bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of an Intervention by a Diabetes Team in Hospitalized Patients With Diabetes
Authors: Koproski Jill , Pretto Zorayda , Poretsky Leonid
Published: March 2007

OBJECTIVE

Hospitalized patients with diabetes have a prolonged length of stay in the hospital. We conducted a controlled prospective randomized feasibility study of the effects of a diabetes team (a diabetes nurse educator and an endocrinologist) on the length of stay and other outcomes of hospitalization in these patients.

RESEARCH DESIGN AND METHODS

A total of 179 hospitalized patients with diabetes were randomly assigned to receive usual care supplemented with (85 patients) or without (94 control patients) a diabetes team intervention. Outcome measures included the length of stay, blood glucose control, and rates of readmission.

RESULTS

For the primary diagnosis of diabetes, the median length of stay was 5.5 days (95% CI 4-8 days) for patients who received diabetes team intervention and 7.5 days (5–11 days) for the control patients (NS). For the secondary diagnosis of diabetes, the median length of stay was 10.0 days (8–13 days) in the intervention group and 10.5 days (8–13 days) in the control group (NS). One month after the team intervention was initiated, 75% of patients in the intervention group were in good glycemic control, compared with 46% in the control group. Readmissions at 3 months after discharge included 13 (15%) patients from the intervention group and 30 (32%) patients in the control group (P = 0.01).

CONCLUSIONS

Randomized controlled prospective trials of clinical interventions in hospitalized patients with diabetes are feasible. Diabetes team intervention appears to reduce the hospital length of stay and to improve glycemic control. Team intervention significantly reduces the rate of recurrent hospitalization.
Impact of Physical Activity on Cardiovascular Risk Factors in IDDM
Authors: Lehmann Roger , Kaplan Vladimir , Bingisser Roland , Bloch Konrad E , Spinas Giatgen A
Published: March 2007

OBJECTIVE

To study the impact of physical activity on glycemic control and plasma lipids [HDL cholesterol (HDL-C), HDL-C subfractions, triglycerides, lipoprotein(a)], blood pressure, weight, and abdominal fat and to determine the necessary short-term adaptations in diabetes management during intensive endurance training in patients with IDDM.

RESEARCH DESIGN AND METHODS

Well-controlled subjects with IDDM (n = 20; HbA1c = 7.6%) engaged in a regular exercise program over a period of 3 months involving endurance sports such as biking, long-distance running, or hiking. Subjects were instructed to exercise at least 135 min per week. If baseline activity exceeded this level, subjects were to increase further their physical activity as much as possible and record the type and time of such activity.

RESULTS

During the 3-month intervention, physical activity increased from 195 ± 176 to 356 ± 164 min (mean ± SD) per week (P < 0.001). Physical fitness as assessed by VO2max increased from 2,914 ± 924 to 3,092 ± 905 ml/min (P < 0.001), and insulin sensitivity increased significantly (steady-state plasma glucose [SSPG] decreased from 10.5 ± 4.8 to 7.0 ± 3.3 mmol/l; P < 0.01). Subsequently, LDL cholesterol decreased by 14% (P < 0.05), and HDL and HDL3-C subfraction increased by 10 (P < 0.05) and 16% (P < 0.05), respectively. Systolic and diastolic blood pressure decreased significantly from 127 ± 9 to 124 ± 8 (P < 0.05) and from 80 ± 5 to 77 ± 5 mmHg (P < 0.01), respectively. Resting heart rate decreased from 63 ± 6 to 59 ± 7 bpm (P < 0.01). Waist-to-hip circumference ratio decreased from 0.882 ± 0.055 to 0.858 ± 0.053 (P < 0.001), body weight decreased from 70.7 ± 10.4 to 68.7 ± 10.2 kg (P = 0.003), with a consequent decrease in body fat from 21.9 ± 8.2 to 18.0 ± 6.3% (P < 0.001) and an increase in lean body mass from 54.9 ± 12.2 to 56.8 ± 11.0 kg. These effects occurred independently of glycemic control. The overall frequency of severe hypoglycemic episodes was reduced from 0.14 to 0.10 per patient-year during the study period.

CONCLUSIONS

This study shows that increasing physical activity is safe and does not result in more hypoglycemic episodes and that there is a linear dose-response between increased physical activity and loss of abdominal fat and a decrease in blood pressure and lipid-related cardiovascular risk factors, with a preferential increase in the HDL3-C subfraction.
Effects of a Quick-Release Form of Bromocriptine (Ergoset) on Fasting and Postprandial Plasma Glucose, Insulin, Lipid, and Lipoprotein Concentrations in Obese Nondiabetic Hyperinsulinemic Women
Authors: Kamath Vinaya , Jones Claire N , Yip Jeannie C , Varasteh Ben B , Cincotta Anthony H , Reaven Gerald M , Chen Yii-Der I
Published: March 2007

OBJECTIVE

To assess the effect on various aspects of carbohydrate and lipid metabolism of administering a quick-release formulation of bromocriptine (Ergoset) to obese, nondiabetic, hyperinsulinemic women.

RESEARCH DESIGN AND METHODS

Hourly concentrations of prolactin, glucose, insulin, free fatty acid (FFA), and triglyceride were measured for 24 h before and after approximately 8 weeks of treatment with Ergoset. In addition, fasting lipid and lipoprotein concentrations and the steady-state plasma glucose (SSPG) concentration in response to a continuous infusion of somatostatin, insulin, and glucose were determined before and after Ergoset administration.

