bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the 1997 American Diabetes Association Diagnostic Criteria for Diabetes in a Hong Kong Chinese Population
Authors: Ko Gary T C , Chan Juliana C N , Woo Jean , Cockram Clive S
Published: March 2007

OBJECTIVE

Recently, the American Diabetes Association (ADA) has proposed revised diagnostic criteria for diabetes. Lowering of the fasting plasma glucose (FPG) cutoff value is intended to reduce the discrepancy with the 2-h plasma glucose (PG) cutoff value and to encourage the use of FPG. We have applied these new criteria to data collected from a population-based prevalence survey in Hong Kong Chinese subjects of working age.

RESEARCH DESIGN AND METHODS

The results of 1,513 oral glucose tolerance tests (OGTTs) from a previously published prevalence survey of glucose intolerance and cardiovascular risk factors in a Hong Kong Chinese working population were reexamined using the new criteria. Of the 1,513 subjects, 27 had a known history of diabetes. Of the remaining 1,486 subjects, 228 were also selected randomly for a second OGTT without prior knowledge of the result of the first test

RESULTS

After exclusion of the 27 subjects with a known history of diabetes, the crude prevalence of diabetes was 2.83% (n=42) when the World Health Organization's (WHO) criteria were applied. When the criterion of FPG ≥7.0 mmol/l was used, as recommended by the ADA, the prevalence of diabetes was 1.41% (n = 21). Twenty-nine subjects (1.95%) with FPG <7.0 mmol/l had a 2-h PG ≥11.1 mmol/l. Eight subjects (0.53%), previously without a diagnosis of diabetes according to the WHO criteria (FPG <7.8 mmol/l and 2-h PG <11.1 mmol/l), had FPG between 7.0 and 7.8 mmol/l and were classified as having diabetes by the ADA criteria. This classification gave a net change of −1.42% in the prevalence of diabetes between the use of FPG 5:7.0 mmol/l alone and the use of WHO criteria. Among the 1,486 subjects with no known history of diabetes, those classified as having diabetes according to the ADA FPG criterion alone had higher HbAlc and fructosamine levels than diabetic subjects defined by the WHO criteria. Of the 228 subjects for whom two FPG measurements were available, those who had consistent definitions (diabetes, impaired fasting glucose, normal fasting glucose) on both occasions were considered to have reproducible tests, giving an overall reproducibility of 90.8% (207 of 228).

CONCLUSIONS

Compared with the WHO criteria, the use of FPG to diagnose diabetes, as recommended by the ADA, was a more reproducible test and identified those subjects who had a greater degree of hyperglycemia. Although lowering of the cutoff value from 7.8 to 7.0 mmol/l increased the number of diagnoses among subjects with low FPG, the omission of the 2-h PG would lead to fewer subjects having their diabetes diagnosed.
Isradipine in Prediabetic Hypertensive Subjects
Authors: Byington Robert P , Furberg Curt D , Craven Timothy E , Pahor Marco , Sowers James R
Published: March 2007

OBJECTIVE

Investigators from the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) previously reported that the isradipine group had a higher incidence of cardiovascular disease (CVD) events than the diuretic group. The ultimate objective of the analyses presented here was to assess how indices of glycemia (specifically, serum glucose, serum insulin, and HbAlc)might have influenced the effects of the two agents on blood pressure control and CVD events.

RESEARCH DESIGN AND METHODS

Inclusion criteria included men and women ≥40 years of age with ultrasonographically confirmed carotid atherosclerosis and a diastolic blood pressure of >90 mmHg. Although insulin-dependent diabetic patients were excluded, the three glycemia indices had wide enough ranges to include patients who may be classified as prediabetic. A total of 883 patients were randomized either to the dihydropyridine calcium antagonist (CA) isradipine (2.5–5 mg twice a day) or to the diuretic hydrochlorothiazide (12.5–25 mg twice a day) and followed in double-blind fashion for 3 years.

RESULTS

Both treatment groups had achieved comparable control of diastolic blood pressure, and there were no statistically significant differences in any of the glycemia indices, either at baseline or during follow-up. However, the excess isradipine events were noted to be clustered among those patients with elevated baseline levels of HbA1c who also experienced greater blood pressure reductions during follow-up.

CONCLUSIONS

The increased cardiovascular risk associated with dihydropyridine CAs in prediabetic patients may be an explanation for the overall CA debate.
Impaired Endothelium-Dependent Vasodilatation in Women With Previous Gestational Diabetes
Authors: Anastasiou Eleni , Lekakis John P , Alevizaki Maria , Papamichael Christos M , Megas John , Souvatzoglou Athanasios , Stamatelopoulos Stamatios F
Published: March 2007

OBJECTIVE

To assess whether otherwise healthy women with a history of gestational diabetes mellitus (GDM) may have abnormalities in endothelial function at a very early stage, before glucose intolerance occurs.

RESEARCH DESIGN AND METHODS

A total of 33 women with previous GDM (17 nonobese [BMI <27] and 16 obese [BMI ≥27]) and 19 healthy nonobese women were examined. A 75-g oral glucose tolerance test was performed, and insulin levels and biochemical parameters were also measured. Using high-resolution ultrasound, we measured vasodilatory responses of the brachial artery during reactive hyperemia (endothelium-dependent vasodilatation), and after nitroglycerin administration, an endothelium-independent vasodilator.

RESULTS

Flow-mediated dilatation (FMD) was significantly and equally decreased in both groups of women with previous GDM, compared with control subjects (1.6 ± 3.7% in the nonobese GDM group and 1.6 ± 2.5% in the obese GDM group vs. 10.3 ± 4.4% in control subjects, P <0.001). FMD correlated inversely with serum uric acid levels, BMI, serum total cholesterol, and basal insulin resistance (homeostasis model assessment). Nitrate-induced dilatation was significantly decreased only in the obeseGDM group compared with control subjects (21.4 ± 5.1 vs. 27.9 ± 9.5, P < 0.05).

