bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Resident Participation in a Multidisciplinary Diabetes Team
Authors: Gray Deborah L , Langefeld Carl D , Golden Michael P , Orr Donald P
Published: March 2007

OBJECTIVE

To determine the impact of participation in a multidisciplinary diabetes team on pediatric residents' perceptions of team members' roles.

RESEARCH DESIGN AND METHODS

Pediatric residents were assigned to a traditional diabetes clinical rotation (n = 34) or to an ambulatory multidiscipl inary diabetes team within their continuity clinic (n = 21). The residents and a smallsample of practicing pediatricians (n = 46) completed a Likert-type instrument at the completion of the 18-mo study.

RESULTS

Multidisciplinary diabetes team residents were significantly more positive about the roles for endocrinological evaluation in monitoring compliance, for the nurse educator/certified diabetes educator in assisting with sick-day management and school behavioral problems, and for the dietitian in helping with cholesterol problems. They were significantly more like practicing pediatricians in their perceptions of pediatric roles in teaching sick-day management, implementing weight reduction, assisting with conflict resolution about diabetes, screening for microvascular complications, and developing behavioral strategies for metabolic control than residents in the traditional rotation. The groups did not differ in their beliefs about patient empowerment.

CONCLUSIONS

Multidisciplinary diabetes team participation may be useful in modifying specific role perceptions of pediatric residents about diabetes care. It does not appear to alter perceptions favoring greater patient empowerment.
Hypersensitivity to Insulin During Remissions in Cyclosporin-Treated IDDM Patients
Authors: Burcelin Rémy G , Eddouks Mohamed , Beylot Michel , Normand Sylvie , Boitard Christian , Feutren Gilles , Landais Paul , Riou Jean Paul , Girard Jean R , Bach Jean François , Assan Roger I
Published: March 2007

OBJECTIVE— To test the sensitivity to insulin in recent-onset IDDM patients, its course according to treatment, and the advent of remissions.

RESEARCH DESIGN AND METHODS— The euglycemic hyperinsulinemic clamp was used in 54 recent-onset IDDM patients and 14 healthy control subjects. Patients were tested after 1,2, and 4 wk of treatment with either insulin or insulin plus cyclosporin A, during cyclosporin A-associated long-lasting remissions, and during relapses.

RESULTS— Insulin sensitivity was markedly decreased in all patients at onset. It was rapidly restored by insulin therapy, whether immunosuppression was associated with it or not. Insulin sensitivity was even higher than normal in the remission patients, who also were characterized by the reappearance of some endogenous insulin secretion and the sustained normalization of blood glucose profiles. During relapses, the deterioration of the blood glucose profiles was associated with some loss of insulin sensitivity.

CONCLUSIONS— Cyclosporin A-associated remissions represent an original situation that associates euglycemia with the persistence of low endogenous insulin secretion. Cyclosporin A by itself had no influence on sensitivity to insulin, but allowed the reappearance of some insulin secretory capacity that contributed, with the improvement of insulin sensitivity, to the development of the diabetes honeymoon. The secretion of endogenous insulin, although lower than normal, was sufficient to secure a high sensitivity to insulin and the maintenance of normal blood glucose profiles, presumably because of the fact that insulin was released directly into the portal vein in these conditions. This metabolic state was precarious: the optimal sensitivity to insulin disappeared in patients who relapsed. These results have important clinical consequences: the preservation of islet residual secretory capacity by the use of newer nontoxic immunosuppressive protocols, combined with a minimal supportive insulin therapy in remission patients, may prolong remissions and maintain an optimal insulin sensitivity.
Transient State of NIDDM in a Patient With AIDS
Authors: Abourizk Nicolas N , Lyons Robert W , Madden Gayle M
Published: March 2007

OBJECTIVE— To describe a glucose abnormality in AIDS that is characterized by transient NIDDM followed by hyperinsulinemic normoglycemia.

RESEARCH DESIGN AND METHODS— A 36-yr-old Hispanic man with AIDS was on long-standing aerosolized pentamidine therapy in 1986. He received a course of intravenous pentamidine 5 mo before the onset of diabetes. Nonketotic hyperglycemia responded to sulfonylurea, which had to be discontinued 3 mo later because of normoglycemia.

RESULTS— Diabetes diagnosis was made by three separate fasting blood glucose values of 16.2, 18.1, and 29.9 mM, and HbA1C of 10.1% (normal 4.2–5.9). The patient became euglycemic 5 mo after diagnosis while on no treatment. An oral glucose tolerance test was then normal, and C-peptide stimulation showed supra-normal response.

CONCLUSIONS— Transient severe NIDDM in this case could not be linked to acute stress. Pentamidine, in a progressively increasing cumulative dose, is one possible, albeit unusual, etiology because the diabetes was not permanent. After diabetes remission, the data suggest residual insulin resistance that is unusual in HIV-positive patients. Diverse glucose abnormalities exist in AIDS. Awareness of their presentation is clinically helpful.
Effect of Third-Party Reimbursement on Use of Services and Indexes of Management Among Indigent Diabetic Patients
Authors: Nordberg Beatrice J , Barlow Myra S , Chalew Stuart A , McCarter Robert J
Published: March 2007

OBJECTIVE

To determine the effect of third-party reimbursement on the use of services and indexes of diabetes-related health management among inner-city diabetic patients.

RESEARCH DESIGN AND METHODS

Adult diabetic patients (n = 158; 67% women, 33% men) from an inner-city diabetes clinic were categorized by level of third-party medical coverage: complete reimbursement for all services (full); partial reimbursement (part); and no reimbursement (none). Patients were followed for 13 mo. Use of billable medical services, diabetes clinic visits, emergency room visits, and hospital admissions were recorded. Use of a free, day-time diabetes telephone hot line was also documented. Indexes of diabetes-related health management, HbA1, blood pressure, and weight were compared from the beginning and the end of the study. Diabetes complications were scored and tabulated.

