bluuebunny/crossref_metadata_2025 huggingface dataset:
Living with Diabetes: Relationship to Gender, Duration and Complications. A Survey in Northern Sweden
Authors: Gåfvels C. , Lithner F. , Börjeson B.
Published: July 2009

A questionnaire was sent to 561 insulin‐treated diabetic patients aged 20–50 years living in the province of Västerbotten in Northern Sweden to assess their experience of living with diabetes. The response rate was 87% (n = 488). Differences in the experience of living with diabetes related to gender, age, duration of diabetes, and chronic diabetic complications were reported. Men seemed to underestimate problems related to diabetes more than women. They worried less about long‐term complications and hypoglycaemia, but were more troubled by the limitation of personal freedom caused by their diabetes. In spite of their worries, women more often than men found positive aspects in having diabetes. Younger patients also had a more positive attitude towards their disease, even though they more often thought that diabetes had negatively affected their relationships with friends. Patients with a shorter diabetes duration were more concerned about the management of their diabetes than were patients with a long duration. The fear of chronic complications increased with diabetes duration. Chronic complications most affected patients' views of diabetes, their self‐perception, and social life. Patients with childhood onset of diabetes knew less about the implications of the disease, and this reduced the intensity of their psychological response to the diagnosis. In conclusion, social and medical factors affected how diabetic patients perceived their disease. These findings suggest that the outcome of diabetes health care might improve if it was more individually adapted to each patient's personal experience of the disease and the psychological needs related to it.
The Gulf War and Diabetes Mellitus
Authors: Rubinstein A. , Koffler M. , Villa Y. , Graff E.
Published: July 2009

The Gulf war was a traumatic and stressful event for the inhabitants of Tel‐Aviv and vicinity. The entire population changed its way‐of‐life. In order to evaluate the influence of the war stress on glucose control, we reviewed the charts of all diabetic patients attending the outpatient clinics at the Tel‐Aviv Medical Centre, whose weight and glycated haemoglobin was determined between 15.1.91 and 2.5.91 (the war period), with comparative measurements within 4 ½ months both before and after these dates. Sixty‐six patients with non‐insulin dependent diabetes mellitus (NIDDM) and 16 with insulin‐dependent diabetes mellitus (IDDM) were examined. During the war, their glycated haemoglobin increased by 10.1 to 10.9% and from 9.6 to 10.2%, respectively. Weight increased from 76.1 to 77.5 kg in the NIDDM and from 63.2 to 64.7 kg in the IDDM patients. Both measurements returned to baseline after the war. No correlation was found between the changes in glycated haemoglobin and weight.
Population Screening for Diabetes Mellitus
Authors: Paterson K.R. ,   Professional Advisory Committee of the British Diabetic Association
Published: July 2009

The role and value of screening for diabetes mellitus is still unclear. If asymptomatic subjects are to be screened, then a fasting plasma glucose > 6.6 mmol 1−1 or a venous plasma glucose 2 h after a 75 g oral glucose load > 8.0 mmol 1−1 or the presence of any glucose in a urine sample passed 2 h after a main meal should be regarded as a positive result. A fasting plasma glucose in the range 5.5–6.6 mmol 1−1 is an equivocal result which should lead to retesting in 6–12 months if there is any risk factor for diabetes (obesity, family history of diabetes, Asian/African racial origin). Other screening tests or combinations of tests are not recommended. Screening should be restricted to subjects between 40 and 75 years and should be undertaken only every 5 years (3 years if a risk factor for diabetes is present), ideally in parallel with other health screening initiatives. No diagnosis should be made or treatment begun on the basis of a single screening test; subjects with a positive result should have further investigations as necessary to reach a diagnosis in line with WHO criteria.
Incidence of Microvascular Complications in Type 1 Diabetic Subjects with Limited Joint Mobility: A 10‐Year Prospective Study
Authors: McCance D.R. , Crowe G. , Quinn M. J. , Smye M. , Kennedy L.
Published: July 2009

Previous cross‐sectional studies have shown a significant correlation between limited joint mobility (LJM) and the microvascular complications of Type 1 diabetes, but whether LJM precedes and, therefore, may be regarded as an early marker for complications is unknown. Twenty‐two Type 1 diabetic patients (10 male/12 female; diabetes duration at follow‐up 20.1 ± 1.3 (SEM) years) with LJM, and 22 subjects matched for age, sex, and duration of diabetes, without LJM were observed over a 10‐year period. Both groups were free of retinopathy and negative for ‘dipstick’ proteinuria at baseline. After 10 years, of 22 patients with LJM, 10 had developed background and 3 proliferative retinopathy compared with 9 and 1 control subjects, respectively. Microalbuminuria (20 ≤ albumin excretion rate < 200 μg min−1) was present in 3 and macroalbuminuria (albumin excretion rate ≥ 200 μg min−1) in 2 of LJM patients compared with 6 and 1 control subjects, respectively. Ankle and toe vibration perception thresholds, HbA1, mean HbA1 (a mean of serial HbA1 measurements obtained during the 10‐year follow‐up period), and arterial blood pressure did not differ between the two groups (p > 0.05). At 10‐year review, 9 of the control subjects had developed LJM of whom 4 had retinopathy and 4 microalbuminuria. Thus, while LJM may be another ‘chronic complication’ of diabetes, its presence does not appear to predict those at increased risk of developing microvascular complications.
Plasma Lipid Levels at Diagnosis in Type 2 Diabetic Patients
Authors: Sosenko J.M. , Kato M. , Soto R. , Goldberg R.B.
Published: July 2009

