bluuebunny/crossref_metadata_2025 huggingface dataset:
Impairment of Polymorphonuclear Leukocyte Function and Metabolic Control of Diabetes
Authors: Marhoffer Wilhelm , Stein Michael , Maeser Erika , Federlin Konrad
Published: March 2007

Objective

In this study, ingestion of Staphylococcus aureus and “bacteria killing” (BK) were measured to evaluate polymorphonuclear leukocyte (PMN) phagocytic functions and chemiluminescence response (CL) to phorbolmyristic acetate (PMA) as respiratory burst activity with regard to metabolic control parameters in diabetic patients.

Research Design and Methods

PMN phagocytic functions were assessed in 40 diabetic patients, all receiving insulin and in poor metabolic control, with 3H-thymidine-labeled Staphylococcus aureus in a modified radiometric assay. Bacteria killing was determined by pure-plate counting of surviving bacteria (colony-forming units [cm]) and luminol-enhanced CL in response to PMA as a measure of respiratory burst. PMN function data were correlated to HbA1 as parameter of recent metabolic control.

Results

PMN of diabetic patients showed a significant reduction in Staphylococcus aureus (50.7 ± 4.1%) and BK (29.4 ± 4.2%) compared with healthy nondiabetic control subjects (76.6 ± 4.6% and 16.3 ± 3.1%, respectively, P < 0.001), and PMN CL response was markedly reduced in diabetic patients also. Linear regression analysis showed a highly significant negative correlation of HbAi versus Staphylococcus aureus (r = -0.67, P = 0.001) and a positive correlation for BK (r = 0.73, P < 0.001). This was also true for CL, although this did not reach statistical significance (P = 0.06).

Conclusions

The data obtained demonstrate impaired PMN phagocytic functions and CL response in diabetic patients. These findings suggest inhibitory effects of elevated glucose concentrations on PMNs, a possible role of protein glycosylation for impairing PMN function, thus contributing in part to altered host defense.
Glucose Transport and NIDDM
Authors: Garvey W Timothy
Published: March 2007

Three major metabolic abnormalities contribute to hyperglycemia in non-insulin-dependent diabetes mellitus (NIDDM) including defective glucose-induced insulin secretion, elevated rates of hepatic glucose output, and insulin's impaired ability to stimulate glucose uptake in peripheral target tissues (insulin resistance). These functions involve cellular glucose transport in β-cells, liver, adipose tissue, and skeletal muscle; and, in some instances, abnormalities in glucose transporter isoforms (GLUT) specifically expressed in these tissues may constitute key biochemical lesions underlying defective glucose homeostasis. In animal models of NIDDM, suppression of GLUT2 in β-cells is correlated with loss of high-Km glucose transport and glucose-sensitive insulin secretion. Although there are no data on humans with NIDDM, GLUT2 loss would constitute an attractive mechanism for defective glucose sensing in β-cells if it can be shown that transport then becomes rate limiting for glucose metabolism. In the liver, however, hepatocyte glucose transport via GLUT2 probably plays only a permissive role in sustaining increased glucose efflux. Peripheral insulin resistance is associated with decreased glucose transport activity, the likely rate-limiting step for glucose uptake in fat and muscle. Accordingly, the insulin-responsive GLUT4 isoform expressed exclusively in insulin target tissues has been studied intensively in NIDDM. In these studies, pretranslational suppression of GLUT4 appears to be the key mechanism of insulin resistance in adipocytes. However, levels of GLUT4 protein and mRNA are normal in vastus lateralis and rectus abdominis, inferring that defects in GLUT4 functional activity or insulin-mediated translocation cause insulin resistance in muscle. Thus, the intensified study of glucose transport has provided important new insights into NIDDM pathogenesis over the past 5 yr and has presented investigators with additional intriguing hypotheses.
Role of Liver in Pathophysiology of NIDDM
Authors: Consoli Agostino
Published: March 2007

