bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival During Renal Replacement Therapy for Diabetic End-Stage Renal Disease in Pima Indians
Authors: Nelson Robert G , Hanson Robert L , Pettitt David J , Knowler William C , Bennett Peter H
Published: March 2007

OBJECTIVE

To examine survival in Pima Indians receiving renal replacement therapy for end-stage renal disease attributed to NIDDM.

RESEARCH DESIGN AND METHODS

Vital status through 1994 was determined for 136 diabetic Pima Indians from the Gila River Indian Community who began renal replacement therapy between 1973 and 1990.

RESULTS

Median survival from the onset of renal replacement therapy was 39 months (95% CI, 31–54), 31 months (95% CI, 11–48) in those who began treatment between 1973 and 1981, and 44 months (95% CI, 32–56) in those who began treatment between 1982 and 1990 (P = 0.020). During these periods, mean age at onset of treatment increased from 53.3 to 56.1 years (P = 0.166), and mean duration of diabetes at the onset of treatment increased from 16.5 to 20.2 years (P = 0.003). After adjustment for sex, duration of diabetes, initial dialysis type, and kidney transplantation by an age-stratified proportional-hazards analysis, the death rate after starting renal replacement therapy in the second half of the study was 0.54 times (95% CI, 0.33–0.88) that in the first half. If this analysis was restricted to those who survived at least 90 days of therapy, the difference between the time periods was diminished (death rate ratio = 0.76; 95% CI, 0.43–1.32).

CONCLUSIONS

Survival in Pima Indians receiving renal replacement therapy improved significantly over the study despite an increase in the average age and diabetes duration of those beginning dialysis. Much of the improvement in survival is attributable to a reduction in the number of deaths within the first 90 days of therapy. The median survival of 47 months in Pima Indians < 65 years old at the initiation of therapy is substantially longer than the 30 months reported in blacks and 16 months reported in whites of similar age with NIDDM.
The Recurrence Rate of Gestational Diabetes in Subsequent Pregnancies
Authors: Moses Robert G
Published: March 2007

OBJECTIVE

To define the recurrence rate of gestational diabetes mellitus (GDM) in a subsequent pregnancy and to determine what factors could be predictive.

RESEARCH DESIGN AND METHODS

The subjects of the index pregnancy were 480 personally cared for women with GDM. One hundred women had had a subsequent pregnancy and had been tested for GDM.

RESULTS

The recurrence rate of GDM was 35% (95% CI, 25.5–44.5). An increase in weight between the two pregnancies and a higher maternal age and parity were risk associates for a recurrence. A recurrence of GDM was not associated with a higher glucose level, insulin use, or fetal birth weight in the index pregnancy.

CONCLUSIONS

GDM occurs in only one-third of subsequent pregnancies. Those women who had a recurrence of their GDM were older, more parous, and also had an increase in weight between the pregnancies.
Deviation from Developmentally Appropriate Self-Care Autonomy: Association with diabetes outcomes
Authors: Wysocki Tim , Taylor Alexandra , Hough Brenda S , Linscheid Thomas R , Yeates Keith O , Naglieri Jack A
Published: March 2007

OBJECTIVE

Treatment of IDDM in youth emphasized balancing children's self-care autonomy with their psychological maturity. However, few data exist to guide clinicians or parents, and little is known about correlates of deviations from this ideal.

RESEARCH DESIGN AND METHODS

In this cross-sectional study, IDDM self-care autonomy of 100 youth was assessed using two well-validated measures. Three measures of psychological maturity (cognitive function, social-cognitive development, and academic achievement) were also collected for each child. Composite indexes of self-care autonomy and of psychological maturity were formed, and the ratio of the self-care autonomy index to the psychological maturity index quantified each child's deviation from developmentally appropriate IDDM self-care autonomy. Based on these scores, participants were categorized as exhibiting constrained (lower tertile), appropriate (middle tertile), or excessive (higher tertile) self-care autonomy. Between-group differences in treatment adherence, diabetes knowledge, glycemic control, and hospitalization rates were explored.

RESULTS

Analysis of covariance controlling for age revealed that the excessive self-care autonomy group demonstrated less favorable treatment adherence, diabetes knowledge, hospitalization rates, and, marginally, glycemic control. Excessive self-care autonomy increased with age and was less common among intact two-parent families but was unrelated to other demographic factors.

CONCLUSIONS

The findings indicate caution about encouragement of maximal self-care autonomy among youth with IDDM and suggest that families who succeed in maintaining parental involvement in diabetes management may have better outcomes.
No Difference in Cardiac Innervation of Diabetic Patients With Painful and Asymptomatic Coronary Artery Disease
Authors: Koistinen M Juhani , Airaksinen K E Juhani , Huikuri Heikki V , Linnaluoto Markku M K , Heikkila Juhani , Torniainen Pentti , Ahonen Aapo
Published: March 2007

OBJECTIVE

To test the hypothesis that diabetic autonomic neuropathy interfering with sensory impulses from the heart by sympathetic denervation is the major cause of the high prevalence of asymptomatic coronary artery disease (CAD) in diabetic patients.

RESEARCH DESIGN AND METHODS

We evaluated cardiac sympathetic innervation in a population-based group of 10 asymptomatic diabetic patients with angiographically proven CAD and in an age- and sex-matched group of 10 diabetic patients with symptomatic CAD using [123I]metaiodobenzylguanide (MIBG) scintigraphy. Exercise electrocardiography and myocardial perfusion imaging by 201Tl were used to detect myocardial ischemia, and standard cardiovascular tests were used to diagnose autonomic nervous dysfunction.