RESULTS

Univariate analysis showed that patients with full reimbursement were more likely to use services than patients without reimbursement. When the combined effects of reimbursement status, age, sex, type of diabetes, and diabetes complications on use of services were analyzed together in a multivariate analysis, complications was the best predictor of admissions to the hospital and whether a patient called the hot line. IDDM patients and patients with full reimbursement were most likely to have an emergency room visit. Age was the best predictor of diabetes clinic attendance. No difference was noted in blood pressure or weight among the reimbursement groups at the beginning and end of study. However, the trend was toward (P < 0.05) an increase in HbA1 in the none group.

CONCLUSIONS

Among inner-city diabetic patients, multiple factors influence use of medical services. Indigent diabetic patients without third-party reimbursement were observed to have a rise in HbA1. These factors should be taken into consideration when planning strategies to prevent diabetes complications and the most effective allocation of health-care resources.
Relationship Between Serum Levels of Methylguanidine and Glycemic Control in IDDM Children
Authors: Nagashima Kanji , Yagi Hideki , Yutani Shigenori , Miyake Hiroshi , Onigata Kazumichi , Kuroume Takayoshi
Published: March 2007

OBJECTIVE

To examine the serum levels of methylguanidine in IDDM children and compare them with markers for glycemic control. Reports have indicated that active oxygen, which damages various tissues, increases in diabetes mellitus. The increase of active oxygen is one of the risk factors for diabetic complications. The synthesis of methylguanidine, a metabolic product of guanidine, is mainly regulated by active oxygen.

RESEARCH DESIGN AND METHODS

Forty-eight children with IDDM (mean age 13.3 yr) and 17 age-matched nondiabetic control subjects were studied. Diabetic children were divided into a well-controlled group (HbA1c < 8%, n = 24) and a poorly controlled group (HbA1c > 8%, n = 24). Serum concentrations of methylguanidine were measured by enzymatic assay.

RESULTS

Levels of methylguanidine in the poorly controlled group (1.31 ± 0.08 μM) were significantly higher than those in both the well-controlled group (0.85 ± 0.08 μM) and the control group (0.59 ± 0.11 μM), respectively (P < 0.01). Methylguanidine levels showed a positive correlation with the levels of HbA1c (P < 0.01) or fructosamine (P < 0.01). No significant correlations were noted between methylguanidine levels and age, sex, duration of diabetes, or insulin dose.

CONCLUSIONS

Our data indicate that the levels of methylguanidine in IDDM children might be affected by glycemic control and that the determination of serum methylguanidine levels could be a useful test for evaluating the state of diabetic control.
Long-Term Glycemic Control and Neurological Function in IDDM Patients
Authors: McCance David R , Atkinson A Brew , Hadden David R , Kennedy Laurence
Published: March 2007

Objective— To examine the relationship between sensory modalities of neurological function and antecedent glycemic control in IDDM patients.

Research Design and Methods— Examinations were conducted on 220 IDDM patients (age at onset <25 yr, duration <18 yr) for the presence or absence of the right or left ankle reflex and determination of vibration perception threshold at each medial malleolus and great toe using biothesiometry. These parameters were related to the concurrent HbA1 and to a mean of serial measurements (mean HbA1) over the previous 6 yr.

Results— Ankle reflexes were absent in 39 (right ankle) and 41 (left ankle) patients, respectively. Mean (right + left) ankle and toe VPTs were 8.7 ± 3.6 and 6.3 ± 4.2 (mean ± SD) (arbitrary units), respectively. Both the mean and concurrent HbA1 were significantly different in patients with absent ankle reflexes (11.6 ± 1.9 and 12.2 ± 2.8%, respectively) compared with present ankle reflexes (10.3 ± 1.7, 10.3 ± 2.1%) (P <0.0001). Similarly, a present ankle reflex was related to mean HbA1 arbitrarily divided into groups <10, 10−12, > 12% (P = 0.0009). In contrast, mean ankle VPT (8.0 ± 2.2, 8.8 ± 3.1, and 10.3 ± 6.2) and toe VPT (5.5 ± 2.2, 6.1 ± 2.9, and 8.5 ± 8.2) did not increase significantly with poor glycemic control (P > 0.05). Age, right ankle reflex, retinopathy, 24-h urinary albumin excretion rate, and erect systolic blood pressure were the only independent variables predicting the toe VPT using linear regression analysis.

Conclusions— These findings support a role for glycemic control in neurological dysfunction in IDDM patients, but also suggest that other unknown factors may be involved.
Long-Term Follow-Up Evaluation of Blood Glucose Awareness Training
Authors: Cox Daniel J , Gonder-Frederick Linda , Julian Diana M , Clarke William
Published: March 2007

OBJECTIVE

Blood glucose awareness training (BGAT) has been found effective in teaching individuals with insulin-requiring diabetes to improve their ability to better recognize blood glucose (BG) fluctuations. This study investigated whether subjects who underwent BGAT a mean of 4.9 years previously were superior to past control subjects in terms of their ability to recognize BG fluctuations, and whether past BGAT subjects had fewer automobile crashes and lost work days and better glycosylated hemoglobin than control subjects. Additionally, the beneficial effects of providing booster training to past BGAT subjects also was evaluated.