Plasma lipid measurements were obtained at the time that 545 subjects were screened for diabetes mellitus. Both the women and men diagnosed with diabetes had significantly higher triglyceride levels (p < 0.05) and lower high‐density‐lipoprotein cholesterol (HDL‐cholesterol) levels (p < 0.05) than those with normal glucose tolerance. Low‐density‐lipoprotein cholesterol (LDL‐cholesterol) levels were only higher in the diabetic women (p < 0.001). Differences in lipid values were diminished somewhat with allowances for the waist‐hip ratio. HDL‐cholesterol values were inversely related to fasting insulin levels in the normoglycaemic men and women (p < 0.01), but not in the diabetic individuals. Triglyceride levels were strongly positively related to insulin values in the normoglycaemic men and women (p < 0.001 for both), while associations tended to be smaller in the diabetic subjects. In 13 of the diabetic individuals who were not medicated for diabetes over a period of 17.5 ± 4.6 months, changes in HDL‐cholesterol levels were positively related (p = 0.80, < 0.001) and changes in tryglyceride levels inversely related (r = –0.70, p < 0.01) to changes in insulin values. These data indicate that at diagnosis Type 2 diabetic patients have an atherogenic lipid pattern that may be related in part to differences in adipose distribution. In addition, the data suggest that HDL‐cholesterol is positively related and triglyceride inversely related to insulin action.
Low Literacy: A Problem in Diabetes Education
Authors: Overland J.E. , Hoskins P.L. , McGill M.J. , Yue D.K.
Published: July 2009

Eighty‐five diabetic patients who were proficient in English were studied to assess the impact of educational material of varying literacy levels on patient comprehension. Two samples of available diabetes foot care material of Grade 11 and 9 readability (measured by SMOG formula) and purposely written in‐house material of Grade 6 readability were used. Patients were randomized to read information of either Grade 6 and Grade 11 or Grade 6 and Grade 9 readability. Socio‐demographic data and reading habits were collected to allow for identification of literacy markers. The mean CLOZE score (a measure of comprehension) was better in patients who read the Grade 6 information than for both the Grade 11 and Grade 9 information (59.5 ± 11.8, 46.8 ± 22.0, 45.8 ± 22.2 respectively, p < 0.001). When evaluated in terms of percent of patients that could independently understand the material, Grade 6 information outperformed the Grade 11 and Grade 9 information (60 %, 19 %, 21 %, respectively, p < 0.001). For the Grade 11 and Grade 9 information, poorer comprehension was associated with a non‐English speaking background, early school leaving age, infrequent reading habits, and preference for tabloids (p < 0.02). Comprehension when patients read the Grade 6 information was no longer dependent on two of the four identified literacy markers. We conclude that reducing literacy demands of health literature improves patients' comprehension. Attention to socio‐demographic data and reading habits can assist educators in assessing patients' literacy status and ensuring patients are given literature of compatible readability.
Coping Behaviour and Degree of Discrepancy Between Retrospective and Prospective Self‐ratings of Change in Quality of Life in Type 1 Diabetes Mellitus
Authors: Wikby A. , Stenström U. , Hörnquist J.O. , Andersson P.‐O.
Published: July 2009

Quality of life and metabolic control were examined in 74 adults with Type 1 diabetes mellitus in 1988. Sixty‐six of the persons were followed up in 1990 with the aim of studying more closely the subgroup that showed a ‘major’ discrepancy between ‘retrospective’ and ‘prospective’ quality of life change ratings. ‘Prospective’ quality of life change was defined as the difference in assessed quality of life status between 1990 and 1988. ‘Retrospective’ quality of life change was assessed directly by subjects in 1990 covering the same time period. Data on quality of life, well‐being, sociodemographics and metabolic control were collected on both occasions. Recent life‐change events and long‐term complications were also recorded in 1990. Subjects with ‘major’ discrepancy reported greater retrospective quality of life improvement, higher quality of life, and greater well‐being, as well as lesser occurrence of negative and greater occurrence of positive recent life‐change events, than did those with ‘minor’ discrepancy, despite their exhibiting poorer metabolic control and a higher prevalence of incipient nephropathy. The results are discussed in terms of possible coping and defence strategies.
The First Two Years of Type 1 Diabetes in Children: Length of the Initial Hospital Stay Affects Costs But Not Effectiveness of Care
Authors: Simell T. , Simell O. , Sintonen H.
Published: July 2009

The long‐term costs of care and the effects of the length of the initial hospital stay on costs and effectiveness of the care of children with Type 1 diabetes are largely unexplored. A randomized prospective study was carried out wherein we shortened the length of the initial hospital stay from 23 ± 4 days to 9 ± 3 days in half of 61 consecutive children with newly diagnosed Type 1 diabetes. Metabolic control, psychosocial adjustment, and direct and indirect costs of care were compared during a 2‐year follow‐up. Having confirmed similar metabolic and psychosocial outcomes, we now report the costs of the two treatment modes. The costs of care of a child with Type 1 diabetes totalled £10834 and £6928 in the long‐term and short‐term alternatives, respectively, during the 2‐year follow‐up (p < 0.001, one‐way ANOVA). Direct costs accounted for 83 % of the expenses in the long‐term and 82 % of the expenses in the short‐term group; 73 % and 56 % of the direct and 78 % and 72 % of the indirect costs were incurred during the first month in the two groups, respectively. The first month's expenses were twice as high in the long‐term than in the short‐term group. Consumed hospital days and the parents' lost work time were the largest cost items in both groups. There were no significant differences in the cost items during the following 23 months. We conclude that the greater part of both the direct and the indirect expenditures were associated with the initial hospital stay. Shortening of the initial hospital stay of children with newly diagnosed Type 1 diabetes from 23 days (mean) to 9 days decreased total costs by 36 % without influencing metabolic or psychosocial outcome during the first 2 years of disease.
Insulin Requirements in Lipodystrophic Diabetes
Authors: Mora P.F. , Ramirez L.C. , Lender D. , Raskin P.
Published: July 2009

