bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss of the First Phase Insulin Response to Intravenous Glucose in Subjects with Persistent Impaired Glucose Tolerance
Authors: Davies M.J. , Rayman G. , Grenfell A. , Gray I.P. , Day J.L. , Hales C.N.
Published: July 2009

Loss of the first phase insulin response to intravenous glucose is one of the earliest detectable defects of beta cell dysfunction in Type 2 diabetes mellitus. Impaired glucose tolerance (IGT) is considered a prediabetic condition, therefore loss of first phase insulin secretion in subjects with IGT would suggest beta cell dysfunction as an early lesion in the development of Type 2 diabetes. Three groups of subjects were studied, 7 subjects with persistent IGT (classified as having IGT at two 75 g oral glucose tolerance tests (OGTT) done 6 months apart), 6 subjects with transient IGT (IGT at the first OGTT, but normal glucose tolerance at a repeat OGTT 6 months later), and 7 normal controls. First phase insulin secretion was studied using an intravenous glucose tolerance test with arterialized blood sampling. Fasting, 3, 4 and 5 min samples were assayed for glucose and insulin (specific two‐site immunoradiometric assay). The fasting insulin was similar in all three groups, however the 3 min insulin response was significantly lower in those with persistent impaired glucose tolerance (p < 0.02). Thus subjects with persistent impaired glucose tolerance demonstrated loss of the first phase insulin response as an early indicator of beta cell dysfunction while subjects with transient IGT had a normal insulin response to intravenous glucose. During the OGTT, the 30 min glucose was not significantly different (p = 0.1) but the 30 min insulin to glucose ratio was significantly lower in subjects with persistent IGT (p < 0.03). In the whole group the 30 min insulin to glucose ratio during the OGTT showed a significant correlation with the peak insulin response during the IVGTT (r = 0.76, p < 0.001). This study suggests that beta cell dysfunction with impaired early insulin release is present before the development of Type 2 diabetes.
Congenital Malformations in Offspring of Diabetic Women Treated with Oral Hypoglycaemic Agents During Embryogenesis
Authors: Hellmuth E. , Damm P. , Mølsted‐Pedersen L.
Published: July 2009

A markedly increased risk (50%) of congenital malformations in the offspring of women treated with oral hypoglycaemic agents during the first trimester has recently been reported. With this background, the medical records of a consecutive sample of 25 pregnant Type 2 diabetic women treated with oral hypoglycaemic agents during embryogenesis between 1966 and 1991 in the diabetic service of a university hospital, were studied retrospectively. None of the infants had major congenital malformations disclosed in the neonatal period (0%, 97.5% confidence interval 0.0–13.7%), but one minor congenital malformation was found (4.0%, 95% confidence interval 0.1–20.3%). Although this study, due to the limited number of pregnancies examined, does not exclude an association between treatment with oral hypoglycaemic agents at the time of embryogenesis and major congenital malformations in the offspring, the previously reported association was not confirmed. Thus we find no obvious indication for therapeutic abortions in patients who have accidentally been treated with oral hypoglycaemic agents during embryogenesis. On the contrary it seems reasonable to reassure these women with respect to their risk of having a malformed baby, stop the treatment with oral hypoglycaemic agents and initiate insulin treatment.
The Prevalence of Foot Ulceration and its Correlates in Type 2 Diabetic Patients: a Population‐based Study
Authors: Kumar S. , Ashe H.A. , Parnell L.N. , Fernando D.J.S. , Tsigos C. , Young R.J. , Ward J.D. , Boulton A.J.M.
Published: July 2009

The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community‐based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34–90) years, diabetes duration 7.4 (0–50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or ≥ 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6% (95% confidence limits 38.3–44.9%) and the prevalence of PVD, 11% (9.1–13.7%). Forty‐eight percent of neuropathic patients reported significant neuropathic symptoms. Forty‐three patients (5.3% (3.8‐6.8%)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.
The N‐acetyltransferase (NAT) Gene: An Early Risk Marker for Diabetic Nephropathy in Japanese Type 2 Diabetic Patients?
Authors: Neugebauer S. , Baba T. , Watanabe T. , Ishizaki T. , Kurokawa K.
Published: July 2009

A point mutation in the N‐acetyltransferase gene (NAT2) leads to the recessive trait for the slow acetylator phenotype, which is suggested to be associated with microalbuminuria in Type 1 diabetic patients. Our study was designed to elucidate whether the NAT2 gene polymorphism would be a marker for diabetic nephropathy. The genotype distribution was studied in Japanese Type 2 diabetic patients with established nephropathy (n= 43), with microalbuminuria (n= 24), with normoalbuminuria (n= 18), non‐diabetic patients with kidney disease (n= 62), and healthy control subjects (n= 51). The different alleles of the NAT2 gene were identified by restriction fragment length polymorphism analysis: the gene was amplified from genomic DNA (obtained from blood) and digested with restriction enzymes. The genotype was classified by the specific pattern of each allele (M1, M2, M3) in the agarose electrophoresis and ethdium bromide fluorescence. Alleles M1, M2, and M3 of NAT2 gene were found in 42.4% of all subjects (40.0% in all diabetic patients and 44.2% in all non‐diabetic controls). The prevalence of the genotype, encoding the slow acetylator phenotype, was 7.0% in diabetic patients with established diabetic nephropathy, 20.8% in microalbuminuric diabetic patients, 0% in normoalbuminuric diabetic patients, 6.5% in non‐diabetic patients with kidney disease, and 7.8% in healthy control subjects. The differences in the prevalence were non‐significant. The results suggest that the N‐acetyltransferase gene polymorphism may not be a genetic risk marker for diabetic nephropathy in Japanese Type 2 diabetic patients. Further studies with larger numbers of patients are required to confirm this observation.
Insulin Loss at the Injection Site in Children with Type 1 Diabetes Mellitus
Authors: Stewart N.L. , Darlow B.A.
Published: July 2009