RESULTS

Circulating prolactin concentrations were dramatically decreased (P < 0.001) following treatment, associated with a significant fall (P < 0.05) in 24-h-long plasma glucose, FFA, and triglyceride concentrations. Neither circulating plasma insulin concentrations nor the ability of insulin to mediate glucose disposal changed with treatment. Finally, fasting total cholesterol fell (P < 0.05) and the ratio of total to HDL cholesterol decreased (P = 0.06) in association with Ergoset treatment.

CONCLUSIONS

The fact that significant metabolic improvement was seen in the obese nondiabetic hyperinsulinemic women studied suggests that Ergoset could be of therapeutic benefit in clinical conditions of hyperglycemia and/or dyslipidemia.
Comparison of a Carbohydrate-Rich Diet and Diets Rich in Stearic or Palmitic Acid in NIDDM Patients: Effects on lipids, glycemic control, and diurnal blood pressure
Authors: Storm Hanne , Thomsen Claus , Pedersen Eva , Rasmussen Ole , Christiansen Christian , Hermansen Kjeld
Published: March 2007

OBJECTIVE

To compare the effects on lipid levels, glycemic control, and diurnal blood pressure of two diets rich in one of the two quantitatively most important saturated fatty acids, stearic and palmitic acid, with a carbohydrate-rich diet in NIDDM patients.

RESEARCH DESIGN AND METHODS

A total of 15 NIDDM patients participated in a randomized crossover study with three 3-week diet interventions separated by 2-week washout periods. Patients started with a diet rich in stearic acid (44 E% [percent of total energy] fat [13 E% stearic acid], 40 E% carbohydrate, 15 E% protein), palmitic acid (45 E% fat [16 E% palmitic acid], 40 E% carbohydrate, 15 E% protein), or carbohydrate (29 E% fat, 51 E% carbohydrate, and 18 E% protein), then were shifted to the other two diets in a randomized block design. At the start and end of each intervention period, fasting blood samples were drawn for analysis of lipids and blood glucose. In addition, diurnal blood pressure was measured.

RESULTS

At the end of the 3-week interventions, total cholesterol was significantly higher after the palmitic acid-rich diet than after the stearic acid-rich or carbohydrate-rich diets (5.3 ± 1.3 vs. 5.0 ± 1.2 and 4.9 ± 1.2 mmol/l, respectively; P = 0.03). No significant differences in triglyceride, LDL, or HDL cholesterol levels were seen after the three intervention diets. No difference in effects between the diet periods were seen for fructosamine, HbA1c, fasting blood glucose, or diurnal blood pressure.

CONCLUSIONS

For the first time, it has been demonstrated that a diet rich in palmitic acid was not as effective in lowering cholesterol levels as carbohydrate-rich and stearic acid-rich diets in NIDDM patients. No deleterious effects were seen on diurnal blood pressure, triglyceride levels, and glycemic control. Development of foods containing stearic acid rather than the more atherogenic saturated fatty acids may allow a wider choice of acceptable foods to NIDDM patients.
Reduced Frequency of Severe Hypoglycemia and Coma in Well-Controlled IDDM Patients Treated With Insulin Lispro
Authors: Holleman Frits , Schmitt Henry , Rottiers Raoul , Rees Alan , Symanowski Sharon , Anderson James H ,   The Benelux-UK Insulin Lispro Study Group
Published: March 2007

OBJECTIVE

Several studies have suggested that use of the short-acting insulin analog, insulin lispro, in multiple injection therapy may reduce the risk of hypoglycemia in comparison with regular insulin. This effect might be more pronounced in well-controlled patients, since intensive treatment of IDDM increases the rate of severe hypoglycemic events. This study evaluated the effects of insulin lispro on glycemic control and hypoglycemia rates in well-controlled IDDM patients.

RESEARCH DESIGN AND METHODS

This was an open, randomized, 6-month crossover study of 199 IDDM patients. Glycemic control was evaluated by HbA1c, home blood glucose measurements, and rate and timing of hypoglycemic events. At the end of the study, patients completed an evaluation form regarding therapy-related quality of life.

RESULTS

HbA1c remained constant at ∼ 7.3% throughout the study. Meal-related glucose excursions were significantly lower with insulin lispro compared with regular insulin (mean −0.8 ± 1.7 vs. 1.1 ± 1.6 mmol/l, P < 0.001), as was the within-day variability (M value 27.7 ± 19.7 vs. 30.2 ± 23.1, P = 0.007). The incidence of severe hypoglycemic events (58 vs. 36, P = 0.037) including coma (16 vs. 3, P = 0.004) was significantly lower with insulin lispro than with regular insulin. Patients felt that insulin lispro increased flexibility and freedom of lifestyle.

CONCLUSIONS

In well-controlled IDDM patients, insulin lispro is associated with a lower risk of severe hypoglycemia and coma.
Risk Factors for the Development of NIDDM in Yonchon County, Korea
Authors: Shin Chan Soo , Lee Hong Kyu , Koh Chang-Soon , Kim Yong Ik , Shin Young Soo , Yoo Keun Young , Paik Hee Young , Park Yong Soo , Yang Byung Goog
Published: March 2007

OBJECTIVE

To determine the risk factors for the development of NIDDM in Yonchon County of Korea.

RESEARCH DESIGN AND METHODS

We studied 1,193 Korean nondiabetic subjects at baseline who participated in a 2-year follow-up study on diabetes in Yonchon County. A 75-g oral glucose tolerance test was performed 2 years after the baseline examination. Age, sex, and anthropometric and metabolic characteristics at baseline were analyzed simultaneously as potential predictors of conversion to NIDDM. We also designed a nested case-control study to determine the role of hyperinsulinemia and/or hyperproinsulinemia in the conversion to NIDDM in patients with newly developed diabetes and control subjects matched for age, sex, BMI, and waist-to-hip-ratio.