RESEARCH DESIGN AND METHODS

This study followed up 28 past BGAT subjects. Half of these subjects (n = 14) received a simple booster-training program. Twelve previous control subjects also were evaluated. Booster subjects were given a BGAT diary to complete for 2 weeks before evaluation. Evaluation for all subjects included completion of a retrospective questionnaire on work and driving history, blood drawing for a glycosylated hemoglobin analysis, and having subjects estimate and measure their BG levels 50–80 times during a 3- to 4-week period during their daily routine.

RESULTS

At long-term follow-up, BGAT subjects had significantly fewer automobile crashes than control subjects. BGAT subjects receiving booster training were significantly more accurate at estimating their BG levels and were more aware of hypoglycemia. Post hoc analyses indicated that the ability to accurately estimate BG fluctuations correlated positively with follow-up glycosylated hemoglobin and the number of hypoglycemic and hyperglycemic symptoms participants demonstrated.Both BGAT and control subjects demonstrated significantly improved glycosylated hemoglobin relative to baseline measures.

CONCLUSIONS

These data suggest that BGAT has long-term benefits, which can be enhanced with booster training. Specifically, BGAT and simple booster training may result in reduction of severe hypoglycemic episodes and automobile crashes in the long term.
Effects of a Small Quantity of ω-3 Fatty Acids on Cardiovascular Risk Factors in NIDDM: A randomized, prospective, double-blind, controlled study
Authors: Axelrod Lloyd , Camuso Janice , Williams Ellen , Kleinman Kenneth , Briones Esperanza , Schoenfeld David
Published: March 2007

OBJECTIVE

To study the effects of a low dose of ω-3 fatty acids on platelet function and other cardiovascular risk factors in patients with non-insulin-dependent diabetes mellus (NIDDM).

RESEARCH DESIGN AND METHODS

We performed a randomized, prospective, double-blind, controlled study of a low dose of ω-3 fatty acids (2.5 g/day) in 20 ambulatory subjects with NIDDM. Subjects ingested five 1-g fish oil capsules each containing 0.5 g ω-3 fatty acids or five 1-g safflower oil capsules per day for 6 weeks followed by a 6-week washout period.

RESULTS

Nine subjects completed the study in each group. Both groups exhibited moderate control of glucose levels; modest elevations in baseline total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride (TG) levels; and normal blood pressure values. In the fish oil group, plasma ω-3 fatty acid levels increased significantly. Fish oil significantly reduced the slope of the dose-response curves for collagen-induced platelet aggregation to one-third the value observed with safflower oil. No difference was observed in collageninduced production of thromboxane A2 (TXA2, measured as the stable derivative TXB2), or in adenosine-5'-diphosphate- (ADP) induced platelet aggregation or TXA2 generation. Patients with high initial collagen-induced platelet TXA2 production showed a significantly larger drop after fish oil than safflower oil. Fish oil significantly reduced TG levels by 44 mg/dl and decreased upright systolic blood pressure (sBP) by 8 mmHg compared with safflower oil. Fish oil caused a significant but small increase in HbA1c (0.56%) and total cholesterol (20 mg/dl) but had no effect on fasting glucose, high-density lipoprotein cholesterol, or LDL-cholesterol levels.

CONCLUSIONS

Small doses of fish oil inhibit platelet aggregation and TXA2 production, reduce upright sBP and TG levels, and have only a small effect on glucose and cholesterol levels in patients with moderately controlled NIDDM. Small quantities of ω-3 fatty acids or dietary fish are safe and potentially beneficial in NIDDM patients.
Comparison of Excess Costs of Care and Production Losses Because of Morbidity in Diabetic Patients
Authors: Olsson Jonny , Persson Ulf , Tollin Claes , Nilsson Sven , Melander Arne
Published: March 2007

OBJECTIVE

To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general population of a Swedish community.

RESEARCH DESIGN AND METHODS

Costs of production losses were calculated from medical and social insurance records on sickness benefit days (short-term illness) and premature retirement (permanent disability) in people with diabetes and in the entire population of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral antidiabetic medications, other drugs, test material, and treatment devices, and they were obtained from patient records, the health care administration, and the statistics of community pharmacy sales.

RESULTS

Of the diabetic patients < 65 years of age, above which both diabetic and nondiabetic people get retirement pension, and sickness benefits cease, 62% of those on insulin treatment in each gender had insulin-dependent diabetes mellitus (IDDM). All insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients were > 40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were prematurely retired twice as often as the average population and had twice as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, the costs of lost production as a result of excess morbidity (< 65 years of age) would be $12 billion and $9 billion for people with insulin-treated and non-insulin-treated diabetes, respectively.

CONCLUSIONS

If improved metabolic control by intensified treatment would reduce excess morbidity in both IDDM and NIDDM, the predominant costs of production losses imply that intensified antidiabetic treatment might save costs.
Diabetic Nephropathy and Microalbuminuria in the Community: The South Auckland Diabetes Survey
Authors: Simmons David , Shaw Lois M , Scott David J , Kenealy Tim , Scragg Robert K
Published: March 2007

OBJECTIVE

To compare the clinical, anthropometric, and metabolic characteristics of New Zealand Europeans, Maori, and Pacific Islanders with non-insulin-dependent diabetes mellitus (NIDDM) with emphasis on risk factors for the development of diabetic nephropathy.

RESEARCH DESIGN AND METHODS

A cross-sectional survey of 555 (74% of 750 available) diabetic patients attending diabetes clinics and randomly selected primary care centers was conducted in Auckland, New Zealand.