CONCLUSIONS

Endothelial dysfunction, which is considered as a very early index of atherogenesis, is alreadypresent in both obese and nonobese women with a history of GDM, even when they have normal glucose tolerance.
Variation of Postprandial Plasma Glucose, Palatability, and Symptoms Associated With a Standardized Mixed Test Meal Versus 75 g Oral Glucose
Authors: Wolever Thomas M S , Chiasson Jean-Louis , Csima Adele , Hunt John A , Palmason Carol , Ross Stuart A , Ryan Edmond A
Published: March 2007

OBJECTIVE

To compare within-subject variability of plasma glucose measured 2 h after a glucose tolerance test (GTT) with that of plasma glucose measured 2 h after administration of a standardized test meal (diabetes screening product [DSP], Ceapro, Edmonton, Alberta, Canada) and to determine the relationship between the two sets of plasma glucose measurements.

RESEARCH DESIGN AND METHODS

Plasma glucose and insulin responses of 36 overnight-fasted subjects (10 lean normal, 9 obese normal, 9 with impaired glucose tolerance [IGT], and 8 with mild diabetes) were studied on eight different mornings after they consumed 75 g oral glucose or 50 g carbohydrate from the DSP. Each test meal was repeated four times by each subject. Within-subject coefficients of variation (CVs) (CV = 100 × SD/mean) of plasma glucose concentrations 2 h after administration of the GTT and DSP were compared by repeated measures ANOVA and linear regression analysis.

RESULTS

Mean plasma glucose 2 h after administration of the DSP (D) was linearly related to that 2 h after the GTT (G): G = 1.5 × D − 1.6 (r = 0.97, P < 0.0001). The CV of 2-h plasma glucose was significantly lower after administration of the DSP, 10.5 ± 1.0%, than after the GTT, 12.7 ± 1.18% (P = 0.025). The effect of test meal on CV differed in different groups of subjects (P = 0.018), with the largest difference found in IGT subjects, in whom the CV after DSP administration was 47% < after the GTT (P = 0.0005). The DSP was significantly more palatable and produced fewer adverse symptoms than the GTT.

CONCLUSIONS

Plasma glucose concentrations measured 2 h after DSP administration are closely related to those measured 2 h after the GTT but are more consistent than the 2-h post-GTT concentrations within the critical IGT range. This finding suggests that measurement of plasma glucose 2 h after administration of the DSP may allow more precise discrimination among normal glucose levels, IGT, and diabetes than measurement of plasma glucose 2 h after the GTT.
Neuropsychological Complications of IDDM in Children 2 Years After Disease Onset
Authors: Northam Elisabeth A , Anderson Peter J , Werther George A , Warne Garry L , Adler Robert G , Andrewes David
Published: March 2007

OBJECTIVE

To compare the neuropsychological profiles of children with IDDM with a community control group at two time points: 3 months after disease onset and 2 years after the baseline assessment.

RESEARCH DESIGN AND METHODS

A total of 123 children (age 3–14 years) with recent IDDM onset were compared with 129 community control subjects, stratified for age and sex, on standardized measures of general intelligence, attention, speed of processing, memory, learning, executive skills, and behavioral adjustment soon after diagnosis and 2 years later. Exclusion criteria were premorbid evidence of central nervous system disease or trauma, or English not spoken in the home.

RESULTS

There were no differences between children with IDDM and control subjects on any measure at the initial assessment 3 months after disease onset. Two years later, children with IDDM tended to show a less positive change, relative to control subjects, in their standardized scores on measures of general intelligence, and significantly so on the vocabulary (P < 0.01) and block design (P < 0.05) subtests. Multivariate group differences were also apparent on speed of processing (P < 0.05) and learning (P < 0.01) subtests, reflecting smaller developmental gains in the children with IDDM when compared with control subjects.

CONCLUSIONS

The findings are consistent with previous reports, suggesting that IDDM is associated with an increased risk of mild neuropsychological dysfunction. The skills most affected in this cohort were information processing speed, acquisition of new knowledge, and conceptual reasoning abilities. Clinicians and educators should be made aware of the risk of specific neuropsychological deficits in children with IDDM.
Induction of β-Cell Rest in Type 1 Diabetes: Studies on the effects of octreotide and diazoxide
Authors: Björk Elisabeth , Berne Christian , Karlsson F Anders
Published: March 2007

OBJECTIVE

To evaluate the inhibitory effects of octreotide and diazoxide on insulin secretion in patients with type 1 diabetes and measurable levels of circulating C-peptide.

RESEARCH DESIGN AND METHODS

Diazoxide was given to six patients during a 7-day period (100 mg three times daily), followed by a 3-week washout. Subsequently, octreotide (50 micrograms, three times daily) was administered subcutaneously for 7 days. Pre- and post- prandial blood glucose and serum C-peptide concentrations were measured before medication (control) and on day 7 of each medication period. Glucagon-stimulated C-peptide was determined in the morning before medication and on the day after each treatment period.

RESULTS

Diazoxide inhibited glucagon-stimulated C-peptide secretion (mean increment 0.08 nmol/l vs. 0.18 nmol/l, P < 0.05), whereas octreotide had no such effect. Both reduced the pre- and postprandial serum C-peptide concentrations (P < 0.05), octreotide being the more potent in this respect. A reduction in basal and meal-related blood glucose was observed during octreotide treatment, whereas the glucose concentrations tended to be higher during treatment with diazoxide than during the 24-h control period.

