bluuebunny/crossref_metadata_2025 huggingface dataset:
The Problem Areas in Diabetes Scale: An evaluation of its clinical utility
Authors: Welch Garry W , Jacobson Alan M , Polonsky William H
Published: March 2007

OBJECTIVE

To evaluate the reliability and concurrent and discriminant validity of the Problem Areas in Diabetes (PAID) scale, a new measure of emotional functioning in diabetes.

RESEARCH DESIGN AND METHODS

A battery of questionnaires, including the PAID, was completed by 256 volunteer diabetic outpatients. In our analyses, we examined the PAID's internal structure and compared mean IDDM and NIDDM treatment group scores in regression analyses to explore its discriminant validity. We also evaluated concurrent validity from the correlations between the PAID and diabetes-specific measures of coping and health attitudes and HbA1c.

RESULTS

Principal component analyses identified a large emotional adjustment factor, supporting the use of the total score. Significant sizable correlations were found between the PAID and a range of selected health attitudinal measures. There were significant differences (with small-to-moderate effect sizes) in PAID scores between IDDM and NIDDM patients and between IDDM and NIDDM insulin- and tablet-treated subgroups; no differences were found between NIDDM insulin- and tablet-treated subgroups.

CONCLUSIONS

The study findings provided support for the construct validity of the PAID, including evidence for discriminant validity from its ability to detect differences between IDDM and NIDDM treatment groups expected to differ in the emotional impact of life with diabetes. Future studies should explore the PAID's performance in nonspecialist treatment settings as well as its responsiveness to clinical change.
Observations of Diabetes Care in Long-Term Institutional Settings With Measures of Cognitive Function and Dependency
Authors: Sinclair Alan J , Allard Imelda , Bayer Antony
Published: March 2007

OBJECTIVE

To document the prevalence of known diabetes and quantity of diabetes care delivered in long-term institutional settings in South Glamorgan, Wales; to measure physical and mental performance of diabetic residents; and to ascertain the level of basic diabetes knowledge of both staff and diabetic residents.

RESEARCH DESIGN AND METHODS

A postal questionnaire survey was sent to 31 nursing or dual registered homes and 88 residential homes in South Wales to determine the prevalence of known diabetes. Medical examination and a semistructured interview of 109 diabetic and 106 age- and sex-matched nondiabetic residents was followed by assessment of dependency (Barthel Activities of Daily Living Scale [15]; Behavioral Rating Scale [16]) and cognitive performance (Mini-Mental State Exam [12]).

RESULTS

The prevalence of known diabetes was 7.2%. Forty percent of diabetic residents were taking long-acting sulfonylureas. Only half of the residents in both homes had regular blood glucose monitoring. Less than 1 in 10 diabetic residents were being followed in a hospital-based diabetic clinic. Diabetic residents had had more hospital admissions in the preceding year than nondiabetic control subjects, and their length of stay was double that of nondiabetic control subjects (P < 0.05). Health professional input was fragmented, with involvement of community nurses and dietitians being rare. Diabetic residents had significantly higher levels of arterial disease (P < 0.05), foot ulceration (P < 0.01), and dementia (P < 0.01), and more severe cognitive impairment and higher levels of dependency (P < 0.01). Knowledge of diabetes was poor among both diabetic and nondiabetic residents and care staff.

CONCLUSIONS

There is an important need for a reappraisal of diabetes care in institutional settings.
Comparison of Fasting and 2-Hour Glucose and HbA1c Levels for Diagnosing Diabetes: Diagnostic criteria and performance revisited
Authors: Engelgau Michael M , Thompson Theodore J , Herman William H , Boyle James P , Aubert Ronald E , Kenny Susan J , Badran Ahmed , Sous Edward S , Ali Mohamed A
Published: March 2007

OBJECTIVE

Nearly two decades ago, the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) Expert Committee on Diabetes Mellitus published diagnostic criteria for diabetes. We undertook this study to compare the performance of three glycemic measures for diagnosing diabetes and to evaluate the performance of the WHO criteria.

RESEARCH DESIGN AND METHODS

In a cross-sectional population-based sample of 1,018 Egyptians ≥ 20 years of age, fasting and 2-h glucose and HbA1c levels were measured, and diabetic retinopathy was assessed by retinal photograph. Evidence for bimodal distributions was examined for each glycemic measure by fitting models for the mixture of two distributions using maximum likelihood estimates. Sensitivity and specificity for cutpoints of each glycemic measure were calculated by defining the true diabetes state (gold standard) as 1) the upper (diabetic) component of the fitted bimodal distribution for each glycemic measure, and 2) the presence of diabetic retinopathy. Receiver operating characteristic (ROC) curves were constructed to determine the performance of the glycemic measures in detecting diabetes as defined by diabetic retinopathy.

RESULTS

In the total population, the point of intersection of the lower and upper components that minimized misclassification for the fasting and 2-h glucose and HbA1c were 7.2 mmol/l (129 mg/dl), 11.5 mmol/l (207 mg/dl), and 6.7%, respectively. When diabetic retinopathy was used to define diabetes, ROC curve analyses found that fasting and 2-h glucose values were superior to HbA1c (P < 0.01). The performance of a fasting glucose of 7.8 mmol/l (140 mg/dl) was similar to a 2-h glucose of 12.2–12.8 mmol/l (220–230 mg/dl), and the performance of a 11.1 mmol/l (200 mg/dl) 2-h glucose was similar to a fasting glucose of 6.9–7.2 mmol/l (125–130 mg/dl).