RESULTS

Among those with NIDDM, Maori and Pacific Islanders were younger at diagnosis, more obese, and had poorer glucose control when compared with the Europeans (fructosamine in μmol/l: Maori 335 ± 78, Pacific Islanders 367 ± 90, Europeans 318 ± 55; overall P < 0.001). Systolic blood pressure (sBP) was higher in Maori (145 ± 31 mmHg) and lower in Pacific Islanders (135 ± 25 mmHg) when compared with Europeans (141 ± 25 mmHg; overall P < 0.005). Mean estimated daily urinary albumin excretion (UAE) was 18.2 (15.5–1.3) mg/day in Europeans, 94.8 (60.5–148.7) mg/day in Maori, and 44.2 (32.3–60.3) mg/day in Pacific Islanders. The prevalence of proteinuria and end-stage renal failure were also higher in Maori and Pacific Islanders. The excess prevalence of microalbuminuria and proteinuria in Maori was present within 5 years of diagnosis. Europeans with impaired renal function were least likely to have associated proteinuria or microalbuminuria. Microalbuminuria and nephropathy were not consistently associated with either higher blood pressure or worse glucose control.

CONCLUSIONS

NIDDM in Maori and Pacific Islanders is associated with a greater degree of proteinuria and end-stage renal failure than that in Europeans. This observation is not explained by conventional risk factors.
Reliability and Validity of Cardiovascular and Vasomotor Autonomic Function Tests
Authors: Hartwig Mary S , Cardoso Sergio S , Hathaway Donna K , Gaber A Osama
Published: March 2007

OBJECTIVE

To determine the reliability and validity of autonomic function tests (AFTs) as clinical tools for diagnosing diabetic autonomic dysfunction.

RESEARCH DESIGN AND METHODS

Twenty-one healthy control subjects and 21 insulin-dependent diabetes mellitus (IDDM) patients (11 with no symptomatology and 10 with symptomatic diabetic autonomic neuropathy [DAN]) were matched for age, and administered three standard cardiovascular tests and two new vasomotor tests of autonomic function. Each of the cardiovascular tests (change in heart rate [Δbpm], Valsalva ratio [VR], change in systolic blood pressure [ΔsBP]) and vasomotor tests (total pulse amplitude [TPA] and percent vasoconstriction [%VC]) were repeated within 1 week. Infrared photoplethysmography measured sympathetic-mediated vasomotor function. Reliability was determined by intraclass correlation coefficients. Validity was determined by analysis of variance procedures to test for differences between known groups and by computing sensitivity, specificity, and positive and negative predictive values.

RESULTS

All AFTs were reliable, with %VC having highest reproducibility (r = 0.90). AFT scores were not different from time 1 to time 2. After controlling for age, two cardiovascular tests had significantly different values for control subjects and asymptomatic diabetic patients. AFTs, except ΔsBP, were significantly different between symptomatic diabetic patients and asymptomatic diabetic patients after controlling for age and duration of disease simultaneously. Sensitivity, specificity, and predictive values for %VC were comparable to the values for Δbpm and VR. TPA indexes were lower but clinically acceptable.

CONCLUSIONS

AFTs were found to be reliable and valid tests for detecting DAN. TPA and %VC are important because they measure an aspect of sympathetic function not assessed by standard cardiovascular AFTs, and they do not depend on the patient's cooperation or ability to exert effort.
Alrial Natriuretic Factor in Hypertensive and Normotensive Diabetic Patients
Authors: Ferri Claudio , Piccoli Alfonso , Laurenti Oriana , Bellini Cesare , De Mattia Giancarlo , Santucci Anna , Balsano Francesco
Published: March 2007

OBJECTIVE

To evaluate plasma amai natriuretic factor (ANF) behavior in hypertensive patients with either insulin-dependent (type I) or non-insulin-dependent (type II) diabetes.

RESEARCH DESIGN AND METHODS

Plasma ANF levels were measured in euglycemic normotensive patients (n = 18) and hypertensive patients (n = 18), in diabetic normotensive patients (type I diabetes, n = 12; type II diabetes, n = 12), and in diabetic hypertensive patients (type I diabetes, n = 12; type II diabetes, n = 22). In all groups, plasma ANF levels were determined at the end of a normal NaCl diet period (120 mmol NaCl per day for 10 days) in both the supine and the upright positions.

RESULTS

Plasma ANF levels were significantly higher (P < 0.05) in hypertensive euglycemic patients (supine vs. upright: 13.4 ± 6.7 vs. 8.5 ± 4.3 fmol/ml) than in normotensive type I diabetic patients (supine vs. upright: 8.6 ± 2.2 vs. 5.9 ± 2.9 fmol/ml) but not in euglycemic normotensive subjects (supine vs. upright: 11.4 ± 5.1 vs. 7.6 ± 5.8 fmol/ml) and normotensive type II diabetic patients (supine vs. upright: 10.1 ±4.1 vs. 7.9 ±4.1 fmol/ml). Moreover, in the normotensive groups plasma ANF levels did not significantly differ among euglycemic type I and type II diabetic patients. However, the highest levels of plasma ANF were observed in hypertensive type II diabetic patients (supine vs. upright: 16.9 ± 7.4 fmol/ml [P < 0.01 vs. euglycemic normotensive subjects, P < 0.0001 vs. normotensive type I diabetic patients, P < 0.01 vs. hypertensive type I diabetic patients and normotensive type II diabetic patients] vs. 11.6 ± 2.9 fmol/ml [P < 0.005 vs. normotensive type I diabetic patients, P < 0.01 vs. hypertensive type I diabetic patients]). On the contrary, plasma ANF levels were higher (P < 0.05) in hypertensive type I diabetic patients (supine vs. upright: 10.8 ±1.9 vs. 6.4 ± 2.2 fmol/ml) compared with normotensive type I diabetic patients, but not with any other patient group. A significant correlation between supine ANF and insulin levels was found in both type II diabetic (r = 0.457; P < 0.05) and nondiabetic hypertensive patients (r = 0.716; P < 0.0001).