RESULTS

At 2 years, 67 subjects developed diabetes, as defined by World Health Organization criteria. The age-adjusted incidence was significantly higher in men (6.4%) than in women (3.0%), and the incidence increased as age increased in both sexes. Multiple logistic regression analysis revealed age, male sex, and fasting and 2-h glucose levels to be significant risk factors for the development of NIDDM, whereas waist-to-hip ratio and BMI were not. In a nested case-control study, baseline proinsulin but not insulin levels were significantly higher in subjects who progressed to NIDDM than in those who did not.

CONCLUSIONS

In the Korean population, β-cell dysfunction, as measured by high proinsulin levels, seems to be associated with subsequent development of NIDDM, whereas regional and general obesity and fasting insulin levels, which may be a surrogate for insulin resistance, were not.
Hyperhomocyst(e)inemia and Endothelial Dysfunction in IDDM
Authors: Hofmann Marion A , Kohl Brigitte , Zumbach Martina S , Borcea Valentin , Bierhaus Angelika , Henkels Mechthild , Amiral Jean , Fiehn Walter , Ziegler Reinhard , Wahl Peter , Nawroth Peter P
Published: March 2007

OBJECTIVE

While elevated blood levels of homocyst(e)ine represent an independent risk factor for macrovascular disease, we assessed the link between hyperhomocyst(e)inemia and diabetic microvascular diseases.

RESEARCH DESIGN AND METHODS

Plasma levels of homocyst(e)ine and thrombomodulin (TM), markers of endothelial cell damage, were measured before and 3 h after oral methionine loading in 75 patients with IDDM and 40 healthy control subjects matched for sex and age. Exclusion criteria were hyperlipidemia, hypertension, smoking, or positive family history for cardiovascular disease.

RESULTS

IDDM patients had higher pre- and postload plasma levels of homocyst(e)ine than did healthy control subjects (12.0 vs. 7.7 μmol/l and 27.6 vs. 16.0 μmol/l; P < 0.001). Of 75 IDDM patients, 26 had plasma homocyst(e)ine levels above the normal range (means ± 2 SD of values obtained in the control group). These IDDM patients with hyperhomocyst(e)inemia had higher plasma TM levels (62.2 vs. 38.2 ng/ml, P < 0.001), higher albumin excretion rates (485 vs. 115 mg/l, P < 0.005), and a higher prevalence of late diabetic complications (nephropathy, 76 vs. 33% retinopathy, 69 vs. 51% neuropathy, 57 vs. 41% and macroangiopathy, 57 vs. 33%) compared with IDDM patients with normal plasma homocyst(e)ine. In vitro experiments with human umbilical vein cells showed an increased release of TM into the culture supernatant only when endothelial cells were pretreated with advanced glycation end product (AGE)-albumin before L-homocystine was added. A synergistic action of homocyst(e)ine and AGEs might contribute to vascular complications in patients with diabetes.

CONCLUSIONS

Hyperhomocyst(e)inemia is common in nephropathic diabetic patients and may contribute to the enhanced morbidity and mortality from cardiovascular diseases characteristically observed in IDDM patients with diabetic nephropathy.
Serum Autoantibodies Against Sulfatide and Phospholipid in NIDDM Patients With Diabetic Neuropathy
Authors: Shigeta Hirofumi , Yamaguchi Makiko , Nakano Koji , Obayashi Hiroshi , Takemura Reiji , Fukui Michiaki , Fujii Mitsuhiro , Yoshimori Kuniaki , Hasegawa Goji , Nakamura Naoto , Kitagawa Yoshihiro , Kondo Motoharu
Published: March 2007

OBJECTIVE

We investigated the presence of antisulfatide and antiphospholipid antibodies and the relationship between these antibodies and the results of quantitative tests of nerve function in NIDDM patients with diabetic neuropathy.

RESEARCH DESIGN AND METHODS

Antisulfatide and antiphospholipid antibodies were measured in serum samples obtained from 68 NIDDM patients with diabetic neuropathy by an enzyme-linked immunosorbent assay (ELISA). Each patient was classified into one of three groups based on the combined neuropathy score (determined by the symptom score, the results of autonomic nerve function tests, and the vibration perception test), as follows: mild (n = 26), moderate (n = 22), and severe (n = 20). Nerve conduction studies were performed in a subgroup of 37 patients.

RESULTS

The antisulfatide antibody was detected in 1 (4%) of 26 patients in the mild group, 4 (18%) of 22 patients in the moderate group, and 8 (40%) of 20 patients in the severe group (P < 0.01 vs. mild group). The antiphospholipid antibody was detected in none of the patients in the mild group, 8 (36%) of 22 patients in the moderate group (P < 0.001 vs. mild group), and 6 (30%) of 20 patients in the severe group (P < 0.01 vs. mild group). The threshold amplitude, determined by the vibration perception test, was significantly higher in antibody-positive patients than in antibody-negative patients: antisulfatide antibody, 55.9 ± 46.8 μm (n = 13) vs. 22.9 ± 13.7 μm (n = 55), P < 0.001; antiphospholipid antibody, 47.2 ± 32.5 μm (n = 14) vs. 24.5 ± 23.2 μm (n = 54), P < 0.01. The conduction velocity of the sural nerve was slower in the antisulfatide antibody-positive group (37.9 ± 11.1 m/s, n = 12) than in the antisulfatide antibody-negative group (45.2 ± 6.0 m/s, n = 19) (P < 0.05).