A simple filter paper technique is described for demonstrating and measuring insulin loss at the injection site in children with type 1 diabetes mellitus. Using this technique in a cohort of 19 children during a 7‐day period, measurable fluid was demonstrated at the injection site in 68% of children at least once and was present following 23% of all injections. In nearly 80% of cases the insulin loss probably represented less than 1 unit but could on occasions be 2 units or more or up to 18% of the injected dose. Insulin losses were observed following injections given by children themselves and by parents. There was no significant relationship between insulin dose and insulin loss. Insulin losses at the injection site are frequent and, although usually small in amount, are a potential source of blood glucose variability.
Childhood‐onset Diabetes in the White and South Asian Population in Leicestershire, UK
Authors: Gujral J. S. , McNally P. G. , Botha J. L. , Burden A. C.
Published: July 2009

The prevalence of childhood‐onset Type 1 diabetes mellitus is important for determining health care provisions. In Leicestershire 13.5% of the childhood population (0–14 years) is of South Asian origin (census 1991). This study determined the prevalence of Type 1 diabetes in Whites and South Asians in Leicestershire, using a capture/recapture method to coincide with the 1991 Census day. Children (0–14 years) with Type 1 diabetes were captured from the central diabetic register. The health visitor and consultant records were used to recapture the cases. Total ascertainment of cases was 95–100%. The prevalence of Type 1 diabetes in White children (107 cases) was 0.75/1000 children (95% CI 0.61–0.89) compared with the South Asian prevalence (18 cases) of 0.77/1000 (95% CI 0.41–1.13). The overall prevalence in White males was 0.82/1000 (0.61–1.03) compared with 0.68/1000 (0.48–0.87) in females. In South Asian males it was 0.59/1000 (0.15–1.03) compared with 0.96/1000 (0.39–1.53) in females. The prevalence of Type 1 diabetes in children of South Asian migrants to the United Kingdom cannot be said to be different from White children.
The Role of General Practitioners in Diabetic Eye Care in Lanarkshire
Authors: Sullivan F. M. , Stearn R. , MacCuish A. C.
Published: July 2009

This study reports data from 50 practices (3550 patients) in Lanarkshire taking part in an audit of diabetes care. Data were obtained by review of general practitioner records and the correspondence from consultants and opticians contained in them. The principal study measures examine the process of care. Overall levels of performance were low: only 35.5% of patients had visual acuity and 54.5% fundoscopy recorded in the previous year. Significantly better results were observed for both examinations in those few practices which performed these examinations in more than 10% of their patients (51.4% vs 32.0% (mean difference 19.4, 95% CI 16.1–23.7) for visual acuity and 65.7% vs 53.3% (mean difference 12.4, 95% CI 3.0–21.8) for fundoscopy. Less than half of diabetic patients in Lanarkshire currently receive adequate screening for the ocular complications of diabetes. Most practices rely on hospital diabetic and ophthalmology services. Where practices undertake ocular examination of patients, this is currently in addition to those services provided elsewhere.
The Cost of Insulin‐dependent Diabetes Mellitus (IDDM) in England and Wales
Authors: Gray A. , Fenn P. , McGuire A.
Published: July 2009

This study estimates the direct health and social care costs of insulin‐dependent diabetes mellitus (IDDM) in England and Wales in 1992 to be £96 million, or £1021 per person in a population with IDDM estimated at 94 000 individuals. These costs include insulin maintenance, hospitalization, GP and out‐patient consultations, renal replacement therapy, and payments to informal carers. Expenditure is concentrated on younger age groups, with one‐third of the total expended on those aged 0–24. Around one‐half of the total costs can be directly attributed to IDDM, with the remainder associated with a range of complications of the disease. The single largest area of service expenditure is renal replacement therapy. The cost estimates are most sensitive to incidence rates of IDDM, numbers on dialysis and average duration of dialysis. A further £113 million pounds may be lost each year due to premature deaths resulting in lost productive contributions to the economy. The direct and indirect costs of IDDM are therefore significant. The cost of illness framework presented here should facilitate the economic evaluation of new and existing treatment regimens, which may improve value for money by reducing costs and/or increasing the quality or quantity of life for people with IDDM.
Evaluation of a Second‐generation Electrochemical Blood Glucose Monitoring System
Authors: Tieszen K.L. , Burton S.F. , Dornan T.L. , Matthews D.R. , McMurray J.R.
Published: July 2009