A ten‐fold increase in daily insulin requirements during the administration of total parenteral nutrition (TPN) is described in a patient with congenital generalized lipodystrophy, insulin‐requiring diabetes mellitus, and acanthosis nigricans during an episode of acute pancreatitis secondary to hypertriglyceridaemia. After a period of 13 days on TPN, insulin requirements increased dramatically to an average of 1428 units per day for a period of 12 days, to achieve a mean blood glucose level of 10.9 mmol l−1. When the patient resumed feeding and the TPN was discontinued, the average daily insulin requirement was 104 units with a mean 24 h blood glucose of 11.8 mmol l−1. Parenteral administration of energy substrates in a rare case of diabetes mellitus and congenital lipodystrophy complicated by acute pancreatitis resulted in a severe insulin insensitive state due to the combination of the hypermetabolism conferred by the pancreatitis plus transient impairments of the glucose disposal mechanism by the energy substrates provided.
Incidence and Prevalence of Type 1 Diabetes in Children and Adolescents in Benghazi, Libya
Authors: Kadiki O.A. , Moawad S.E.
Published: July 2009

The mean annual incidence rates of Type 1 diabetes mellitus in Arab children and adolescents in Benghazi, Libya were assessed as based on prospective registration of patients during the period 1981–1990. Results showed an annual incidence (per 100 000) of 7.0 (6.0–8.2) (males 6.3(5.0–7.9) females 7.8(6.3–9.7)) in 0–14 year olds and 8.8(7.8–10.0) (males 8.3(6.9–10.0), females 9.2(7.7–11.0)) in 0–19 year olds. There were no significant differences between males and females or between season of onset. The commonest age of onset was 15–19 years. Annual variations were significant in the 0–14 years age group (p < 0.001) and non‐significant in the 0–19 years age group. In 1981 the age adjusted prevalence rates of Type 1 patients (per 100 000) were 23.5 (17.1–31.5) (males 21.2(13.1–32.3), females 25.9(16.8–38.3)) in 0–14 year olds and 36.2(29.1–45.1) (males 31.4(22.2–43.2), females 41.0(30.2–54.5)) in 0–19 year olds. In 1990 the prevalence rates had increased to 37.3(30.5–45.5) (males 40.7(30.8–53.3), females 33.8 (24.6–45.3)) in 0–14 year olds and 59.5(51.6–58.5) (males 60.3(49.3–73.6), females 58.6 (47.7–72.1)) in 0–19 year olds. Increase in prevalence rates was significant in both sexes and in both age groups (p < 0.001).

Increase in prevalence rates in girls in 1981 and in boys in 1990 were not significant. It is concluded that Type 1 diabetes is a common chronic disease of children and adolescents in Benghazi, Libya.
Cultural and Religious Influences in Diabetes Care in Great Britain
Authors: Hawthorne K. , Mello M. , Tomlinson S.
Published: July 2009

Type 2 diabetes is four times more common in people originating from the Indian subcontinent (Asians) than in white English Caucasians. British Asians with diabetes have been shown to have poorer blood glucose control, awareness of diabetes management, and knowledge of complications. This review examines some of the dietary customs that can affect glucose control, problems with communication and diabetic education, and a brief description of health beliefs commonly held by Asian patients that may help the physician understand why some patients appear to show poor compliance with accepted Western medicine. Patients must always be approached as individuals with their own unique needs within the context of their cultural backgrounds.
Association of Erythrocyte Aldose Reductase Activity with Diabetic Complications in Type 1 Diabetes Mellitus
Authors: Hamada Y. , Kitoh R. , Raskin P.
Published: July 2009

Erythrocyte aldose reductase was isolated and its activity measured in 72 Type 1 (insulin dependent) diabetic patients and 21 age and sex matched non‐diabetic subjects. The diabetic patients were categorized into two groups in terms of presence (n = 29) or absence (n = 43) of severe diabetic complications. Age, sex, duration of diabetes and HbA1c levels were matched between the diabetic groups. Erythrocyte aldose reductase (mean ± SEM) was increased in patients with Type 1 diabetes compared to the non‐diabetic subjects (7.22 ± 0.24 vs 5.66 ± 0.19 Ul‐erythrocytes‐1, < 0.0001). There was a four‐fold variation in its activity among the diabetic patients (3.38‐12.23 Ul‐erythrocytes‐1). The enzyme activity was significantly higher in patients with complications than those without (8.17 ± 0.39 vs 6.58 ± 0.26 Ul‐erythrocytes‐1, p < 0.002). When the patients were stratified by duration of the disease, the enzyme activity was highest in patients who had developed complications with a duration of less than 20 years and lowest in those without complications for 20 years or longer (8.54 ± 0.48 vs 6.46 ±p± 0.33 Ul‐erythrocytes‐1, p < 0.002). Patients who had an aldose reductase activity greater than the mean + 2SD of that seen in non‐diabetic controls were four times more likely to have diabetic complications than those whose enzyme activity fell within 2SD of non‐diabetic individuals (p < 0.0005). We conclude that the activity of aldose reductase varies among Type 1 diabetic patients and the differences in its activity may result in a variable susceptibility of these patients to the complications of the disease.
Changes in Glucose Disposal and Cellular Insulin Binding in Obese Black Southern African Patients with Type 2 Diabetes Mellitus Before and After Sulphonylurea Therapy
Authors: Wing Jeffrey R. , Panz V.R. , Joffe B.I. , Seftel H.C.
Published: July 2009

