reminding Test long-term memory scores. Multiple linear regression analysis revealed that age, education, and insulin levels (either fasting or 2-h value) were associated with the MMSE score in subjects with persistent IGT. Other potential risk factors for impaired cognitive function were not significantly associated with the MMSE score.

CONCLUSIONS

Our study showed that persistent IGT in the elderly is associated with mildly impaired cognitive function, and hyperinsulinemia may account for this association.
Chronic Treatment of African-American Type 2 Diabetic Patients With β-Glucosidase Inhibition
Authors: Johnston Peter S , Feig Peter U , Coniff Robert F , Krol Alice , Kelley David E , Mooradian Arshag D
Published: March 2007

OBJECTIVE

To evaluate the long-term efficacy, safety, and tolerability of the alpha-glucosidase inhibitor miglitol in the treatment of African-American patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 345 African-American type 2 diabetic patients (mean age 55.6 years, BMI 31.9 kg/m2, duration of diabetes 4.9 years, baseline HbA1C 8.7%) treated with either diet alone or sulfonylurea were randomized to 1 year of double-blind treatment with either placebo (n = 117) or miglitol (n = 228) at doses of 50 or 100 mg t.i.d., titrated based on tolerability. The primary efficacy criterion was change from baseline in HbA1C at the 6-month visit. Secondarily efficacy parameters included changes from baseline in plasma glucose and serum insulin (both fasting and 120 min after a standardized test meal), fasting lipids, and urinary albumin-to-creatinine ratio. Safety and tolerability evaluations were primarily based on reporting of adverse events and symptoms and on periodic laboratory analyses.

RESULTS

Miglitol treatment was associated with a mean placebo-subtracted reduction in HbA1C from baseline of 1.19% at 6 months. Fasting and 120-min postprandial plasma glucose levels were reduced in parallel to HbA1C, in association with miglitol treatment. Significant reductions versus placebo in 120-min postprandial insulin levels, in LDL cholesterol, and in fasting triglycerides, were also seen in the miglitol group at individual study time points. Softer, more frequent stools and flatulence were significantly more common in the miglitol group. Urinary tract infections, hematuria, and herpes simplex infections were significantly more common in the placebo group.

CONCLUSIONS

Miglitol treatment appears to be at least as efficacious in the African-American type 2 population as in the U.S. type 2 population at large, with comparable tolerability. alpha-Glucosidase treatment may be an important therapeutic option in these patients in view of their greater risk for microvascular complications and the accumulating body of evidence that better glucose control reduces the risk of these complications.
Treatment of a Unique Anemia in Patients With IDDM With Epoetin Alfa
Authors: Rarick Mark U , Espina Byron M , Colley Daniel T , Chrusoskie Aaron , Gandara Shannan , Feinstein Donald I
Published: March 2007

OBJECTIVE

To identify and treat a unique form of anemia in patients with long-term IDDM.

RESEARCH DESIGN AND METHODS

Patients with IDDM, unexplained symptomatic anemia, and serum creatinine levels of < 177 μmol/l (2.0 mg/dl) were treated with epoetin alfa (Procrit, Ortho Biotech, Raritan, NJ), 50 U/kg three times weekly, subcutaneously, to reach a target hematocrit of 38–40%. Baseline serum erythropoietin titers were measured before drug therapy.

RESULTS

Six patients were treated with epoetin alfa. Median age of the group was 74 years, with IDDM being diagnosed for a median of > 20 years. All patients had symptoms of anemia with a median hematocrit of 28.9% (range 27–31). Compared with iron deficiency control patients, the group had a limited erythropoietin (EPO) response to the degree of anemia. All patients showed increases in hematocrit, median peak of 40.9%, with median time-to-peak response of 12 weeks. Baseline symptoms of anemia resolved in all patients. No adverse effects were noted during the treatment period.

CONCLUSIONS

There is a unique form of anemia in patients with long-term IDDM and clinically normal renal function who respond to low-dose epoetin alfa therapy. The rapid response to therapy and depressed baseline erythropoietin titers suggest the anemia is due to a lack of endogenous EPO release.
Treatment of Hypercholesterolemia and Combined Hyperlipidemia With Simvastatin and Gemfibrozil in Patients With NIPPM: A multicenter comparison study
Authors: Tikkanen Matti J , Laakso Markku , Ilmonen Marja , Helve Eero , Kaarsalo Esko , Kilkki Esa , Saltevo Juha ,   The Study Group
Published: March 2007

OBJECTIVE

To compare the lipid-lowering efficacies of simvastatin and gemfibrozil in NIDDM patients with combined (mixed) hyperlipidemia (CHL) or isolated hypercholesterolemia (IHC).

RESEARCH DESIGN AND METHODS

Patients with primary dyslipidemia and NIDDM were recruited for this double-blind, double-dummy comparison study from 10 Finnish centers. After a 4-week placebo run-in period, they were randomly assigned to simvastatin or gemfibrozil. The simvastatin group (n = 47) received 10 mg once nightly for 8 weeks, 20 mg for the next 8 weeks, and 40 mg for the third 8-week period. The gemfibrozil group (n = 49) received 600 mg twice daily throughout the 24 weeks. The lipid-lowering efficacies of both drugs were compared in all patients as well as separately in patients with CHL and IHC.