CONCLUSIONS

These results suggest that autoimmune nerve destruction may be involved in diabetic neuropathy in NIDDM patients.
Diabetes, Asymptomatic Hyperglycemia, and 22-Year Mortality in Black and White Men: The Chicago Heart Association Detection Project in Industry Study
Authors: Lowe Lynn P , Liu Kiang , Greenland Philip , Metzger Boyd E , Dyer Alan R , Stamler Jeremiah
Published: March 2007

OBJECTIVE

To assess relationships of diabetes and asymptomatic hyperglycemia at baseline to the risk of cardiovascular disease (CVD) and all-cause (ALL) mortality in employed, white and black middle-aged men.

RESEARCH DESIGN AND METHODS

A prospective cohort study of 11,554 white men and 666 black men between the ages 35 and 64 from 1967 to 1973 was conducted using data from the Chicago Heart Association (CHA) Detection Project in Industry 22-year mortality follow-up. cox proportional hazards models, adjusted fro age and other CVD risk factors, were used to estimate the relative risk (RR) and the 95% CI of mortality associated with baseline glycemic status.

RESULTS

Age-adjusted baseline prevalence of clinical diabetes was similar in white (3.7%) and black (4.3%) men; asymptomatic hyperglycemia (glucose post–50-g load ≥ 11.1 mmol/l) was present in 11.1% of whites and 7.8% of blacks. After controlling for age, lifestyle, and other CVD risk factors, mortality risk was increased among white men with clinical diabetes (CVD: RR 2.51, CI 2.08−3.02; ALL: RR 1.88, CI 1.63−2.17) and asymptomatic hyperglycemia (CVD: RR 1.18, CI 1.01−1.37; ALL: RR 1.24, CI 1.11−1.37), compared with men with postload glucose < 8.9 mmol/l. Risks were similarly, though nonsignificantly (owing to low statistical power), increased among black men with clinical diabetes (CVD: RR 1.60, CI 0.60−4.29; ALL: RR 1.78, CI 0.97−3.25) and asymptomatic hyperglycemia (CVD: RR 1.29, CI 0.61−2.72; ALL: RR 1.37, CI 0.85−2.20).

CONCLUSIONS

Asymptomatic hyperglycemia and clinical diabetes appear to confer increased mortality risk in both white and black men. In addition, mortality risk is increased with increased severity of glycemia. These findings indicate the importance of applying efforts to reduce risk factors and prevent diabetes in both blacks and whites.
The Safety of Injecting Insulin Through Clothing
Authors: Fleming Doris R , Jacober Scott J , Vandenberg Melissa A , Fitzgerald James T , Grunberger George
Published: March 2007

OBJECTIVE

Many of the “antiseptic” practices recommended by health care professionals for insulin injection have been successfully challenged as unnecessary. Since people with diabetes have long been observed to inject their insulin through their clothing, this study was undertaken to determine the safety and perceived benefits of administering insulin by this “rogue” technique.

RESEARCH DESIGN AND METHODS

Fifty people with insulin-treated diabetes were randomized into a 20-week single-blinded prospective crossover study comparing the conventional subcutaneous injection technique (with skin preparation) to an experimental injection technique through clothing. Skin assessment, glycated hemoglobin levels, and leukocyte count were determined before randomization, at 10 weeks (before crossover), and again at 20 weeks (at completion). The participants injected through a single layer of fabric, which ranged from nylon to denim. Problems, benefits, type of clothing, and other comments were recorded by the subjects in an injection log.

RESULTS

Forty-two (84%) subjects completed the study. The mean age was 41 years (range, 23–63 years), 50% were women, 86% were Caucasian, and 80% had type I diabetes. The mean duration of diabetes was 14 years (range, 1–33 years). Fifty-one percent had > 16 years of education. The demographic characteristics of the dropouts were similar to those who completed the study. Over the 20-week period ∼ 13,720 injections were performed by participants. None of the subjects experienced erythema, induration, or abscess at injection sites. Neither the glycated hemoglobin levels nor the leukocyte counts differed between the conventional and experimental regimens. During the injection-through-clothing phase of the study, only minor problems, such as blood stains on clothing and bruising, were recorded in the logbooks. However, subjects reported that injection through clothing offered benefits such as convenience and saving time.

CONCLUSIONS

It is safe and convenient to inject insulin through clothing.
Acarbose in the Treatment of Type I Diabetes
Authors: Hollander Priscilla , Pi-Sunyer Xavier , Coniff Robert F
Published: March 2007

OBJECTIVE

This 36-week multicenter double-blind placebo-controlled study was designed to assess the safety and efficacy of acarbose, administered in conjunction with diet and insulin therapy, for the treatment of patients with type I diabetes.

RESEARCH DESIGN AND METHODS

Acarbose was administered using a forced titration protocol in dosages ranging from 50 to 300 mg t.i.d.

RESULTS

Treatment with acarbose was associated with a mean reduction in postprandial glucose levels (60 min after the administration of a test meal) of 59 mg/dl and a mean reduction in HbA1c levels of 0.48%. There was no difference in the incidence of hypoglycemia between treatment groups. Gastrointestinal events, including flatulence, diarrhea, and abdominal pain, were reported more frequently in acarbose-treated patients than in placebo-treated patients.

CONCLUSIONS

Acarbose was found to be a safe and effective agent, when used in combination with diet and insulin therapy, for the treatment of type I diabetes.
Factors Influencing Height and Weight Development in Children With Diabetes: Results of the Berlin Retinopathy Study
Authors: Danne Thomas , Kordonouri Olga , Enders Ingo , Weber Bruno
Published: March 2007

OBJECTIVE

To investigate the influence of glycemic control and insulin therapy on the longitudinal growth and weight development of children with diabetes.