RESULTS

Thallium scintigraphy revealed perfusion defects in all 10 symptomatic patients and in 9 of the asymptomatic patients. MIBG accumulation defects were found in all cases with painless and with painful disease. In the asymptomatic group, the denervation area exceeded the ischemic area in six cases and areas with total MIBG accumulation defects were seen in four cases. In one case, the MIBG defect was not in the ischemic region. In the symptomatic group, the denervation area exceeded the area of the ischemic region in all cases and areas of total denervation were seen in six cases. The autonomic nervous function tests were abnormal in two asymptomatic and three symptomatic patients with CAD.

CONCLUSIONS

Cardiac sympathetic denervation is common in both patients with painful CAD and patients with asymptomatic CAD regardless of diabetic autonomic neuropathy. This finding supports the view that sympathetic innervation of the heart is highly sensitive to ischemia and this profound effect of ischemia masks the potential effects of autonomic neuropathy on sympathetic innervation. Mechanisms leading to the lack of ischemic pain in diabetic patients with CAD are complex and are not solely explained by autonomic neuropathy.
Renal Function in Long-Duration Type I Diabetes
Authors: Mackin Paul , Macleod Jean M , New John P , Marshall Sally M
Published: March 2007

OBJECTIVE

The development of persistent proteinuria is reported to be uncommon after 30 years of type I diabetes, and the significance of microalbuminuria in patients with long-duration diabetes is unclear. We therefore undertook to study, in detail, renal function in patients with long-duration type I diabetes.

RESEARCH DESIGN AND METHODS

We measured albumin excretion rate (AER), glomerular filtration rate (GFR), and serum creatinine in 140 patients with ≥30 years of type I diabetes. We also assessed patients for other micro- macrovascular complications of diabetes together with factors implicated in the development of diabetic renal disease.

RESULTS

Of the patients, 23% had microalbuminuria (AER 20–200 μg/min and/or urinary albumin-to-creatinine ratio [ACR] > 2.5 mg/mmol [men] or > 3.5 mg/mmol [women] and dipstick negative for proteinuria), 4% had overt nephropathy (AER > 200 μg/min or persistent dipstick positive proteinuria), and 73% were normoalbuminuric (AER < 20 μg/min or ACR < 2.5 mg/mmol [men], < 3.5 mg/mmol [women]). Patients with microalbuminuria had lower GFR (81.5 ± 30.2 vs. 96.0 ± 20.3 ml · min−1 · 1.73 m−2; P = 0.06) and higher serum creatinine (104 ± 32 vs. 92 ± 16 μmol/l; P = 0.06) than those patients with normoalbuminuria. Both serum creatinine (P < 0.05) and tobacco consumption (P = 0.01) were significantly and independently related to elevated albumin excretion.

CONCLUSIONS

A substantial proportion of these patients have microalbuminuria and evidence of impaired renal function, suggesting that progression to end-stage renal failure may still be inevitable. Clinicians should continue to monitor renal function in these patients. The relationship between tobacco consumption and nephropathy also makes clear the need to reduce cigarette smoking in the diabetic population.
Human Insulin-Induced Lipoatrophy: Successful treatment using a jet-injection device
Authors: Logwin S , Conget I , Jansa M , Vidal M , Nicolau C , Gomis R
Published: March 2007

OBJECTIVE

To evaluate the efficacy of the administration of insulin by a jet-injector device in stopping and reversing severe human insulin-induced lipoatrophy.

CASE

We report a case of a woman with severe human insulin-induced lipoatrophy who has been treated exclusively with recombinant DNA human insulin since the onset of IDDM.

RESULTS

The loss of subcutaneous tissue in the injection areas was demonstrated and measured by high-frequency ultrasound. Dermatologic exam demonstrated a severe reduction of fat tissue. After 8 months of administration of human insulin by a jet injector, there were no more new lesions of lipoatrophy and those affected areas were substantially ameliorated.

CONCLUSIONS

Jet-injection devices might constitute a helpful method to treat those patients affected by severe human insulin-induced lipoatrophy.
Time-Space Clustering of Date at Birth in Childhood-Onset Diabetes
Authors: Dahlquist Gisela G , Källen Bengt AJ
Published: March 2007

OBJECTIVE

To investigate whether there was a temporal and geographical clustering of time of birth for infants with childhood-onset diabetes.

RESEARCH DESIGN AND METHODS

The nationwide Swedish Childhood Diabetes Registry, which ascertains 99% of children with recent-onset diabetes (0-14 years), was linked with the Swedish Medical Birth Registry. Clustering of 3,725 patients as to place and time of birth was studied compared with the general population. For each municipality (and in the three large cities of Sweden for each parish), the observed number of patients was compared with the expected number calculated from the average total rate and the number of births in that municipality. Clustering in time of birth within municipality was analyzed using a modification of a set technique by Chen (14).

RESULTS

There was no consistent variability in diabetes risk by calendar birth month, but for specific years, the risk varied during the year. When geographic localization for place of birth was studied on a municipality level, four municipalities snowed a statistically significant case excess while one would have been expected by chance. When we looked for clusters in both time and space for date of birth, clearly more clusters than expected were identified (P < 0.01). Of the total of 198 primary clusters, 42 included three or more patients being born in the same municipality within an unlikely short period always <2 years.

CONCLUSIONS

This is the first study indicating a clustering according to place and time of birth for later risk to develop type I diabetes. Such a phenomenon would agree with the hypothesis that infections in early life, including fetal infections, can increase the risk for diabetes.
Use of Dermagraft, a Cultured Human Dermis, to Treat Diabetic Foot Ulcers
Authors: Gentzkow Gary D , Iwasaki Scott D , Hershon Kenneth S , Mengel Marvin , Prendergast J Joseph , Ricotta John J , Steed David P , Lipkin Scott
Published: March 2007

OBJECTIVE

To assess the effect of a tissue-engineered human dermis (Dermagraft) in healing diabetic foot ulcers.