CONCLUSIONS

Optimal cutpoints for defining diabetes differ according to how diabetes itself is defined. When diabetes is defined as the upper component of the bimodal population distribution, a fasting glucose level somewhat lower than the current WHO cutpoint and a 2-h glucose level somewhat higher than the current WHO cutpoint minimized misclassification. When diabetic retinopathy defines diabetes, we found that the current fasting diagnostic criterion favors specificity and the current 2-h criterion favors sensitivity. These results should prove valuable for defining the optimal tests and cutpoint values for diagnosing diabetes.
Insulin and Cognitive Function in an Elderly Population: The Rotterdam Study
Authors: Stolk Ronald P , Breteler Monique M B , Ott Alewijn , Pols Huibert A P , Lamberts Steven W J , Grobbee Dlederick E , Hofman Albert
Published: March 2007

OBJECTIVE

To examine the association between insulin and cognitive function in the population-based Rotterdam Study.

RESEARCH DESIGN AND METHODS

Serum insulin was measured 2 h after an oral glucose load, while global cognitive function was assessed by the Mini Mental State Examination in 5,510 subjects, aged 55 years and over.

RESULTS

An increase in postload insulin only in women was associated with a decrease in cognitive function (age-adjusted regression coefficient −0.10 per 50 mU/l insulin; 95% CI −0.16 to −0.04). The association between insulin resistance, assessed by the ratio of postload insulin over glucose, and cognitive function was not statistically significant. Further adjustment for the individual risk factors of serum glucose, BMI, HDL, systolic blood pressure, smoking, or use of estrogen did not change the results. The association was present in women with and without cardiovascular disease and present after excluding subjects with diabetes. Women with dementia, the extreme of cognitive dysfunction, had increased age-adjusted insulin levels (76.3 ± 4.9 vs. 66.8 ± 1.0 mU/l [means ± SE], P = 0.06).

CONCLUSIONS

The results of this study suggest that increased serum insulin may be associated with decreased cognitive function and dementia in women. These findings are more compatible with a direct effect of insulin on the brain than with an effect through an increase in cardiovascular risk factors.
Attentional Functioning in Children and Adolescents With IDDM
Authors: Rovet Joanne , Alvarez Miguel
Published: March 2007

OBJECTIVE

To determine whether specific attentional cognitive processes are disrupted in children and adolescents with IDDM.

RESEARCH DESIGN AND METHODS

We tested 103 children and adolescents with IDDM and 100 healthy control subjects (age range 9.3–18.3 years) for intelligence and attention. Subjects were given multiple clinical tests of attention and a computerized vigilance test, all of which served to provide information about multiple components of attentional processing. Specific components studied were the abilities to focus, select, shift, suppress, inhibit, and sustain attention. A diabetic history was obtained for the IDDM group, and blood glucose levels were determined before and after computerized attention testing.

RESULTS

Across tests, IDDM subjects differed from control subjects only in the select component of attention, which was accounted for mainly by the poorer performance of children with early-onset diabetes (< 6 years). When subgrouped by history of seizures from hypoglycemia, those having had seizures demonstrated a lower verbal IQ and greater difficulty with select, focus, and inhibit attentional components, whereas sustain, suppress, and shift attentional components were unaffected. Correlation analyses showed that higher concurrent blood glucose levels were associated with less adequate ability to inhibit impulsive responses, whereas multiple regression analyses indicated that inhibit and focus were best predicted by onset age and concurrent blood glucose.

CONCLUSIONS

In children and adolescents with IDDM, attention is poorer in several but not all aspects of attention; these aspects are affected by a history of seizures from hypoglycemia and higher ambient blood glucose levels at time of testing. These results suggest both organizational and activational effects of diabetes on specific subcomponents of attention in diabetes.
A Multicenter Study on the Prevalence of Diabetic Neuropathy in Italy
Authors: Fedele Domenico , Comi Giancarlo , Coscelli Carlo , Cucinotta Domenico , Feldman Eva L , Ghirlanda Giovanni , Greene Douglas A , Negrin Paolo , Santeusanio Fausto ,   The Italian Diabetic Neuropathy Committee
Published: March 2007

OBJECTIVE

The prevalence of neuropathy, a common complication of diabetes, was determined in diabetic patients recruited from 109 outpatient diabetes clinics in Italy.

RESEARCH DESIGN AND METHODS

Neuropathy was diagnosed using the Diabetic Neuropathy Index (DNI), a standardized examination developed for use in the outpatient setting. A total of 8,757 diabetic patients were studied, 51.2% men and 48.8% women, with average and median ages of 56 and 58 years, respectively.

RESULTS

Of the 8,757 patients, 32.3% had neuropathy, defined as a positive score of > 2 points on the DNI. A total of 2,033 (49.6% men and 50.4% women) were administered the Diabetic Neuropathy Score (DNS), the second component of the screening program, by a neurologist. This component consists of a quantitative neurological examination and nerve conduction studies that together provide a summated score. A total of 335 patients (16.5%) were not neuropathic, and 395 (19.4%) had borderline, 453 (22.3%) mild, 592 (29.1%) moderate, and 258 (12.7%) severe neuropathy. The concordance between a positive score on the DNI and a DNS indicating neuropathy was 83.5%. The severity of neuropathy increased with both age and disease duration. Of patients with neuropathy, 64.1% had an average age between 58 and 59 years with a disease duration between 12.4 ± 8.4 years (mild neuropathy) and 15.6 ± 9.7 years (severe neuropathy).