CONCLUSIONS

The study indicates that the two drugs reduce insulin output by different mechanisms. Diazoxide inhibits hormonal release directly on the beta-cells, whereas octreotide exerts its effect indirectly, presumably by multiple actions on insulin sensitivity and insulin-releasing hormones. The results suggest that each drug is capable of inducing beta-cell rest in type 1 diabetes.
The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications
Authors: Yosipovitch Gil , Hodak Emmilia , Vardi Pnina , Shraga Ilana , Karp Moshe , Sprecher Eliott , David Michael
Published: March 2007

OBJECTIVE

The aim of our study was to evaluate the frequency of skin manifestations, including the diabetic hand syndrome, in young IDDM patients. In addition, we studied the relation of the cutaneous manifestations to diabetes duration, glycemic control, and microvascular complications.

RESEARCH DESIGN AND METHODS

The frequency of skin manifestations, including the diabetic hand syndrome, were examined in 238 IDDM patients (disease duration >5 years) and 122 healthy control subjects in a cross-sectional study. In addition, we studied the relation of the cutaneous manifestations with diabetes duration, glycemic control, BMI, microvascular complications, and stratum corneum hydration using a stepwise logistic regression.

RESULTS

Diabetic skin manifestations were detected in 168 of 238 (71%) IDDM patients and in 18 of 122 (14%) of the control subjects. Ichthyosiform skin changes of the shins, scleroderma-like skin changes, tinea pedis, and dry scaly palms were detected in 48 vs. 7%, 39 vs. 0%, 32 vs. 7%, and 21 vs. 0.8% of the patients and control subjects, respectively. In the diabetic patients, a significant association was found between ichthyosis of the shins and sclerodermalike skin changes of the hand (P < 0.001) and between scleroderma-like skin changes and the skin dryness of the palms (P < 0.0001). When diabetic risk factors were considered, diabetes duration was significantly associated with scleroderma-like skin changes and ichthyosis of the shins (P < 0.0001). The latter was also found to be related to diabetic retinopathy (P < 0.0001). Keratosis pilaris was present in 21% of the patients versus 9% in control subjects and was found to be exclusively associated with high BMI.

CONCLUSIONS

Acquired ichthyosis is a common finding and the most prevalent skin manifestation in young IDDM patients. The development of several skin manifestations in insulin-dependent patients seems to be related to duration of diabetes and to development of diabetic microvascular complications.
Ratio of Motor Nerve Conduction Velocity to F-Wave Conduction Velocity in Diabetic Neuropathy
Authors: Ohgaki Kimiko , Nakano Koji , Shigeta Hirofumi , Kitagawa Yoshihiro , Nakamura Naoto , Iwamoto Kazuhide , Makino Masahiro , Takanashi Yoshiaki , Kajiyama Shizuo , Kondo Motoharu
Published: March 2007

OBJECTIVE

To investigate the usefulness of a new parameter, the ratio of motor nerve conduction velocity to F-wave conduction velocity (M/F ratio), for the differential diagnosis of diabetic neuropathy.

RESEARCH DESIGN AND METHODS

Nerve conduction studies were conducted in 95 patients with diabetic neuropathy, 44 nondiabetic patients with peripheral neuropathy, and 24 normal control subjects. Nondiabetic patients with neuropathy were grouped by clinical diagnosis as follows: segmental demyelination (n = 15), axonal neuropathy (n = 11), alcoholic polyneuropathy (n = 4), and other polyneuropathy (n = 14). Motor nerve conduction velocity (MCV) of post-tibial nerves, sensory nerve conduction velocity (SCV) of sural nerves, and F-wave conduction velocity (FWCV) of post-tibial nerves were measured by standardized techniques. The M/F ratio was calculated from these measurements.

RESULTS

The MCV and SCV of diabetic patients were significantly slower and the M/F ratio was significantly lower than those of normal subjects: MCV, 43.7 ± 5.4 vs. 47.1 ± 2.9 m/s, P < 0.001; SCV, 44.7 ±11.1 vs. 48.3 ± 5.7 m/s, P < 0.05; M/F ratio, 0.84 ± 0.09 vs. 0.90 ± 0.06, P < 0.001. The FWCV of nondiabetic patients with neuropathy was significantly slower (40.0 ± 6.3 vs. 48.3 ± 4.0 m/s, P < 0.001) and the M/F ratio was significantly higher (1.04 ± 0.12, P < 0.001) than that of normal subjects, respectively. Although MCV, SCV, and FWCV were correlated with age in normal control subjects, the M/F ratio was independent of age in the diabetic as well as the nondiabetic patients with neuropathy.

CONCLUSIONS

Results suggest that the M/F ratio, which is influenced by the neuronal damages in the distal segment of peripheral nerves, is useful in the differential diagnosis of diabetic neuropathy.
Arrhythmias and Mortality After Myocardial Infarction in Diabetic Patients: Relationship to diabetes treatment
Authors: Davis Timothy M E , Parsons Richard W , Broadhurst Robin J , Hobbs Michael S T , Jamrozik Konrad
Published: March 2007

OBJECTIVE

To assess the relationship between clinical course after acute myocardial infarction (AMI) and diabetes treatment.

RESEARCH DESIGN AND METHODS

Retrospective analysis of data from all patients aged 25–64 years admitted to hospitals in Perth, Australia, between 1985 and 1993 with AMI diagnosed according to the International Classification of Diseases (9th revision) criteria was conducted. Short- (28-day) and long-term survival and complications in diabetic and nondiabetic patients were compared. For diabetic patients, 28-day survival, dysrhythmias, heart block, and pulmonary edema were treated as outcomes, and factors related to each were assessed using multiple logistic regression. Diabetes treatment was added to the model to assess its significance. Long-term survival was compared by means of a Cox proportional hazards model.