Peripheral insulin action and cellular insulin binding were studied in 10 newly detected, obese, black, Southern African women with Type 2 diabetes mellitus before and after midterm oral sulphonylurea therapy and in five obese, non‐diabetic controls. Glucose disposal (assessed by the euglycaemic insulin clamp technique) was significantly reduced in diabetic patients compared to control subjects (4.4 ± 0.5 vs 6.4 ± 0.5 mg kg‐1 min‐1, p < 0.05), and increased after 1 and 3 months of sulphonylurea therapy to 6.8 ± 0.6 mg kg‐1 min‐1 (p = 0.01) and 6.3 ± 0.7 mg kg‐1 min‐1 (p = 0.04), respectively. The major change in the binding kinetics of insulin to peripheral monocytes was an increase in the mean receptor concentration in the diabetic patients which was significant after 3 months of therapy (0.2 ± 0.08 to 0.6 ± 0.01 nM, p = 0.05). The basal plasma C‐peptide concentration was significantly lower in the diabetic patients than in the controls and remained so following sulphonylurea therapy, despite significant reductions in fasting glucose and HbA‐1 concentrations. We conclude that newly diagnosed, obese, black Southern Africans with Type 2 diabetes showed diminished peripheral glucose disposal which increased following sulphonylurea therapy. This was accompanied by an increase in insulin receptor concentration but not with changes in basal insulin secretion.
Does Ethanol Cause Hypoglycaemia in Overnight Fasted Patients with Type 1 Diabetes?
Authors: Moriarty K.T. , Maggs D.G. , Macdonald I.A. , Tattersall R.B.
Published: July 2009

Drinking ethanol is widely believed to predispose to hypoglycaemia in patients with Type 1 diabetes, the suggested mechanism being suppression of hepatic gluconeogenesis. The hypoglycaemic effect of ethanol was investigated by measuring steady‐state glucose infusion rate during a hypoinsulinaemic (mean plasma insulin 14 ± 1.3 (SEM) mU I‐1), euglycaemic (blood glucose 5 mmol I‐1) clamp. Nine patients with Type 1 diabetes fasted overnight and then had, in single‐blind fashion, ethanol 0.5 g kg‐1 by intravenous bolus followed by 0.25 g kg‐1 h‐1 or matched volumes of saline. After 1 h of ethanol or saline, all infusions were stopped and blood glucose monitored for a further 90 min. A 60‐min ethanol infusion leading to a steady‐state blood concentration of 26.2 ± 1.4 mmol I‐1 (120.7 mg %) did not alter the glucose infusion rate needed to maintain euglycaemia (1.22 ± 0.12 mg kg‐1 min‐1 before and 1.23 ± 0.12 during ethanol infusion), the initial rate of fall of blood glucose (ethanol 0.039 mmol I‐1 min‐1 vs control (0.033), the lowest blood glucose (4.43 mmol I‐1 vs 4.31), or the rate of blood glucose recovery (ethanol 0.050 mmol I‐1 min‐1 vs control 0.054). We conclude that a moderate amount of ethanol, administered intravenously under controlled conditions, does not lead to hypoglycaemia in patients with Type 1 diabetes who have fasted overnight.
Self‐care Behaviour and Blood Glucose Control in Young Adults With Type 1 Diabetes Mellitus
Authors: Peveler Robert , Davies B.A. , Mayou R.A. , Fairburn C.G. , Mann J.I.
Published: July 2009

Self‐care behaviour, knowledge about diabetes, and blood glucose control were studied in 113 young adults with Type 1 diabetes using a semi‐structured interview, self‐report questionnaires, and a biochemical measure (glycated haemoglobin). The majority of subjects followed their prescribed regimen reasonably accurately, but individuals followed different aspects of the regimen to different degrees. Subjects were more concerned with the avoidance of hypoglycaemia than with attainment of ‘tight’ blood glucose control. The blood glucose test level at which subjects took remedial action was the best single predictor of symptomatic control. Frequency of nocturnal polyuria appeared to be a reliable indicator of impaired metabolic control. Insulin omission or dose reduction for the purpose of body weight reduction was common among women, who also had worse blood glucose control than men. Elevated glycated haemoglobin levels were associated with higher alcohol consumption in men. Theoretical knowledge about diabetes management was only weakly associated with self‐care behaviour and blood glucose control in this population. The blood glucose test result at which subjects take remedial action appears to be the most appropriate behavioural target for intervention to improve control in such subjects.
Investigating the Capillary Circulation of the Foot with 99mTc‐macroaggregated Albumin: A Prospective Study in Patients with Diabetes and Foot Ulceration
Authors: Moriarty K.T. , Perkins A.C. , Robinson A.M. , Wastie M.L. , Tattersall R.B.
Published: July 2009

Macroaggregated albumin has been used to assess capillary circulation for over 20 years. The aim of the present study was to use 99mTc‐macroaggregated albumin (99mTc‐MAA) perfusion scanning to assess capillary circulation in feet with ischaemic ulcers in patients with diabetes, and relate the appearances to outcome. Twenty‐three patients with diabetes presented with a total of 41 neuroischaemic foot ulcers. Perfusion scanning was performed by direct femoral artery injection of approximately 400 000 particles of 99mTc‐MAA and imaging with a gamma camera. Patients were followed prospectively for 3 months. Scans were graded independently by a radiologist who was unaware of the site of the ulcers. Significant associations were detected between a radiologist's assessment of increased tissue perfusion and complete healing after 3 months (p = 0.047) and poor tissue perfusion on the image and failure to heal (p = 0.0005). This technique may be useful in deciding whether to persist with conservative treatment in patients with diabetes and foot ulceration.
Bisphosphonates: A New Treatment for Diabetic Charcot Neuroarthropathy?
Authors: Selby P.L. , Young M.J. , Boulton A.J.M.
Published: July 2009

