bluuebunny/crossref_metadata_2025 huggingface dataset:
Diet Therapy of Diabetes: Description of a Successful Methodologic Approach to Gaining Diet Adherence
Authors: Weinsier Roland L , Seeman Anne , Herrera M Guillermo , Simmons Jeanette J , Collins Mary E
Published: December 2014

A multifaceted educational program was designed to maximize dietary adherence of twenty-three diabetic subjects in order to study two experimental diets for forty weeks. The results of the program showed that a high level of diet adherence was achieved in spite of the strict dietary guidelines. The success of the educational approach was also reflected in the high attendance rate (99 per cent of 270 subject visits) and the low voluntary attrition rate (4 per cent).

Five aspects of the over-all design were felt to have been of major importance in gaining subject cooperation: (1) the small, grouporiented learning process; (2) frequent intervals of follow-up; (3) feedback on laboratory data; (4) individualization of diet prescriptions; and (5) family involvement.

Since the majority of diabetics seen in medical clinics fail to follow their prescribed diets, the concepts and approach applied to this study may be applicable to the dietary management of diabetic patients. Such implications and specific recommendations are presented in this report.
“Staircase” Glucose Stimulation of Insulin Secretion in Obesity: Measure of Beta-cell Sensitivity and Capacity
Authors: Karam John H , Grodsky Gerold M , Ching K-N , Schmid Florence , Burrill Karen , Forsham Peter H
Published: December 2014

A special glucose infusion test was used to provide successive steplike increments of glucose stimulation in six normal-weight and seven obese subjects. This “staircase” method of glucose infusion demonstrates that insulin responds in “spike” fashion despite maintenance of a continuous, fixed, submaximal glucose stimulation. Further, the “spike” response recurs as the glucose concentration is stepped up.

Obese subjects showed an exaggeration of both the first phase “spike” pattern and the more gradual second phase of insulin release. Mathematical analysis of early phase insulin release indicates that obese persons have greater total amounts of insulin available for release at all glucose concentrations than do normals, yet the proportion of totally available insulin released to a given glucose stimulus is not increased in obesity.

These findings imply that the early phase, hyperinsulin response to glucose in obesity is due to a greater quantity of insulin available for release rather than to an increased sensitivity of the beta cell to glucose.
Diabetes in Pregnancy Panel Discussion
Authors: Duncan Garfield G , Davis M Edward , Taylor E Stewart , Palmer Lester J , White Priscilla
Published: December 2014

Moderator Duncan: I should like to begin by asking Dr. Palmer to say a few words about the importance of the prepregnancy examination of the diabetic woman.

Dr. Palmer: I have always felt that the diabetic woman in the childbearing age should not become pregnant by accident. I believe that we can gain that objective by proper education of these women as they learn more and more about the diabetic life. From the professional standpoint, there are definitely some diabetic women who should not become pregnant. If diabetic women do become pregnant, when pregnancy is contraindicated, then we are faced with the problem of deciding on therapeutic abortion or possibly, against our better judgment, being forced to permit the pregnancy to go on with the frequent result of a miscarriage or premature stillbirth. Further damage to the diabetes without accomplishing the desired results of a pregnancy may, and often does, occur. Therefore, we try to teach diabetic women that they should electhely become pregnant; that they should use contraception until such time as they have consulted their doctors and found they are physically fit to become pregnant.
Specific Enzymatic Determination of Glucose in Blood and Urine Using Glucose Oxidase
Authors: Froesch E Rudolf , Renold Albert E , McWilliams B
Published: December 2014

Adequate methods for the determination of glucose in biologic fluids based upon its reducing ability are well established. These methods, however, lack specificity since they will detect reducing substances other than glucose. Improved specificity has resulted from procedures designed to remove interfering reducing substances. These measures have been applied most successfully to blood and plasma.

The procedure for the precipitation of proteins introduced by Somogyi eliminates the great majority of interfering reducing substances likely to be present in blood, such as proteins, amino acids, glutathione, phosphorylated hexoses, and others. This, however, does not make it possible to distinguish glucose from other hexoses (such as fructose or galactose) or from pentoses and from such substances as glyceraldehyde. For fluids such as urine where many of the interfering reducing substances cannot be removed by available technics the need for a specific determination is obvious. Fermentation, formation of osazones, and chromatography have proved their usefulness, but being rather cumbersome and difficult to quantitate, have not found access to routine laboratories.

Muller in 1928 and Coulthard and co-workers in 1942 isolated an enzyme from Aspergillus nlger and Penicillum notatum which had the unique property of specifically catalyzing the conversion of beta-glucose to gluconic acid. This enzyme, which was given the name of glucose oxidase, has been studied extensively by Bentley and Neuberger5 and by Keilin and Hartree. Glucose oxidase was shown to be a flavoprotcin with a molecular weight of 152,000 and an alloxazine-adenine dinucleotide as a prosthetic group.
What I Teach My Diabetic Patients: Panel Discussion
Authors: White Priscilla , Gates Edwin W , Holcomb Blair , Guest George M , Joslin Elliott P , Rippy Edwin L
Published: December 2014

Moderator Priscilla White: It is obvious that, without new therapeutic discoveries, the better prognosis for the diabetic patient today depends upon his greater self-knowledge of this disorder. Therefore, the subject of our panel concerns the teaching of diabetic patients.