CONCLUSIONS

These findings indicate that circulating ANF levels are markedly elevated in type II diabetic patients affected by essential hypertension. On the contrary, plasma ANF levels are in the range of normality in normotensive type I and type II diabetic patients.
Increased Urinary Endothelin-1 -Like Immunoreactivity Excretion in NIDDM Patients With Albuminuria
Authors: Lee Yau-Jiunn , Shin Shyi-Jang , Tsai Juei-Hsiung
Published: March 2007

OBJECTIVE

To determine the urinary endothelin-1-like immunoreactivity (ET- 1-LI) in non-insulin-dependent diabetes mellitus (NIDDM) patients and toinvestigate whether urinary ET-l-LI excretion is elevated in patients with albuminuria.

RESEARCH DESIGN AND METHODS

Urinary ET-l-LI substance was determined byradioimmunoassay in 45 normoalbuminuric and 28 albuminuric NIDDM patients.

RESULTS

The mean amounts of 24-h ET-1 -LI excretion in NIDDM patients with normoalbuminuria and albuminuria were 154.9 ± 13.5 and 174.4 ± 12.9 ng/day, respectively. The latter was significantly higher thanthat of the 40 normal control subjects (111.8 ± 7.9 ng/day, P < 0.01).

CONCLUSIONS

The increase in urinary ET-l-LI substance excretion in patients with albuminuria suggests that ET-1 may be a pathogenetic factor in diabetic nephropathy.
The Evaluation of Two Measures of Quality of Life in Patients With Type I and Type II Diabetes
Authors: Jacobson Alan M , Groot Mary De , Samson Jacqueline A
Published: March 2007

OBJECTIVE

To examine the effects of type I and type II diabetes on patient perceptions of their quality of life and compare the psychometric properties of a generic versus a diabetes-specific quality of life measure.

RESEARCH DESIGN AND METHODS

Consecutive outpatients (n = 240) from a large multispecialty diabetes clinic were studied on a single occasion using two measures of quality of life—Diabetes Quality of Life Measure (DQOL) and the Medical Outcome Study Health Survey 36-Item Short Form (SF-36). No interventions were performed. This study examines three issues: 1) the reliability(internal consistency) of the two measures; 2) the relationship between the DQOL and SF-36 scales; and 3) the influence of clinical patient characteristics, such as number and severity of diabetes complications, on quality of life. Examination of this issue provides information about the construct validity of the two quality of life measures.

RESULTS

The estimates of internal consistency (Cronbach's alpha) for the DQOL and SF-36 subscales ranged from 0.47 to 0.97. These values werevery similar to the published findings from previous studies. The subscales of the two measures were variably correlated with one another (range of correlations: —0.003 to 0.60), indicating that the areas of functioning addressed by the DQOL and SF-36 overlapped only to a modest degree. Examination of the relationship of demographic factors to the DQOL measures suggests that they are not generally confounded by factors such as education, sex, or duration of diabetes. Health-related quality of life is affected by the marital status of both type I and type II diabetic patients, with separated and divorced individuals generally experiencing lower levels of quality of life. The quality of life measures were sensitive to clinical characteristics, such as frequency and severity of complications. Even after factors such as marital status and, among type II diabetic patients, type of treatment, patients' severity of diabetes complications was a significant predictor of both the diabetes-related and the more broad-based measure of quality of life. For type II diabetic patients, insulin treatment was associated with lower levels of satisfaction with diabetes and greater impact of diabetes on quality of life.

CONCLUSIONS

This study provides evidence for the reliability and validity of two measures of quality of life. The two measures examine quality of life from different but complimentary perspectives. The DQOL seems more sensitive to lifestyle issues and contains special questions and worry scales oriented toward younger patients, whereas the SF-36 provides more information about functional health status. Thus, the measures may be used usefully in combination in studies of both type I and type II diabetic patients.
Efficacy of 24-Week Monotnerapy With Acarbose, Glibenclamide, or Placebo in NIDDM Patients: The Essen Study
Authors: Hoffmann Juergen , Spengler Manfred
Published: March 2007

OBJECTIVE

To compare the different therapeutic principles of α-glucosidase inhibitors and sulphonylureas as first-line treatment in non-insulin-dependent diabetes mellitus (NIDDM) patients with dietary failure.

RESEARCH DESIGN AND METHODS

Ninety-six NIDDM patients (35–70 years of age, body mass index [BMI] ≤ 35), insufficiently treated with diet alone (HbA1c 7–9%) were randomized into three groups and treated for 24 weeks with acarbose, glibenclamide, or placebo. Efficacy, based on fasting blood glucose (BG), BG 1 h after ingestion of standard breakfast (postprandial), serum insulin, postprandial insulin increase, and HbA1c; and tolerability, based on subjective symptoms and laboratory values, were investigated every 6 weeks. Efficacy evaluation was valid for 85 patients.