CONCLUSIONS

Neuropathy is a common complication of diabetes and, in this study, was present in 32.3% of all patients. An increased awareness of the high prevalence of neuropathy can lead to early therapeutic intervention and possible prevention of later neuropathic complications, such as infection and foot ulcers.
Existence of Early-Onset NIDDM Japanese Demonstrating Severe Diabetic Complications
Authors: Yokoyama Hiroki , Okudaira Maki , Otani Toshika , Takaike Hiroko , Miura Junnoske , Saeki Akiko , Uchigata Yasuko , Omori Yasue
Published: March 2007

OBJECTIVE

To identify the clinical characteristics of early-onset NIDDM patients with severe diabetic complications.

RESEARCH DESIGN AND METHODS

The clinical cases of a large number of diabetic patients who visited a diabetes center within the period 1970–1990 were reviewed. Of a total of 16,842 diabetic patients, 1,065 (6.3%) had early-onset NIDDM (diabetes diagnosed before 30 years of age). These 1,065 patients were divided into two groups, those who developed proliferative retinopathy before the age of 35 (n = 135) and those who did not (n = 930). Development of proliferative retinopathy, nephropathy, renal failure, blindness, and atherosclerotic vascular disease were compared between the two groups.

RESULTS

The subgroup of 135 patients was characterized by poor glycemic control, often requiring insulin therapy and a higher familial prevalence of diabetes, and contained a greater proportion of women than the subgroup of 930 patients. Of the 135 patients, 99 (67%) developed proliferative retinopathy before the first visit. The 135 patients developed severe progressive complications in contrast to the 930 patients. A total of 81 patients (60%) developed diabetic nephropathy at a mean age of 31 years, 31 (23%) developed renal failure requiring dialysis at a mean age of 35 years, 32 (24%) became blind at a mean age of 32 years, and 14 (10%) developed atherosclerotic vascular disease at a mean age of 36 years.

CONCLUSIONS

Some Japanese early-onset NIDDM patients develop severe diabetic complications in their youth. Most of them had no symptoms nor regular treatment regarding diabetes until they were noticed to have developed severe diabetic complications. Although the relevant prevalence and the pathogenetic mechanism underlying the rapid onset of the complications remain to be determined, prolonged inadequate treatment of and familial predisposition to diabetes may be contributing factors. Careful diabetes care in the twenties, not only for IDDM but also for NIDDM patients, is warranted.
Gestational Diabetes: Should It Be Added to the Syndrome of Insulin Resistance?
Authors: Clark Charles M , Qiu Chunfu , Amerman Barbara , Porter Beverly , Fineberg Naomi , Aldasouqi Saleh , Golichowski Alan
Published: March 2007

OBJECTIVE

The significance of gestational diabetes mellitus (GDM) results from its short-term detrimental effects on the fetus and its long-term prediction of NIDDM in the mother. We compared several variables associated with insulin resistance between GDM and non-GDM pregnant women to show the similarities between GDM and NIDDM (and thus insulin resistance).

RESEARCH DESIGN AND METHODS

On the basis of a 3-h oral glucose tolerance test (OGTT), 52 GDM patients and 127 non-GDM patients were recruited from pregnant, non-diabetic women who had a nonfasting 1-h-50-g glucose screening test ≥ 7.2 mmol/l (130 mg/dl) performed between 16 and 33 weeks of gestation (a total of 518 of 3,041 women drawn from six community health care prenatal clinics were screened positive). During the OGTT, several potential markers of insulin resistance were measured at fasting and 2-h time points, in addition to the standard glucose measurements. The relationship of these variables with the diagnosis of GDM was studied.

RESULTS

GDM patients, compared with non-GDM patients, had 1) higher prepregnancy weight (P = 0.011), prepregnancy BMI (P = 0.006), C-peptide at fasting (P = 0.002) and at 2 h (P < 0.001), insulin at fasting (P = 0.001) and at 2 h (P < 0.001), triglycerides at fasting (P = 0.005) and at 2 h (P = 0.003), free fatty acids at fasting (P = 0.017), β-hydroxybutyrate at fasting (P = 0.007); and 2) lower HDL cholesterol at fasting (P = 0.029). These variables were all predictive of GDM (P < 0.036) individually. Using stepwise logistic regression with all of these variables available, fasting (P = 0.019) and 2-h (P < 0.001) insulin levels, fasting free fatty acids (P = 0.031), and fasting β-hydroxybutyrate (P = 0.036) were statistically significant as jointly predictive of GDM. Comparisons between GDM patients and non-GDM patients matched by BMI confirmed that the metabolic abnormalities persisted when difference in BMI was taken into account. Concomitant blood pressure measurements in women with GDM did not differ significantly from those without GDM.

CONCLUSIONS

Our results show that many of the known metabolic components of the syndrome of insulin resistance (syndrome X) are predictive of GDM. These results are in keeping with the argument that GDM is one phase of the syndrome of insulin resistance. We suggest that GDM be looked upon as a component of the syndrome of insulin resistance that provides an excellent model for the study and prevention of NIDDM in a relatively young age-group.
Autoantibodies to Sympathetic Ganglia, GAD, or Tyrosine Phosphatase in Long-Term IDDM With and Without ECG-Based Cardiac Autonomic Neuropathy
Authors: Muhr Daniela , Mollenhauer Ulrike , Ziegler Anette-Gabriele , Haslbeck Manfred , Standl Eberhard , Schnell Oliver
Published: March 2007

OBJECTIVE

To evaluate the association of autoantibodies to complement-fixing sympathetic ganglia (CF-SG), and tyrosine phosphatase (IA-2) with electrocardiogram (ECG)-based cardiac autonomic neuropathy (CAN) in long-term IDDM.