The panel members, coming as they do from all sections of the country, should give us the teaching goals of the entire United States. Their qualifications are well known to this audience. The teaching experience of this panel exceeds two centuries. From these experts, we should learn the subjects and the technics which they have found to be successful in maintaining their diabetic patients in the most nearly normal state. Beginning with our problems, as we meet them in the patients, let us question our panel.

Dr. Rippy, how do you indoctrinate the new diabetic, especially the adult, shocked with the diagnosis of a chronic disorder?
The Lente Insulins
Authors: Hallas-Mø K
Published: December 2014

The results of chemical, biologic, and clinical studies of the interaction between insulin and zinc were published in 1951 and 1952 by K. Hallas-Møller, P. M. Jersild, K. Petersen, and J. Schlichtkrull. It was reported that insulin is insoluble at blood pH in the presence of zinc ions, since at this pH a slowly soluble and slowly resorbable insulin-zinc compound is formed. The degree of retardation of an insulin-zinc suspension is governed first and foremost by the physical state of the suspended insulin. As seen in figure I, a suspension of the amorphous modification, Semilente, has a somewhat longer action than ordinary insulin, whereas the crystalline modification, Ultralente, may be compared to protamine-zinc insulin.
Preliminary Studies on the Demonstration of Insulin in the Islets by the Fluorescent Antibody Technic
Authors: Lacy Paul E , Davies Jack
Published: December 2014

Since Moloney and Coval1 have demonstrated that antibodies to insulin can be produced in the guinea pig, it seemed feasible that these antibodies could be labeled with fluorescein isocyanate by the method of Coons and Kaplan2 and used as an immunochemical stain for insulin. The results obtained from the application of these labeled antibodies to frozen sections of pancreas are reported in this paper.
Diabetes in the Pediatric Literature
Authors: RosenBloom Arlan L
Published: December 2014

Mini-Reviews will be a regular feature of DIABETES CARE. In the last issue, the first of these recurring reviews examined the literature on Psychosocial Issues in Diabetes. This issue the subject is Diabetes in the Pediatric Literature. The format of the Mini-Reviews is the presentation of abstracts of selected articles, with commentary on the topics raised by these articles. Dr. Arlan Rosenbloom will also be responsible for subsequent reviews of the pediatric literature. In order to provide a broad spectrum of commentary, the Editor will also ask other experts to comment on the articles. This month's guest commentator is Dr. Richard A. Guthrie.
Transient Cataracts and Hyperosmolar Coma in a Pediatric Patient
Authors: Hunt Stephen C , Snow Patrick
Published: December 2014

Hyperosmolar coma heralding diabetes mellitus has been reported in at least a dozen pediatric patients1–6 since initial recognition of the phenomenon in 1957.7 We recently treated a child with this entity. The patient developed transient cataracts during the acute episode. He demonstrated a favorable clinical response in the face of profound laboratory and clinical abnormalities, with complete resolution of the cataracts. Few cases of evanescent cataracts have been reported in children with diabetic ketoacidosis.8 To our knowledge this is the first report of this finding in a patient with hyperosmolar coma.
Comparison of Pharmacokinetics, Metabolic Effects and Mechanisms of Action of Glyburide and Glipizide During Long-Term Treatment
Authors: Groop Leif , Groop Per-Henrik , Stenman Svante , Saloranta Carola , Tötterman Karl-Johan , Fyhrquist Frej , Melander Arne
Published: December 2014

Fourteen non-insulin-dependent diabetic (NIDDM) patients continued their previous medication (7 on glyburide, 7 on glipizide) for 6 mo, after which they switched to the alternate treatment for another 6 mo. The treatment periods were followed by 1 mo of placebo. The sulfonylurea dose was increased to achieve fasting plasma glucose levels <9 mM or to a total maximum daily dose of 25 mg. The mean final doses of glyburide (14.7 ± 2.4 mg/day) and glipizide (15.2 ± 2.2 mg/day) were similar. Postprandial (postdose) glipizide levels were higher than those of glyburide, whereas fasting (predose) glyburide concentrations were higher than those of glipizide. Both treatments improved glucose controlby 25% compared with placebo. Glipizide therapy evoked higher postprandial insulin concentrations than did glyburide, whereas basal insulin concentrations were higher during glyburide. Insulin sensitivity, assessed by an insulin tolerance test, was more improved with glyburide than with glipizide. In conclusion, overall glucose control is similarly improved by glyburide and glipizide. However, glipizide amplifies the plasma insulin response to meals more than glyburide, whereas glyburide enhances basal insulin secretion more than glipizide. Both pharmacokinetic and pharmacodynamic factors may contribute to these differences.
Stress and Autonomic Nervous System in Type II Diabetes: A Hypothesis
Authors: Surwit Richard S , Feinglos Mark N
Published: December 2014