RESULTS

The test drugs were dosed as follows: 100 mg acarbose (A) three times a day, 1 placebo tablet three times a day, 3.5 mg glibenclamide tablets dosed 1–0-0 or 1–0-1, mean dose 4.3 mg/day. Compared with the placebo, both drugs showed the same mean efficacy on fasting BG (–1.4 raM with acarbose, –1.6 mM with glibenclamide), 1-h postprandial BG (–2.2 mM with acarbose, –1.9 mM with glibenclamide), and HbA1c (–1.1% with acarbose, –0.9% with glibenclamide); but they showed a marked difference in 1-h postprandial insulin values (–80.7 pM with acarbose, 96.7 pM with glibenclamide). The mean relative insulin increase (1-h postprandial) was 1.5 in the placebo group, 1.1 in the acarbose group, and 2.5 in the glibenclamide group. No changes in body weight could be observed. No adverse events were seen under placebo. Acarbose led to mild or moderate intestinal symptoms in 38% of patients. Glibenclamide led to hypoglycemia, which could be solved by dose reduction, in 6% of patients. No dropouts occurred in any of the treatment groups.

CONCLUSIONS

Acarbose and glibenclamide are effective drugs for the monotherapy of NIDDM patients when diet alone fails. Because postprandial insulin increase has been shown to be associated with increased risk for cardiovascular disease, acarbose, which lowers pp increase, may be superior to glibenclamide, which elevates postprandial insulin increase.
Chicken and Fish Diet Reduces Glomerular Hyperfiltration in IDDM Patients
Authors: Pecis Miriam , Azevedo Mirela J De , Gross Jorge L
Published: March 2007

OBJECTIVE

To compare the effect of a normal protein diet (test diet) in which chicken and fish were substituted for red meat with a low-protein diet (LPD) on glomerular nitration rate (GFR) in normoalbuminuric insulin-dependent-diabetes mellitus (IDDM) patients.

RESEARCH DESIGN AND METHODS

A crossover randomized clinical trial was performed in 15 normoalbuminuric IDDM patients, 9 normofiltering, and 6 hyperfiltering patients. They followed three diets for a 3-week period each: a usual diet (UD), an LPD (0.5 g · kg–1 · day–1 of proteins, 7% calories as protein, 33% as fat, and 60% as carbohydrates), and a normoproteic isocaloric test diet in which white meat (chicken and fish) was substituted for red meat of the UD. At the end of each diet, a clinical evaluation and measurements of GFR (51Cr-ethylenediaminetetraacetate (EDTA) single injection technique), urinary albumin excretion (UAE), and plasma amino acids were performed. Dietary compliance was assessed by a 24-h urinary urea and weekly interviews with the dietitian.

RESULTS

In all diabetic patients, GFR after the LPD (114.9 ± 16.5ml · min–1 · 1.73 m∼2) and after the test diet (122.7 ± 16.7 ml · min–1 · 1.73 m∼2) was significantly lower than after the UD (132.0 ± 27.7 ml · min–1 · 1.73 m∼2) (P = 0.001). Similar results were found in the hyperfiltering group: after UD = 161.1 ± 15.4 ml · min–1 · 1.73 m–2, after LPD = 129.8 ± 9.0 ml-min–1 · 1.73 m–2, and after the test diet = 136.5 ± 3.1 ml · min–1 · 1.73 m–2, (P < 0.001). In the normofiltering group, no significant changes in GFR were observed after the three diets. Metabolic control, nutritional indexes, blood pressure (BP), and UAE did not change after the three diets in all patients.

CONCLUSIONS

A normoproteic diet with chicken and fish as the only meat protein source decreases the GFR in the hyperfiltering normoalbuminuric IDDM patients. The GFR reduction after this diet is similar to that observed after an LPD.
Evaluation of a Subcutaneous Glucose Sensor out to 3 Months in a Dog Model
Authors: Gilligan Barbara J , Shults Mark C , Rhodes Rathbun K , Updike Stuart J
Published: March 2007

OBJECTIVE

To advance the feasibility of an impiantatile long-term glucose sensor with bioprotective sensor membranes and test protocols using a somatostatin analog (octreotide).

RESEARCH DESIGN AND METHODS

Implantable sensors were constructed with one of eight bioprotective membranes and screened in vitro for stable response to glucose. Sensors were implanted subcutaneously into nondiabetic mongrel dogs and monitored at 4-min intervals via radiotelemetry. When implanted sensor responses showed evidence of tracking blood glucose after glucagon challenge (8–21 days postimplant), a glucose infusion protocolwas used to assess performance. Sensor data were collected every 4 s after octreotide inhibition of endogenous insulin release. Reference plasma glucose samples were taken every 4–10 min.

RESULTS

Preimplant in vitro testing of sensors verified linearity to 33.3 mM glucose and response times to 90% of equilibrium in 2–7 min. Ten implanted sensors tracked glucose for 20–114 days, during which 25 separate glucose infusion studies were conducted. The resulting regression data yielded a mean slope of 0.99 ± 0.06, an intercept of 0.24 ± 0.53 mM glucose, and a correlation coefficient 0.98 ± 0.01. Long-term sensor stability was not judged adequate for clinical application, although two sensors tracked within ±15% for 33 and 42 days. In vivo oxygen delivery was shown toaffect sensor performance. On expiant, two of eight tested bioprotective membranes were found to be biostable and to fully protect the sensor's enzyme membrane. The foreign body capsule was adequately vascularized adjacent to the sensor up to 91 days postimplant. Sensor units eventually failed because of electronic problems (package leakage) or because of biodegradation or biofouling of test bioprotective membranes.

CONCLUSION

Further development of this type of sensor may provide diabetic patients with a better means of monitoring blood glucose.
Type II Diabetes and Cognitive Function: A population-based study of Native Americans
Authors: Lowe Lynn P , Tranel Daniel , Wallace Robert B , Welty Thomas K
Published: March 2007

OBJECTIVE

To explore the relationship between type II diabetes and cognitive function in older Native Americans and to assess the effects of other selected risk factors for cognitive dysfunction on this relationship.