RESEARCH DESIGN AND METHODS

This controlled prospective multicenter randomized single-blinded pilot study evaluated healing over a 12-week period in 50 patients with diabetic foot ulcers. These patients were randomized into four groups (three different dosage regimens of Dermagraft and one control group). All patients received identical care except for the use of Dermagraft tissue. Ulcer healing was assessed by percentage of wounds achieving complete or 50% closure, time to complete or 50% closure, and volume and area measurements.

RESULTS

Ulcers treated with the highest dosage of Dermagraft, one piece applied weekly for 8 weeks (group A), healed significantly more often than those treated with conventional wound closure methods; 50% (6 of 12) of the Dermagraft-treated and 8% (1 of 13) of the control ulcers healed completely (P = 0.03). The percentage of wounds achieving 50% closure was also significantly higher (75 vs. 23%; P = 0.018), and the time to complete or 50% closure was faster (P = 0.056). The group A regimen was more effective than other treatment regimens. All three were better than the control, however, and a dose-response was observed. There were no safety concerns. After a mean of 14 months of follow-up (range 11-22 months), there were no recurrences in the Dermagraft-healed ulcers.

CONCLUSIONS

Dermagraft was associated with more complete and rapid healing in diabetic foot ulcers. The recurrence data may indicate an improved quality of wound healing.
A Comparison of the Effects of n-3 Fatty Acids From Linseed Oil and Fish Oil in Well-Controlled Type II Diabetes
Authors: McManus Ruth M , Jumpson Jacqueline , Finegood Diane T , Clandinin M Thomas , Ryan Edmond A
Published: March 2007

OBJECTIVE

Supplementation of type II diabetic diets with n-3 fatty acids (FAs) from fish oil (FO) has been associated with lowered triglyceride and VLDL levels, although reports of impaired glycemic control have limited their use. Effects of n-3FAs from nonmarine sources are less well documented. Therefore, an investigation comparing the effects of linseed oil (LO) with FO supplementation was undertaken in subjects with type II diabetes.

RESEARCH DESIGN AND METHODS

Eleven subjects with type II diabetes were given supplements with LO and FO for 3 months each in a randomized double-blind crossover fashion after 3 months of olive oil placebo. Oils were given as 35 mg FA · kg body wt−1 · day−1. After each 3-month period, fasting glucose and insulin levels, HbA1c, lipid profiles, insulin sensitivity (SI), glucose effectiveness (SG), and acute insulin response to glucose (AIRG) were evaluated.

RESULTS

HbA1c and lipid values were within the normal range at randomization. Repeated measures analysis of variance testing found no significant differences in weight; fasting glucose and insulin levels; HbA1c; total, LDL, and HDL cholesterol levels; SI; SG; or AIRG with either active oil. FO was associated with significant reductions in triglycerides and a trend toward decreased SI.

CONCLUSIONS

In a population with well-controlled type II diabetes, 3 months of FO but not LO resulted in lowered triglyceride levels. Neither LO nor FO significantly affected glycemic control, cholesterol values, SG, or insulin secretion, while a nonsignificant trend toward decreased insulin sensitivity was found with FO.
Erythrocyte Na+-K+-ATPase Activity, Metabolic Control, and Neuropathy in IDDM Patients
Authors: Raccah Denis , Fabreguettes Claudie , Azulay Jean-Philippe , Vague Phillippe
Published: March 2007

OBJECTIVE

To study the relationship among red blood cell Na+-K+-ATPase activity, metabolic control, and diabetic neuropathy.

RESEARCH DESIGN AND METHODS

Na+-K+-ATPase activity has been measured in the red cell membrane of 43 long-standing IDDM patients (duration of diabetes 17.5 ± 2 years, mean ± SE), with 20 of the patients presenting with peripheral neuropathy. There were 23 healthy subjects serving as the control group.

RESULTS

Na+-K+-ATPase activity was significantly lower in diabetic patients than in healthy subjects (236.5 ± 7.5 vs. 294 ± 10 nmol P1 · mg protein−1 · h−1, P < 0.05). Among diabetic patients, Na+/K+-ATPase activity was not dependent on the degree of diabetic control, nor was it correlated with either fasting blood glucose (r = 0.16, NS) or HbA1c (r = 0.01, NS). Na+-K+-ATPase activity was lower in patients with neuropathy than in those without it (212 ± 8.5 vs. 261 ± 6.6, P < 0.05). Furthermore, in a subgroup of 20 patients, a positive correlation was observed between erythrocyte Na+-K+-ATPase activity and nerve conduction velocity in the peroneal (r = 0.558, P < 0.02) and tibial nerve (r = 0.528, P < 0.05).

CONCLUSIONS

These results suggest that diabetes-induced Na+-K+-ATPase activity dysfunction could be implicated in the pathogenesis of human diabetic neuropathy and the electrophysiological abnormalities observed in these patients.
An Importance of Carbohydrate Ingestion for the Expression of the Effect of α-Glucosidase Inhibitor in NIDDM
Authors: Hara Tomohiro , Nakamura Jiro , Koh Naoki , Sakakibara Fumihiko , Takeuchi Naohide , Hotta Nigishi
Published: March 2007

OBJECTIVE

To examine the usefulness of α-glucosidase inhibitors in glycemic control of patients with NIDDM. The involvement of carbohydrate ingestion in manifestation of the effects of α-glucosidase inhibitors was also investigated.