Many investigators have begun to speculate that the sympathetic nervous system is involved in the pathophysiology of type II (noninsulin-dependent) diabetes mellitus (1–4). Recalling the early observations of Claude Bernard, who found that hyperglycemia could be produced in normal rabbits by lesioning the area of the hypothalamus, several groups have noted that hyperglycemia can be produced by chemical stimulation of the brain with morphine as well as with a variety of endogenous neuropeptides and can be abolished by bilateral adrenalectomy (1,5). Similarly, hyperglycemia has been shown to result from slow intravenous infusion of epinephrine (6) as well as from certain forms of stress that produce prolonged sympathetic discharge (7).
Endocrinology An Endangered Species
Authors: Kreisberg Robert A
Published: December 2014

Endocrinology and metabolism, once a chosen subspecialty, has fallen on hard times. To understand the difficulties that confront this traditional subspecialty of internal medicine, its problems must also be viewed in the context of the overall problems facing internal medicine. There is considerable concern over the lack of interest among medical students for careers in internal medicine, and within internal medicine, and the lack of interest among residents for careers as subspecialists in endocrinology and metabolism and other noninvasive specialties. In the past, the best and the brightest of the senior medical students selected internal medicine for their graduate medical education. Although program directors of the most sought-after programs may not have noticed, most other program directors have observed a dramatic decline in the academic credentials of those students applying for residency positions in internal medicine.
Diabetics Need Not Apply
Authors: Fisher Joseph N
Published: December 2014

As the end of the twentieth century draws near, we can look back with some satisfaction at the progress that has been made in combating discrimination on many fronts and applaud the laws—national, state and local— that have attempted to ensure fair employment practices. For example, it is worth remembering that before 1941, no one with diabetes was eligible for any federal employment, and until 1985, if you took >25 U insulin/ day, you were ineligible for any hazardous federal job, regardless of how well controlled your diabetes might be. Although such blatant and irrational discrimination against people with diabetes has been eliminated, more subtle societal barriers to employment still exist.
Diabetes, Atherosclerosis, and Aging
Authors: Stout Robert W
Published: December 2014

There is a close and intimate relationship between advancing age, diabetes, and atherosclerosis. Atherosclerosis and its complications in the heart, brain, and lower limbs become more common with advancing age. Diabetes, especially non-insulin-dependent diabetes mellitus, also becomes increasingly prevalent with advancing age and predisposes to premature and accelerated atherosclerosis. Both aging and diabetes are associated with hyperglycemia, hyperinsulinemia, insulin resistance, and hypertension, and these four abnormalities are related to each other and, both individually and in combination, with atherosclerosis. Abnormal lipid levels are less consistently related to age but are found in both diabetes and atherosclerosis. There have been few studies of the effect of reducing cardiovascular risk factors in elderly people, but it is reasonable to advise regular physical activity and avoidance of obesity and cigarette smoking.
Community-Based Study of Prevalence of NIDDM in Older Adults
Authors: Wingard Deborah L , Sinsheimer Peter , Barrett-Connor Elizabeth L , McPhillips Janice B
Published: December 2014

Prevalence rates of non-insulin-dependent diabetes mellitus (NIDDM) based on an oral glucose tolerance test, history, and medication use were evaluated in an upper-middle-class community of older White adults in southern California between 1984 and 1987. By World Health Organization (WHO) criteria, 14.7% of the 997 men and 11.3% of the 1243 women 50–89 yr of age had NIDDM. Of those classified as having diabetes by WHO criteria, 55.8% of the men and 73.8% of the women met the criteria solely by their postchallenge glucose (PCG) levels. Prevalence rates of diabetes were substantially lower when based on fasting hyperglycemia (5.0% of men and 2.2% of women) or a history of diabetes (5.7% of men and 3.1% of women). When all criteria were considered, 16.5% of the men and 12.7% of the women had NIDDM, and 89.2% of those classified as having diabetes by any criteria met the WHO criteria for diabetes. Prevalence of NIDDM based on WHO criteria or PCG level alone increased systematically with age (P < 0.001), and at each decade for every criterion the prevalence of NIDDM was more common among men than women. By these criteria, NIDDM is one of the most common chronic diseases associated with aging.
Use of Sulfonylurea Drugs in Elderly Patients
Authors: Halter Jeffrey B , Morrow Linda A
Published: December 2014

Sulfonylureas are used widely to treat hyperglycemia in elderly non-insulin-dependent diabetes mellitus (NIDDM) patients. Because this patient population is growing rapidly, it is likely that use of these agents will continue to increase. There is a considerable knowledge base regarding the clinical pharmacology, mechanism of action, and adverse side effects of these agents and >30 yr of clinical experience with their use. However, there is little specific information about these drugs in patients >65 yr of age and virtually no information about use of these drugs in people >85 yr of age. The effectiveness of sulfonylureas to lower glucose levels, the simplicity of dosing regimens, and their relative safety are all advantages for their use in an elderly NIDDM population. Disadvantages of these agents include the relatively low likelihood of achieving euglycemia, the risk of hypoglycemia, and a number of negative interactions with other drugs. In common with all other modalities used to treat hyperglycemia, of most concern is the lack of established benefit of these drugs to reduce the risk of long-term complications of diabetes mellitus. There is clearly a need for more information about the benefits and risks of the use of sulfonylureas in an elderly diabetic patient population.
Sulfonylureas Why, Which, and How?
Authors: Melander Arne , Lebovitz Harold E , Faber Ole K
Published: December 2014