RESULTS

Of 5,715 patients, 745 (12.9%) were diabetic. Mortality at 28 days was 12.0 and 28.1% for nondiabetic and diabetic patients, respectively (P < 0.001); there were no significant drug effects in the diabetic group. Ventricular fibrillation in diabetic patients taking glibenclamide (11.8%) was similar to that of nondiabetic patients (11.0%) but was lower than that for those patients taking either gliclazide (18.0%; 0.1 > P > 0.05) or insulin (22.8%; P < 0.05). There were no other treatment-related differences in acute complications. Long-term survival in diabetic patients was reduced in those taking digitalis and/or diuretics but type of diabetes treatment at discharge had no significant association with outcome.

CONCLUSIONS

These results do not suggest that ischemic heart disease should influence the choice of diabetes treatment regimen in general or of sulfonylurea drug in particular.
The Reliability and Validity of a Brief Diabetes Knowledge Test
Authors: Fitzgerald James T , Funnell Martha M , Hess George E , Barr Patricia A , Anderson Robert M , Hiss Roland G , Davis Wayne K
Published: March 2007

OBJECTIVE

To examine the reliability and validity of a brief diabetes knowledge test. The diabetes knowledge test has two components: a 14-item general test and a 9-item insulin-use subscale.

RESEARCH DESIGN AND METHODS

Two populations completed the test. In one population, patients received diabetes care in their community from avariety of providers, while the other population received care from local health departments. Cronbach's coefficient a was used to calculate scale reliability for each sample. To determine validity, patient group differences were examined. It was hypothesized that test scores would be higher for patients with type 1 diabetes, for patients with more education, and for patients who had received diabetes education.

RESULTS

The coefficient as for the general test and the insulin-use subscale indicate that both are reliable, α ≥ 0.70. In the community sample, patients with type 1 diabetes scored higher than patients with type 2 diabetes on the general test and the insulin-use subscale. In the health department sample, patients with type 1 scored higher than patients with type 2 on the insulin-use subscale. For both samples, scores increased as the years of formal education completed increased, and patients who received diabetes education scored higher than patients who did not.

CONCLUSIONS

Although the samples differed demographically, the reliability and validity of the test were supported in both the community andthe health department samples. This suggests that the test is appropriate for a variety of settings and patient populations.
Codon 972 Polymorphism of the Insulin Receptor Substrate-1 Gene in Impaired Glucose Tolerance and Late-Onset NIDDM
Authors: Yamada Kentaro , Yuan Xiaohong , Ishiyama Satomi , Shoji Singo , Kohno Shusuke , Koyama Ken-Ichi , Koyanagi Atsuko , Koyama Wasaku , Nonaka Kyohei
Published: March 2007

OBJECTIVE

To assess the relevance of a Gly→Arg substitutionin codon 972 of the insulin receptor substrate-1 gene in impaired glucose tolerance (IGT) and NIDDM.

RESEARCH DESIGN AND METHODS

The genotype of 1,106 Japanese subjects consisting of 310 subjects with NIDDM, 305 subjects with IGT, and 491 normal control subjects was analyzed by an allele-specific assay using polymerase chain reaction and restriction fragment length polymorphism.

RESULTS

The frequency of the variant allele was not different between subjects with NIDDM (0.021) and normal control subjects (0.020). However, subjects with IGT showed a significantly higher prevalence of the variant allele (0.041, P = 0.027). We found two homozygous individuals for the variant; both had IGT with mild insulin resistance. The allelic frequency tended to be lower in normal control subjects aged >50 years than in younger control subjects. Conversely, in the subjects with IGT or NIDDM, the Gly972Arg substitution was more frequently found in subjects aged >50 years. Furthermore, NIDDM patients with the variant allele had older ages of diagnosis than patients without the variant.

CONCLUSIONS

The codon 972 variant may be associated with IGT anda subset of lateonset NIDDM in the elderly Japanese population.
Validation of a Diabetes-Specific Quality-of-Life Scale for Patients With Type 1 Diabetes
Authors: Bott Uwe , Mühlhauser Ingrid , Overmann Hubert , Berger Michael
Published: March 2007

OBJECTIVE

To validate a diabetes-specific quality-of-life scale and to assess its psychometric properties in a large sample of patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

To assess the quality of diabetes care in a population-based study, a representative sample of 684 patients with type 1 diabetes was examined. A total of 657 patients (42% female; mean age 36 years; mean diabetes duration 18 years) completed the diabetes-specific quality-of-life scale (DSQOLS), which comprised 64 items on individual treatment goals (10 items), satisfaction with treatment success (10 items), and diabetes- related distress (44 items). Statistical examinations covered factor analysis, internal consistency of subscales, and construct and discriminant validity.

RESULTS

Factor analysis of the 44 items on diabetes-specific burdens revealed six reliable components (Cronbach's α): social relations (0.88), physical complaints (0.84), worries about future (0.84), leisure time flexibility (0.85), diet restrictions (0.71), and daily hassles (0.70). All six subscales were significantly correlated with a validated well-being scale (r = -0.35 to -0.53, P < 0.001) and treatment satisfaction (r = 0.28 to 0.43, P < 0.001). Physical complaints (r = 0.24) and worries about future (r = 0.17) showed the highest correlations with HbA1c (P < 0.001). A flexible insulin therapy, a liberalized diet, the absence of late complications, and a higher social status were significantly associated with more favorable scores in different domains.