RESEARCH DESIGN AND METHODS

We examined the prevalence of autoantibodies to CF-SG (by complement-fixing indirect immunoflourescence), GAD, and IA-2 (by radioligand assay) and islet cells (by indirect immunofluorescence) in 96 long-term IDDM patients (41 with ECG-based CAN, ≥ 2 of 5 cardiac reflex tests abnormal; 55 without ECG-based CAN). As a control group, 89 healthy nondiabetic subjects were investigated.

RESULTS

CF-SG autoantibodies were observed more frequently in long-term IDDM patients than in the control group (25 vs. 4%, P = 0.0001). Of the IDDM patients, 14 (34%) with CAN and 10 (18%) without CAN presented with CF-SG autoantibodies (P = 0.06). GAD or IA-2 autoantibodies were detected in 14 (34%) and 17 (41%) IDDM patients with CAN, compared with 24 (44%) and 29 (53%) IDDM patients without CAN (P = 0.2, P = 0.2). Islet cell antibodies were observed in 6 (15%) IDDM patients with and in 9 (16%) IDDM patients without CAN (P = 0.5).

CONCLUSIONS

In long-term IDDM, the role of CF-SG autoantibodies, which tend to be more frequent in patients with ECG-based CAN, requires further investigations. The persistence of GAD and IA-2 autoantibodies is not related to ECG-based CAN.
Brain Abnormalities Demonstrated by Magnetic Resonance Imaging in Adult IDDM Patients With and Without a History of Recurrent Severe Hypoglycemia
Authors: Perros Petros , Deary Ian J , Sellar Robin J , Best Jonathan JK , Frier Brian M
Published: March 2007

OBJECTIVE

Previous studies of a cohort of 100 patients with IDDM have shown that a history of recurrent severe hypoglycemia is associated with a modest impairment of cognitive function. The aim of the present study was to determine whether IDDM patients with and without a history of severe hypoglycemia have lesions in the brain that are identifiable by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) and to investigate the putative relationship of any structural brain abnormalities with cognitive function.

RESEARCH DESIGN AND METHODS

MRI and MRS of the brain were performed in 22 patients from the original cohort. Eleven IDDM patients with no history of severe hypoglycemia (group A) were compared with 11 IDDM patients who had a history of five or more episodes of severe hypoglycemia (group B).

RESULTS

Nine patients (41%) had abnormal scans. Two types of abnormalities were observed: high-intensity rounded lesions, > 3 mm in diameters, distributed in the periventricular white matter (leukoaraiosis) in four patients; and cortical atrophy in five patients. Five patients in group B had cortical atrophy, whereas no patient in group A demonstrated this feature (P < 0.05). MRS of the frontal and parietal lobes showed no differences in the N-acetyl aspartate/creatine or N-acetyl aspartate/choline ratios between groups A and B. Patients with cortical atrophy showed a nonsignificant trend toward reduced performance on Rapid Visual Information Processing.

CONCLUSIONS

Brain abnormalities demonstrated by MRI are common in patients with IDDM of long duration and are suggestive of premature aging of the brain. IDDM per se may be an important pathogenic factor, but a significant association was observed between a history of recurrent severe hypoglycemia and cortical atrophy, which may be related to the modest impairment of cognitive function that has been reported previously.
Glucocorticoid-Induced Ketoacidosis in Gestational Diabetes: Sequela of the Acute Treatment of Preterm Labor: A case report
Authors: Bedalov A , Balasubramanyam A
Published: March 2007

Pregnancy induces complex changes in energy metabolism, manifested clinically by insulin resistance, low fasting blood glucose levels, and proneness to ketosis. It is quite unusual for pregnant women who do not have type I diabetes to progress from ketosis to frank ketoacidosis, although this phenomenon is common in larger mammals. In the case described here, glucocorticoid administration in the setting of a prolonged fast triggered a metabolic cascade leading to ketoacidosis in a pregnant woman without type I diabetes. Other details of this illustrative case serve to synthesize several disparate observations regarding the pathogenesis of pregnancy ketoacidosis. Physicians should be aware of the potential for rapidly developing ketoacidosis with atypical biochemical and clinical features in pregnant women who are treated with high doses of glucocorticoids.
Comparison of Laboratory Test Frequency and Test Results Between African-Americans and Caucasians With Diabetes: Opportunity for Improvement: Findings from a large urban health maintenance organization
Authors: Wisdom Kimberlydawn , Fryzek Jon P , Havstad Suzanne L , Anderson Robert M , Dreiling Michael C , Tilley Barbara C
Published: March 2007

OBJECTIVE

To compare African-American and Caucasian patients with preexisting diabetes in a health maintenance organization (HMO) on: 1) frequency with which they received a subset of recommended laboratory tests according to the American Diabetes Association (ADA) consensus guidelines and 2) the results of laboratory test values (glycosylated hemoglobin, cholesterol, and creatinine).

RESEARCH DESIGN AND METHODS

A cross-sectional study of 2,312 HMO members with diabetes continuously enrolled during 1991 was conducted using computerized medical record and billing data. Receipt of the ADA recommended tests for glycosylated hemoglobin, cholesterol, and creatinine was compared between African-Americans and Caucasians, stratified by insulin requirements. In addition, group comparisons were made based on the laboratory test results.

RESULTS

Less than 20 percent of all subjects received the recommended number of ADA tests. This did not differ by race except for creatinine and cholesterol testing in insulin users only, where African-Americans had more tests. On average, after adjusting for covariates, African-Americans had significantly higher glycosylated hemoglobin and creatinine laboratory values. Both groups had elevated cholesterol values.