Although controversies remain as to the usefulness of sulfonylureas, most evidence is in favor of their use in many if not most patients with non-insulin-dependent diabetes mellitus. When used properly, sulfonylureas improve insulin secretion and action, and these effects may be maintained for years. If combined with hypocaloric dietary regulation, rapid- and short-acting sulfonylureas may help patients reach and maintain euglycemia without provoking chronic hyperinsulinemia or weight increase. There is no evidence that sulfonylurea treatment causes β-cell exhaustion; instead, the antihyperglycemic effect helps improve β-cell function. Sulfonylurea “failures” are often dietary failures or may be due to late introduction of these drugs, i.e., when β-cell function is already attenuated. Desensitization of the insulinotropic effect of sulfonylureas may occur but might be avoided by discontinuous (<24 h/day) sulfonylurea exposure, i.e., once-daily administration of a short-acting sulfonylurea in a moderate dose. The most important adverse effect of sulfonylureas is long-lasting hypoglycemia, which may lead to permanent neurological damage and even death. This is mainly seen in elderly subjects who are exposed to some intercurrent event, e.g., acute energy deprivation or a drug interaction, i.e., aspirin. Longacting sulfonylureas may be more likely to promote long-lasting hypoglycemia. The dose-response relationships of sulfonylureas have been poorly investigated, and sulfonylurea therapy should always be initiated and maintained at the lowest possible dose.
Characterization and Significance of Sulfonylurea Receptors
Authors: Siconolfi-Baez Linda , Banerji Mary Ann , Lebovitz Harold E
Published: December 2014

This study describes and characterizes a putative sulfonylurea receptor. The radioligand used was [3H]glipizide (9 Ci/mmol). The β-cell plasma membranes were derived from a transplantable rat insulinoma generated by subcutaneous injection of RINm5F cells and purified by ultracentrifugation on a 15–55% sucrose gradient. Specific binding of [3H]glipizide to purified β-cell plasma membranes was determined to be maximal at temperatures of 4–23°C, pH 7.3, and an incubation of 2 h. Scatchard analysis indicated a single binding site with Kd = 7 nM and sulfonylurea binding of 0.93 pmol/mg membrane protein. Displacement of [3H]glipizide from the purified β-cell plasma membranes by various sulfonylureas and their analogues correlated well with their known hypoglycemic and insulinreleasing activities. Various agents, including nutrients, agents affecting Ca2+ flux, gastrointestinal hormones, and pancreatic hormones, had no effect on [3H]glipizide binding to the β-cell plasma membranes. Putative sulfonylurea receptors on β-cell and brain cell plasma membranes have been reported by several groups of investigators. Sulfonylurea binding to the β-cell is hypothesized to close an ATP-sensitive K+ channel, which leads to depolarization of the membrane and activation of a voltage-dependent Ca2+ channel.
Acute Actions of Sulfonylurea Drugs During Long-Term Treatment of NIDDM
Authors: Faber Ole K , Beck-Nielsen H , Binder C , Butzer P , Damsgaard EM , Froland F , Hjollund E , Lindskov HO , Melander A , Pedersen O , Petersen P , Sorensen N Schwarts , Wåhlin-Boll E
Published: December 2014

The acute effect of sulfonylurea drugs during long-term treatment was evaluated in two separate studies. In the first study, the levels of plasma glucose, insulin, and C-peptide were measured after intake of 10 mg glyburide alone or together with a standardized mixed meal in 10 non-insulin-dependent diabetes mellitus (NIDDM) patients treated with 10–20 mg glyburide/day for >2 yr. There was no acute effect of glyburide on the insulin and C-peptide responses to the meal or during continued fasting, indicating the absence of an acute insulinotropic action of glyburide during chronic treatment. The glucose increase after the meal was also unchanged, but a significant glucose reduction was found after glyburide intake during continued fasting, suggesting a sustained acute extrapancreatic (hepatic) effect. In the second study, the diurnal glycemic excursions in 8 NIDDM patients chronically and continuously (24 h/day) exposed to glipizide (2.5–7.5 mg 3 times/day) were similar when the drug was taken 30 min before each of the three main meals and when taken immediately before the meals. It is concluded that there is no acute insulinotropic action of sulfonylurea drugs during chronic continuous exposure, whereas an acute extrapancreatic action may prevail. During such exposure, there seems to be no clinical benefit in taking a sulfonylurea 30 min before rather than at the start of a meal.
Effect of Acarbose on Carbohydrate and Lipid Metabolism in NIDDM Patients Poorly Controlled by Sulfonylureas
Authors: Reaven Gerald M , Lardinois Claude K , Greenfield Michael S , Schwartz Herbert C , Vreman Hendrick J
Published: December 2014