One hundred and ninety‐five diabetic patients attending hospital clinics gave blood samples to test the accuracy and precision of a second generation glucose sensor (satellite G, MediSense Inc., Abingdon, UK) with particular emphasis on its performance with venous blood. Sensor results correlated closely with a standard laboratory method; analysis of residuals showed no deviation from zero slope. Mean percentage difference was low (< ± 6.0 %) and the 95 % limits of agreement were < ± 30 % with both capillary and venous blood. Error Grid Analysis showed that none of the measurements would have led to serious management errors. Precision of the system was good with coefficients of variation (CV) between 2.8 % and 7.1 % for glucose concentrations ranging from 3.0 to 24.0 mmol I‐1. The mean CV for duplicate measurements was 5.4 % with capillary and 4.4 % with venous blood. We conclude that the electrochemical glucose method gives accurate and precise measurements of venous and capillary blood glucose.
Forearm Substrate Exchange during Hyperinsulinaemic Hypoglycaemia in Normal Man
Authors: Abilgaard N. , Ørskov L. , Petersen J.A.K. , Schmitz O. , Møller N. , Alberti K.G.M.M.
Published: July 2009

To assess muscle substrate exchange during hypoglycaemia, 8 healthy young male subjects were studied twice during 2 h of hyperinsulinaemic euglycaemia followed by 4 h of (1) hypoglycaemia (plasma glucose < 2.8 mmol l−1), and (2) euglycaemia. Insulin was infused at a rate of 1.5 mU kg−1 min−1 throughout. When compared to euglycaemia, hypoglycaemia was associated with: (1) increment in circulating glucagon (65 ± 8 vs 23 ± 4 ng l−1, p < 0.05), growth hormone (19.9 ± 3.6 vs 2.6 ± 1.3 μg l−1, p < 0.05), adrenaline (410 ± 88 vs 126 ± 32 ng l−1, p < 0.05) and increased suppression of C‐peptide (0.5 ± 0.1 vs 1.0 ± 0.1 μg l−1, p < 0.05) along with a modest lowering of insulin (103 ± 10 vs 130 ± 13 mU l−1, p < 0.05); (b) decrease in plasma glucose level (3.0 ± 0.07 vs 5.0 ± 0.12 mmol l−1 p < 0.05), forearm glucose uptake (0.21 ± 0.09 vs 1.21 ± 0.21 mmol l−1, p < 0.05) and requirement for exogenous glucose (5.6 ± 1.1 vs 13.2 ± 0.9 mg kg−1 min−1 p < 0.005) together with an impaired suppression of isotopically determined endogenous glucose production (0.34 ± 0.5 vs −2.3 ± 0.3 mg kg−1 min−1, p < 0.05); (3) exaggerated increase in blood lactate (1680 ± 171 vs 1315 ± 108 μmol l−1, p < 0.05) and a decrease in alanine (215 ± 18 vs 262 ± 19 μmol l−1, p < 0.05). Forearm release of lactate (130 ± 43 vs 12 ± 31 μmol l−1, p = 0.09) tended to be increased, whereas alanine balance (18 ± 6 vs 17 ± 5 μmol l−1) was unchanged. (4) Total forearm blood flow increased similarly during both studies (4.4 ± 0.6 vs 4.2 ± 0.5 ml 100 ml−1 min−1). These data suggest that the human forearm is not a major site for glucose uptake nor for lactate production during protracted hypoglycaemia; the fact that forearm glucose uptake is reduced sixfold during hypoglycaemia further suggests that restriction of glucose uptake in muscles plays a frontline role in the defence against hypoglycaemia.
Evaluation of a Structured Teaching and Treatment Programme for Type 2 Diabetes in General Practice in a Rural Area of Austria
Authors: Pieber T.R. , Holler A. , Siebenhofer A. , Brunner G.A. , Semlitsch B. , Schattenberg S. , Zapotoczky H. , Rainer W. , Krejs G.J.
Published: July 2009

The efficacy of a treatment and teaching programme for non‐insulin‐treated Type 2 diabetic patients in general practice was evaluated in a prospective, controlled study. In a rural area in southern Austria, 53 patients from seven general practices participated in a structured programme (intervention group) and 55 patients from seven general practices without the programme served as the control group. After 6 months the weight reduction in the intervention group was 2.6 kg (1.6–3.7 kg, p < 0.001) and the difference in HbA1c between the groups was 0.92% (0.23–1.61%, p < 0.01) at follow‐up. Systolic (– 16.6 mmHg) and diastolic (–11.1 mmHg) blood pressure, serum triglycerides (– 0.63 mmol I−1), and serum cholesterol (– 0.40 mmol I−1) were reduced significantly in the intervention group (p < 0.006). The number of patients with callus formation and poor nail care decreased significantly after participating in the teaching programme (p < 0.001). In the control group no reduction in body weight, metabolic control or in risk factors for diabetic foot complications were observed. Calculated health care costs per patient and year decreased in the intervention group (£ − 33) and increased in the control group (£ +30) mainly due to changes in prescription of oral hypoglycaemic agents in both groups. This programme may be an efficient and helpful model to increase overall quality of diabetes care according to the St Vincent Declaration.
Abnormal Insulin Treatment Behaviour: a Major Cause of Ketoacidosis in the Young Adult
Authors: Thompson C. J. , Cummings F. , Chalmers J. , Newton R. W.
Published: July 2009