CONCLUSIONS

The opportunity exists to improve the process of care for both African-Americans and Caucasians with diabetes in an HMO setting. The need to improve glycosylated hemoglobin results and subsequently limit complications is especially pressing among the African-American population.
Age and Sex Effects on HbA1c: A study in a healthy Chinese population
Authors: Yang Yi-Ching , Lu Feng-Hwa , Wu Jin-Shang , Chang Chih-Jen
Published: March 2007

OBJECTIVE

To evaluate whether glycohemoglobin levels increase with age in both sexes and to determine the effect of BMI on this increment.

RESEARCH DESIGN AND METHODS

A cross-sectional survey of 4,580 healthy Chinese men and women, aged 20–85 years, was performed. All subjects who did not have identifiable diseases and who were not on medication known to influence glucose tolerance were recruited from participants at the preventive services of the National Cheng-Kung University Hospital. As an indicator of plasma glucose levels, glycohemoglobin was measured. The subjects were classified according to their age and BMI for both men and women, and any relationships with glycohemoglobin levels were evaluated.

RESULTS

In all the BMI groups divided into quartiles, glycohemoglobin levels increased with age. The largest elevation of glycohemoglobin was observed in the 45- to 54-year-old age-group, except in men with a BMI between the lowest and highest quartiles. The group with a BMI above the highest quartile had a higher glycohemoglobin than the group with a BMI below the lowest quartile in men aged < 54 years and women aged 35–64 years. Men had higher average glycohemoglobin levels than women < 55 years of age.

CONCLUSIONS

The age factor itself may cause an elevation in glycohemoglobin independent of other age-related factors in Chinese men and women, and there is a sex difference with a lower average glycohemoglobin level in women before menopause. Furthermore, BMI, but not a family predisposition to diabetes or leisure-time physical activity, affects this age-dependent increase in glycohemoglobin levels.
Stability of Insulin Lispro in Insulin Infusion Systems
Authors: Lougheed William D , Zinman Bernard , Strack Thomas R , Janis Linda J , Weymouth Alexandra B , Bernstein Elyse A , Korbas Annette M , Frank Bruce H
Published: March 2007

OBJECTIVE

To test stability of insulin lispro in two insulin infusion systems over 48 h.

RESEARCH DESIGN AND METHODS

We used reverse-phase and size-exclusion high-performance liquid chromatography (HPLC) to determine the purity, potency, and degree of polymerization of U100 insulin lispro (Humalog) after 24- and 48-h pump cycles conducted at 37°C in five Disetronic H-TRON V100 and five MiniMed 504 pumps. Pumps were set to deliver a basal rate of 0.5 U/h and 6-U boluses at t = 0, 4, 8, 24, 24.5, 28.5, 32.5, and 48 h during each cycle. The effluent was collected into 1-ml vials, pooled at 24 or 48 h, and stored at 4°C until assay. After each 48-h run period of insulin delivery, assays for potency, polymer, and purity were performed on the pooled samples from each individual cycle. m-cresol content and the pooled reservoir content were assayed in the 48-h pooled samples.

RESULTS

Insulin lispro retained full HPLC potency (Δ ≤ 4%) at 48 h, with no degradation of insulin lispro to des-amidoinsulin forms (24 or 48 h). No increase in pumped insulin polymer concentration was observed following 24 h of pump flow. Nonsignificant increases of ≤0.09% (Disetronic) and ≤0.15% (MiniMed) from initial concentrations of 0.18% (polymer divided by total insulin) were detected in three of five pump cycles at 48 h when compared with 37°C paired controls. Nonsignificant decreases (<5 and 10%, Disetronic and MiniMed, respectively) of m-cresol content occurred in both systems following 48 h storage in each device, but sterility was not compromised by this decrease (initial m-cresol concentration, 3.15 mg/ml). Pump performance was without mechanical or electrical fault throughout the study Basal and bolus insulin delivery was evaluated three times daily and remained as expected. Occlusion of catheters by insulin precipitation did not occur, and no change in pH was observed following delivery.

CONCLUSIONS

We conclude that insulin lispro is suitable for prolonged infusion in these two medical devices when syringes and catheters are replaced at 48-h intervals.
The Homeostasis Model in the San Antonio Heart Study
Authors: Haffner Steven M , Miettinen Heikki , Stern Michael P
Published: March 2007

OBJECTIVE

Both insulin resistance and decreased insulin secretion have been shown to predict the development of NIDDM. However, methods to assess insulin sensitivity and secretion are complicated and expensive to apply in epidemiological studies. The homeostasis model assessment (HOMA) has been suggested as a method to assess insulin resistance and secretion from the fasting glucose and insulin concentrations. However, this method has not been extensively evaluated, particularly in different ethnic groups.

RESEARCH DESIGN AND METHODS

We applied the HOMA model to cross-sectional analyses of the San Antonio Heart Study (n = 2,465).