Glucose homeostasis is physiologically maintained by the balance between glucose production by the liver and glucose utilization by the peripheral tissues. Insulin controls hepatic glucose production and promotes glucose utilization by the skeletal muscle. In non-insulin-dependent diabetes mellitus (NIDDM), postabsorptive hepatic glucose production is increased and exhibits a positive correlation with fasting plasma glucose concentration. This increase in hepatic glucose production is the main cause of fasting hyperglycemia in NIDDM. Between the two processes by which the liver produces glucose (gluconeogenesis and glycogenolysis), gluconeogenesis appears to be drastically increased in NIDDM. The increase in gluconeogenesis accounts for most of the increased hepatic glucose production in this condition, and a positive correlation has been found in NIDDM subjects between the rates of gluconeogenesis and fasting plasma glucose concentration. Increased production of gluconeogenic precursors (lactate, alanine, glycerol) fuels this increased gluconeogenesis, but some type of intrahepatic mechanism is also present in NIDDM that increases the hepatic conversion of these substrates into glucose. Hyperglucagonemia and increased hepatic free fatty acid oxidation might be responsible for this increase hepatic gluconeogenic efficiency in NIDDM. Reduced suppression of hepatic glucose production after carbohydrate ingestion also plays an important role in the impairment in postprandial glucose homeostasis in NIDDM. In NIDDM subjects splanchnic extraction of an oral glucose load is not decreased, but hepatic glucose production is suppressed less than in nondiabetic subjects after the load. Residual hepatic glucose production after glucose ingestion is also correlated with fasting plasma glucose in NIDDM. Preliminary data suggest that in the postprandial state increased gluconeogenesis represents the primary mechanism responsible for impaired suppression of hepatic glucose production. Given the primary role of increase hepatic gluconeogenesis in the pathogenesis of hyperglycemia in NIDDM, development of new drugs aimed at correcting the factors that might cause increased gluconeogenesis (e.g., increased free fatty acid oxidation and hyperglucagonemia) might open the way for new form of treatment of this disorder.
Short-Term Effect of Red Wine (Consumed During Meals) on Insulin Requirement and Glucose Tolerance in Diabetic Patients
Authors: Gin Henri , Morlat Philippe , Ragnaud Jean M , Aubertin Jean
Published: March 2007

Objectives

To determine the effect of wine on insulin requirement or glucose tolerance.

Research Design and Methods

Five men with insulin-treated diabetes and 10 men with non-insulin-treated diabetes ate the same lunch with the same volume of either water or red wine (2 glasses). Insulin requirement was determined with an artificial pancreas (Biostator). Glucose tolerance was evaluated from the postprandial glycemic level.

Results

There was no significant difference in insulin requirement determined with an artificial pancreas in the insulin-treated patients after the two meals (31.5 ± 4.21 U with water and 31.8 ± 4.3 U with wine). Glucose tolerance in the non-insulin-treated patients was lower after the meal with wine.

Conclusions

Moderate prandial wine consumption has no adverse effect on the glycemic control of diabetic patients. Thus, it appears unnecessary to proscribe the consumption of red wine in moderation with meals to diabetic patients. Wine contains tannins and phytates that can explain its action.
Role of Industry Representatives in Providing Assistance to Certified Diabetes Educators
Authors: Daughtry Sue B , O'Brien Kevin F , Long Stuart D , Scharf Daniel R
Published: March 2007

Objectives

As diabetes educators have become more frequently involved in decisions regarding medications, equipment, and supplies, industry representatives have increasingly provided various types of assistance. The major objectives of this survey were to determine 1) the types of assistance being provided to certified diabetes educators (CDEs) by industry representatives, 2) whether product recommendations are based on assistance provided, and 3) the types of assistance that CDEs consider appropriate.

Research Design and Methods

We developed the survey instrument and it was mailed to every fifth person listed in the 1989 directory of CDEs. Three hundred twenty-five (51%) of the active surveys were returned.

Results

Those responding indicated that 1) the types of support provided most frequently by industry representatives include instructional materials, samples, supplies, and equipment for patient care and education; 2) the number of types of support provided is directly related to the number of industry representatives seen on a regular basis and the frequency of interaction; 3) 22% of the educators state that they make product recommendations based on support provided; and 4) the role of the industry reps should be to continue support for patient care and education, to provide more support for public and professional education, and to minimize support for personal items, e.g., gifts or meals.

Conclusions

The survey indicates that CDEs are receiving many types of assistance from industry representatives and that they prefer that such assistance be targeted toward patient and professional education.
Glycosylated Serum Protein Levels Assayed With Highly Sensitive Immunoradiometric Assay Accurately Reflect Glycemic Control of Diabetic Patients
Authors: Gordon Amirav , Glaser Benjamin , Wald Moshe , Rio Graziano Del , Casa Luciano Della , Gross Jack , Cerasi Erol
Published: March 2007

Objective

To develop a sensitive and reliable immunoreadiometric assay to measure glycosylated lysine residues on serum proteins (GSP) and to evaluate its efficacy in monitoring glycemic control.

Research Design

The effect of acute and chronic in vitro and in vivo changes in glucose levels on GSP concentration was evaluated. GSP determinations from insulin-dependent diabetic (IDDM) patients, non-insulin-dependent diabetic (NIDDM) patients, and control subjects were correlated with other indices of glycemic control.