CONCLUSIONS

The DSQOLS is a reliable and valid measure of diabetes-specific quality of life. The scale is able to distinguish between patients with different treatment and dietary regimens and to detect social inequities. Use of the DSQOLS for assessment of individual treatment goals as defined by the patients may be helpful to identify motivational deficits and to tailor individual treatment strategies.
Do Postmenopausal Women With NIDDM Have a Reduced Capacity to Deposit and Conserve Lower-Body Fat?
Authors: Stoney Rachel M , Walker Karen Z , Best James D , Ireland Paul D , Giles Graham G , O'Dea Kerin
Published: March 2007

OBJECTIVE

To compare regional body fat distribution and sex hormone status of postmenopausal women with NIDDM with those of age- and BMI-matched normoglycemic women.

RESEARCH DESIGN AND METHODS

The regional body fat distribution and sex hormone status of 42 postmenopausal women with NIDDM were compared with those of 42 normoglycemic women matched for age and BMI, who served as control subjects. Body composition was measured by dual-energy X-ray absorptiometry, and sex hormone-binding globulin (SHBG) and testosterone were measured in serum.

RESULTS

Although the levels of total body fat were similar between the two groups, the women with NIDDM had significantly less lower-body fat (LBF) (P < 0.01) than the control subjects matched for age and BMI. This pattern of fat deposition in women with NIDDM was accompanied by an androgenic hormone profile, with decreased SHBG concentration and an increased free androgen index (P < 0.05 and P < 0.01, respectively).

CONCLUSIONS

A reduced capacity to deposit and/or conserve LBF may be an independent factor associated with (or may be a marker of) the metabolic manifestations of the insulin resistance syndrome in women with NIDDM. The possibility that the smaller relative accumulation of LBF is a consequence of the androgenic hormonal profile should be investigated in future studies.
Pubertal Growth in ID DM Is Determined by HbA1c Levels, Sex, and Bone Age
Authors: Ahmed Marion L , Connors Matthew H , Drayer Nick M , Jones Jennifer S , Dunger David B
Published: March 2007

OBJECTIVE

In cross-sectional studies of subjects with IDDM, the relationship between suboptimal pubertal growth, glycemic control, and abnormal insulin-like growth factor 1 (IGFI) levels has proved difficult to define. The objective of this study was to examine these relationships in a longitudinal prospective study.

RESEARCH DESIGN AND METHODS

A total of 46 children (23 boys) were measured every 3 months, and their bone age was assessed annually. Blood samples were obtained for HbA1c, 1GF-I, and C-peptide. Growth data were compared with national standards, and 1GFI data were compared with a parallel longitudinal study of normal schoolchildren. Data were analyzed as SD scores (mean ± SD).

RESULTS

The onset of puberty was not delayed, although in the girls, bone age was advanced (bone age, 11.48 ± 1.01 years vs. chronological age, 10.93 ± 0.86 years “mean ± SD”; P = 0.04). The timing of peak height velocity (PHV) was normal in both sexes, but the magnitude was reduced in girls (PHV SDS = −0.56 ± 0.90, P < 0.02), and reductions in height SDS between diagnosis and final height were observed (P = 0.014). At PHV, 1GF-1 levels were reduced in both sexes, and there were no sex differences in HbA1c levels and insulin doses. 1GF- 1 SDS correlated with insulin dose (r = 0.47, P = 0.004) but not with PHV SDS, whereas HbA1c correlated negatively with PHV SDS in both sexes (r = −0.35, P = 0.03). In a stepwise multiple regression analysis, the major determinants of PHV SDS were HbA1c (P = 0.04), sex (P = 0.0007), and bone age (P = 0.01).

CONCLUSIONS

We conclude that the magnitude of the pubertal growth spurt is related to HbAlc levels in both sexes, but it is reduced only in girls. This sexual dimorphism cannot be explained by differences in 1GF-I levels and may relate to the bone age advance at the onset of puberty in the girls.
Variants of the Fatty Acid-Binding Protein 2 Gene Are Not Associated With Coronary Heart Disease in Nondiabetic Subjects and in Patients With NIDDM
Authors: Saarinen Laura , Pulkkinen Arto , Kareinen Anu , Heikkinen Sami , Lehto Seppo , Laakso Markku
Published: March 2007

OBJECTIVE

To investigate the association of variants of the fatty acid-binding protein (FABP) 2 gene with coronary heart disease (CHD) in nondiabetic subjects and in patients with NIDDM.

RESEARCH DESIGN AND METHODS

Cross-sectional study included 135 nondiabetic and 79 NIDDM subjects with stenosis (>50%) in at least two coronary arteries. A group of 81 healthy nondiabetic men without CHD served as a control population. All exons and intron-exon junctions of the FABP2 gene were amplified with the polymerase chain reaction, and variants were screened with the single-strand conformation polymorphism analysis.

RESULTS

The allele frequency of an amino acid polymorphism (alanine→threonine) in codon 54 of exon 2 of the FABP2 gene was 0.26 in nondiabetic subjects with CHD and 0.27 in NIDDM subjects with CHD. Other variants (GTA 118 GTC, GCGCA→GCACA in the 3'- noncoding region, and the number of ATT repeats in intron 2) also did not associate with CHD.

CONCLUSIONS

The variants of the FABP2 gene are not likely to contribute to the risk of CHD in Finnish nondiabetic and NIDDM subjects.
Mapping Genes for NIDDM: Design of the Finland—United States Investigation of NIDDM Genetics (FUSION) Study
Authors: Valle Timo , Tuomilehto Jaakko , Bergman Richard N , Ghosh Soumitra , Hauser Elizabeth R , Eriksson Johan , Nylund Stella J , Kohtamäki Kimmo , Toivanen Liisa , Vidgren Gabriele , Tuomilehto-Wolf Eva , Ehnholm Christian , Blaschak Jillian , Langefeld Carl D , Watanabe Richard M , Magnuson Victoria , Ally Delphine S , Hagopian William A , Ross Edna , Buchanan Thomas A , Collins Francis , Boehnke Michael
Published: March 2007

OBJECTIVE

To map and identify susceptibility genes for NIDDM and for the intermediate quantitative traits associated with NIDDM.