RESULTS

HOMA insulin resistance (IR) was very strongly correlated with fasting insulin (r = 0.98) and HOMA β-cell function (β-cell) was moderately correlated with the 30-min increment in insulin concentration over the 30-min increment in glucose concentration (Δ I30/Δ G30) in an oral glucose tolerance test (OGTT) (r = 0.44). NIDDM was characterized by both high HOMA IR and low HOMA β-cell function. In Mexican-Americans, HOMA IR in NIDDM subjects was 9.5 compared with 2.7 in normal glucose tolerance (NGT) subjects. In contrast, HOMA β-cell function showed only small differences in Mexican-Americans (176 NIDDM; 257 NGT). However, the ΔI30/ΔG30 (pmol/mmol) showed much larger differences (75 NIDDM; 268 NGT). When modeled separately, impaired glucose tolerance (IGT) was characterized by high HOMA IR and high HOMA β-cell function. However, when analyzed in the same regression model, high HOMA IR and low HOMA β-cell function characterized subjects with IGT. These results were similar in both ethnic groups. Mexican-Americans had increased insulin resistance (as judged by both HOMA IR and fasting insulin) and insulin secretion (by HOMA β-cell and ΔI30/ΔG30) relative to non-Hispanic whites.

CONCLUSIONS

We conclude that HOMA provides a useful model to assess insulin resistance and β-cell function in epidemiological studies in which only fasting samples are available and that, further, it is critical to take into account the degree of insulin resistance in assessing insulin secretion by the HOMA model.
Dexfenfluramine in Obese Chinese NIDDM Patients: A placebo-controlled investigation of the effects on body weight, glycemic control, and cardiovascular risk factors
Authors: Chow Chun-Chung , Ko Gary TC , Tsang Lynn WW , Yeung Vincent TF , Chan Juliana CN , Cockram Clive S
Published: March 2007

OBJECTIVE

To investigate the safety, efficacy, and metabolic effects of dexfenfluramine in obese Chinese NIDDM patients.

RESEARCH DESIGN AND METHODS

Thirty-two patients, mean (± SD) body weight 76.2 ± 8.5 kg with corresponding BMI 31.1 ± 2.1 kg/m2, were randomized into a two-phase study, after a 2-week single-blind run-in period on placebo. Phase 1 was a randomized 3-month double-blind placebo-controlled trial during which either dexfenfluramine or placebo was added to the existing treatment regimens of diet plus or minus sulfonylureas without metformin. Phase 2 was a further 3-month single-blind trial during which the placebo group was given dexfenfluramine without patients' knowledge of changing to active medication, while the active group continued with dexfenfluramine. Body weight, glycemic control, blood pressure, lipids, and quality of life were assessed before and at 3 and 6 months after randomization. A total of 27 patients were also followed for an additional period of 6–12 months (215 ± 53 days) after dexfenfluramine treatment was withdrawn.

RESULTS

During the run-in period, both groups were comparable for all parameters measured. At 3 months, mean changes in BMI were −1.2 ± 1.0 kg/m2 (dexfenfluramine) vs. −0.1 ± 0.5 kg/m2 (placebo) (P < 0.001). The mean changes in fasting plasma glucose were −1.14 ± 0.99 vs. 0.51 ± 1.34 mmol/l (dexfenfluramine vs. placebo, P = 0.004). HbA1c also significantly improved in the dexfenfluramine group (−0.80 ± 0.53 vs. 0.25 ± 0.64%, P < 0.001). During the 3-month single-blind dexfenfluramine treatment in the ex-placebo group, there were similar improvements in body weight and glycemic indexes. After cessation of dexfenfluramine therapy at 6 months, significant increases in body weight and glycemic indexes, almost back to the baseline, were observed for both groups.

CONCLUSIONS

Dexfenfluramine aids weight loss and improves glycemic control in obese Chinese NIDDM patients over a 3- to 6-month period. These effects are emphasized after withdrawal of treatment and further support the longer-term use of dexfenfluramine for chronic complicated obesity.
Physical Activity Efficacy and Effectiveness Among Older Adults and Minorities
Authors: Clark Daniel O
Published: March 2007

The objective of this study was to consider efficacy and effectiveness of physical activity for the prevention and management of NIDDM among minorities and older adults of the U.S. Relevant population trends and projections are discussed, followed by a review of the efficacy of physical activity based on theoretical, prospective cohort, and intervention studies. With few empirical studies available, the assessment of effectiveness is largely theoretical and focuses on potentially important issues for future studies among older adults and minorities. Efficacy studies have shown that moderate-intensity physical activity is associated with a one- to two-thirds lower incidence of NIDDM over 4–14 years and 15–20% lower glycosylated hemoglobin over 3–4 months among people with NIDDM. With physical inactivity prevalence at 60–70%, much work remains to be done to improve physical activity effectiveness. In the most vulnerable populations, physician referral and community involvement structured around stage of change and self-efficacy theories are suggested as the most promising approaches to promoting physical activity adoption and maintenance. Effectiveness or demonstration studies that test and build on stage of change, self-efficacy, and other concepts of physical activity promotion and outcomes would likely prove to be highly valuable investments for public health.
Effect of Race on Outcome After Kidney and Kidney-Pancreas Transplantation in Type 1 Diabetic Patients
Authors: Douzdjian Viken , Bhaskar S Shanmuga , Baliga Prabakar K , Gugliuzza Kristene K , Rajagopalan P R
Published: March 2007

OBJECTIVE

The racial impact on graft outcome is not well defined in diabetic recipients. The purpose of this study is to analyze our experience with kidney-alone (KA) and kidney-pancreas (KP) transplantation in type 1 diabetic recipients and evaluate the impact of racial disparity on outcome.

RESEARCH DESIGN AND METHODS

The records of 217 kidney transplants (118 KA, 99 KP) performed on type 1 diabetic patients between 1985 and 1995 at the Medical University of South Carolina and the University of Texas Medical Branch were reviewed.