Diabetic ketoacidosis occurs more frequently in the young adult population than in any other age group. In a 3‐year retrospective casenote review of all patients admitted with ketoacidosis to this hospital, we have defined the clinical characteristics of ketoacidosis in this age group. Young adults (< 25 years) had worse preceding glycaemic control (median HbA1 14.6 vs 10.1%, p = 0.0001) and more frequent episodes of ketoacidosis in the previous 5 years (3 vs 0, p = 0.0001) than older adults (> 25 years); on admission they had lower blood urea concentrations (p = 0.0001) and had a lower incidence of systolic hypotension (6% vs 32%, p = 0.007). There were fewer complications of ketoacidosis in the young adults, and the duration of hospital stay was less than that in the older age group (4 vs 8 days, p = 0.0003). Young adults were less likely to have a proven underlying infective or other organic precipitant for ketoacidosis, but were investigated and treated in a similar way to older adults. Insulin error or manipulation was identified in 42% of young adults; abnormal insulin treatment behaviour is likely to be the major cause of ketoacidosis in this age group.
Importance of Early Insulin Levels on Prandial Glycaemic Responses and Thermogenesis in Non‐insulin‐dependent Diabetes Mellitus
Authors: Markovic T.P , Furler S.M. , Jenkins A.B. , Campbell L.V. , Kraegen E.W. , Chisholm D.J.
Published: July 2009

To examine the effect of different profiles of insulin administration on glycaemia and thermogenesis, we studied 10 subjects with mild non‐insulin‐dependent diabetes mellitus on four occasions after a standard mixed meal: (1) with no supplementary insulin (control), (2) with intravenous insulin (1.8***U over 15 min = short), (3) as for short but extended over 30 min to simulate the normal initial rise in portal vein insulin levels (medium), (4) as for medium with additional insulin to normalize the profile from 30–60 min (3.6***U over 60 min, long). All studies in which supplemental insulin was administered lowered the integrated glucose response above baseline versus the control study (short 76%, medium 71%, and long 56% of control, p = 0.003). The insulin infusions also increased the non‐protein respiratory quotient in the first hour following the meal (0.82 ± 0.01 (control) vs 0.87 ± 0.01 (short), 0.86 ± 0.01 (medium) and 0.87 ± 0.01 (long), p = 0.003) and augmented thermogenesis (7.6 ± 1.5 (control) vs 10.5 ± 2.9 (short), 13.0 ± 1.9 (medium) and 13.2 ± 2.8% (long), p = 0.02). Total integrated insulin area above baseline was significantly greater in the long study (short 121, medium 111 vs long 179% of control, p = 0.02). Thus the greatest glycaemic benefit in relation to insulinaemia was obtained with the two shorter insulin infusions (short and medium). In conclusion, this study confirms the role of early prandial insulin secretion (or delivery) in limiting prandial glycaemia in NIDDM and increasing thermogenesis and highlights the pivotal role of the timing of elevation of insulin levels in modulating hyperglycaemia and hyperinsulinaemia.
Diabetes Care in South Asian and White European Patients with Type 2 Diabetes
Authors: Close C.F. , .Lewis P.G , Holder R. , Wright A.D. , Nattrass M.
Published: July 2009

Aspects of diabetes care in South Asian and white European patients with Type 2 diabetes attending a hospital review clinic were explored. Among the clinic population of 1710 patients, 25B (15%) were of South Asian origin. A significantly greater proportion (95% CI for difference in proportions 8–22%) of these patients was treated with oral hypoglycaemic drugs than in white Europeans, in whom there was a correspondingly greater proportion receiving insulin treatment. In a case‐control study, where 154 patients in each racial group were stratified according to treatment regimen, significantly more South Asian patients (13/30 vs 6/30, p < 0.05) on insulin were treated with a once‐daily regimen. Despite these observed differences in treatment of diabetes, glycaemic control was no worse in South Asian patients when compared to their white European counterparts. South Asian diabetic patients attending hospital diabetes clinics in the UK can experience similar levels of glycaemic control to white Europeans.
Glycated Haemoglobin Levels in Patients with Diabetes in One General Practice over a 10‐year Period
Authors: Bradshaw C. , Steen I.N. , Eccles M.
Published: July 2009