RESEARCH DESIGN AND METHODS

Prospective measurements of standing height and weight were recorded longitudinally in 634 children after IDDM onset (median age at onset, 9 years [range 1–15 years]; median diabetes duration at final examination, 11 years [range 1–19]; 3,236 patient-years on two or three injections daily; 399 patient-years on multiple injection therapy [MIT]).

RESULTS

Normal development was found until puberty, with a tendency toward stunted growth and overweight (weight > 97th centile) thereafter. Female sex (P < 0.01) and MIT (P < 0.01) were associated with overweight. Final height was evaluated in a subgroup of 197 young adults followed until age 18 years. Relative growth was calculated as the difference between the standard deviation scores (SDSs) at manifestation (median 0.2 [range −3.5 to 2.9]) and at 18 years of age (reduction of −0.5 [−2.5 to 1.8]), equivalent to a median loss of 2.9 cm in boys and 2.3 cm in girls. Significant linear correlations with the change in height SDS after diabetes manifestation were found for age at manifestation (r = 0.21, P < 0.001) and prepubertal (r = −0.40, P < 0.001) and postpubertal HbA1c (r = −0.15, P < 0.001). While children with poorer relative growth also had a higher BMI (P < 0.05), no influences of sex, prevalence of limited joint mobility, or presence of retinopathy were found.

CONCLUSIONS

Female sex and MIT are associated with diabetes-related obesity. Prepubertal and postpubertal glycemic control appear to be of importance for the diabetes-associated relative growth deficit.
Risk of Hypoglycemia in Users of Human Insulin: The Wisconsin Epidemiologic Study of Diabetic Retinopathy
Authors: Klein Barbara E K , Klein Ronald , Moss Scot E
Published: March 2007

OBJECTIVE

To evaluate whether there has been a change in frequency of hypoglycemic reactions associated with use of insulin of animal or human type.

RESEARCH DESIGN AND METHODS

Data are from a longitudinal population-based study of people with diabetes onset before 30 years of age who were receiving primary care in an 11-county area of south central Wisconsin in 1980. Interviews of study participants were conducted regarding occurrence of hypoglycemic reactions and the frequency, dose, and type of insulin used. At the 4-year follow-up, 727 of the 765 subjects were using only animal insulin and 33 were using human insulin; by the 10-year follow-up, 352 were using animal insulin and 388 were using human insulin.

RESULTS

Those using animal insulin reported fewer hypoglycemic reactions than did users of human insulin (X12 = 4.66, P = 0.03). Those who changed insulin type between visits were no more likely to report more hypoglycemic reactions during the year before the visit than those who remained on the same type at the two examinations (X24 = 3.37, P = 0.50). At the 10-year exam, users of human insulin were more likely to be taking multiple doses of insulin (86.6%) than were users of animal insulin (73.9%; P < 0.0001). In multiple logistic regression, the following variables were significantly related to the frequency of hypoglycemic reactions at the 10-year visit: body mass index (lower), glycosylated hemoglobin (lower), and being female.

CONCLUSIONS

In this population, level of glycemia is related to the frequency of hypoglycemic reactions. While type of insulin (human vs. animal) may be related to glycemia, it appears to have little independent effect on the frequency of reactions.
Diabetic Ketoacidosis Charges Relative to Medical Charges of Adult Patients With Type I Diabetes
Authors: Javor Kimberly A , Kotsanos James G , McDonald Robert C , Baron Alain D , Kesterson Joseph G , Tierney William M
Published: March 2007

OBJECTIVE

To determine the medical charges for treating diabetic ketoacidosis (DKA) episodes relative to direct medical care charges of adult patients with type I diabetes.

RESEARCH DESIGN AND METHODS

Using data from an electronic medical record system, we identified adult patients with type I diabetes who had received inpatient or outpatient care on at least two occasions between 1 January 1993 and 30 June 1994. Resources and charges for hospitalizations, emergency room visits, outpatient visits, and pharmaceuticals were recorded during this period. One additional year of information was collected to assess the resources and charges associated with multiple DKA episodes.

RESULTS

A total of 200 patients were identified, of whom 72 (36.0%) experienced a total of 161 DKA episodes. The direct medical care charges associated with DKA episodes represented 28.1% of the direct medical care charges for the cohort of patients with type I diabetes. The average charge per DKA episode was $6,444. The estimated annual medical care charge for each patient was $7,855 ($13,096 per patient experiencing a DKA episode versus $4,907 per patient not experiencing an episode). Multiple DKA episodes were experienced by 24 (12.0%) of the study patients and accounted for 55.6% of the direct medical care charges for these patients.

CONCLUSIONS

DKA episodes represented more than $1 of every $4 spent on direct medical care for adult patients with type I diabetes and $1 of every $2 in those patients experiencing multiple episodes. Interventions that are capable of even a modest reduction in the number of DKA episodes could produce substantial cost savings in a health care system and could be particularly cost-effective in adult patients with recurrent DKA.
Effect of Chronic Quinapril Administration on Heart Rate Variability in Patients With Diabetic Autonomic Neuropathy
Authors: Kontopoulos Athanasios G , Athyros Vasilios G , Didangelos Trianiaffilos P , Papageorgiou Athanasios A , Avramidis Michael J , Mayroudi Melahrini C , Karamitsos Dimitrios T
Published: March 2007

OBJECTIVE

Heart rate variability (HRV) time and frequency domain indexes are strong predictors of malignant arrhythmias and sudden cardiac death. Patients with diabetic autonomic neuropathy (DAN) have an increased cardiovascular mortality rate compared with diabetic patients without DAN.