RESULTS

In all patients, simvastatin reduced LDL and total cholesterol and the LDL-to-HDL cholesterol ratio more effectively, whereas gemfibrozil was more effective in elevating HDL cholesterol and decreasing triglyceride levels. The drug effects differed according to lipid phenotype at baseline. Simvastatin decreased LDL cholesterol levels by 30–40% in both phenotypes. Gemfibrozil caused a 15% reduction in LDL cholesterol in IHC but no change in CHL patients. Simvastatin produced 15–30% reductions in triglyceride levels in CHL but no change in IHC patients. Gemfibrozil caused reductions in triglycerides in CHL (50% and more) and in IHC (40%) patients, with 12–18% increases in HDL cholesterol in these groups.

CONCLUSIONS

Simvastatin is useful in both CHL and IHC patients, whereas gemfibrozil can be used in patients with high triglyceride and low or normal LDL cholesterol levels.
Fish Oil and Glycemic Control in Diabetes: A meta-analysis
Authors: Friedberg Cylla E , Janssen Martien J F M , Heine Robert J , Grobbee Diederick E
Published: March 2007

OBJECTIVE

Hypertriglyceridemia is associated with cardiovascular disease in diabetes. Fibrates effectively lower, but do not always normalize, serum triglyceride levels. Fish oil supplements may then be added to lower serum triglyceride levels. Doubt remains whether the net effect of fish oil intake on glycemic control is beneficial in diabetes. We therefore performed a meta-analysis from published clinical trials.

RESEARCH DESIGN AND METHODS

Data sources were Medline (Cologne, Germany), Excerpta Medica, Current Contents, review articles, and published reference lists. Publications of 26 trials were selected, and all trials included more than five diabetes (IDDM and NIDDM) patients and addressed the effects offish oil (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) on serum lipids and glucose tolerance. We (C.E.F, M.J.F.M.J.) extracted data independently based on predetermined criteria. Studies were classified according to design.

RESULTS

All studies combined showed a decrease in mean triglyceride concentrations in association with fish oil: −0.60 mmol/1 (95% CI, −0.84 to −0.33, P < 0.01) and a slight but significant increase in serum LDL cholesterol: 0.18 mmol/1 (95% CI, 0.04−0.32, P = 0.01), with both findings most prominent in NIDDM. No significant changes in HbA1c percentages occurred in diabetic subjects treated with fish oil. Fasting blood glucose levels were increased with borderline significance in NIDDM subjects (0.43 mmol/1 [95% CI, 0.00–0.87], P = 0.06) and were significantly lower in IDDM subjects (−1.86 mmol/1 [95% CI, −3.1 to −0.61], P < 0.05). Significant dose-response effects of EPA (g/day) on HbA1c and triglycerides and of DHA (g/day) on fasting blood glucose levels, HbA1c, and triglycerides were demonstrated only in NIDDM subjects.

CONCLUSIONS

The use of fish oil has no adverse affects on HbA1c in diabetic subjects and lowers triglyceride levels effectively by almost 30%. However, this may be accompanied by a slight increase in LDL cholesterol concentration. Fish oil may be useful in treating dyslipidemia in diabetes.
Childhood Diabetes in China: Enormous variation by place and ethnic group
Authors: Yang Ze , Wang Kean , Li Tianlin , Sun Wei , Li Yurui , Chang Yue-Fang , Dorman Janice S , LaPorte Ronald E
Published: March 2007

OBJECTIVE

To investigate the incidence rate of IDDM in China.

RESEARCH DESIGN AND METHODS

The Chinese IDDM registry was established in 1991 as part of the World Health Organization's Multinational Project for Childhood Diabetes (DiaMond) project. Twenty-two centers were developed to monitor the incidence of IDDM in children <15 years of age. The population under investigation includes >20 million individuals, representing ∼7% of the children in China. Capture-recapture methods were used to estimate the ascertainment.

RESULTS

The overall ascertainment-corrected IDDM incidence rate in China was 0.51 per 100,000, the lowest rate ever reported. There was a 12-fold geographic variation (0.13–1.61 per 100,000). In general, the incidence rate was higher in the north and the east. There was a sixfold difference among ethnic groups (highest: Mongol group, 1.82 per 100,000; lowest: Zhuang group, 0.32 per 100,000).

CONCLUSIONS

China has an extremely low overall IDDM incidence rate. China also has the greatest geographic and ethnic variation seen for any country.
Validation of Home Blood Glucose Meters With Respect to Clinical and Analytical Approaches
Authors: Brunner Gernot A , Ellmerer Martin , Sendlhofer Gerald , Wutte Andrea , Trajanoski Zlatko , Schaupp Lukas , Quehenberger Franz , Wach Paul , Krejs Guenter J , Pieber Thomas R
Published: March 2007

OBJECTIVE

To evaluate the clinical and analytical accuracy of home blood glucose meters.