The aim of the study was to evaluate the level of control, as reflected by HbA1c, in patients with diabetes attending one general practice over a 10‐year period. The study was based in one general practice in South Tyneside, UK and consisted of an analysis of HbA1c values of all patients with diabetes attending the practice between 1983 and 1992. HbA1c levels were analysed and are presented as multiples of the standard deviation above the mean. In the practice 256 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and 76 with insulin‐dependent diabetes mellitus (IDDM), attended for a total of 1596 doctor/patient contacts in the diabetic clinic over 10 years. The prevalence of diabetes was 1.9%. Over the course of the clinic, in any one year, 25% of patients with NIDDM and 55% with IDDM had levels of HbA1c above those thought to be associated with increased risk of microvascular complications. Significant reduction in glycated haemoglobin (HbA1c) occurred in the first year after diagnosis (p < 0.01) and after changing treatment from diet alone to diet and oral hypoglycaemic agents (p < 0.001). We conclude that a large proportion of patients within this population had levels of glycaemic control that put them ‘at increased risk’.
An Evaluation of Fructosamine Estimation in Screening for Gestational Diabetes Mellitus
Authors: Hughes P.F. , Agarwal M. , Newman P. , Morrison J.
Published: July 2009

Although persuasive arguments against routine screening for gestational diabetes mellitus (GDM) have been made, it is widely but not universally performed as a part of antenatal care. There is no international agreement on methods or criteria used for screening (or for diagnosis), and administered glucose‐load methods have significant practical difficulties in a busy antenatal clinic setting. However, recent evidence supports the concept of an increased level of importance being given to a diagnosis of GDM, with interest in the fetal and neonatal origins of adult disease being added to the short‐term obstetric and fetal concern during pregnancy. A second generation fructosamine test, corrected for total protein, has been evaluated as a practical alternative to glucose screening for GDM in a busy, multi‐ethnic antenatal clinic. This achieved a 79.4 % sensitivity and a 77.3 % specificity for a diagnosis of GDM confirmed by a glucose tolerance test using Carpenter's modified criteria. In view of the organizational simplicity of this sample/test requirement, a wider evaluation is suggested together with a re‐evaluation of clinical outcome criteria rather than blood glucose levels alone.
Cigarette Smoking and Free Radical Activity in Young Adults with Insulin‐dependent Diabetes
Authors: Leonard M. B. , Lawton K. , Watson I. D. , Patrick A. , Walker A. , MacFarlane I.
Published: July 2009

Cigarette smoke is potentially capable of generating a high free radical load in the body and many patients with diabetes are smokers. This study was designed to investigate the relationship between long‐term smoking and free radical activity in young adult insulin‐dependent diabetic patients with no evidence of macrovascular disease. Eighty‐five patients (48 male) aged 17–40 years were studied. Mean duration of diabetes was 10.5 years (0.08–33) and 39 were cigarette smokers. All had normal serum creatinine levels. The free radical markers measured were: thiobarbituric acid reactive substances, glutathione perioxidase, and superoxide dismutase. No significant differences in thiobarbituric acid reactive substances, glutathione peroxidase, or superoxide dismutase, were found between the diabetic smokers and non‐smokers. Also, no difference was found comparing the diabetic patients with 40 non‐diabetic control subjects (20 smokers). Persistent albuminuria was present in 16 patients (10 microalbuminuria) and free radical marker concentrations in these subjects were similar to the normoalbuminuric patients. This data suggests that any increase in free radical activity due to cigarette smoke is adequately scavenged in young adults with diabetes who are free of significant macrovascular disease.
Blood Rheology and Albumin Excretion in Diabetic Pregnancy
Authors: MacRury S. M. , Pinion S. , Quin J. D. , O'Reilly D. St. J. , Lunan C. B. , Lowe G. D. O. , MacCuish A. C.
Published: July 2009

Blood rheology is altered in diabetes and also in non‐diabetic pregnant women. The cumulative effect of hyperfiltration, abnormal rheology of pregnancy, and diabetes could be one mechanism contributing to increased intraglomerular pressure and albuminuria in diabetic pregnancy. We conducted a prospective study of 22 Type 1 (insulin‐dependent) diabetic patients and 22 non‐diabetic women to determine if there was an association of altered blood rheology on glomerular function in diabetic pregnancy. Albumin excretion showed no increment with increasing gestation and was similar in diabetic and non‐diabetic women throughout pregnancy (first trimester: 5.0 (3.0–14.0) vs 5.8 (3.7–10.7) mg l‐1, p=0.89; second trimester: 6.0 (5.0–12.0) vs 5.1 (3.6–10.4) mg l‐1, p=0.25; third trimester: 7.5 (3.5–16.0) vs 4.9 (2.9–7.3) mg l‐1, p=0.18). Red cell aggregation index increased in both groups between the first and third trimesters (diabetic patients: mean difference 2.0; CI: 1.0–2.9, p=0.003, and control patients: mean difference 2.3, CI: 1.0–3.5, p=0.002). Fibrinogen levels were significantly higher between the third and first trimesters in diabetic patients (mean difference 0.7, CI: 0.2–1.3 g l‐1, p=0.006). Pregnancy, therefore, was associated with increased red cell aggregation, related in part to increased fibrinogen levels but the extent of change was similar in diabetic and nondiabetic women and appeared to have no adverse effect on glomerular function in pregnant insulin‐dependent diabetic women.
Insulin Resistance with Respect to Lipolysis in Non‐diabetic Relatives of European Patients with Type 2 Diabetes
Authors: Gelding S. V. , Coldham N. , Niththyananthan R. , Anyaoku V. , Johnston D. G.
Published: July 2009