RESEARCH DESIGN AND METHODS

The present double-blind, randomized, and placebo-controlled study analyzed the effect of quinapril, an ACE inhibitor, on HRV time and frequency domain variables in patients with DAN. Forty patients (17 men and 23 women) of a mean age of 51 (range 19–68) years, free of coronary artery disease and arterial hypertension, were randomized into a quinapril or placebo group. HRV was recorded at months 0, 3, and 6. The parameters measured were 1) time domain indexes: SD of all 24-h R-R intervals (intervals between consecutive electrocardiogram R waves), or SDNN/24-h; mean of SD of R-R intervals of all 5-min segements (SDNN/5-min); root-mean-square of the differences of successive R-R intervals (RMSSD); and percentage of the R-R intervals differing more than 50 ms (pNN50); and 2) frequency domain indexes: total power (TP), high-frequency power (HFP), low-frequency power (LFP), and very-low-frequency power (VLFP). HRV level of the 40 patients were compared with one of 20 matched diabetic patients, of analogous glycemic control without DAN, and 20 healthy control subjects.

RESULTS

Quinapril, compared with placebo, increased total HRV: SDNN/24-h (P < 0.05), TP (P < 0.05), and HRV parameters related to parasympathetic activity: pNN50 (P < 0.01). RMSSD (P < 0.05), and HFP in absolute and normalized units (P < 0.01). LFP/HFP ratio was decreased (P < 0.01). Despite the beneficial effect of quinapril on parasympathetic variables of HRV these remained < those of diabetic patients without DAN and healthy control subjects.

CONCLUSIONS

Our findings suggest that quinapril significantly increases parasympathetic activity in patients with DAN 3 months after treatment initiation and sustains this effect until the 6th month. This might contribute to the reduction of the risk for malignant ventricular arrhythmias in these patients.
Effects of Treatment With the Antioxidant α-Lipoic Acid on Cardiac Autonomic Neuropathy in NIDDM Patients: A 4-month randomized controlled multicenter trial (DEKAN Study)
Authors: Ziegler Dan , Schatz Helmut , Conrad Frank , Gries F Arnold , Ulrich Heinz ,   The DEKAN Study Group, Reichel Gerhard
Published: March 2007

OBJECTIVE

To evaluate the efficacy and safety of oral treatment with the antioxidant alpha-lipoic acid (ALA) in NIDDM patients with cardiac autonomic neuropathy (CAN), assessed by heart rate variability (HRV).

RESEARCH DESIGN AND METHODS

In a randomized, double-blind placebo-controlled multicenter trial (Deutsche Kardiale Autonome Neuropathie [DEKAN] Study), NIDDM patients with reduced HRV were randomly assigned to treatment with daily oral dose of 800 mg ALA (n = 39) or placebo (n = 34) for 4 months. Parameters of HRV at rest included the coefficient of variation (CV), root mean square successive difference (RMSSD), and spectral power in the low-frequency (LF; 0.05–0.15 Hz) and high-frequency (HF; 0.15–0.5 Hz) bands. In addition, cardiovascular autonomic symptoms were assessed.

RESULTS

Seventeen patients dropped out of the study (ALA n = 10; placebo n = 7). Mean blood pressure and HbA1 levels did not differ between the groups at baseline and during the study, but heart rate at baseline was higher in the group treated with ALA (P < 0.05). RMSSD increased from baseline to 4 months by 1.5 ms (−37.6 to 77.1) [median (minimum-maximum)] in the group given ALA and decreased by −0.1 ms (−19.2 to 32.8) in the placebo group (P < 0.05 for ALA vs. placebo). Power spectrum in the LF band increased by 0.06 bpm2 (−0.09 to 0.62) in ALA, whereas it declined by −0.01 bpm2 (−0.48 to 1.86) in placebo (P < 0.05 for ALA vs. placebo). Furthermore, there was a trend toward a favorable effect of ALA versus placebo for the CV and HF band power spectrum (P = 0.097 and P = 0.094 for ALA vs. placebo). The changes in cardiovascular autonomic symptoms did not differ significantly between the groups during the period studied. No differences between the groups were noted regarding the rates of adverse events.

CONCLUSIONS

These findings suggest that treatment with ALA using a well-tolerated oral dose of 800 mg/day for 4 months may slightly improve CAN in NIDDM patients.
Granulocyte Function in Women With Diabetes and Asymptomatic Bacteriuria
Authors: Balasoiu Daniela , van Kessel Kok C , van Kats-Renaud Hennie J , Collet Theo J , Hoepelman Andy I
Published: March 2007

OBJECTIVE

To study whether diabetic women with asymptomatic bacteriuria have impaired granulocyte function and compare them with nonbacteriuric diabetic women.

RESEARCH DESIGN AND METHODS

A prevalence study with granulocyte function testing in a randomly selected number of patients was conducted; the setting was the university. The patients consisted of 63 women visiting the outpatient clinic for routine control of their diabetes. Measurements of routine blood controls and urine cultures were conducted in all patients. Granulocyte function testing (chemotaxis, opsonization, oxidative burst, phagocytosis, and killing) was performed in the first 20 patients (10 with and 10 without asymptomatic bacteriuria) and in 7 healthy control subjects.

RESULTS

The prevalence of bacteriuria was 32%. Demographic characteristics were not significantly different between bacteriuric and nonbacteriuric women. Leukocytes were found more often in the urine of bacteriuric women (P < 0.05). No differences in any of the granulocyte function tests were documented among diabetic women with true asymptomatic bacteriuria, nonbacteriuric women, and healthy control subjects.