Charcot neuroarthropathy is one of the most devastating complications of diabetes causing much discomfort and disability and sometimes leading to amputation. The current therapies are disappointing and fail to address the underlying disease process. In order to try and halt the underlying bone resorption we have studied the action of the bisphosphonate, pamidronate, in six diabetic patients with active Charcot neuroarthropathy. The treatment was associated with improvement in the patients' symptoms and a reduction in Charcot activity as measured by temperature of the affected foot which fell from 3.4 ± 0.7 (SE)°C to 1.0 ± 0.5°C above the intact foot (p = 0.05). There was a significant reduction in bone turnover as judged by alkaline phosphatase activity which fell by 25 ± 3% (p < 0.001). These preliminary data suggest that bisphosphonates may be the first definitive treatment for active Charcot neuroarthropathy and that controlled trials are now indicated.
Increased Maternal Fasting Proinsulin as a Predictor of Insulin Requirement in Women with Gestational Diabetes
Authors: Nicholls J.S. , Ali K. , Gray I.P. , Andres C. , Niththyananthan R. , Beard R.W. , Dornhorst A.
Published: July 2009

Circulating proinsulin was assessed during a 75g OGTT in 55 pregnant women who fulfilled WHO criteria for impaired glucose tolerance before the 32nd gestational week. Proinsulin was assayed retrospectively using a two‐site immunoradiometric assay and immunoreactive insulin by radioimmunoassay. Of the 55 women, 19 required insulin treatment in addition to diet later in pregnancy. Fasting proinsulin concentrations were significantly higher in the 19 women who later required insulin treatment compared with the 36 women treated with diet alone (3.4 ± 0.7 vs 1.8 ± 0.2 pmol l−1, p < 0.005). There was no difference between the treatment groups of 60 and 120 min proinsulin values during the OGTT. Fasting plasma glucose and immunoreactive insulin were similar in the insulin‐treated and diet‐treated women and remained similar during the OGTT. No women within the insulin‐treated group had a fasting plasma proinsulin value < 1.1 pmol l−1 in contrast with 12 women in the diet‐treated group (p = 0.0123). Ten of the 19 insulin‐treated women had a fasting plasma proinsulin > 2.5 pmol l−1 compared with 8 of the 36 diet‐treated women (p = 0.0346). Fasting proinsulin values early in pregnancy have prognostic implications in women with gestational diabetes.
Home Glucose Monitoring in Type 2 Diabetes: Is It a Waste of Time?
Authors: Patrick A.W. , Gill G.V. , MacFarlane I.A. , Cullen A. , Power E. , Wallymahmed M.
Published: July 2009

A cross‐sectional study to assess home glucose monitoring practices was conducted in 200 non‐insulin‐treated diabetic patients consecutively attending our hospital clinic. Of the 200, 97 (48 %) patients (Group 1) regularly monitored urine (n = 74), blood (n = 19) or both (n = 4); 103 (52 %) patients (Group 2) performed no home monitoring. The two groups were similar in terms of age, sex, duration of diabetes and type of treatment. The prevalence of diabetic complications was also closely comparable and only peripheral neuropathy differed between the groups, being more common in Group 1 (n = 12) than Group 2 (n = 4); p < 0.05. There was also no significant difference between the HbA1 concentration (mean ± SD) in Group 1 (9.7 ± 2.2 %) and Group 2 (9.4 ± 2.0 %). The mean frequency of home monitoring was four tests weekly, but only 21 (22 %) kept a written record and 60 (62 %) would never alter their treatment on the basis of their results. Almost a third of patients could not interpret the results of monitoring or give the normal range of values. Home glucose monitoring, particularly of urine, is widely practised in Type 2 diabetes, at considerable overall expense. However, convincing evidence of its value in helping patients improve their blood glucose control or preventing the complications of the disease is lacking.
Improved Beta Cell Function, with Reduction in Secretion of Intact and 32/33 Split Proinsulin, after Dietary Intervention in Subjects with Type 2 Diabetes Mellitus
Authors: Davies M.J. , Metcalfe J. , Day J.L. , Grenfell A. , Hales C.N. , Gray I.P.
Published: July 2009

Diet in Type 2 diabetes often reduces both hyperglycaemia and weight and both these factors may contribute to improvement in beta cell function. Sixty‐nine subjects with newly diagnosed Type 2 diabetes had their glucose, insulin, intact and 32/33 split proinsulin measured at diagnosis, and after 16 (12–20) weeks of conventional diet. In the whole group following diet there was reduction in weight (p < 0.0001), Haemoglobin A1 (p < 0.0001), and fasting glucose (p < 0.0001). There was a fall in fasting intact proinsulin (p < 0.03), 32/33 split proinsulin (p < 0.0001), and the percentage of fasting proinsulin to total insulin‐like molecules (p < 0.0001). Subjects were separated according to weight loss (group 1 < 0.5 kg, group 2 0.5–4 kg, group 3 > 4 kg). Only subjects in group 3 (mean weight loss 6.2 kg) had a fall in fasting insulin (p < 0.04). The fasting glucose achieved following diet was positively correlated with the initial fasting glucose (r = 0.7) and negatively correlated with the degree of insulin deficiency at diagnosis (with the initial 30 min insulin r = −0.62). The effect of diet on the final concentration of insulin, 32/33 split proinsulin and intact proinsulin was examined using multiple regression. The final insulin concentration was determined by the initial BMI and absolute weight loss, 32/33 split proinsulin concentration by the initial fasting glucose and absolute glucose fall, and intact proinsulin concentration by a combination of both weight loss and glucose reduction. We conclude that diet without weight loss increases the insulin secreted relative to the glucose concentration and reduces the concentration of proinsulin‐like molecules. Weight loss reduces insulin resistance thereby lowering the insulin and intact proinsulin concentrations.
Effects of High Monounsaturated and Polyunsaturated Fat Diets on Plasma Lipoproteins and Lipid Peroxidation in Type 2 Diabetes Mellitus
Authors: Parfitt V.J. , Desomeaux K. , Bolton C.H. , Hartog M.
Published: July 2009