RESULTS

A total of 53 (31%) white patients and 15 (33%) black patients experienced at least one episode of biopsy-proven acute rejection of the renal graft (NS). Patient survival at 1, 2, and 5 years was similar in white (92, 87, 69%) and black (91, 91, 69%) patients (NS). Kidney graft survival at 1, 2, and 5 years in the KA group was 72, 62, and 42% in blacks, compared with 79, 76, and 53% in whites (NS). Kidney graft survival at 1, 2, and 5 years in the KP group was 92, 92, and 74% in blacks, compared with 83, 77, and 58% in whites (NS). Pancreas graft survival at 1, 2, and 5 years was 81, 81, and 81% in blacks, compared with 81, 75, and 62% in whites (NS). Cox regression analysis revealed that donor age ≥ 40 years increased the risk of renal graft failure 6.2-fold (P = 0.0001), whereas the addition of a pancreas transplant to a kidney and a living-related transplant decreased the risk of failure of the kidney graft 0.2 (P = 0.005) and 0.1 times (P = 0.005).

CONCLUSIONS

Our results suggest that when compared with whites, there may be a trend toward an improved kidney and pancreas graft outcome in blacks undergoing KP transplants. These findings suggest that diabetes may override the risk factors that account for the pronounced disparity in outcome observed between nondiabetic white and black recipients.
The Insulin Resistance Syndrome in Native Hawaiians
Authors: Mau Marjorie K , Grandinetti Andrew , Arakaki Richard F , Chang Healani K , Kinney Everett K , Curb J David ,   Native Hawaiian Health Research (NHHR) Project
Published: March 2007

OBJECTIVE

To investigate whether fasting hyperinsulinemia is associated with a clustering of cardiovascular disease (CVD) risk factors, manifesting as the insulin resistance syndrome (IRS), in a population of native Hawaiians.

RESEARCH DESIGN AND METHODS

A total of 574 native Hawaiians ≥ 30 years of age were examined for blood pressure, waist-to-hip ratio (WHR), BMI, oral glucose tolerance, and fasting lipid, insulin, and C-peptide concentrations. All statistical analyses (n = 384) excluded 190 individuals who had NIDDM or who were taking hypertension medication. Using logistic regression analysis, fasting insulin and C-peptide levels were compared with CVD risk factors (glucose intolerance, hypertension, central adiposity, elevated triglyceride levels, and low HDL cholesterol levels) after adjusting for age and obesity.

RESULTS

Sixty-six percent of native Hawaiians were overweight or obese, and 70% were found to have central adiposity. Fasting insulin concentrations were correlated with BMI, WHR, blood pressure, and triglyceride, HDL cholesterol, and glucose concentrations. Fasting insulin was also significantly associated with an increasing number of CVD risk factors in each participant (P < 0.001). Fasting insulin and C-peptide concentrations were independently associated with glucose intolerance, high triglyceride levels, and low HDL cholesterol levels. However, only fasting C-peptide concentrations were independently associated with hypertension and central adiposity. Apparent differences in the correlates of fasting insulin and C-peptide may be related to multiple factors and warrant further evaluation.

CONCLUSIONS

This study provides cross-sectional data confirming the existence of the IRS in native Hawaiians. However, further longitudinal studies are needed to examine the relationship of insulin resistance and/or surrogate markers to increased rates of NIDDM and CVD mortality in native Hawaiians.
The Epidemiology of Diabetes in Pregnant Native Canadians: A risk profile
Authors: Harris Stewart B , Caulfield Laura E , Sugamori Mark E , Whalen Elaine A , Henning Beth
Published: March 2007

OBJECTIVE

The purpose of this study was to determine the prevalence of diabetes in pregnancy (gestational diabetes mellitus [GDM] and NIDDM) and to identify risk factors in the development of GDM in a native population in northwestern Ontario, Canada.

RESEARCH DESIGN AND METHODS

A retrospective analysis of 1,305 singleton deliveries among Ojibwa-Cree women from northwestern Ontario, Canada, was conducted from 1990 to 1993 inclusive. GDM was diagnosed using a 3-h oral glucose tolerance test (OGTT) and defined according to standard guidelines.

RESULTS

The overall prevalence of diabetes in pregnancy (NIDDM and GDM) was 11.6% (152 of 1,305) with a GDM prevalence of 8.4% (110 of 1,305). Among 741 women with complete data, prevalence rates increased with age, peaking at 46.9% in the age-group ≥ 35 years. Significant risk factors for GDM included older maternal age, multiparity, prepregnancy obesity, a family history of diabetes, and a history of GDM in previous pregnancies.

CONCLUSIONS

Diabetes in pregnancy among Ojibwa-Cree reported here represent the highest rates reported to date in a Canadian population. The high rates of maternal obesity and relative young age of this population further highlight the urgent need for diabetes screening and prevention in this population.
The Use of Biothesiometry to Detect Neuropathy in Children and Adolescents With IDDM
Authors: Davis E A , Jones T W , Walsh P , Byrne G C
Published: March 2007

OBJECTIVE

To develop clinically useful reference ranges for vibration perception thresholds (VPTs), using biothesiometry in children and adolescents and to assess the reliability of the technique to identify subclinical neuropathy in subjects with IDDM at this age and to examine a large population-based sample of pediatric patients.