The ability of acarbose to lower plasma glucose concentration was studied in 12 patients with noninsulin-dependent diabetes mellitus (NIDDM) who were poorly controlled by diet plus sulfonylurea drugs. Patients were studied before and 3 mo after the addition of acarbose to their treatment program, and a significant improvement in glycemic control was noted. Although the decrease in fasting plasma glucose concentration was modest (12.0 ± 0.8 to 10.8 ± 0.3 mM), average postprandial plasma glucose concentration decreased by 3.4 mM. When acarbose therapy was discontinued in 5 patients, plasma glucose levels rapidly returned toward pretreatment levels. In addition to the improvement in glycemia, acarbose treatment also led to a significant reduction in HbA1c (7.4 ± 0.2 to 6.4 ± 0.2%, P < 0.01) and triglyceride (2.4 ± 0.1 to 2.1 ± 0.1 mM, P < 0.01) concentrations. Neither the plasma insulin response to meals nor insulin-stimulated glucose uptake improved with acarbose therapy, consistent with the view that acarbose improves glycemic control by delaying glucose absorption. Considerable individual variation was noted in the response to acarbose, and the results in 4 patients were dramatic, with striking reductions in both fasting and postprandial glucose concentrations. The addition of acarbose to patients with NIDDM not well controlled by sulfonylureas appears to have significant clinical benefit.
Mechanisms of Sulfonylurea-lnduced Insulin Release
Authors: Malaisse Willy J , Lebrun Philippe
Published: December 2014

The mechanisms responsible for the stimulation of insulin release from the pancreatic β-cell by hypoglycemic sulfonylureas are reviewed herein. One hypothesis postulates that these agents act, at the level of the plasma membrane, by causing the closure of a class of K+ channels characterized by their sensitivity to ATP. This may lead to depolarization of the plasma membrane, gating of voltage-sensitive Ca2+ channels, increase in cytosolic Ca2+ activity, and activation of the effector system for insulin release. However, it is not evident that the closure of ATP-sensitive K+ channels accounts for effects of sulfonylureas such as inhibition of K+ inflow into the islet cells, increase in their Na+ content, or even stimulation of Ca2+ inflow and insulin release at physiological or higher concentrations of Dglucose.
Kelly West Lecture 1991 Challenges in Diabetes Epidemiology—From West to the Rest
Authors: Zimmet Paul Z
Published: December 2014

The application of epidemiology to the study of non-insulin-dependent diabetes mellitus (NIDDM) is providing new insights into many aspects of this major public-health problem, including its natural history, prevalence, incidence, morbidity, and mortality in diverse populations around the globe. The main impetus came from the late Kelly West's book Epidemiology of Diabetes and its Vascular Lesions. These studies are providing direction for research into the possible moleculardefect or defects and biochemical mechanism or mechanisms underlying NIDDM and important information on the extrinsic (social, cultural, environmental) risk determinants. Studies have highlighted the importance of regional adipose tissue distribution, particularly upper-body obesity, and physical inactivity in enhancing risk of NIDDM. These findings have important implications for the primary prevention of NIDDM, particularly in populations with increased genetic susceptibility such as Polynesians, Micronesians, American and Asian Indians, Mexican Americans, and Australian aborigines.
Periodontal Disease: The sixth complication of diabetes mellitus
Authors: Löe Harald
Published: December 2014

Periodontal disease is a chronic inflammatory condition characterized by destruction of the periodontal tissues and resulting in loss of connective tissue attachment, loss of alveolar bone, and the formation of pathological pockets around the diseased teeth. Some level of periodontal disease has been found in most populations studied and is responsible for a substantial portion of the tooth loss in adulthood.
Diabetes and the World Health Organiiation: Progress towards prevention and control
Authors: King Hilary
Published: December 2014

Diabetes has a long history at WHO, and official relations were established between WHO and IDF as early as 1957. The WHO Expert Committee meeting on diabetes in 1979, and the first WHO Study Group on diabetes in 1985, each produced blue-book reports (1,2), which have become classics of the diabetes literature and for which demand continues to grow.
A Joint Venture With the Commonwealth of Independent States
Authors: Etzwiler Donnell , Bergenstal Richard , Mazze Roger , Franz Marion , Haig Broatch , Birk Randi , Neimann Diane , Henry William
Published: December 2014

One hesitates to comment on the frequent alterations occurring in the former Soviet Union (or disunion, as one Russian recently commented). Since Mr. Gorbachev first wrote of perestroika in 1987, the changes have been beyond imagination, and the future remains totally unpredictable.
Immunogenicity and Allergenic Potential of Animal and Human Insulins
Authors: Schernthaner Guntram
Published: December 2014

Immunological complications of insulin therapy have been evident since animal insulins became available for the treatment of diabetes mellitus in 1922. Insulin allergy has been particularly common, with local symptoms still occurring in ∼ 5% of all patients. Insulin antibodies of high titers were observed in many patients treated with early insulin preparations containing proinsulin, C-peptide, and other peptide contaminants. Immunoglobulin G-insulin antibodies of very high levels can lead to immune-mediated insulin resistance, which is now extremely rare because of the widespread use of highly purified porcine insulin and human insulin preparations. Lipoatrophy, which was reported in 10–55% of patients treated with nonpurified bovine/porcine insulin preparations, has almost disappeared in patients since the advent of exclusive human insulin treatment. In view of the wide spectrum of immune-mediated complications of insulin therapy, much attention has been directed to the reduced immunogenicity and allergenicity of highly purified porcine insulins and the more recently available recombinant and semisynthetic human insulin preparations. Insulin antibodies of the immunoglobulin G and immunoglobulin E type can develop, however, in very low titers in patients treated exclusively with human insulin. Frequency and levels of immunoglobulin G insulin antibodies are identical in patients treated either with biosynthetic or semisynthetic human insulin preparations. Allergic symptoms to human insulin are now found in < 1% of de novo-treated patients, but still may occur when human insulin is used in the insulin-allergic patient. In summary, immunological complications of insulin therapy have decreased significantly during the last two decades and are now predominantly observed in patients with interrupted insulin therapy.
Implications of the DCCT: Looking beyond tight control
Authors: Rubin Richard R , Peyrot Mark
Published: December 2014