Results

The GSP levels were unaffected by acute glucose changes after food or intravenous glucose administration but increased during storage at−20°C due to in vitro glycosylation by endogenous glucose. Immediate acidification of the serum prevented this, permitting long-term storage despite high ambient glucose levels. In randomly selected diabetic patients, 96% of GSP values were greater than the mean +3SD of nondiabetic control subjects. In diabetic patients, GSP levels correlated with mean plasma glucose concentrations (Kendall correlation statistics 0.47, P <0.001), fasting plasma glucose levels (Kendall statistics 0.42, P <0.001), and glycosylated hemoglobin (GHb, Kendall statistics 0.30, P <0.005). Induction of near-normal glycemia in poorly controlled NIDDM patients reduced GSP levels with a slope consistent with a half time of disappearance of 4.7 ± 0.4 days. GSP levels remained elevated in 6 of 10 well-controlled NIDDM patients, despite normal GHb concentrations. Chronic hypoglycemic states, like pregnancy and hyperinsulinemic hypoglycemia, were associated with significantly low GSP levels.

Conclusion

We describe a reproducible and sensitive immunoradiometric assay for GSP that closely reflects the degree of glycemic control in diabetic patients. Further studies are needed to determine whether this assay may be useful in screening for glucose intolerance or gestational diabetes.
Biosynthetic Human Proinsulin: Review of Chemistry, in Vitro and in Vivo Receptor Binding, Animal and Human Pharmacology Studies, and Clinical Trial Experience
Authors: Galloway John A , Hooper Susan A , Spradlin C Thomas , Howey Daniel C , Frank Bruce H , Bowsher Ronald R , Anderson James H
Published: March 2007

Objective

To describe the rationale for the preclinical and clinical developmental course of human proinsulin (HPI), the second product after human insulin for the treatment of diabetes mellitus to be manufactured by DNA technology.

Research Design and Methods

The relevant and available published and unpublished preclinical and clinical information generated on pork proinsulin and human proinsulin has been integrated to demonstrate how certain clinically attractive features of pork proinsulin (a soluble intermediate-acting and possibly hepatospecific insulin agonist) led to the development of HPI.

Results

Clinical pharmacology studies demonstrated that HPI was definitely, although marginally, hepatospecific. More striking was the finding that the intrasubject/patient coefficient of variation of response to HPI was significantly less than that observed with NPH insulin. However, the fact that unique efficacy in controlled multicenter studies was not demonstrated suggested that these pharmacological features were not translated into clinical benefit. In one multicenter new patient study there were six myocardial infarctions, including two deaths, in patients treated for ≥1 yr with HPI and none in the control group.

Conclusions

To obtain an independent review of the risks and benefits of HPI, in February 1988, Lilly convened a consultant group that examined all relevant information on HPI available. These experts shared our concerns about the safety of HPI in light of the failure to demonstrate unique efficacy. Accordingly, clinical trials with HPI were suspended in February 1988. Experience with HPI demonstrates the challenge associated with the development of new drugs in general and insulin agonists in particular.
Sulfonylureas in NIDDM
Authors: Groop Leif C
Published: March 2007

Sulfonylureas have represented the backbone of oral therapy in non-insulin-dependent diabetes mellitus for > 30 yr. Despite this, our knowledge about the mode of actions of these agents is limited, and the use of them is far from rational. Sulfonylureas lower blood glucose concentrations primarily by stimulating insulin secretion. The evidence for clinically significant extrapancreatic effects is scanty. Therefore, the effect of sulfonylurea is limited to patients with preserved β-cell function, with the best effect observed in the early stages of the disease. Sulfonylurea treatment is often started relatively late and is continued when the agents can no longer achieve the treatment goals. Drug dosages are increased to maximum recommended doses, although there is no evidence for a dose-response relationship between the sulfonylurea dose and its biological effect. To rationalize the use of sulfonylureas, we should ask the questions to whom, how much, and for how long? The decision to stop treatment is as important as the decision to start treatment.
Intracellular Free Magnesium Deficiency Plays a Key Role in Increased Platelet Reactivity in Type II Diabetes Mellitus
Authors: Nadler Jerry L , Malayan Sam , Luong Helen , Shaw Sylvia , Natarajan Rama D , Rude Robert K
Published: March 2007

Objective

Mg deficiency may be an important factor leading to cardiovascular disease. Diabetic subjects show an increase in platelet reactivity that can enhance the risks of vascular disease. In addition, diabetic patients have been reported to be at risk of developing extracellular Mg deficiency. However, the intracellular free Mg concentration and its role in the enhanced platelet reactivity in diabetes is not known.