RESEARCH DESIGN AND METHODS

VPTs were measured using a handheld biothesiometer at the medial malleolus and hallux in 232 nondiabetic children and adolescents aged 7–18 years (12.9 ± 4.2 years) and a population-based sample of 307 young IDDM patients (13.3 ± 4.6 years of age). The mean of three readings at each site was correlated with height, pubertal status, and age for all subjects and, in addition for the IDDM sample, with the duration of IDDM, ambient blood glucose, and mean HbA1c from diagnosis. Those IDDM subjects found to have elevated VPTs (> 97th percentile), and a control group of patients with IDDM underwent nerve conduction studies to determine the sensitivity and specificity of biothesiometry to detect abnormal neural function in children. Interoperator reliability was assessed in a separate trial in which two operators measured VPTs independently in the same 11 children.

RESULTS

In the nondiabetic control subjects, height demonstrated the best correlation with VPT measures, and a reference range was thus established with percentile charts, using mean VPT and height. VPTs were higher in the diabetic sample, compared with the nondiabetic sample (P < 0.05). Of the children, 28 (9.1%) had VPT values > 97th percentile developed from studies of the nondiabetic subjects; of these, 11 were younger than 11 years and 8 were prepubertal. Nerve conduction studies confirmed reduced conduction velocity and prolonged distal latencies in those with abnormal VPTs, compared with normal control subjects and IDDM patients with normal VPTs. Sensitivity of biothesiometry to reflect abnormal nerve function was estimated as 82% and specificity as 75% at this age. Interoperator variation was small (7.25% of total variance).

CONCLUSIONS

Biothesiometry is a useful noninvasive tool for the detection of subclinical neuropathy in children and adolescents. The use of height-related reference ranges may make screening for neuropathy more feasible in younger patients and allow large-scale longitudiral analysis of its development.
Role of Glycemic Control and Blood Pressure in the Development and Progression of Nephropathy in Elderly Japanese NIDDM Patients
Authors: Tanaka Yasushi , Atsumi Yoshihito , Matsuoka Kenpei , Onuma Tomio , Tohjima Toshio , Kawamori Ryuzo
Published: March 2007

OBJECTIVE

To investigate the role of glycemic control and blood pressure in the development and progression of nephropathy and to suggest goals for glycemic control and blood pressure for the prevention of nephropathy in elderly Japanese NIDDM patients.

RESEARCH DESIGN AND METHODS

A total of 123 age- and diabetes duration-matched elderly Japanese NIDDM patients (aged 60−75 years; 74 normoalbuminuric and 49 microalbuminuric) were retrospectively studied for 6 years.

RESULTS

The group that developed microalbuminuria from normoalbuminuria (group NM: n = 24) showed a higher 6-year mean HbA1c than the group that remained normoalbuminuric (group NN: n = 50; 9.0 ± 0.8 vs. 8.1 ± 0.8%, P < 0.01) in spite of no significant difference in 6-year mean blood pressure (MBP). On the other hand, the group that progressed from microalbuminuria to overt proteinuria (group MP: n = 26) showed a higher 6-year MBP than the group that remained microalbuminuric (group MM: n = 23; 106 ± 5 vs. 95 ± 6 mmHg, P < 0.01) in spite of no significant difference in 6-year mean HbA1c. The cutoff level of HbA1c separating group NN from group NM was 8.5% (normal range ≤ 6.5%), and that of MBP separating group MM from group MP was 100 mmHg.

CONCLUSIONS

Glycemic control is a more potent factor than blood pressure level on the development of microalbuminuria. However, as far as the progression of microalbuminuria to overt proteinuria is concerned, hypertension is the most crucial factor in elderly NIDDM patients. Suggested goals for glycemic control and blood pressure level for the prevention of nephropathy in elderly Japanese patients are an HbA1c of ≤8.5% (equivalent to 7.8% in the current measurement of stable HbA1c; normal range ≤5.8%) and an MBP of ≤ 100 mmHg.
Fractional Esterification Rate of HDL Particles in Patients With Type 2 Diabetes: Relation to coronary heart disease risk factors
Authors: Tan Meng-Hee , Loh Keh-Chuan , Dobiasova Milada , Frohlich Jiri J
Published: March 2007

OBJECTIVE

To study the fractional esterification rate of cholesterol on HDL particles (FERHDL) in adults with type 2 diabetes and assess its correlation with serum lipids and other coronary heart disease (CHD) risk factors.

RESEARCH DESIGN AND METHODS

FERHDL was measured in 90 adult (57 men, 33 women) patients by an isotopic assay method involving several steps, including preparation of VLDL- and LDL-depleted plasma, labeling of the sample with a trace amount of tritiated cholesterol, separation of free and esterified cholesterol fractions by chromatography post incubation, and subsequent counting of radioactivity in the individual fractions.

RESULTS

Male patients have higher FERHDL values than their female counterparts. When HDL cholesterol was controlled for in a multivariate regression analysis, the sex factor was not significant. There was a significant positive correlation between FERHDL and plasma total cholesterol (r = 0.32), triglycerides (r = 0.82), apolipoprotein B (apo B; r = 0.48), insulin (r = 0.46), BMI (r = 0.31), and waist-to-hip ratio (WHR; r = 0.50). There was a negative correlation between FERHDL and HDL cholesterol (r = −0.76) and apolipoprotein AI (r = −0.60). When both HDL cholesterol and triglycerides were controlled for, the only significant correlation was between FERHDL and BMI.

CONCLUSIONS

Non-insulin-requiring type 2 diabetic patients have FERHDL, which correlated positively with triglycerides and negatively with HDL cholesterol. The positive correlation of FERHDL with serum insulin, WHR, total cholesterol, and apo B, but not that with BMI, loses its significance when HDL cholesterol and triglycerides are controlled. The sex difference between men and women in FERHDL also loses its significance when HDL cholesterol is controlled.