RESEARCH DESIGN AND METHODS

A total of 41 patients hospitalized with NIDDM (22 patients receiving sulfonylurea and 19 receiving insulin therapy) were given α-glucosidase inhibitors during the period when their blood glucose levels were well controlled. They were followed for 3 weeks as inpatients and for an additional 6 months as outpatients. They were retrospectively divided into two groups according to the percentage of carbohydrates in all sources of calories during outpatient management: the <50% group and the >50% group. Between these two groups, we compared circadian variation in blood glucose levels, HbA1c, and urine C-peptide.

RESULTS

Treatment with alpha-glucosidase inhibitors during the hospital stay markedly improved circadian variation in blood glucose levels and HbA1c and decreased urine C-peptide in both groups. While HbA1c returned to its pretreatment level at 6 months after the treatment in the <50% group, HbA1c had further improved in the >50% group at 6 months.

CONCLUSIONS

α-Glucosidase inhibitors are useful for glycemic control in patients with NIDDM and the percentage of carbohydrate in all calorie sources is an important factor for the expression of their effects.
The Medical Management of Hyperglycemia Over a 10-Year Period in People With Diabetes
Authors: Klein Ronald , Klein Barbara E K , Moss Scot E , Cruickshanks Karen J
Published: March 2007

OBJECTIVE

The purpose of the study was to examine changes in the medical management of glycemia in diabetes and its relation to changes in hyperglycemia as measured by glycated hemoglobin.

RESEARCH DESIGN AND METHODS

A total of 765 patients with younger-onset diabetes diagnosed before 30 years of age and 533 older-onset diabetic patients participated in a population-based study in southern Wisconsin, at baseline (1980–1982), at 4 years (1984–1986), and at 10 years (1990–1992). Glycated hemoglobin, the presence of complications, and information regarding medical management of glycemia, hypoglycemic reactions, and socioeconomic factors were determined using standardized protocols at the three examinations.

RESULTS

In the younger-onset group, there was a significant increase (P < 0.001) in the use of three or more insulin injections per day or in the use of an insulin infusion pump from 3.6% of the cohort at baseline to 24.4% at the 10-year follow-up. This increase was associated with female sex, the presence of gross proteinuria, more education, and better glycemic control at baseline. In the older-onset group, there was a significant (P < 0.05) increase in the proportion of patients taking insulin, from 49.2% at baseline to 61.9% at the 10-year follow-up. This was associated with being younger, having a longer duration of diabetes, having higher glycated hemoglobin values, and having more education at baseline, or developing proliferative diabetic retinopathy or macular edema between baseline and the 4-year follow-up.

CONCLUSIONS

These data suggest a change in the pattern of use of insulin to treat people with diabetes. However, there is still a large number of individuals with poorly controlled diabetes in the population.
Clinical and Radiographic Findings That Lead to Intervention in Diabetic Patients With Foot Ulcers: A nationwide survey of primary care physicians
Authors: Edelman David , Matchar David B , Oddone Eugene Z
Published: March 2007

OBJECTIVE

To determine which elements of clinical history, physical examination, and diagnostic tests are important to primary care physicians in their management of foot ulcers in diabetic patients.

RESEARCH DESIGN AND METHODS

We conducted a national mail survey of 600 primary care physicians to determine which patient characteristics and diagnostic test results were important in their decisions to seek radiographic studies, surgical referrals, and hospitalization for diabetic patients with foot ulcers.

RESULTS

The case characteristics most likely to influence physicians to order advanced diagnostic or therapeutic interventions are the presence of osteomyelitis on plain radiographs, the failure of the ulcer to improve with conservative therapy, and the presence of visible bone, crepitus, or necrosis within the ulcer (P < 0.001). Information from the initial clinical history was less likely to influence physicians to order advanced diagnostic or therapeutic interventions (P < 0.001) than was information from the physical examination.

CONCLUSIONS

We conclude that 1) the patient's history is relatively unimportant to primary care physicians in their management of diabetic foot ulcers; 2) the failure of conservative management is a major reason that primary care physicians order surgical referral, hospitalization, or radiographic testing for diabetic patients with foot ulcers; and 3) primary care physicians rely heavily on plain × ray of the foot, a test with poor sensitivity and specificity, in deciding whether to order further interventions for their diabetic patients with foot ulcers.
Cortical Blindness and Cerebral Infarction Associated with Severe Hypoglycemia
Authors: Gold Ann E , Marshall Sally M
Published: March 2007

OBJECTIVE

To describe a case of cortical blindness and cerebral infarction associated with severe hypoglycemia.

CONCLUSIONS

The possible pathogenesis of the neurological defects is discussed.
Eikenella corrodens Infections. Case report in two adolescent females with IDDM
Authors: Newfield Ron S , Vargas Ileana , Huma Zilla
Published: March 2007

OBJECTIVE

To alert physicians caring for patients with diabetes to the microorganism Eikenella corrodens and to discuss the appropriate preventive and therapeutic measures to take against this potentially morbid opportunistic Gram-negative bacilli.

CASES

We present two cases of extra-oral E. corrodens infections in adolescent females with IDDM. The first patient had diabetes of 4 years' duration, which was moderately well controlled. Chronic finger biting resulted in a complex felon that evolved gradually and worsened while the patient received cephalexin orally. Delay in seeking further intervention resulted in necrosis of her distal fingertip and nail bed. The second patient had poorly controlled diabetes for 5 years. She developed an acute thigh abscess at an insulin injection site that resolved after drainage and intravenous antibiotics.