CONCLUSIONS

The prevalence of asymptomatic bacteriuria is increased in women with diabetes. Granulocyte function impairment, however, cannot be the explanation for this finding.
Body Iron Stores Are Associated With Serum Insulin and Blood Glucose Concentrations: Population study in 1,013 eastern Finnish men
Authors: Tuomainen Tomi-Pekka , Nyyssönen Kristiina , Salonen Riitita , Tervahauta Arja , Korpela Heikki , Lakka Timo , Kaplan George A , Salonen Jukka T
Published: March 2007

OBJECTIVE

To study if there is an association between mildly elevated body iron and glucose homeostasis indexes.

RESEARCH DESIGN AND METHODS

A cross-sectional population study was conducted in 1,013 middle-aged men, and an association of serum ferritin with concentrations of serum insulin, blood glucose, and serum fructosamine was tested.

RESULTS

The mean concentration of fasting serum insulin was 21.6% higher (95% CI 7.3–37.9%, P < 0.001) in the 5th quintile of serum ferritin compared with the 1st quintile. The elevation in blood glucose was 6.1% (95% CI 2.3–9.9%, P < 0.001) and in serum fructosamine 3.9% (1.5–6.9%, P < 0.01).

CONCLUSIONS

Mildly elevated body iron stores are associated with statistically significant elevations in glucose homeostasis indexes.
Noninvasive Blood Glucose Monitoring
Authors: Klonoff David C
Published: March 2007

The concentration of glucose in the blood may soon be measured noninvasively, without puncturing the finger to obtain a drop of blood. Current prototype devices for this purpose require greater accuracy and miniaturization to be commercially viable. No such device has been approved for marketing by the U.S. Food and Drug Administration. The technology used for noninvasive blood glucose monitoring involves either radiation or fluid extraction. With radiation technology, an energy beam is 1) applied to the body, 2) modified proportionate to the concentration of glucose in the blood, and 3) measured. The blood glucose concentration is then calculated. With fluid extraction technology, a body fluid containing glucose in a concentration proportionate to the blood glucose concentration is extracted and measured. The blood glucose concentration is then calculated. The most promising technologies are 1) near-infrared light spectroscopy, 2) far-infrared radiation spectroscopy, 3) radio wave impedance, 4) optical rotation of polarized light, 5) fluid extraction from skin, and 6) interstitial fluid harvesting. Each method has features predictive of commercial viability, as well as technical problems to overcome.
The Treatment of Type II Diabetes in Texas: Current issues for managed care and employers
Authors: Davidson Jaime A
Published: March 2007

In 1995, a forum was held in Dallas, Texas, to discuss the current state of treatment for type II diabetes and the issues facing managed care organizations (MCOs) and employers. Attendees included representatives from the American Diabetes Association (ADA), diabetologists, medical directors from leading MCOs in the area, benefits managers and employee representatives from large corporations in the region, diabetes educators, and a range of health care personnel directly involved in the care and treatment of patients with type II diabetes. The objectives of the forum were to discuss the state of diabetes treatment from the perspectives of MCOs and employers, to create a better understanding of the issues in treating diabetic patients, and to reach a consensus on the standards of care and the treatment guidelines for managed care patients with diabetes. Several needs were agreed on and identified by the attendees, including the need to develop minimum standards of care for the management of diabetes care, to improve patient and physician education programs and the communication between MCOs and employers, to acquire more sophisticated outcomes data, to pursue aggressive treatment of hyperglycemia, to increase emphasis on managing care to achieve long-term cost savings, and to stress greater patient responsibility for their own care.
The Glycemic Index: Flogging a Dead Horse?
Authors: Wolever Thomas M S
Published: March 2007

The glycemic index (GI) is a classification of foods based on their blood glucose-raising potential. The American Diabetes Association (ADA) has questioned the clinical utility of the GI and recommends that priority should be given to the amount rather than the source of carbohydrate. Some have interpreted this to mean that all carbohydrates have a nearly equal impact on blood sugar, and some feel that the GI is now a dead issue. Nevertheless, the reasons for questioning the clinical utility of the GI are unfounded because of the following: 1) they are based on studies of single test meals, which provide insufficient evidence on which to base dietary recommendations; 2) they are based on a faulty interpretation of the studies actually cited as evidence; 3) they take no account of better designed studies showing that the GI does apply in mixed meals; and 4) they take no account of studies showing that a low-GI diet improves overall blood glucose control in persons with diabetes. The GI is a valid and potentially useful concept, but is also deceptively complex. There are a number of unresolved problems and unanswered questions, and the appropriate place for the GI in patient education is not known. However, progress cannot be made without balance and objectivity.
Is the Quality of Diabetes Care Better in a Diabetes Clinic or in a General Medicine Clinic?
Authors: Ho Marion , Marger Michael , Beart Jenna , Yip Ian , Shekelle Paul
Published: March 2007

OBJECTIVE

To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center.

RESEARCH DESIGN AND METHODS

This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria. A total of 112 patients with diabetes were randomly selected, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were examined: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quality, defined as a blood pressure measurement, a record of type of hypoglycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit.

RESULTS

The diabetes clinic performed significantly better than the general medicine clinic on the following criteria: a record of a patient's self-monitoring of blood glucose levels; a foot examination; a comprehensive eye examination; a glycated hemoglobin measurement; and a referral for diabetic education. The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic (73 vs. 52%, P = 0.02).

CONCLUSIONS

Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attention needs to be paid to ensure that generalists have the knowledge and system resources necessary to deliver an acceptable quality of diabetes care.
Sulfonylurea Treatment Prevents Recurrence of Hyperglycemia in Obese African-American Patients With a History of Hyperglycemic Crises
Authors: Umpierrez Guillermo E , Clark W Scott , Steen Mark T
Published: March 2007

OBJECTIVE

Many newly diagnosed obese African-American patients with history of severe hyperglycemia or diabetic ketoacidosis (DKA) are able to discontinue pharmacological treatment with continued good metabolic control. However, many of these individuals relapse into hyperglycemia within 1 year. In such patients, we compared the effect of low-dose sulfonylurea and dietary therapy in the prevention of recurrence of hyperglycemia.