RESEARCH DESIGN AND METHODS

We describe the methodology and sample of the Finland-United States Investigation of NIDDM Genetics (FUSION) study. The whole genome search approach is being applied in studies of several different ethnic groups to locate susceptibility genes for NIDDM. Detailed description of the study materials and designs of such studies are important, particularly when comparing the findings in these studies and when combining different data sets.

RESULTS

Using a careful selection strategy, we have ascertained 495 families with confirmed NIDDM in at least two siblings and no history of IDDM among the first-degree relatives. These families were chosen from more than 22,000 NIDDM patients, representative of patients with NIDDM in the Finnish population. In a subset of families, a spouse and offspring were sampled, and they participated in a frequently sampled intravenous glucose tolerance test (FSIGT) analyzed with the Minimal Model. An FSIGT was completed successfully for at least two nondiabetic offspring in 156 families with a confirmed nondiabetic spouse and no history of IDDM in first-degree relatives.

CONCLUSIONS

Our work demonstrates the feasibility of collecting a large number of affected sib-pair families with NIDDM to provide data that will enable a whole genome search approach, including linkage analysis.
Apolipoprotein E Polymorphism and Renal Function in German Type 1 and Type 2 Diabetic Patients
Authors: Werle Egon , Fiehn Walter , Hasslacher Christoph
Published: March 2007

OBJECTIVE

To examine the association of renal function in diabetic patients with apolipoprotein (apo) E polymorphism.

RESEARCH DESIGN AND METHODS

Apo E genotypes, lipid and lipoprotein serum levels, creatinine clearance (CCr), and excretion of marker proteins were determined in German type 1 (IDDM; n = 162) and type 2 (NIDDM; n = 124) diabetic patients. Albumin and immunoglobulin (Ig) G are considered to reflect charge-size permselectivity of the glomerular capillary basement membrane, and increased alpha 1-microglobulin (MG) excretion indicates compromised reabsorptive capacity of the renal tubules.

RESULTS

Patients with NIDDM had higher lipid levels and lower CCrs than patients with IDDM. In patients with IDDM, age- and sex-adjusted analysis of variance showed an association between apo E genotypes and CCr, and the Jonckheere-Terpstra test demonstrated a decreasing glomerular filtration rate in the following order of genotypes: ε4ε4/ε4ε3 > ε3ε3 > ε2ε2/ε2ε3. Multiple linear regression analyses revealed that in patients with IDDM, the ε2 allele was a negative predictor of CCr and a positive predictor of urinary excretion of albumin, IgG and α 1-MG independent from HDL and LDL cholesterol, TG concentration, age, and sex.

CONCLUSIONS

Apo E polymorphism influences serum lipoprotein levels in patients with IDDM and NIDDM. Apo E polymorphism may be a renal risk factor of clinical relevance in normolipidemic patients with IDDM.
An Asian Multicenter Clinical Trial to Assess the Efficacy and Tolerability of Acarbose Compared With Placebo in Type 2 Diabetic Patients Previously Treated With Diet
Authors: Chan Juliana CN , Chan Kin-Wei A , HO Larry LT , Fuh Martin MC , Horn Lee Chung , Sheaves Richard , Panelo Araceli A , Kim Duk-Kyu , Embong Mustaffa ,   For the Asian Acarbose Study Group
Published: March 2007

OBJECTIVE

To assess the efficacy, safety, and tolerability of acarbose versus placebo during a 24-week treatment period in Asian type 2 diabetic patients with dietary failure.

RESEARCH DESIGN AND METHODS

After a 6-week screening period, 126 multiethnic Asian type 2 diabetic patients (64 men, 62 women; mean age ± SD, 53.4 ± 10 years) were randomized to receive acarbose (n = 63) or placebo (n = 63). The dosage was increased from 50 mg t.i.d. at week 0 to 100 mg t.i.d. at week 4. Patients were then followed up at weeks 10, 16, and 24. At each visit, body weight, blood pressure, and metabolic indexes were measured. At weeks 0 and 24, fasting plasma glucose and insulin were measured before and 1 h after the administration of an individually tailored breakfast.

RESULTS

Using the intention-to-treat analysis, there were greater reductions in (mean [95% CI]) HbA1c (−0.70 [−1.00 to −0.39] vs. −0.27% [−0.54 to 0]; P = 0.04), fasting plasma glucose (−0.37 [−0.75 to 0.02] vs. 0.41 mmol/1 [−0.08 to 0.90]; P = 0.017) and 1-h plasma glucose (−0.77 [−1.44 to −0.10] vs. 0.65 mmol/1 [−0.07 to 1.36]; P = 0.05) in the acarbose group compared with the placebo group. With acarbose treatment, 78% of patients achieved an HbA1c <8% compared with 56% in the placebo group (P = 0.003). There was a greater reduction in body weight (−1.31 [−2.46 to −0.15] vs. 0.16 kg [−3.36 to 0.10]; P = 0.02) and higher incidence of flatulence (56 vs. 37%; P = 0.032) in the acarbose than in the placebo group. Using baseline HbA1c and race as covariates, there were no significant interethnic differences in treatment responses (P = 0.232 for treatment-race interaction; P < 0.001 for treatment effect). The dropout rates were similar between the two groups (acarbose, 11 of 63; placebo, 6 of 63). There were no significant laboratory adverse events in either group.