The main conclusion of the recently completed, landmark Diabetes Control and Complications Trial (DCCT), i. e., the fact that tight control significantly reduces the risk of diabetes-related complications, has been widely acclaimed. This enthusiasm has been fueled in part by the magnitude of the advantage tight control seems to offer: the 2% difference in average HbA1c between the DCCT standard and intensive treatment groups was associated with a 60% reduction in risk for diabetic reti-nopathy, nephropathy, and neuropathy.
Nutrition Principles for the Management off Diabetes and Related Complications
Authors: Franz Marion J , Horton Edward S , Bantle John P , Beebe Christine A , Brunzell John D , Coulston Ann M , Henry Robert R , Hoogwerf Byron J , Stacpoole Peter W
Published: December 2014

Health professionals and people with diabetes recognize nutrition therapy as one of the most challenging aspects of diabetes care and education (1). Adherence to meal planning principles requires the person with diabetes to learn specific nutrition recommendations. It may require altering previous patterns of eating and implementing new eating behaviors, which requires motivation for a healthy lifestyle and may also require participation in exercise programs. Finally, individuals must be able to evaluate the effectiveness of these lifestyle changes. Despite these challenges, nutrition is an essential component of successful diabetes management.
Reimbursement for Diabetes Self-Care Training: The North Carolina experience
Authors: Fore William W
Published: December 2014

The Diabetes Control and Complications Trial (DCCT) results prove that in insulin-dependent diabetes mellitus (IDDM), the better the level of glucose control, the lower the prevalence of complications. The team approach to help these patients is revalidated. Reimbursement for these required services has improved, but varies widely from state to state. All parties involved face the problems of translating the results to a larger diabetic population and of confronting the very real issue of how the services required to care for the disease can be made affordable and available to this patient population. These problems are very similar to those presented by the publication of standards for patient education in 1980 and its revision in 1983 (1).
A Systematic Approach to Diabetes Management in the Post-DCCT Era
Authors: McCulloch David K , Glasgow Russell E , Hampson Sarah E , Wagner Ed
Published: December 2014

As with the discovery of a new wonder drug, the reporting of a major newclinical trial is usually followed by a three-step adjustment period in the collective attitudes of the health-care profession and the general public. There is initial euphoria that this is the answer, the panacea, i.e., the treatment for everyone. These feelings are followed by a rebound response of despondency that the side effects and problems with the new treatment are too serious and that the treatment is too costly and complex to make it useful at all. Finally, a rational place for the new discovery is found in medical practice.
Glomerular Hyperfiltration in Human Diabetes
Authors: Mogensen Carl Erik
Published: December 2014

The presence of the characteristic early glomerular hyperfiltration seenin diabetes was originally suggested long ago by Cambier (1), indeed a few years before the well-known studies by Kimmelstiel and Wilson (2) that documented the typical glomerular structural lesions in diabetic patients. Brenner (3,4), in his breakthrough glomerular hyperfiltration- hemodynamic theory, also used diabetes as an example and proposed that hyperfiltration was an important factor in the genesis of glomerular damage, and not only in the damage caused by diabetes. This means that the two classic findings (1,2) may well be closely connected, with the former causing the latter.
Teaching the Person with Diabetes: Experience with a Follow-up Session
Authors: Whitehouse Fred W , Whitehouse Iris J , Smith Joellen , Hohl Richard D
Published: December 2014

We studied 371 diabetic patients who attended an outpatient follow-up session after completing an in-patient diabetes education program. Identified gaps in information on diabetes care included problems with understanding the prescribed diet (155 patients), incorrect urine testing (30 patients), and unacceptable technics of insulin administration (26 patients). We also reviewed 178 consecutive patients who had been invited to this follow-up session to ascertain how often readmission to the hospital occurred. 88 of these patients attended a follow-up session while 90 patients did not attend. Over the ensuing 5 yr, the latter group had a significantly higher readmission rate (P < 0.01), yet readmissions for education-related reasons (ketoacidosis, foot infections, and hypoglycemia) were not significantly different. Even when diabetic patients have recently attended education sessions on living with diabetes, attendance at regular follow-up sessions is encouraged to reinforce learning and to identify persisting gaps in information.
Asymptomatic Hyperglycemia and Cardiovascular Diseases in Three Chicago Epidemiologic Studies
Authors: Stamler R , Stamler J , Dyer A , Cooper R , Collette P , Berkson D M , Lindberg H A , Stevens E , Schoenberger J A , Shekelle R B , Shekelle S , Paul O , Lepper M , Garside P , Tokich T , Hoeksema R
Published: December 2014