RESEARCH DESIGN AND METHODS

We conducted an intention-to-treat study in 35 obese newly diagnosed diabetic patients (17 with DKA and 18 with severe hyperglycemia). After discontinuation of insulin, seven of 17 patients with DKA and seven of 18 patients with hyperglycemia were managed with diet and glyburide (1.25–2.5 mg/day), whereas other patients were followed with diet alone. In all patients, pancreatic insulin reserve was documented 1 day after resolution of hyperglycemic crises and within 1 week of discontinuation of insulin. Recurrence of hyperglycemia was defined as fasting blood glucose > 7.8 mmol/l (140 mg/dl) or random blood glucose > 10 mmol/l (180 mg/dl) on two or more consecutive determinations, or HbA1c > 7.5%.

RESULTS

Both treatment groups were comparable in age, sex, duration of diabetes, months of insulin therapy, BMI, glucose, and HbA1c. At presentation, the acute C-peptide response to glucagon in obese DKA patients was lower than in patients with hyperglycemia (P < 0.01), but responses were comparable after discontinuation of insulin. Sulfonylurea treatment significantly reduced recurrence of hyperglycemia in both obese DKA and obese hyperglycemic patients (P = 0.03). With a median follow-up of 16 months, hyperglycemia recurred in six of 10 DKA patients and in five of 11 hyperglycemia patients treated with diet alone, compared with one of seven DKA and one of seven hyperglycemia patients treated with glyburide. Readmission with metabolic decompensation occurred in four patients treated with diet but in none of the patients treated with diet and glyburide.

CONCLUSIONS

Low-dose sulfonylurea therapy prevents recurrence of hyperglycemia in newly diagnosed obese African-American patients with a history of hyperglycemic crises.
Unchanged Insulin Absorption After 4 Days' Use of Subcutaneous Indwelling Catheters for Insulin Injections
Authors: Hanas S Ragnar , Carlsson Sten , Frid Anders , Ludvigsson Johnny
Published: March 2007

OBJECTIVE

Since 1985, we have used indwelling catheters (Insuflon, Maersk Medical, Lynge, Denmark; Chronimed, Minnetonka, MN) to lessen pain when injecting insulin. However, some patients experience a rise in blood glucose after using indwelling catheters for a few days. We therefore studied the absorption of 125I-labeled insulin when using indwelling catheters.

RESEARCH DESIGN AND METHODS

Five men and five women participated (age 18–25 years, C-peptide negative, HbA1c 9.0 ± 1.0% [mean ± SD, DCA-2000 method], diabetes duration 5–21 [median 9.5] years). After thyroid blockage with potassium iodide, we injected 5IU of 125I-labeled short-acting insulin subcutaneously in the abdomen (“ordinary injection”) and 5 IU on the contralateral side through an indwelling catheter (“catheter injection”). The injection/insertion area was free of lipohyper- and lipohypotrophies. Disappearance rate was measured for 180 min with a gamma camera. The patients injected all premeal injections of short-acting insulin through the same indwelling catheter in the following 4 days. The investigation procedure was repeated day 3 and 5.

RESULTS

We found no statistically or clinically (95% CI) significant difference in residual activity of 125I-insulin after 60 min or in time for 50% of the injected depot to disappear (T-50%) among catheter injections on day 1, 3, and 5; ordinary injections on days 1, 3, and 5; or catheter and ordinary injections on days 1, 3, and 5, respectively. HbA1c correlated both to T-50% (r = 0.73, P = 0.016) and residual activity of 125I-insulin after 60 min (r = 0.69, P = 0.028), indicating that patients with a slower absorption will have a less ideal metabolic control when using premeal bolus injections.

CONCLUSIONS

We conclude that using indwelling subcutaneous catheters for insulin injections for up to 4 days does not affect the absorption of short-acting insulin.
An Intervention for Enhancing Compliance With Screening Recommendations for Diabetic Retinopathy: A bicoastal experience
Authors: Legorreta Antonio P , Hasan Malik M , Peters Anne L , Pelletier Kenneth R , Leung Kwan-Moon
Published: March 2007

OBJECTIVE

To determine whether an intervention at both the provider and patient level can increase the utilization of diabetic retinal examination among diabetic patients and to compare the results from a comparable study conducted on the East Coast.

RESEARCH DESIGN AND METHODS

For the regional intervention study, all diabetic patients 18 years or older who enrolled in a large network-based health maintenance organization (HMO) in California were identified (n = 19,397). The identified diabetic patients received educational materials and a notification of their prior diabetic retinal examination status. Also, their primary care physicians received the current American Diabetes Association (ADA) guidelines for dilated retinal examinations and a list of patients due for diabetic retinal examination.

RESULTS

There were 25 and 27% increases in the percentage of diabetic patients who received diabetic retinal examinations in 1995 compared with the percentages in 1993 and 1994, respectively. The increase in diabetic retinal examinations was most significant after the intervention (odds ratio = 1.4). Furthermore, the improvements in compliance after the intervention were almost identical between the studies implemented on the East and West Coasts.

CONCLUSIONS

This study and the prior study demonstrate that such a “reminder” intervention can improve compliance with diabetic retinal screening recommendations. A generalizable intervention, such as this, may be applicable on a national level. For these programs to be successful, however, HMOs and physicians must have a collaborative relationship.