RESEARCH DESIGN AND METHODS

Six blood glucose meters—Reflolux S (Boehringer Mannheim, Mannheim, Germany), One Touch II (LifeScan, Milpitas, CA), Glucocard Memory (Menarini, Florence, Italy), Precision QID (Medisense, Cambridge, U.K.), HaemoCue (HaemoCue, Ängelholm, Sweden), and Accutrend a (Boehringer Mannheim, Mannheim, Germany)—were compared with a reference method (Beckman Glucose Analyzer II) under controlled conditions (glucose clamp technique). Validation of the blood glucose meters was accomplished by clinically oriented approaches (error grid analysis), statistical approaches (variance components analysis), and by the criteria of the American Diabetes Association (ADA), which recommend a target variability of <5%.

RESULTS

A total of 1,794 blood glucose monitor readings and 299 reference values ranging from 2.2 to 18.2 mmol/1 were analyzed (705 readings <3.89 mmol/1, 839 readings between 3.89 and 9.99 mmol/1, and 250 readings >9.99 mmol/1). According to error grid analysis, only Reflolux S and Glucocard M had 100% of estimations within the clinically acceptable zones A and B. Assessment of analytical accuracy revealed substantial differences between the glucose meters after separation of the data into defined glycemic ranges. None of the devices met the ADA criteria.

CONCLUSIONS

To evaluate accuracy of blood glucose meters, error grid analysis, as well as statistical models, are helpful means and should be performed together. Analytical performance of currently available home blood glucose meters differs substantially within defined glycemic ranges.
Muscular Endurance in Long-Term IDDM Patients
Authors: Andersen Henning
Published: March 2007

OBJECTIVE

To determine the short-term muscular endurance and working capacity of leg muscles in long-term IDDM patients in relation to neuropathic complications, muscle strength, and metabolic control.

RESEARCH DESIGN AND METHODS

The muscular endurance of extensors and flexors at the ankle and knee was assessed in 44 IDDM patients and in 44 matched control subjects during 30 maximal isokinetic movements. The endurance index was the work performance of the last 5 movements relative to the first 5 movements. Total work was the summated work of all movements. All patients underwent a neurological evaluation, nerve conduction studies, and quantitative sensory tests.

RESULTS

The combined endurance index of the ankle extensors and flexors was 70% (51–88) (median [range]) in the diabetic group and 65% (55–82) in the control group (P < 0.01). For knee extensors and flexors the combined endurance index was 65% (55–103) for the diabetic patients and 63% (48–75) in the control subjects (P < 0.01). The endurance index related neither to the severity of neuropathy nor to the metabolic control (blood glucose and HbA1c) for any of the muscle groups. Diabetic patients had reduced strength of all muscle groups (14–24%, P < 0.02) and impaired total work performance (15–20%, P < 0.01) for ankle movements.

CONCLUSIONS

Long-term IDDM patients have increased endurance but reduced strength and work performance of leg muscles. The combined effect of the motor abnormalities is suggested to give rise to functional impairment, including an increased risk of falls and injuries.
Angiographic Evaluation of Peripheral Arterial Occlusive Disease and Its Role as a Prognostic Determinant for Major Amputation in Diabetic Subjects With Foot Ulcers
Authors: Faglia Ezio , Favales Fabrizio , Quarantiello Antonella , Calia Patrizia , Clelia Paratore , Brambilla Giorgio , Rampoldi Antonio , Morabito Alberto
Published: March 2007

OBJECTIVE

To evaluate in diabetic patients with foot ulcers the angiographic findings of peripheral occlusive arterial disease and their role as a prognostic determinant for major amputation.

RESEARCH DESIGN AND METHODS

From 1993 to 1995, 104 diabetic inpatients with foot ulcers underwent arteriography on the ulcerated limb. Stenoses in the iliac trunk, the superficial femoral artery, the profunda femoral artery, the popliteal artery, the anterior tibial artery, the posterior tibial artery, and the peroneal artery were scored on the basis of vessel lumen reduction: 0 if stenoses involved a reduction in the vessel lumen of <50%, 1 if stenoses involved 50 to <75% reduction, 2 if stenoses involved 75 to <100% reduction, and 3 if total occlusion was present. The sum of the points assigned to each of these arteries was called the angiographic score.

RESULTS

Stenoses causing a vessel lumen reduction ≥50% were detected in 103 patients (99%). Stenoses were also detected in subjects with palpable foot pulses, ankle-brachial indexes ≥1, or transcutaneous oxygen tension ≥50 mmHg. The risk of major amputation was increased significantly when total occlusion was present in the popliteal and infrapopliteal arteries (x2 for trend = 50.57, P < 0.001). No major amputation was carried out in patients with angiographic scores <10; major amputation was carried out in all the patients with scores >14. Multivariate analysis indicated a high angiographic score as an independent risk factor for major amputation (odds ratio 2.32, P = 0.001, CI 1.40–3.84).

CONCLUSIONS

Angiography permits an exact detection of occlusive arterial disease in subjects with normal results for noninvasive vascular procedures. A score that has a relevant prognostic value for major amputation can be obtained from the evaluation of the extent and diffusion of the stenoses.