CONCLUSIONS

E. corrodens commonly inhabits the human oral cavity and becomes a pathogen mostly when host defenses are impaired, causing abscesses and infections that are at times fatal. Patients with IDDM are compromised hosts and with daily microtrauma to their skin via glucose monitoring and insulin injections, are prone to develop E. corrodens infections that can be introduced through oral secretions by licking or biting their skin. Educational efforts aimed at preventing exposure of traumatized skin to oral secretions can minimize the risk of E. corrodens infections in compromised hosts. Early intravenous administration of antibiotics, bearing in mind E. corrodens resistance to clindamycin, metronidazole, and other antibiotics, coupled with prompt surgical intervention, is essential in successfully managing E. corrodens infections.
Familial Aggregation of Medial Arterial Calcification in Pima Indians With and Without Diabetes
Authors: Narayan K M Venkat , Pettitt David J , Hanson Robert L , Bennett Peter H , Fernandes Richard J , Courten Maximilian De , Rose Frederick A , Knowler William C
Published: March 2007

OBJECTIVE

Little is known about medial arterial calcification (MAC) other than its association with age, sex, diabetes, and diabetes complications. Familial aggregation of this disorder was studied to determine the importance of potential genetic factors and to assess whether such familial aggregation was independent of that of diabetes.

RESEARCH DESIGN AND METHODS

Members of 1,256 Pima Indian nuclear families with 3,339 offspring were examined radiologically for MAC of the feet. Multiple logistic regression analyses were used to compare the presence of the disorder in a parent with the presence of MAC in an offspring and to determine whether familial aggregation of MAC was independent of parental diabetes.

RESULTS

Controlled for age, sex, diabetes, serum cholesterol, and blood pressure, offspring of one parent with MAC had 3.3 (95% CI 1.5–7.6) times the odds of MAC as did offspring of parents without MAC, and offspring with both parents affected had an even higher risk (odds ratio, 8.1; 95% CI 3.4–18.8). Controlled for offspring age and sex and for parental age and diabetes, parental MAC was associated with the disorder in offspring (P < 0.001), but the effect of parental diabetes on MAC in the offspring was not significant when controlled for parental MAC (P = 0.36). Furthermore, offspring of nondiabetic parents with MAC, controlled for age, sex, diabetes, and diabetes duration, had 1.7 (95% CI 0.9–3.1) times the odds of MAC than did offspring of diabetic parents with MAC.

CONCLUSIONS

Independent of parental age and diabetes and offspring age, sex, diabetes, and diabetes complications, parental MAC confers an increased risk of MAC in offspring. These findings suggest that the factors responsible for the familial clustering of MAC may be different from those for diabetes.
Lifestyle Changes May Reverse Development of the Insulin Resistance Syndrome. The Oslo Diet and Exercise Study: a randomized trial
Authors: Torjesen P A , Birkeland K I , Anderssen S A , Hjermann I , Holme I , Urdal P
Published: March 2007

OBJECTIVE

To compare and assess the single and joint effect of diet and exercise intervention for 1 year on insulin resistance and the development leading toward the insulin resistance syndrome.

RESEARCH DESIGN AND METHODS

An unmasked, randomized 2 × 2 factorial intervention trial was applied with a duration of 1 year for each participant. The trial comprised 219 men and women with diastolic blood pressure of 86–99 mmHg, HDL cholesterol < 1.20 mmol/l, triglycerides > 1.4 mmol/l, total cholesterol of 5.20–7.74 mmol/l, and BMI > 24 kg/m2. Participants were randomly allocated to diet group (n = 35), diet and exercise group (n = 67), exercise group (n = 54), and control group (n = 43). The diet included increased intake of fish and reduced total fat intake. The exercise program entailed supervised endurance exercise three times a week. Baseline cross-sectional changes and 1-year changes in insulin resistance, fasting serum levels of insulin, C-peptide, proinsulin, glucose, and lipids as well as weight, mean blood pressure, and plasminogen activator inhibitor 1 (PAI-1) values were recorded.

RESULTS

The cross-sectional results at baseline showed significant correlations between the calculated insulin resistance and BMI (r = 0.54) and correlations between the mean blood pressure (mBP) (r = 0.26) and PAI-1 (r = 0.40). The 1-year diet intervention gave a significant decrease in the calculated insulin resistance from 4.6 to 4.2 and a positive correlation between the changes in insulin resistance and changes in BMI (r = 0.40). The diet and exercise intervention also led to significantly decreased insulin resistance (from 5.0 to 4.0). The exercise intervention did not significantly change insulin resistance.

CONCLUSIONS

The cross-sectional and 1-year intervention results supported each other and underscored the important connection between increased BMI and the development leading toward the insulin resistance syndrome.
Cognitive Function in Younger Type II Diabetes
Authors: Dey Jayant , Misra Anoop , Desai Nimesh G , Mahapatra A K , Padma M V
Published: March 2007

OBJECTIVE

To examine central nervous system involvement as a possible complication of diabetes by performing a comprehensive neuropsychological evaluation of relatively young (age < 55 years) NIDDM patients and a group of control subjects.

RESEARCH DESIGN AND METHODS

A cross-sectional comparative study of 28 patients, with duration of diabetes 5–18 years (mean ± SD ± 3.2 years), screened for acceptable glycemic control and absence of hypoglycemia on the day of examination, compared with 28 demographically similar, nondiabetic control subjects. Neuropsychometric tests performed were Mini-Mental Status Examination (MMSE), Neurobehavioral Cognitive Status Examination (NCSE), and P300 latencies (endogenous evoked potentials).