CONCLUSIONS

In this multicenter study involving six ethnic groups, acarbose 100 mg t.i.d. was an effective, safe, and generally well-tolerated therapy in Asian type 2 diabetic patients with dietary failure. In some patients with troublesome gastrointestinal symptoms, a lower dosage may be necessary.
Rigiscan Evaluation of Specific Nervous Impairment in Patients With Diabetes and Erectile Disorders
Authors: Bax Giuseppe , Marin Narciso , Piarulli Francesco , Lamonica Mario , Bellio Fabiana , Fedele Domenico
Published: March 2007

OBJECTIVE

A proposed new, minimally invasive, and painless method for studying impairment of the autonomic system of the penile region in type 2 diabetes patients.

RESEARCH DESIGN AND METHODS

Thirteen subjects were selected from 150 patients with type 2 diabetes and erectile dysfunction who were studied in accordance with the National Institutes of Health consensus. The 13 subjects (group A), aged 55 ± 8 years, had acceptable metabolic control (HbA1c, <8%); no arterial or venous diseases or initial Peyronie's disease, as evaluated by penile Doppler ultrasonography and intracavernous prostaglandin E1 injection; and penile tumescence at the base (PTB) <30 mm. Group B consisted of 13 control subjects with the same characteristics, including mean age (53.1 ± 9 years), metabolic control (HbA1c, 7.3 ± 0.7%), and duration of disease (8.3 ± 0.7 years), but PTB was =30 mm. Student's t test was used to evaluate differences in the results of autonomic cardiovascular tests, somatic tests (vibration perception threshold [VPT]), and diabetic neuropathy score (DNS) in both groups. The coefficient of variation of PTB was evaluated using the Rigiscan device (Dacomed, Minneapolis, MN), and Bayes' test was used to test sensitivity, specificity, and positive predictive values of the cardiovascular tests.

RESULTS

Patients with PTB <30 mm had significant (P < 0.05) impairment of parasympathetic tests (lying to standing, P < 0.02; standing to lying, P < 0.04; squat test, P < 0.03) compared with subjects with higher PTB values. No difference in DNS and VPT at the base and tip of the penis was found between the two groups. The variability of the test is 10% in normal subjects and 15% in both groups of patients. PTB sensitivity was 54%, specificity 89%, and positive predictive value 79%.

CONCLUSIONS

In patients with diabetes and without vascular diseases, the PTB evaluated by Rigiscan is related to impairment of the autonomic nervous system. A PTB value <30 mm may be considered a useful, noninvasive marker in studying parasympathetic damage of the penile region.
Potential Economic Benefits of Lower-Extremity Amputation Prevention Strategies in Diabetes
Authors: Ollendorf Daniel A , Kotsanos James G , Wishner William J , Friedman Mark , Cooper Tamara , Bittoni Marisa , Oster Gerry
Published: March 2007

OBJECTIVE

To estimate the potential economic benefits of selected strategies from published literature—educational interventions, multidisciplinary clinics, and insurance coverage for therapeutic shoes—to reduce the incidence of lower-extremity amputation among individuals with diabetes.

RESEARCH DESIGN AND METHODS

We developed a model to estimate the expected incidence and associated costs of lower-extremity amputation in a hypothetical cohort of 10,000 people with diabetes. Prevention strategies were assumed to be targeted at individuals with a history of foot ulcer, and benefits were estimated over a period of 3 years.

RESULTS

The total potential economic benefits (discounted at 5%) of strategies to reduce amputation risk ranged from $2.0 to $3.0 million ($2,900 to $4,442 per person with a history of foot ulcer) over 3 years. Benefits were highest for educational interventions. Most benefits were found to accrue among individuals aged ≥ 70 years.

CONCLUSIONS

Strategies to reduce the risk of lower-extremity amputation may generate substantial economic benefits and should be a standard component of routine diabetes care. Benefits may best be achieved through a partnership of government, private payers, health care service providers and producers, and individuals with diabetes.
Effect of Glycemic Control on Glucose Counterregulation During Hypoglycemia in NIDDM
Authors: Levy Carol J , Kinsley Brendan T , Bajaj Mandeep , Simonson Donald C
Published: March 2007

OBJECTIVE

We examined the effect of glycemic control of NIDDM on counterregulatory hormone responses to hypoglycemia and compared the effect with that seen in patients with IDDM.

RESEARCH DESIGN AND METHODS

Eleven subjects with NIDDM and eight age- and weight-matched control subjects and ten subjects with IDDM and ten age- and weight-matched control subjects were studied. All subjects underwent a stepped hypoglycemic-hyper-insulinemic clamp study during which plasma glucose levels were lowered in a stepwise manner from 5.0 to 2.2 mmol/l in steps of 0.6 mmol/l every 30 min. Counterregulatory hormones (epinephrine, norepinephrine, glucagon, ACTH, cortisol, and growth hormone [GH]) were measured, and a symptom survey was administered during the last 10 min of each 30-min interval.

RESULTS

The threshold for release of epinephrine, norepinephrine, ACTH, and cortisol occurred at higher plasma glucose levels in NIDDM than in IDDM patients (P < 0.05–0.01). The glucose threshold for release of epinephrine and norepinephrine correlated with glycemic control as measured by glycosylated hemoglobin (P < 0.05–0.01). However, for a given level of glycemic control, the threshold for release of epinephrine and norepinephrine occurred at a higher glucose level in NIDDM versus IDDM patients (P < 0.05–0.01). At the nadir level of hypoglycemia, glucagon, ACTH, and cortisol levels were all higher in NIDDM compared with IDDM subjects, whereas GH levels were lower.