Three epidemiologic studies in Chicago populations yielded inconsistent findings on the relationship of diabetes to cardiovascular disease
Hemoglobin A1c Values in Children with Overt Diabetes Maintained in Varying Degrees of Control
Authors: Jackson Robert L , Hess Randall L , England Jack D
Published: December 2014

The concentration of hemoglobin A1c has been found to be elevated in patients with uncontrolled diabetes. HbA1c levels change at a slow rate so that a single measurement is believed to reflect the overall degree of control achieved by a patient for about the previous 2 mo. Using the Trivelli method, we determined HbA1c levels in 81 children with overt insulin-dependent diabetes and in 14 healthy children and young adults who served as controls. Five of the diabetic children with recent onset had sequential HbA1c determinations at 3–6-wk intervals. Each had a rapid decline in HbA1c level to near normal values after the patient was kept essentially euglycemic for about 60 days. Before the HbA1c determination, each diabetic child was given an overall control rating for the previous 2 mo or more based on criteria defined in our clinic. HbA1c values increased progressively as diabetic control declined. There was a statistically significant correlation between the clinical control ratings and HbA1c levels (P < 0.01 between all subgroups). Although there was a positive correlation between duration of diabetes and insulin requirement per kilogram of body weight in all groups combined, there was no significant difference when each subgroup was compared separately. These observations document the validity of our criteria for classifying patients in higher degrees of metabolic control.
Dependency of Muscle Capillary Basement Membrane Thickness on the Duration of Diabetes
Authors: Siess Elmar A , Näthke Heike E , Dexel Thomas , Haslbeck Manfred , Mehnert Hellmut , Wieland Otto H
Published: December 2014

Skeletal muscle biopsy specimens were obtained for measuring capillary basement membrane width from 63 male patients with juvenile, insulin-dependent diabetes mellitus and from 17 healthy controls. Each sample was divided into two portions: one fixed in osmium tetroxide and the other in glutaraldehyde. Measurements were made both of average basement membrane width (BMT) using the multiple measurement techniques of Siperstein et al. and of minimum basement membrane width using the technique of Williamson et al. With both methods, basement membrane thickness appeared to be a function of duration of diabetes.
Reducing the Burden of Diabetes: The National Diabetes Education Program
Authors: Clark Charles M.
Published: December 2014

The National Diabetes Education Program (NDEP) is a joint initiative sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and the Division of Diabetes Translation of the Centers for Disease Control and Prevention. The program will develop a partnership of public and private organizations and implement educational activities to help reduce the morbidity and mortality associated with diabetes and its complications. Participating public and private organizations include the Indian Health Service, the Department of Veterans Affairs, the American Diabetes Association, the American College of Physicians, the American Dietetic Association, and the American Association of Diabetes Educators. Key program activities will include (1) ongoing public awareness and education (2) and identification and dissemination of existing educational tools and resources for patients and their families, health care providers, and payers and purchasers of health care. The NDEP will also sponsor the development and dissemination of new educational tools and resources, including science-based guidelines, efforts to improve quality and access to diabetes care, and program evaluation.
The U.K. Prospective Diabetes Study: A review
Authors: Turner Robert C
Published: December 2014

The objective of the U.K. Prospective Diabetes Study (UKPDS), initiated in 1977, was set up to determine whether improved blood glucose control in people with type 2 diabetes will prevent the complications of diabetes. The UKPDS was also designed to determine whether there are differences between conventional policy (diet therapy) and three different regimens of intensive treatment policy, based on sulfonylurea, metformin, or insulin. Interim efficacy analyses revealed that the intensive policies with sulfonylurea, insulin, and metformin were equally effective in reducing fasting plasma glucose concentrations. However, glucose and HbA1c measurements steadily increased with time, reflecting ongoing deterioration of β-cell function. Cardiovascular disease was the major cause of complications, and the risk factors included raised LDL cholesterol concentrations, low HDL cholesterol concentrations, elevated blood pressure, elevated HbA1c concentrations, and smoking. A final study report was issued in September 1998, when the median duration of therapy was 11 years.
Valuing Quality of Life and Improvements in Glycemic Control in People With Type 2 Diabetes
Authors: Testa Marcia A , Simonson Donald C , Turner Ralph R
Published: December 2014