RESEARCH DESIGN AND METHODS

Cognitive function was assessed in 80 diabetic and 81 nondiabetic Native Americans who were 45–76 years of age in a cross-sectional population-based sub-study of the Strong Heart Study. Thirteen cognitive function tests were administered during a personal interview. Information about six other risk factors for cognitive dysfunction, including depressive symptoms, physical function, alcoholism, current alcohol use, hypertension, and myocardial infarction, was ascertained from interviews andfrom abstraction of medical records.

RESULTS

Diabetes was associated with impairment on only two tests of cognitive function: verbal fluency (P = 0.004) and similarities (P = 0.010). Depressive symptoms were related to verbal fluency (P = 0.004), but did not explain thediabetes-related difference in performance. The effects of hypertension, depressive symptoms, and current alcohol use explained the diabetes-related performance difference on similarities. Cognitive function was not related to metabolic control (HbA1c level).

CONCLUSIONS

We found little evidence that type II diabetes in this population of Native Americans is associated with decrement in cognitive function. Some of the cognitive impairment previously attributed to diabetes may be related, at least in part, to the influence of other risk factors. This should be considered in the design of future studies in other populations.
Remission of Proteinuria Following Correction of Hyperlipidemia in NIDDM Patients With Nondiabetic Glomerulopathy
Authors: Dubois Daniéle , Chanson Philippe , Timsit José , Chauveau Dominique , Nochy Dominique , Guillausseau Pierre-Jean , Lubetzki Jean
Published: March 2007

OBJECTIVE

Animal studies suggest that hyperlipidemia may play a direct role in glomerular damage. In patients with non-insulin-dependent diabetes mellitus (NIDDM), dyslipidemia occurs early in the course of nephropathy and may be involved in the progression of renal disease.

CASES

We report on two young NIDDM patients with marked hyperlipidemia and proteinu ria, in whom renal biopsy demonstrated nondiabetic glomerulopathy. In both cases, the decrease in blood lipid levels was associated with a major decrease in proteinuria. Episodes of hyperlipidemia were associated with a resumption of heavy protcinuria in one patient with serum triglyceride levels and proteinuria being closely correlated.

CONCLUSIONS

These two cases suggest that hyperlipidemia has an important rolein the pathogenesis of glomerular disease.
In-Shoe Foot Pressure Measurements in Diabetic Patients With At-Risk Feet and in Healthy Subjects
Authors: Sarnow Marc R , Veves Aristidis , Giurini John M , Rosenblum Barry I , Chrzan James S , Habershaw Geoffrey M
Published: March 2007

OBJECTIVE

To measure in-shoe foot pressures in diabetic patients and healthy subjects and compare them with the foot pressures when they walked without their shoes.

RESEARCH DESIGN AND METHODS

Forty-four diabetic patients at risk of foot ulceration and 65 healthy subjects were matched for age, sex, race, and weight. Neuropathy was evaluated clinically, and the F-Scan program was used to measure the foot pressures. Foot pressures were measured with the sensors placed in the shoes (S measurements), between the foot and the sock with shoes (H measurements) or with their socks alone (B measurements).

RESULTS

In the control group, significant differences were found between S (4.77 ± 1.87 kg/cm2) and H measurements (5.12 ± 1.87 kg/cm2, P < 0.001), between S and B (7.23 ± 2.95 kg/cm2, P < 0.0001), and between H and B (P < 0.0001). In the diabetic group, no difference was found between S and H measurements (5.28 ± 2.22 vs. 5.27 ± 2.39 kg/cm2, NS). In contrast, the B pressure was significantly higher when compared with both (8.77 ± 4.67 kg/cm2, P < 0.02). When compared with the control group, the S and H pressures did not differ significantly, but the B pressure in the diabetic group was significantly higher (P < 0.02). The peak S pressure was above the normal limit in 24 (27%) diabetic and 21 (16%) control feet (P < 0.05), the H pressure in 17 (19%) diabetic feet and 22 (17%) control feet (NS), and the B pressure in 24 (27%) diabetic and 21 (16%) control feet (P < 0.05).

CONCLUSIONS

In-shoe foot pressure measurements are significantly lower than the ones measured when walking with the socks only in both diabetic patients and healthy subjects. The shoes of diabetic patients provided a higher pressure reduction than did those of the control group, but the number of feet with abnormally high pressures did not change. The F-Scan system may be particularly helpful in designing footwear suitable for diabetic patients with at-risk feet.
How Does Provider and Patient Awareness of High-Risk Status for Lower-Extremity Amputation Influence Foot-Care Practice?
Authors: Del Aguila Michael A , Reiber Gayle E , Koepsell Thomas D
Published: March 2007

OBJECTIVE

To assess whether patients with diabetes at high risk for lower extremity amputation received more intensive medical care or self-care instruction and to determine the association between foot care and risk of lower-extremity amputation.

RESEARCH DESIGN AND METHODS

Patients with diabetes were seen at the Seattle Veterans Affairs Medical Center (VAMC) between October 1984 and April 1987; 67 patients were seen for initial non-traumatic amputation, and 236 consecutive control subjects were seen for non-traumatic but medically necessary surgery unrelated to diabetes. Data collection included patient interview and medical record review. High-risk status, defined as presence of peripheral neuropathy, peripheral vascular disease, or prior foot ulcer, was temporally fixed at 2 years before study enrollment.