Increased free radical peroxidation of lipoproteins may contribute to the excess atherosclerosis in Type 2 diabetes mellitus and may be aggravated by increasing polyunsaturate intake. Increasing intake of monounsaturates might have similar hypolipidaemic effects while avoiding this problem. Therefore the effects of high monounsaturated and polyunsaturated fat diets on plasma lipoproteins and lipid peroxidation were compared, against each other and a relatively high saturated fat baseline diet, in 13 men with Type 2 diabetes and 12 healthy controls, randomized in crossover fashion to each diet. There were no differences in plasma lipoproteins between the monounsaturated and polyunsaturated fat diets in the diabetic and control groups separately, but when both groups were combined, high density lipoprotein cholesterol was higher on the monounsaturated fat diet (p = 0.04). Plasma lipid peroxidation was similar on the monounsaturated and polyunsaturated fat diets in both groups, but all indices of plasma lipid peroxidation in the diabetic group and lipid peroxides in the controls were significantly lower on these diets compared to the baseline diet. Both high monounsaturated and polyunsaturated fat diets increase hepatic metabolism of low density lipoprotein and shorten its circulating half‐life and both may reduce lipid peroxidation, compared to high saturated fat diets, by this mechanism. On high polyunsaturated fat diets, this effect may offset any increased susceptibility of polyunsaturate enriched low density lipoprotein to peroxidation.
Complete Ophthalmoplegia in A Hypertensive Diabetic Patient
Authors: Chen H.D. , Fong V.H. , Tang T.W.
Published: July 2009

Combined paresis of all three ocular motor nerves is a rare ocular manifestation in diabetic patients. We present a case of a 73‐year‐old female with complete ophthalmoplegia. There was no evidence of peripheral neuropathy. Diagnostic angiography showed atherosclerotic stenosis in the cavernous segment of left internal carotid artery. The ophthalmoplegia had a self‐limited course despite the severe vascular lesions.
Low Mumps Antibody Levels Induced by Mumps‐Measles‐Rubella Vaccinations in Type 1 Diabetic Children
Authors: Hiltunen M. , Hyöty H. , Leinikki P. , Åkerblom H.K. , Tuomilehto J. , Vesikari T.
Published: July 2009

Mumps‐measles‐rubella vaccination‐induced antibody responses were studied in Type 1 diabetic children to find out the possible aberrations in mumps antibody responsiveness previously seen after natural mumps in Type 1 diabetic children. Mumps, measles, and rubella virus antibodies were studied in 364 newly diagnosed Type 1 diabetic subjects, their 240 non‐diabetic siblings and 59 age‐ and sex‐matched, unrelated, non‐diabetic control subjects who all had received mumps‐measles‐rubella vaccine but had not had the respective infections. Sera were collected from all children at the time of the diagnosis of diabetes in the index case which was on average 2.5 years after the mumps‐measles‐rubella vaccination. The levels of IgG class mumps virus antibodies were lower in diabetic patients than in their non‐diabetic siblings (p < 0.0005). This difference was most pronounced in males as male patients had significantly lower IgG mumps antibody levels than female patients. Rubella and measles IgG antibodies did not differ between patients and control subjects. The results are in accordance with previous studies suggesting a selective decrease in mumps antibody levels in Type 1 diabetic children. As the exposure to mumps virus had been exactly the same in all study groups, low mumps antibodies in diabetic children suggest decreased responsiveness rather than different number of past infections in these patients.
Antihyperglycaemic Efficacy, Response Prediction and Dose—Response Relations of Treatment with Metformin and Sulphonylurea, Alone and in Primary Combination
Authors: Hermann L.S. , Scherstén B. , Melander A.
Published: July 2009

The short‐term (2–12 weeks) antihyperglycaemic efficacy of metformin (M), glibenclamide (G), and their primary combination (MG) was assessed in a double‐blind study including 165 unselected patients with Type 2 diabetes. Patients with diet failure were randomized to M, G or MG. The dose was titrated with a fasting blood glucose concentration (FBG) of < 6.7 mmol I−1 as the target, using at most six dose levels, the first three comprising increasing monotherapy (M or G) or low‐dose primary combination (MGL), and the second three add‐on therapies (M/G and G/M) and primary combination therapy escalated to high dose (MGH). Success rates were higher on MGL than on monotherapy. The difference in achieving acceptable control (FBG ≤ 7.8 mmol I−1) was 70% versus 51% (95% confidence interval 3–36%, p = 0.032). When the drugs were combined, a slightly greater FBG reduction (p = 0.026) was observed, at lower dosage (p = 0.013). The response could not be predicted from body weight, but depended upon initial FBG (p = 0.019) and meal‐stimulated C‐peptide (p = 0.007). FBG declined progressively with increasing doses of metformin, whereas glibenclamide exerted most of its effect at low dose. Primary combination therapy with metformin and sulphonylurea may be clinically useful.
Lipoprotein(a) in Type 1 Diabetic Patients with Renal Disease
Authors: Groop P.‐H. , Viberti G.C. , Elliott T.G. , Friedman R. , Mackie A. , Ehnholm C. , Jauhiainen M. , Taskinen M.‐R.
Published: July 2009