RESULTS

Seven (25.0%) patients reported history suggestive of cognitive impairment during day-to-day activities, and 17 (60.7%) had distal symmetrical polyneuropathy. Average P300 latencies were significantly delayed among the diabetic patients compared with the control subjects (349.5 ± 28.2 vs. 312.9 ± 19.3 ms; t = 5.68, P < 0.001). Although there was no significant difference in MMSE scores, compared with control subjects significantly more patients had impairment in NCSE tests of attention (χ2 = 7.38, P < 0.01), repetition (χ2 = 4.073, P < 0.05), and memory (χ2 = 5.83, P < 0.05), while there was no significant difference in tests of comprehension, naming, construction, and calculation. Duration of diabetes, HbA1c levels, and the presence of distal symmetrical polyneuropathy among patients each did not correlate with any of the parameters of cognitive function evaluated. Higher blood glucose levels during the electrophysiological testing were associated with less delay in P300 latencies among the patients.

CONCLUSIONS

Central nervous system impairment, manifesting as mild impairments in certain cognitive skills, should be recognized as a possible complication of long-standing NIDDM, even in relatively younger individuals.
Self-Monitoring of Blood Glucose in Type I Diabetic Patients: Comparison With Continuous Microdialysis Measurements of Glucose in Subcutaneous Adipose Tissue During Ordinary Life Conditions
Authors: Bolinder Jan , Hagström-Toft Eva , Ungerstedt Urban , Arner Peter
Published: March 2007

OBJECTIVE

To evaluate whether frequent self-monitoring of blood glucose (SMBG) sufficiently reflects the true diurnal glucose control during ordinary daily life in type I diabetic patients.

RESEARCH DESIGN AND METHODS

By using a microdialysis technique, continuous monitoring of adipose tissue glucose was performed in 24 type I diabetic patients during ambulatory conditions. A microdialysis probe was implanted subcutaneously and perfused by a portable microinfusion pump. Dialysate fractions were collected in 1- to 2-h samples during 3 consecutive days. The diurnal microdialysis glucose profiles were compared with those obtained by SMBG recordings performed seven times a day.

RESULTS

In seven patients, the SMBG profiles showed marked aberrations as compared to the continuous microdialysis glucose recordings; during the 3-day study period, 5–6 inconsistencies were registered. In only 4 patients (17%) did SMBG provide a valid reflection (0–2 inconsistencies) of the diurnal glucose profile, whereas in 13 patients the SMBG recordings paralleled the diurnal adipose tissue glucose profiles in an intermediate way (3–4 major inconsistencies). The inaccuracy of the SMBG data was due more often to the fact that wide glucose swings remained unrecognized, rather than to erroneous testing techniques (P < 0.05), and it was more evident during the night (P < 0.05).

CONCLUSIONS

In many type I diabetic patients, the true diurnal variability in glycemia is too great to be accurately reflected even by frequent self-monitoring of blood glucose.
Effective Postponement of Diabetic Nephropathy With Enalapril in Normotensive Type 2 Diabetic Patients With Microalbuminuria
Authors: Ahmad Jamal , Siddiqui Mohammad A , Ahmad Habib
Published: March 2007

OBJECTIVE

This study determines the long-term efficacy of the ACE inhibitor, enalapril, in reducing the progression of microalbuminuria to clinical albuminuria in normotensive patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

There were 103 normotensive type 2 diabetic patients with persistent albumin excretion rate (AER) 20–200 micrograms/min and normal renal function followed for 5 years in a prospective randomized single-blind placebo-controlled trial. AER, blood pressure, fasting plasma glucose, and HbA1 were measured every 3–4 months and glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary urea every 12 months.

RESULTS

In the patients treated with enalapril, AER decreased from 55 ± 33 to 20 ± 59 micrograms/min (geometric mean ± SD), whereas in the placebo group, AER increased from 53 ± 31 to 85 ± 90 micrograms/min after 5 years. Within 5 years, 7.7% (4/52) of enalapril-treated subjects and 23.5% (12/51) of placebo-treated subjects progressed to clinical albuminuria defined as AER > 200 micrograms/min and at least 34% above baseline (risk reduction = 66.7%, P < 0.001). AER increased at an annual rate of 12.3% (95% CI 9.8–14.9) in the placebo group, while it declined by 16.7% (95% CI −18.3 to −15.2) in the enalapril group (P < 0.001). In addition, 8 of the 12 placebo-treated patients had evidence of coronary artery disease. The rest of the parameters remained practically unchanged in the two groups.

CONCLUSIONS

After 5 years of therapy with enalapril, compared with placebo, normotensive subjects with type 2 diabetes experienced significantly less progression of microalbuminuria to clinical albuminuria, reduced AER, and preserved GFR.
The Recurrence of Gestational Diabetes: Could Dietary Differences in Fat Intake Be an Explanation?
Authors: Moses Robert G , Shand Judi L , Tapsell Linda C
Published: March 2007

OBJECTIVE

To present the results of a comprehensive dietary review of a group of women with a recurrence of gestational diabetes mellitus (GDM), compared with a group of women with no recurrence of GDM during a subsequent pregnancy.

RESEARCH DESIGN AND METHODS

The dietary intake of 14 women with a recurrence of GDM was compared with 21 women with no recurrence of GDM. Women with GDM in one pregnancy have a recurrence rate of only 30–50%. While the reasons for this have not been determined, dietary factors have been considered probable.

RESULTS

The women with a recurrence of GDM consumed 38.4 (by diet history) and 41.4% (by food record) of their total energy intake as fats, compared with 34.1 (P <0.01) and 33.1% (P <0.001), respectively, for women with no recurrence. The percentage intake of polyunsaturated, monounsaturated, and saturated fatty acids was similar in both groups. There was a proportionate reduction in carbohydrate intake as a percentage of total energy and in fiber intake in grams for the women with a recurrence of GDM.