Type 2 diabetes is characterized by resistance to insulin action of glucose metabolism and lipolysis. First‐degree relatives of diabetic patients are at increased risk of developing diabetes themselves and early metabolic abnormalities in these relatives may represent primary defects in the pathogenesis of diabetes. Our previous work has demonstrated impaired suppression of lipolysis after an oral glucose load in glucose‐tolerant relatives of Asian origin, but not in European relatives. To investigate whether a more subtle defect exists in the European population we studied 8 first‐degree relatives of European patients and 9 matched control subjects. All had normal glucose tolerance. Glycerol and glucose turnovers were measured using a primed constant infusion of the stable isotopic tracers [1, 1, 1, 2, 32H5] glycerol and [6, 62H] glucose, basally and in response to a very low dose insulin infusion (0.005 units kg‐1 h‐1). The relatives had higher basal insulin concentrations (median (range): 49 (30 to 113) vs 28 (18 to 66) pmol 1‐1, p < 0.05) compared to controls, but basal glycerol and glucose turnovers and plasma concentrations of glycerol, glucose, and non‐esterifed fatty acids (NEFA) were similar. Following insulin, the suppression of glycerol appearance in the circulation measured isotopically was significantly less complete in the relatives compared with controls (mean change ± SEM: + 0.06 ± 0.21 vs ‐0.51 ± 0.16 μmol kg‐1 min‐1, p < 0.05). Plasma glycerol concentration decreased to a similar extent in relatives and controls, as did glucose and NEFA levels (mean change ± SEM: glycerol ‐12 ± 3 vs ‐8 ± 4 μmol 1‐1; glucose ‐0.37 ± 0.06 vs ‐0.30 ± 0.10 mmol.l‐1; NEFA ‐152 ± 48 vs ‐130 ± 32 μmol.1‐1). The change in glucose turnover was not different in relatives and controls (change ‐0.10 ± 0.03 vs ‐0.07 ± 0.06 mg kg‐1 min‐1). We conclude that glucose‐tolerant relatives of European origin exhibit subtle defects in insulin sensitivity with respect to lipolysis.
The Costs of Diabetes‐related Lower Extremity Amputations in the Netherlands
Authors: van Houtum W.H. , Lavery L.A. , Harkless L.B.
Published: July 2009

Diabetes mellitus is a common problem in the Netherlands and in the rest of the world. A complication seen in association with diabetes is peripheral neuropathy which can lead to lower extremity amputation. The purpose of this study is to identify the duration of hospital stay and the direct costs associated with diabetes‐related lower extremity amputations in the Netherlands in 1992. Total direct costs included costs associated with hospital stay and the average procedure specific costs (surgeons' fees, anaesthetists' fees, and operating room fees) for the specific level of amputation. In the Netherlands in 1992, 1575 hospitalizations for 1810 diabetes‐related lower extremity amputations occurred. The total number of days in the hospital for the diabetic population was 65 778 days with a mean of 41.8 days per hospitalization. Mean costs associated with diabetes‐related hospitalizations for amputation were £E10531 (Dfl. 28 433) per hospitalization. Persons who underwent multiple amputations during their hospitalization stayed in the hospital longer and the costs associated with these hospitalizations were higher when compared to hospitalization with a single amputation. An increase in length of stay and costs with increasing age and higher level of amputation was identified.
Insulin‐like Growth Factor‐I and IGF‐I Receptors in Diabetic Patients with Neuropathy
Authors: Migdalis I.N. , Kalantzis L. , Samartzis M. , Kalogeropoulou K. , Nounopoulos C. , Bouloukos A.
Published: July 2009

Since a number of animal studies have shown that Insulin‐like growth I (IGF‐I) stimulates nerve regeneration, the aim of our study was to evaluate the possible relationship between IGF‐I and IGF‐I receptors in diabetic patients with peripheral neuropathy. One hundred and four patients with Type 2 diabetes (57 with peripheral neuropathy and 47 non‐neuropathic) were studied. Controls were 17 non‐diabetic persons. After an overnight fast, blood was taken for IGF‐I, IGF‐I receptors, glucose, HbA1, C‐peptide, and insulin. The neuropathy study group had significantly lower levels of IGF‐I:144.5 ng mI‐1 (57.5–363.0, 95% confidence limits) compared to controls: 186.2 ng mI‐1 (93.3–371.5), p<0.01, and to diabetic patients without neuropathy: 173.7 ng mI‐1 (83.1–363.0), p<0.01. The study group also had a lower number of IGF‐I receptors per red cell: 22.9 times 103 (13.08–38.01) vs control subjects: 28.1 times 103 (18.62–42.65), p<0.01, and non‐neuropathic diabetic patients: 26.3 times 103 (16.59–41.68), p<0.01. In diabetic subjects there was a positive correlation (r = 0.20, p<0.05) between IGF‐I and HbA1, while in the neuropathy group there was a negative correlation between the score for nerve dysfunction with the IGF‐I (r = ‐0.39, p<0.01) and with IGF‐I receptors (r = ‐0.34, p<0.01). We conclude that in diabetic patients with peripheral neuropathy there are abnormalities of IGF‐I and IGF‐I receptors which may contribute to impaired neuronal regeneration.
Nascent Entrepreneurs and Venture Emergence: Opportunity Confidence, Human Capital, and Early Planning
Authors: Dimov Dimo
Published: July 2009