Lp(a) was measured in 64 normoalbuminuric, 52 microalbuminuric, and 37 proteinuric Type 1 diabetic patients and 54 healthy subjects. Microalbuminuric and proteinuric Type 1 diabetic patients had higher median Lp(a) values (133 (16–1932) and 169 (17–1149) mg I−1) than patients with normal AER (73 (15–1078) mg I−1; p=0.048 and p=0.027). Lp(a) in healthy subjects (110 (15–1630)mg I−1) did not differ from the diabetic subgroups. The frequency of Lp(a) values in the upper quarter of the normal distribution was similar in the diabetic groups and did not differ between diabetic and control subjects. The cumulative distribution of Lp(a) was similar in all groups. Lp(a) concentrations were not related to AER, age, gender, duration of diabetes, body mass index, glycaemic control, serum creatinine, free insulin or systolic blood pressure. Cholesterol, LDL‐cholesterol, triglycerides, and apo B were higher in microalbuminuric and proteinuric than in normoalbuminuric Type 1 diabetic patients. Lp(a) was independently related to diastolic blood pressure, fibrinogen, and macroangiopathy. In conclusion, median Lp(a) concentrations tend to be higher in Type 1 diabetic patients with early and established renal disease, although the differences are small and the overlap between groups large. Lp(a) is related to diastolic blood pressure and fibrinogen, and this association of powerful risk factors suggests that Lp(a) may play a role in the pathogenesis of cardiovascular disease in Type 1 diabetic patients with proteinuria. Whether Lp(a) is an independent determinant of increased cardiovascular risk in these patients needs to be elucidated by prospective studies.
Glibenclamide vs Gliclazide in Type 2 Diabetes of the Elderly
Authors: Tessier D. , Dawson K. , Tétrault J.P. , Bravo G. , Meneilly G.S.
Published: July 2009

The objective of this study was to compare the effect of two sulphonylureas on the frequency of hypoglycaemic events and glycaemic control in elderly patients with Type 2 diabetes. Twenty‐two untreated elderly patients were treated with glibenclamide or gliclazide in a randomized double‐blind fashion. Prior to treatment, a biochemical profile, an oral glucose tolerance test, and a 2‐h hyperglycaemic glucose clamp (glucose 5.4 mmol I‐zs‐1 above baseline) were performed. Patients were seen regularly over 6 months to assess glycaemic control and the frequency of hypoglycaemic reactions. Hyperglycaemic clamp studies and oral glucose tolerance tests were repeated at 1 and 6 months. The area under the curve for the oral glucose tolerance test (glibenclamide: 15.5 ± 0.7; gliclazide: 14.9 ± 0.8 mmol I−1 ((p = NS)) and the haemoglobin A1C (glibenclamide: 7.4 ± 0.2%; gliclazide: 7.9 ± 0.5% (p = NS)) were similar at 6 months. Hypoglycaemic reactions were significantly more frequent with glibenclamide than with gliclazide: 17 vs 4 (p < 0.01). Insulin sensitivity index (ml kg−1 min−1 pmol −1 × 100) was increased significantly by glibenclamide but not gliclazide (glibenclamide: 0.284 ± 0.116 (baseline) vs 0.518 ± 0.102 (6 months) (p < 0.05), gliclazide: 0.260 ± 0.048 (baseline) vs 0.358 ± 0.048 (6 months) (p = NS)). We conclude that glycaemic control was equivalent with the two drugs but the incidence of hypoglycaemic reactions was significantly greater with glibenclamide probably because this drug increases insulin sensitivity to a greater degree.
Prevalence of Diabetes Mellitus in an Elderly Finnish Population
Authors: Hiltunen L. , Luukinen H. , Koski K. , Kivelä S‐L.
Published: July 2009

The prevalence of diabetes mellitus was investigated in a northern Finnish community population aged 70 years or over. Of the eligible 483 persons, 78.5% (n = 379) took part in the study. The presence of diabetes mellitus was assessed by questions about the participants' previously diagnosed diabetes and 2 h oral glucose tolerance tests, which were performed according to the current WHO criteria. Only the participants who were on oral hypoglycaemic drugs or insulin treatment were excluded from the 2 h oral glucose tolerance tests. In the total population the prevalence of Type 2 diabetes was 22.0% among men and 28.2% among women; the difference between sexes was not significant (women's risk ratio (RR) 1.3, 95% confidence interval (CI) 0.9‐1.9). Among those aged 80 years or over the risk ratio for women was 11.3 compared with men (95% CI 1.6–79.5). Among men the prevalence was higher in the age group 70–79 years compared with those aged 80 years or over (RR 8.1, 95% CI 1.2–57.1). By contrast, among women, diabetes was less common among those aged 70–79 years compared with those aged 80 years or over (RR 0.6, 95% CI 0.4‐1.0). The proportion of undiagnosed diabetes was clearly over one‐third among men and just over one‐third among women. Of men, 31.9% suffered from impaired glucose tolerance; the corresponding figure for women was 35.3%. The comparatively high proportion of undiagnosed diabetes and impaired glucose tolerance among elderly people lends support to the more frequent use of the 2 h glucose tolerance test in clinical practice.
The Mortality of Elderly People with Diabetes
Authors: Croxson S.C.M. , Price D.E. , Burden M. , Jagger C. , Burden A.C.
Published: July 2009

To assess the full effect of diabetes on survival in elderly subjects, residents of Melton Mowbray aged 65, 70, 75, 80, and 85 years were screened by glucose tolerance test and followed up for 4.5 years. Death occurred in 56 of 520 normal subjects, 9 of 44 subjects with impaired glucose tolerance, 7 of 19 newly diagnosed diabetic subjects, and 27 of 52 known diabetic subjects. Diabetic subjects were 4.5 times (95% confidence interval 2.9‐7.0) more likely to die than subjects with normal glucose tolerance. Thus elderly diabetic subjects have a substantially increased risk of death compared to their normal glucose tolerant peers.
Diabetes Mellitus but not Impaired Glucose Tolerance is Associated with Dysfunction in Peripheral Nerves
Authors: Eriksson K.F. , Nilsson Håkan , Lindgärde F. , Österlin S. , Dahlin L.B. , Lilja B. , Rosén I. , Sundkvist G.
Published: July 2009