RESULTS

Peripheral neuropathy, peripheral vascular disease, and prior foot ulcer were independently associated with risk of lower-extremity amputation: peripheral neuropathy odds ratio (OR) = 1.4 (95% confidence interval (CI) 0.7-2.7), peripheral vascular disease OR = 2.6 (95% CI 1.5-4.5), and prior foot ulcer OR = 10.9 (95% CI 4.6-25.5). Patients with a prior foot ulcer were significantly more likely to have seen a podiatrist and to have received outpatient diabetes education at the Seattle VAMC; their providers were more likely to prescribe clipping toenails, regular foot washing, and elevating feet during the day (X12 for proportions P < 0.05). However, for patients with a history of peripheral neuropathy or peripheral vascular disease, there was no statistically significant increase in medical care (podiatry visits, outpatient diabetes education) or self-care instruction (clip nails, elevate feet, or self-monitor blood glucose) compared with patients without either of these two conditions (x12 for proportions P > 0.20).

CONCLUSIONS

When clinicians were aware of a patient's very elevated risk for lower-extremity amputation (evidenced by prior history of foot ulcer), they were more likely to prescribe preventive foot-care behaviors, but awareness of other risk factors (peripheral neuropathy or peripheral vascular disease) did not necessarily increase preventive care. Physicians and patients should receive periodic education and reinforcement of diabetes management skills to modify care delivered to individuals at highest risk for lower-extremity amputation.
Erythrocyte Sodium-Lithium Countertransport Activity as a Marker of Predisposition to Hypertension and Diabetic Nephropathy in NIDDM
Authors: Fujita Jun , Tsuda Kinsuke , Seno Michiyo , Obayashi Hiroshi , Fukui Iwao , Seino Yutaka
Published: March 2007

OBJECTIVE

To evaluate the potentiality of erythrocyte sodium-lithium countertransport activity (SLC) as a marker of predisposition to hypertension and diabetic nephropathy in non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

We examined 96 patients with NIDDM and 26 healthy control subjects. SLC and other data were compared among subgroups of the patients classified on the basis of hypertension, family history of hypertension, and stages of nephropathy. Data were also analyzed by stepwise multiple regression analyses.

RESULTS

SLC was significantly higher in patients with hypertension than in those with normotension and significantly higher in patients with a positive family history of hypertension than in the negative group. Further analysis revealed that a family history of hypertension has independent influence on SLC, but hypertension itself does not. SLC was significantly higher in patients with macroalbuminuria than with microalbuminuria and higher in patients with microalbuminuria than with nor-moalbuminuria. In stepwise multiple regression analyses, a family history of hypertension was the most important determinant of SLC, and SLC was the most important determinant of nephropathy.

CONCLUSIONS

These data suggest that SLC strongly reflects a predisposition to hypertension and that it can be a useful marker of diabetic nephropathy in NIDDM.
Intraperitoneal Insulin Absorption After Lona-Term Intraperitoneal Insulin Therapy
Authors: Scavini Marina , Pincelli Angela , Petrella Giovanna , Galimberti Gabriella , Zager Philip G , Torri Michiela , Pozza Guido
Published: March 2007

OBJECTIVE

To evaluate insulin absorption through the peritoneal membrane after long-term intraperitoneal insulin therapy using an implanted programmable device.

RESEARCH DESIGN AND METHODS

Seven insulin-dependent diabetes mellitus (IDDM) patients implanted with a programmable pump were studied after 3 and 30 months of intraperitoneal insulin therapy. A 20-min square wave infusion of 15 IU of insulin was administered in the peritoneal space, and plasma glucose and plasma free insulin levels were monitored for 180 min. Hypoglycernia was prevented by intravenous glucose infusion.

RESULTS

After 30 months of intraperitoneal insulin therapy, plasma free insulin profiles following the administration of insulin in the peritoneal space were similar to those observed at the beginning of this mode of therapy.

CONCLUSIONS

In IDDM patients, intraperitoneal insulin absorption does not change after long-term intraperitoneal insulin therapy using an implanted device.
Probucol Normalizes Cholesteryl Ester Transfer in IDDM
Authors: Bagdade J D , Stein E , Ritter M C
Published: March 2007

OBJECTIVE

Cholesteryl ester transfer (CET) is pathologically increased in insulin-dependent diabetes mellitus (IDDM), and the resulting enrichment of the apolipoprotein B-containing lipoproteins with cholesteryl ester (CE) is believed to increase their atherogenicity. Because we have shown previously that treatment with the lipid-modifying antioxidant probucol normalizes CET in nondiabetic patients with hypercholesterolemia, we sought to determine whether the same beneficial effects could be achieved in IDDM.

RESEARCH DESIGN AND METHODS

CET was measured by both mass and isotopic assay in eight normolipidemic (triglyceride, 102; cholesterol, 192; high-density lipoprotein [HDL] cholesterol, 45 mg/dl) IDDM patients (fructosamine 495 ± 146 μmol/l; normal 174–286) before and after 2 months of treatment with probucol (1.0 g/day).

RESULTS

Before treatment, CET was accelerated abnormally (P < 0.001). As expected, probucol decreased plasma (−13%; P < 0.025) and HDL2 cholesterol levels (−52%; P < 0.025) and the concentration of lipoprotein A-I particles (P < 0.025). In conjunction with these changes, CET fell dramatically in all subjects (mass assay: −94%; isotopic assay: −22%, P < 0.001) with no change in the mass of cholesteryl ester transfer protein (CETP) (pretreatment 2.91 ± 0.97 vs. posttreatment 3.21 ± 1.03 μg/ml). Glycemic control, however, improved significantly (fructosamine 409 ± 85 μmol/l, P < 0.025).

CONCLUSIONS

Because it is believed that accelerated CET promotes the formation of apolipoprotein B-containing lipoproteins enriched with atherogenic CE, the capacity of probucol to reverse this functional abnormality without adversely affecting glycemic control suggests that it has a place in the therapy of IDDM.