CONCLUSIONS

When the relationship between saturated fat intake and insulin resistance is considered, the possibility exists that dietary modification of fat intake before and during pregnancy may reduce the recurrence rate of GDM.
Metabolic Effects of Alterations in Meal Frequency in Type 2 Diabetes
Authors: Arnold Leeanne , Mann Jim I , Ball Madeleine J
Published: March 2007

OBJECTIVE

The effects of altering meal frequency on measures of glucose and lipid metabolism in type 2 diabetes were examined by comparing isocaloric dietary regimens in which daily food intake was provided by three or nine meals each day.

RESEARCH DESIGN AND METHODS

A total of 13 free-living men and women with type 2 diabetes or persistently impaired glucose tolerance participated in a randomized crossover study in which three- and nine-meal regimes were followed for 4-week periods. Fasting plasma lipid and lipoprotein, glucose and insulin concentrations were measured at weekly intervals and glucose, insulin, and triglyceride responses following a 75-g glucose load at weeks 2 and 4 of each diet period. Dietary intake was also recorded during these weeks.

RESULTS

Nutrient intakes and all measures of carbohydrate and lipid metabolism were similar on the three- and nine-meal regimes.

CONCLUSIONS

This longer-term study could not confirm the potential benefits of increased meal frequency suggested by comparable 4-week studies in type 2 diabetic individuals and acute experiments in individuals with diabetes. However, as there were no adverse effects of consuming nine meals per day, it would seem appropriate that meal frequency in those with type 2 diabetes should be left to personal choice, provided that energy balance is maintained.
Diabetic Peripheral Neuropathy: Amelioration of Pain With Transcutaneous Electrostimulation
Authors: Kumar Dinesh , Marshall Howard J
Published: March 2007

OBJECTIVE

To evaluate the efficacy of transcutaneous electrotherapy for chronic painful peripheral neuropathy in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Thirty-one patients with symptoms and signs of peripheral neuropathy were randomized to the electrotherapy or sham treatment (control) group. The electrostimulation was given by a portable unit (H-Wave machine) than generated a biphasic, exponentially decaying waveform (pulse width 4 ms, 25–35 V, ≥ 2 Hz). Patients treated each of their lower extremities for 30 min daily for 4 weeks at home. Nine patients from the sham-treatment group participated for a second period, during which all of them received the active electrotherapy. Patient's degree of pain and discomfort was graded on a scale of 0 to 5.

RESULTS

In the sham-treated group (n = 13), the neuropathic symptoms improved in five (38%) patients, and the pain score declined from 2.92 ± 0.13 to 2.38 ± 0.26 (P < 0.04), suggesting a procedure-related placebo effect. In the electrotherapy group (n = 18), symptomatic improvement was seen in 15 (83%) cases, 3 of which were completely asymptomatic; the pain score declined from 3.17 ± 0.12 to 1.44 ± 0.25 (P < 0.01) and the posttreatment pain scores were considerably lower (P < 0.03), indicating a substantial treatment effect over and above any placebo influence. Patients in the electrotherapy group reported greater reduction in symptoms (52 ± 7% vs. 27 ± 10% in control subjects, P < 0.05) on an analog scale. Moreover, the electrotherapy decreased pain scores (from 3.0 ± 0.62 to 1.56 ± 0.32, P < 0.02) in nine patients who had received sham treatment earlier.

CONCLUSIONS

A form of transcutaneous electrotherapy ameliorated the pain and discomfort associated with peripheral neuropathy. This novel modality offers a potential non-pharmacological treatment option.
Reduction of Albumin Excretion Rate in Normotensive Microalbuminuric Type 2 Diabetic Patients During Long-Term Simvastatin Treatment
Authors: Tonolo Glancarlo , Ciccarese Milco , Brizzi Patrizia , Puddu Loreta , Secchi Giannina , Calvia Pierangela , Atzeni Maria M , Melis Maria G , Maioli Mario
Published: March 2007

OBJECTIVE

To study the long-term effects of simvastatin on urinary albumin excretion rate (AER) in normotensive microalbuminuric type 2 diabetic patients with hypercholesterolemia.

RESEARCH DESIGN AND METHODS

A total of 19 normotensive microalbuminuric hypercholesterolemic type 2 diabetic patients entered a double-blind crossover study for 2 years, receiving either simvastatin (20 mg/day) or placebo (each treatment for 1 year).

RESULTS

Simvastatin significantly decreased plasma cholesterol (total and LDL) after 52 weeks of treatment. A concomitant significant decrease of AER (25% from basal) with no significant changes in creatinine clearance was observed during the same period.

CONCLUSIONS

Our data are in keeping with the hypothesis that simvastatin might be used as an additional means to preserve renal function in microalbuminuric hypercholesterolemic type 2 diabetic patients.
Antibodies to GAD and Glycemic Control in Recent-Onset IDDM
Authors: Hoeldtke Robert D , Bryner Kimberly D , Horvath Gabriella G , Byerly Michele R , Hobbs Gerald R , Marcovina Santica M , Lernmark Ake
Published: March 2007

OBJECTIVE

To analyze the effect of antibodies to glutamic acid decarboxylase (GAD65Ab) and islet cells (ICA512Ab) on glycemic control early in IDDM.

RESEARCH DESIGN AND METHODS

GAD65Ab and ICA512Ab were measured twice in 35 patients (10 male, 25 female; age 10–40 years) initially within 2 years of diagnosis and again 1 year later. The glycosylated hemoglobin was measured one to four times each year, and the average glycosylated hemoglobin for the preceding year was calculated each time the antibodies were measured.