To clarify whether long‐term impaired glucose tolerance (IGT) is associated with dysfunction of peripheral and autonomic nerves, age‐matched men with IGT and diabetes mellitus were followed prospectively for 12–15 years, when peripheral and autonomic nerve function was assessed. The patients comprised four subgroups: (1) 51 IGT subjects (duration of IGT at least 12–15 years); (2) 35 diabetic patients, with IGT 12–15 years ago, who later developed diabetes; (3) 34 diabetic patients, duration of diabetes at least 12–15 years; and (4) 62 age‐matched non‐diabetic control subjects. Mean age of the whole study population was 61±2 years (mean ±SD), not different in the four groups. Peripheral nerve function tests included nerve conduction velocities, amplitudes, distal latencies, F‐reflexes, and sensory perception thresholds for heat, cold, and vibration. Autonomic nerve function tests included the heart rate reaction during deep breathing (expiration to inspiration ratio) and to tilt (acceleration and brake indices). Despite 12–15 years of IGT, peripheral nerve function did not differ between IGT and control subjects, whereas autonomic nerve function deviated; an abnormal expiration to inspiration ratio (a sign of vagal nerve dysfunction) was significantly more common (15/51 versus 5/62;p<0.01) in IGT than in control subjects. Diabetic patients (groups 2 and 3) showed lower conduction velocities (in general 2–4 m s−1 lower) than IGT and control subjects in all tested nerves. In conclusion, diabetes but not IGT, is associated with peripheral nerve dysfunction.
Effect of Sulphonylurea Therapy on Plasma Insulin, Intact and 32/33 Split Proinsulin in Subjects with Type 2 Diabetes Mellitus
Authors: Davies M. J. , Metcalfe J. , Day J. L. , Grenfell A. , Hales C. N. , Gray I. P.
Published: July 2009

This study was undertaken to clarify the effect of sulphonylurea therapy on beta cell function in 27 subjects with newly diagnosed Type 2 diabetes mellitus. Plasma glucose, insulin, intact and 32/33 split proinsulin were measured at diagnostic OGTT. After 8–12 weeks on a conventional diet, subjects with a fasting glucose > 9 mmol I−1 (n = 12) were commenced on sulphonylurea therapy. At diagnosis, the sulphonylurea requiring group were more hyperglycaemic (p < 0.0001), less obese (p<0.05) and more insulin deficient with a lower 30 min insulin (p < 0.0002) than the diet group. Following dietary intervention in the sulphonylurea group, weight remained unchanged but there was a reduction in fasting glucose (p < 0.009). Fasting insulin, intact proinsulin, and 32/33 split proinsulin remained unchanged. After 12 weeks of sulphonylurea therapy there was a weight gain of 1.5 kg (p < 0.01), but a reduction in fasting glucose (p < 0.0001). Fasting insulin and intact proinsulin increased (p < 0.004) but 32/33 split proinsulin remained unchanged. There was a significant increase in both the fasting insulin to glucose ratio (p < 0.005), and the intact to 32/33 split proinsulin ratio (p < 0.02). Final fasting glucose following sulphonylurea therapy was positively correlated with the initial intact and 32/33 split proinsulin and the fasting glucose following dietary treatment. It is clear from this work that sulphonylureas have a complex effect on beta cell physiology and as well as stimulating release of insulin they increase the release of intact proinsulin but not that of 32/33 split proinsulin, hence they increase the intact to 32/33 split proinsulin ratio.
Estimated Glucose Requirement Following Massive Insulin Overdose in a Patient with Type 1 Diabetes
Authors: Fasching P. , Roden M. , Stühlinger H.G. , Kurzemann S. , Zeiner A. , Waldhäusl W. , Laggner A.N.
Published: July 2009

A well‐documented case of a 35‐year‐old male Type 1 diabetic patient who was admitted as an emergency after having injected 1500 international units (IU) of insulin (750 IU regular insulin,750 IU NPH‐insulin) subcutaneously as a suicidal attempt is reported. Computing disappearance rates of glucose from its infused amounts necessary to maintain euglycaemia during 65 h after the insulin injection in analogy to experimental hyperinsulinaemic euglycaemic clamp examinations, a glucose consumption of 55.6 μmol kg−1 min−1 was found at peak serum insulin concentrations of about 14400 pmol I−1. The insulin‐induced glucose dynamics resemble closely those seen in healthy persons and Type 1 diabetic subjects during a 10 mU kg−1 min−1 euglycaemic clamp. This information may be useful in the handling of similar cases of insulin intoxication.
Cigarette Smoking and Diabetes: An Update
Authors: Mühlhauser Ingrid
Published: July 2009

The article provides an overview of recent scientific information on the role of cigarette smoking in the prognosis of diabetes. Data sources included an English‐language MEDLINE search for 1989 through 6/1993, supplemented by manual search of bibliographies of pertinent articles. Only studies of humans were considered. Cigarette smoking is related to the development and progression of diabetic nephropathy. Therefore, smoking status has to be taken into account in clinical studies on the course of nephropathy. The association between smoking and retinopathy is less consistent. Evidence is accumulating that cigarette smoking influences insulin action. Several large prospective cohort studies have shown that the relative risk for all‐cause mortality is about twice as high for smoking compared to non‐smoking diabetic patients. Strong associations are consistently found between cigarette‐pack years and complications. It has been calculated that the theoretical benefit of stopping smoking is the most (cost‐)effective risk factor intervention for diabetic patients. However, available programmes to help diabetic patients to stop smoking are unsuccessful.