CONCLUSIONS

Glycemic control alters counterregulatory responses to hypoglycemia in NIDDM as has been previously reported in IDDM. However, at similar levels of glycemic control, NIDDM patients release counterregulatory hormones at a higher plasma glucose level than patients with IDDM. In addition, subjects with NIDDM maintain their glucagon response to hypoglycemia. These data suggest that patients with NIDDM may be at reduced risk of severe hypoglycemia when compared with a group of IDDM patients in similar glycemic control, thus providing a more favorable risk-benefit ratio for intensive diabetes therapy in NIDDM.
Dissociation of Microangiopathy and Macroangiopathy in Patients With Type 2 Diabetes
Authors: Yamamoto Maki , Egusa Genshi , Okubo Masamichi , Yamakido Michio
Published: March 2007

OBJECTIVE

Although persistent hyperglycemia contributes greatly to the progression of diabetic micro- and macroangiopathy, microangiopathy progresses more rapidly than macroangiopathy in some type 2 diabetic patients, with the opposite being true in others. This study was conducted to identify factors responsible for such dissociation.

RESEARCH DESIGN AND METHODS

Patients with proliferative diabetic retinopathy and a carotid intima-media thickness (IMT) level ≤1.0 mm were classified as the microangiopathy group (MIG); those with an IMT level >1.1 mm and without retinopathy or with background retinopathy were assigned to the macroangiopathy group (MAG). Only middle-aged patients, 50–69 years old, were included in this study. There were 54 patients in the MIG and 68 patients in the MAG.

RESULTS

Patients in the MIG were significantly younger at the onset of diabetes, and those in the MAG had a significantly higher mean ratio of apoprotein (apo) B to apoAI. The percentage of patients with a family history of diabetes was significantly higher in the MIG. Maternal inheritance was common among these patients. Those with obesity, a family history of diabetes, and younger onset of hypertension were more common in the MAG. In the multiple logistic regression analyses, maternal inheritance and early onset of diabetes were independent risk factors for the acceleration of microangiopathy. A personal history of obesity and a family history of hypertension were independently related to the development of macroangiopathy.

CONCLUSIONS

Our results suggest that patients with early onset and maternal inheritance of diabetes may have a high risk for the progression of diabetic microangiopathy, while patients with hyperlipidemia, a history of obesity, and a family history of hypertension seem prone to the development of atherosclerosis.
Meal-Generated Oxidative Stress in Type 2 Diabetic Patients
Authors: Ceriello Antonio , Bortolotti Nadia , Motz Enrico , Crescentini Adriana , Lizzio Sebastiano , Russo Assunta , Tonutti Laura , Taboga Claudio
Published: March 2007

OBJECTIVE

Free radical production has been reported to be increased in diabetic patients and to be involved in the pathogenesis of diabetic complications. In this study, a standardized meal was administered to 10 type 2 diabetic patients and 10 healthy matched normal subjects to evaluate its effects on plasma oxidative stress generation.

RESEARCH DESIGN AND METHODS

In diabetic patients, at baseline and after the meal, plasma malondialdehyde (MDA), vitamin C, protein SH groups, uric acid, vitamin E, and total plasma radical-trapping parameter, which evaluates plasma antioxidant capacity due to known and unknown antioxidants present in the plasma as well as their mutual cooperation, were measured.

RESULTS

After the meal, plasma MDA and vitamin C increased, while protein SH groups, uric acid, vitamin E, and total plasma radical-trapping parameter decreased more significantly in the diabetic subjects than in control subjects.

CONCLUSIONS

This finding shows that in the absorptive phase, free radicals are produced in diabetic patients. Since plasma glucose, but not insulin, rose significantly more in diabetic subjects than in control subjects, hyperglycemia may play an important role in the generation of postprandial oxidative stress in diabetic patients.
Increased Left Ventricular Mass in Normotensive Type 1 Diabetic Patients With Diabetic Nephropathy
Authors: Sato Asako , Tarnow Lise , Parving Hans-Henrik
Published: March 2007

OBJECTIVE

Diabetic nephropathy increases the risk of premature cardiovascular disease and sudden death, particularly in type 1 diabetic patients. One possible mechanism for this risk may be left ventricular hypertrophy. In our study, we aimed to evaluate left ventricular structure and function in normotensive type 1 diabetic patients with and without nephropathy.

RESEARCH DESIGN AND METHODS

M-mode and Doppler echocardiography was performed in 17 type 1 diabetic patients with nephropathy (albuminuria [median (range)], 345 (135–2,846) mg/24 h) and compared with 34 normotensive, normoalbuminuric (10 [3–30] mg/24 h) type 1 diabetic patients matched for arterial blood pressure (mean ± SD) ([134/77] ± [13/7] vs. [129/78] ± [12/7] mmHg), age (40 ± 11 vs. 42 ± 10 years), duration of diabetes (28 ± 7 vs. 28 ± 6 years), and BMI (24.2 ± 4.2 vs. 24.6 ± 2.4 kg/m2).

RESULTS

Left ventricular mass (LVM) index was significantly higher in patients with nephropathy compared with patients with normoalbuminuria (100.8 ± 10.3 vs. 88.2 ± 21.0 g/m2, respectively; P = 0.02). Greater ventricular septum width was demonstrated in the nephropathic group compared with the control group (9.4 ± 1.0 vs. 8.2 ± 1.3 mm, respectively; P = 0.002). No significant difference in posterior wall thickness was apparent. The nephropathic group tended to have reduced diastolic function (E/A ratio, 1.2 ± 0.3 vs. 1.4 ± 0.4; P = 0.09). Fractional shortening was normal and about the same in the two groups. The groups did not differ with respect to serum creatinine or hemoglobin, while metabolic control (assessed by HbA1c) and plasma renin and prorenin levels were elevated in the nephropathic group compared with the normoalbuminuric group.

CONCLUSIONS

A blood pressure-independent increase in LVM may contribute to the increased cardiac morbidity and mortality in normotensive type 1 diabetic patients with diabetic nephropathy. Glycemic abnormalities and activation of the renin-angiotensin system may lead to the ventricular enlargement.