abstract

Nascent entrepreneurs continuously evaluate the merits of the opportunities they pursue and so can abandon those that lack promise and persist with those that remain attractive. This paper articulates this evolving judgment about the opportunity as the nascent entrepreneur's opportunity confidence. It situates this construct in the context of the nascent entrepreneur's human capital and early planning actions in respect to the pursued opportunity, and in respect to the emergence of the nascent venture. Analyses of PSED data show that opportunity confidence positively affects venture emergence and that, through it, entrepreneurial experience and early planning have only indirect effects on venture emergence. In contrast, industry experience has a direct, positive effect on venture emergence. These results provide some novel insights into the nascent entrepreneurial process as well as into the role of human capital and early planning in that process.
Representing intentions in self and other: studies of autism and typical development
Authors: Williams David , Happé Francesca
Published: July 2009

Two experiments were conducted to explore the extent to which individuals with Autism Spectrum Disorder (ASD), as well as young typically developing (TD) children, are explicitly aware of their own and others’ intentions. In Experiment 1, participants with ASD were significantly less likely than age‐ and ability‐matched comparison participants to correctly recognize their own knee‐jerk reflex movements as unintentional. Performance on this knee‐jerk task was associated with performance on measures of false belief understanding, independent of age and verbal ability, in both participants with ASD and TD children. In Experiment 2, participants with ASD were significantly less able than comparison participants to correctly recognize their own or another person’s mistaken actions as unintended, in a ‘Transparent Intentions’ task (Russell & Hill, 2001; Russell, Hill & Franco, 2001). Performance on aspects of the Transparent Intentions task was associated with performance on measures of false belief understanding, independent of age and verbal ability, in both participants with ASD and TD children. This study suggests that individuals with ASD have a diminished awareness of their own and others’ intentions and that this diminution is associated with other impairments in theory of mind.
PSYCHIATRY IN A BATTLE ZONE
Authors: PAJEVIĆ IZET , HASANOVIĆ MEVLUDIN , KOPRIĆ ALINA
Published: July 2009

The authors describe the arrival and treatment of 164 severe chronic psychiatric patients who were displaced from the Serbian army‐controlled Jakes psychiatric hospital and off‐loaded on the afternoon of 28th of May, 1992 at the gates of the Psychiatry Clinic in Tuzla.

Through analysis of their incomplete medical records, which arrived with the patients in Tuzla, and analysis of their activities during and after the war, they found that 83 of the patients (50%) were males and 147 (89.6%) were admitted to the Psychiatry Clinic in Tuzla. Of the patients, 86 (58.5%) were found to be Serbs. The majority of them were incapable of independent living and required ongoing medical and social care. They were from all regions of Bosnia‐Herzegovina, 81.6% had schizophrenia and 70 (47.6%) were over 50 years of age.

For its humanitarian work, its contribution to peace and for the maintenance of the multi‐ethnic Bosnia‐Herzegovina, the Psychiatry Clinic in Tuzla received the Golden Award for Peace from the International Legion of Humanists in May 1998.
‘EARLY TERMINAL SEDATION’ IS A DISTINCT ENTITY
Authors: CELLARIUS VICTOR
Published: July 2009

There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called ‘early terminal sedation’. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and nutrition, even if these are life‐sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase.

Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine.
RECONSIDERING THE VALUE OF CONSENT IN BIOBANK RESEARCH
Authors: ALLEN JUDY , MCNAMARA BEVERLEY
Published: July 2009

Biobanks for long‐term research pose challenges to the legal and ethical validity of consent to participate. Different models of consent have been proposed to answer some of these challenges. This paper contributes to this discussion by considering the meaning and value of consent to participants in biobanks. Empirical data from a qualitative study is used to provide a participant view of the consent process and to demonstrate that, despite limited understanding of the research, consent provides the research participants with some level of control and a form of self determination that they value. Participation is framed as a moral act of a responsible citizen providing reinforcement of self identity. Consent symbolizes the trust invested in researchers and research institutions to use the biobank for the public good. The paper argues that consent continues to play an important role in biobank participation and that a participant view should inform proposals to modify consent processes.
Institutional Change in Advanced Political Economies
Authors: Thelen Kathleen
Published: July 2009

The political‐economic institutions that have traditionally reconciled economic efficiency with social solidarity in the advanced industrial countries, and specifically in the so‐called ‘coordinated market economies’, are indisputably under pressure today. However, scholars disagree on the trajectory and significance of the institutional changes we can observe in many of these countries, and they generally lack the conceptual tools that would be necessary to resolve these disagreements. This article attempts to break through this theoretical impasse by providing a framework for determining the direction, identifying the mode, and assessing the meaning of the changes we can observe in levels of both economic coordination and social solidarity.
Retrieval-Induced Forgetting and Executive Control
Authors: Román Patricia , Soriano M. Felipa , Gómez-Ariza Carlos J. , Bajo M. Teresa
Published: July 2009