Outcomes research is used increasingly for assessing the health economic benefits of new therapeutic programs and interventions. The measurement properties of the outcomes assessment tools are important. If overlooked, they can mislead health care administrators and caregivers regarding the importance and value of these programs and interventions. We reviewed the literature and conducted two analyses to determine the absolute, relative, and operative quality-of-life ranges for people with type 2 diabetes. Quality of life and fasting blood glucose and HbA1c concentrations were measured at baseline and at 4,8, and 12 weeks of treatment in 569 men and women randomized to either glipizide gastrointestinal therapeutic system (GITS) or placebo in a double-blind, multicenter clinical trial. A subgroup of 290 patients completed a diabetes-specific health states questionnaire at endpoint (week 12 or early termination) rating 10 health-state descriptions on a health thermometer scale ranging from 0 (death) to 100 (full health). Health losses at the higher end of the scale had a greater negative utility than did comparable losses at lower health states, indicating patients' strong preferences for maintaining asymptomatic or mildly symptomatic conditions. Patients rated their current health state at 83.4 ± 0.8% of full health and indicated that a loss of 27 points below this value would prevent them from living and working as they currently do. The calibration analysis applied to the quality-of-life scales suggested that the targeted range for clinical investigation and quality-of-care evaluation must be more narrowly focused. Effect sizes as seemingly small as 2% (0.25 responsiveness units) on the absolute scale can correspond to quality-of-life losses of 15–20% on the personal operative scale. Differences in glycemic control clearly affected quality of life. Those patients with the best HbA1c responses (decreasing 1.5% or more from baseline) versus those with the worst responses (increasing 1.5% or more from baseline) were separated by 0.6 responsiveness units for the overall quality-of-life summary measure. The calibration analysis suggested that this degree of better glycemic control provides a nearly 50% gain in quality of life according to personal expectations within the operative range. In conclusion, general measures of quality of life may be too crude and insensitive to capture the important gains in health outcomes due to new therapeutic interventions and programs in diabetes. Quality-of-care evaluations for diabetes are at risk of favoring inferior programs with lower costs simply because gains or losses in health outcomes go undetected.
The Economic Impact of Diabetes
Authors: Jonsson Bengt
Published: December 2014

In assessing the economic impact of diabetes for a population, several factors should be considered, including the incidence and prevalence of the disease, the level of development of the health care system, and the population's overall level of economic development. Two different approaches have been used to address the economic impact of an increasing incidence of diabetes. The first approach uses disability-adjusted life-years (DALYs) to measure intangible costs associated with diabetes. It combines the number of healthy life-years lost as a result of early mortality with those lost because of disability. The second approach, which has been used more frequently, is the cost-of-illness approach, which includes the concepts of direct, indirect, and intangible costs. A study conducted by the World Bank found that of the 1,362 million DALYs lost to all illnesses in 1990, 7.97 million DALYs were lost because of diabetes. In a 1992 study that assessed the direct costs of treating diabetes in the U.S., the American Diabetes Association used the cost-of-illness approach and found that the estimated total expenditure for 1 year was $45.2 billion. The 1994 epidemiological studies by Zimmet and the World Health Organization include estimates of increased prevalence of diabetes resulting from an increase in population. Estimates of the global cost of diabetes based on these studies reveal that diabetes accounts for 2–3% of the total health care budget in every country; therefore, an increase in diabetes incidence and prevalence translates into a significant economic impact.
Community Outreach in Diabetes: The Kentucky Protocol
Authors: Leichter Steven B , Collins Peggy , Ferguson Susan , Rhodes Ann , Kentucky Lexington
Published: December 2014

Many ongoing projects in diabetes care delivery or manpower training involve the interface of university-based subspecialty teams in diabetes with primary care workers in outlying communities. The development of functional community contacts is an integral part of diabetes education projects at various universities, including a diabetes education program (the Kentucky Diabetes Program) based at the University of Kentucky. In these and similar diabetes programs, establishing functional and convenient community contacts is often difficult and frustrating.
Effects of Gestational Diabetes on Diurnal Profiles of Plasma Glucose, Lipids, and Individual Amino Acids
Authors: Metzger Boyd E , Phelps Richard L , Freinkel Norbert , Navickas Irene A
Published: December 2014

To assess the effects of gestational diabetes mellitus (GDM) on intermediary metabolism in late pregnancy, circulating levels of glucose, FFA, triglycerides, cholesterol, and individual amino acids were monitored for 24 h while subjects received a liquid formula diet (containing 2110 cal and 275 g carbohydrate) in three equal feedings at 0800, 1300, and 1800. Attempts were made to distinguish between varying degrees of severity of gestational diabetes by subdividing the population into those with fasting plasma glucose within the normal range for pregnancy, i.e., below 105 mg/dl (GDM < 105), and those with fasting plasma glucose of 105 mg/dl or greater (GDM ≥ 105). Both groups were compared with pregnant women with normal carbohydrate metabolism (NM). The diurnal profiles indicated that premeal, postprandial averages, and integrated 24-h values for plasma glucose were consistently higher in GDM ≥ 105 than in GDM < 105; both GDM groups uniformly exceeded the values in NM. Plasma FFA tended to be higher in all GDM, with maximal increments occurring in the early hours before breakfast and assuming greatest significance in GDM ≥ 105. The elevations in circulating cholesterol that occur in pregnancy were not significantly different at any time point in NM, GDM < 105, and GDM ≥ 105. However, the increases in plasma triglycerides were greater in GDM < 105 and GDM ≥ 105 than in NM and most marked in GDM ≥ 105. Diurnal profiles for a number of individual amino acids (phenylalanine, tyrosine, alanine, serine, proline) were not affected by gestational diabetes. However, certain other amino acids, particularly the branched chain (leucine, isoleucine, valine), tended to be elevated in subjects with GDM and to the most significant extent in GDM ≥ 105. Although the GDM subjects tended to be heavier than the NM, the progressively more pronounced metabolic abnormalities in GDM ≥ 105 than in GDM < 105 would suggest that relative insulinopenia rather than obesity contributed to the differences. Our findings indicate that gestational diabetes is attended by disturbances of varying degrees in all major classes of insulin-dependent foodstuffs and must be viewed as a disorder of multiple fuels.