RESULTS

The mean HbA1 at the time of the initial evaluation was 8.04 ± 0.30 (reference range 4.7–7.3% for nondiabetic patients), the average GAD65Ab index was 0.735 ± 0.306, and the mean ICA512Ab index was 1.94 ± 0.65. The GAD65Ab index correlated with HbA1 (r = 0.41, P < 0.025), whereas the ICA512Ab index did not (r = 0.13). One year later, the mean GAD65Ab index was 0.94 ± 0.34, the mean ICA512Ab index was 1.04 ± 0.40, and the mean HbA1 was 9.03 ± 0.30. The GAD65Ab index correlated with HbA1 (r = 0.61 P < 0.001), whereas the ICA512Ab index did not (r = −0.06). Stratification of patients into tertiles according to the average GAD65 index revealed, at the follow-up evaluation, that the better glycemic control in the lowest GAD65Ab tertile was accomplished with significantly less insulin (0.43 ± 0.08 U/kg for the lowest tertile vs. 0.71 ± 0.09 and 0.64 ± 0.09 for the middle and highest tertiles, respectively; P < 0.05).

CONCLUSIONS

In summary, patients with IDDM and low GAD65Ab have better glycemic control even though they require less insulin. The ICA512Ab index, however, fails to correlate with glycemia.
Subclinical and Clinical Eating Disorders in IDDM Negatively Affect Metabolic Control
Authors: Affenito Sandra G , Backstrand Jeffrey R , Welch Garry W , Lammi-Keefe Carol J , Rodriguez Nancy R , Adams Cynthia H
Published: March 2007

OBJECTIVE

To characterize the relationship of subclinical and clinical eating disorders to HbA1c values in women with IDDM.

RESEARCH DESIGN AND METHODS

Ninety women with IDDM (18–46 years of age) were recruited from diabetes clinics throughout Connecticut and Massachusetts. Subjects were categorized into one of three groups according to the Diagnostic Statistical Manual of Mental Disorders (DSM-III-R) criteria for eating disorders as follows: the clinical group (n = 14), the subclinical group (partially fulfilling the diagnostic criteria; n = 13), and the control group (n = 63). Group differences in the degree of dietary restraint, binge eating, and bulimic behaviors and weight, shape, and eating concerns were assessed with the Eating Disorder Examination (EDE) and the Bulimia Test Revised (BULIT-R).

RESULTS

Women with subclinical and clinical eating disorders had clinically elevated HbA1c results and more diabetes-related complications, compared with the control subjects. The severity of bulimic behaviors, weight concerns, reduced BMI, and decreased frequency of blood glucose monitoring were associated with elevated HbA1c.

CONCLUSIONS

HbA1c may have clinical utility in the identification of eating disorder behavior in females with IDDM. Health care professionals should be aware of the potent effect of subclinical and clinical eating behaviors including insulin misuse in weight-conscious women with IDDM who have poor glycemic control.
Short-Term Insulin Therapy and Normoglycemia: Effects on erythrocyte lipid peroxidation in NIDDM patients
Authors: Peuchant Evelyne , Delmas-Beauvieux Marie Christine , Couchouron Anne , Dubourg Liliane , Thomas Marie José , Perromat Annie , Clerc Michel , Gin Henri
Published: March 2007

OBJECTIVE

To evaluate erythrocyte lipid peroxidation (LPO) before and after an adaptive short-term insulin therapy in NIDDM patients who were chronically hyperglycemic.

RESEARCH DESIGN AND METHODS

Twenty-six patients with NIDDM (mean HbA1c, 11.28%) aged 53.04 ± 2.03 years were submitted for 3 days to constant intravenous glucose and continuous insulin perfusion at an adaptable rate to maintain glycemia within the normal range. An evaluation of LPO at baseline and after euglycemic insulin therapy was determined by erythrocyte free and total malondialdehyde (MDA) levels, polyunsaturated fatty acid (PUFA) percentage, vitamin E and glutathione content, and the following antioxidant enzymatic activity determinations: glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT). Fasting serum glucose, HbA1c, triglycerides, cholesterol, and HDL cholesterol levels were also determined at these time points.

RESULTS

At baseline, erythrocyte free and total MDA were significantly higher in NIDDM patients than in control subjects (11.14 ± 0.80 vs. 1.74 ± 0.11 nmol/g Hb [P < 0.0001] for free MDA; 18.04 ± 1.79 vs. 7.85 ± 0.55 nmol/g Hb [P < 0.0001] for total MDA). PUFAs, particularly C20:4 and C22:5, were increased (14.69 ± 0.34 vs. 12.03 ± 0.31 and 2.31 ± 0.04 vs. 1.71 ± 0.03% of total fatty acids, respectively). Vitamin E and glutathione were reduced significantly (6.16 ± 0.61 vs. 14.84 ± 0.64 nmol/g Hb and 0.42 ± 0.04 vs. 0.97 ± 0.06 mmol/l, respectively). No difference was observed for the enzymatic activities. After euglycemic insulin therapy, triglycerides significantly decreased compared with baseline concentrations (1.55 ± 0.13 vs. 2.42 ± 0.22 mmol/l; P < 0.001), whereas other lipidic parameters were unchanged. Free MDA significantly decreased (8.60 ± 0.76 vs. 11.14 ± 0.80 nmol/g Hb [P < 0.01]), while vitamin E increased (7.93 ± 0.73 vs. 6.16 ± 0.61 nmol/g Hb [P < 0.05]). No difference was observed for PUFAs, glutathione, or total MDA.

CONCLUSIONS

The observed erythrocyte LPO in NIDDM decreased after a short-term adaptive insulin therapy. This decrease could be principally attributed to the normalized glycemia that reduces reactive oxygen species (ROS) production, which in turn may explain the increase in erythrocyte membrane vitamin E and the decrease in MDA. This study shows the value of a euglycemic environment in NIDDM to reduce LPO and, at long range, to minimize clinical diabetes complications.