Retrieving information from long-term memory can lead people to forget previously irrelevant related information. Some researchers have proposed that this retrieval-induced forgetting (RIF) effect is mediated by inhibitory executive-control mechanisms recruited to overcome interference. We assessed whether inhibition in RTF depends on executive processes. The RIF effect observed in a standard retrieval-practice condition was compared to that observed in two different conditions in which participants had to perform two concurrent updating tasks that demanded executive attention. Whereas the usual RIF effect was observed when retrieval practice was performed singly, no evidence of forgetting was found in the dual-task conditions. Results strongly suggest that inhibition involved in RIF is the result of executive-control processes.
Latent Ability
Authors: Walton Gregory M. , Spencer Steven J.
Published: July 2009

Past research has assumed that group differences in academic performance entirely reflect genuine differences in ability. In contrast, extending research on stereotype threat, we suggest that standard measures of academic performance are biased against non-Asian ethnic minorities and against women in quantitative fields. This bias results not from the content of performance measures, but from the context in which they are assessed—from psychological threats in common academic environments, which depress the performances of people targeted by negative intellectual stereotypes. Like the time of a track star running into a stiff headwind, such performances underestimate the true ability of stereotyped students. Two meta-analyses, combining data from 18,976 students in five countries, tested this latent-ability hypothesis. Both meta-analyses found that, under conditions that reduce psychological threat, stereotyped students performed better than nonstereotyped students at the same level of past performance. We discuss implications for the interpretation of and remedies for achievement gaps.
Accelerated Recurrence Time Models
Authors: HUANG YIJIAN , PENG LIMIN
Published: July 2009

Abstract. For the analysis with recurrent events, we propose a generalization of the accelerated failure time model to allow for evolving covariate effects. These so‐called accelerated recurrence time models postulate that the time to expected recurrence frequency, upon transformation, is a linear function of covariates with frequency‐dependent coefficients. This modelling strategy shares the same spirit as quantile regression. An estimation and inference procedure is developed by generalizing the celebrated Powell's (J. Econometrics25, 1984, 303;J. Econometrics32, 1986, 143) estimator for censored quantile regression. Consistency and asymptotic normality of the proposed estimator are established. An algorithm is devised to attain good computational efficiency. Simulations demonstrate that this proposal performs well under practical settings. This methodology is illustrated in an application to the well‐known bladder cancer study.
Bridging a gap: the (lack of a) sociology of oral health and healthcare
Authors: Exley Catherine
Published: July 2009

This article provides an historical review of international research related to sociology and oral health and healthcare. I begin by considering the relevance of the mouth and oral health to social interactions and physical health, and outline existing inequalities in oral health and healthcare experiences. The paper examines critically some of the existing published research in the field – considering both what might be described as sociology of oral health and healthcare and sociology in oral healthcare – and demonstrates the dearth of sociological research related to this subject compared to other areas of interest within the field of sociology of health and illness. I conclude by suggesting some ways in which this area could be expanded and developed further. I suggest that sociological analyses of how individuals experience, understand and manage their mouth and oral health, can add to and enhance the broader field of the sociology of health and illness. Further, examining experiences and provision of oral healthcare may provide sociology with a new opportunity to explore the neglected field of private healthcare, but also to engage with health policy makers who seek to address oral healthcare needs.
IS METAPHYSICAL NIHILISM INTERESTING?
Authors: EFIRD DAVID , STONEHAM TOM
Published: July 2009

Suppose nothing exists. Then it is true that nothing exists. What makes that true? Nothing! So it seems that if nothing existed, then the principle that every truth is made true by something (the truthmaker principle) would be false. So if it is possible that nothing exists, a claim often called ‘metaphysical nihilism’, then the truthmaker principle is not necessary. This paper explores various ways to resolve this conflict without restricting metaphysical nihilism in such a way that it would become trivial and uninteresting.
Illegitimacy, paternal financial responsibility, and the 1834 Poor Law Commission Report: the myth of the old poor law and the making of the new
Authors: NUTT THOMAS
Published: July 2009

The new poor law's bastardy clauses were amongst the most contested of the 1834 Act, and their unpopularity led to their (partial) reversal by 1844. The issue of paternal financial responsibility for the maintenance of illegitimate children was central to the reforms, and this article uses the Rural and Town Queries to show how parishes could enforce this responsibility effectively. This evidence could have been used as an alternative model of reform; instead, the Poor Law Commissioners misrepresented the operation of the law and recommended the abolition of affiliation. Rooted in the writings of Malthus, their proposals proved ultimately impracticable.
New evidence and new methods to measure human capital inequality before and during the industrial revolution: France and the US in the seventeenth to nineteenth centuries
Authors: CRAYEN DOROTHEE , BATEN JOERG
Published: July 2009

We explore pre‐ and early industrial inequality of numeracy using the age heaping method and anthropometric strategies. For France, we map differential numeracy between the upper and lower segments of a sample population for 26 regions during the seventeenth century. For the US, inequality of numeracy is estimated for 25 states during the 19th century. Testing the hypothesis of a negative impact of inequality on welfare growth, we find evidence that lower inequality increased industrial development in the US, whereas for France such an effect was only evident in interactions with political variables such as proximity to central government.