Research Design and Methods

We evaluated the intracellular erythrocyte (RBC) Mg2+ concentration in 20 non-insulin-dependent (type II) diabetics. In addition, the effects of intravenous 3-h drip or 8 wk of oral Mg supplementation on intracellular RBC Mg2+ levels and platelet reactivity was studied. To more clearly evaluate the direct role of Mg in these effects, we induced isolated Mg deficiency in 16 nondiabetic control subjects with an Mg-free liquid diet for 3 wk.

Results

The intracellular RBC Mg2+ concentration of diabetic patients was significantly reduced compared with values in nondiabetic control subjects (166 ± 7 vs. 204 ± 7 μM, P < 0.01). Serum Mg levels were also reduced in the diabetic patients compared with the control subjects (1.59 ± 0.04 vs. 1.9 ± 0.1 mEq/L, P < 0.05). Oral Mg supplementation for 8 wk (400 mg/day) restored RBC Mg2+ concentration to normal without significantly changing serum Mg concentration. Both intravenous and oral Mg supplementation markedly reduced platelet reactivity in response to the thromboxane A2 analog, U46619. The Mg-free diet resulted in a significant reduction in RBC Mg2+ concentration and markedly enhanced the sensitivity of platelet aggregation to U46619 and ADP.

Conclusions

These results suggest that type II diabetic patients have intracellular Mg2+ deficiency and that Mg deficiency may be a key factor in leading to enhanced platelet reactivity in type II diabetes. Therefore, Mg supplementation may provide a new therapeutic approach to reducing vascular disease in patients with diabetes.
Sensory Function at Diagnosis and in Early Stages of NIDDM in Patients Detected Through Screening
Authors: Sosenko Jay M , Kato Marta , Soto Ramon , Goldberg Ronald B
Published: March 2007

Objective

We studied whether sensory function abnormalities are present at diagnosis and whether they develop in the early stages of non-insulin-dependent diabetes (NIDDM).

Research Design and Methods

Quantitative assessments of vibration sensitivity at the hallux and index fingers, and thermal sensitivity at the hallux were performed at screening (2-h oral glucose tolerance tests) for diabetes in 364 individuals. Twenty-five subjects diagnosed with NIDDM and 25 matched nondiabetic subjects were restudied after an interval of 12–41 mo.

Results

When those with NIDDM (n = 41) or impaired glucose tolerance (IGT) (n = 38) were compared with nondiabetic subjects, there were no significant differences in sensory function indices. However, the vibration threshold and HbA1c were related among those found to be hyperglycemic (IGT and NIDDM combined P < 0.05; NIDDM alone P < 0.05). Among diabetic subjects, the vibration threshold and interaction term of height and Hba1c were positively related in a multiple regression analysis (P < 0.01). There were increments in all sensory thresholds in diabetic patients at follow-up (P < 0.05 for all). Increments were smaller in control subjects.

Conclusions

These data suggest that although sensory function tends to be normal at diagnosis in NIDDM patients, there appears to be a diminution in sensory function as the disease progresses. An interaction between metabolic factors and height may influence sensory function early in the course of NIDDM.
Effect of Thermal Biofeedback-Assisted Relaxation Training on Blood Circulation in the Lower Extremities of a Population With Diabetes
Authors: Rice Birgitta I , Schindler Jay V
Published: March 2007

Objective

Investigate the effect of relaxation training/thermal biofeedback on blood circulation in the lower extremities of diabetic subjects.

Research Design and Methods

Diabetic subjects (n = 40) aged 17–73 yr were volunteers recruited through the University of Wisconsin-La Crosse, the local ADA Chapter, and a medical clinic. A within-subjects experimental design was used. During phase 1, all subjects used a self-selected relaxation method and recorded toe temperatures daily. During phase 2, subjects were taught a biofeedback-assisted relaxation technique designed to elicit sensations of warmth in the lower extremities and increase circulation and temperature. Subjects relaxed at home with the use of a designated relaxation tape. They measured and recorded toe temperatures. Each phase lasted 4 wk.

Results

Toe temperature and blood volume pulse (BVP) data were gathered at the beginning and end of phases 1 and 2. Paired t tests compared the means of temperature percent change scores between 1 and 2. Mean temperature change scores were 8.73% (phase 1) and 31.38% (phase 2) (t = −8.00, df = 39, P < 0.001). Mean BVP change scores were 2.33% (phase 1) and 22.47% (phase 2) (t = −9.24, df = 35, P < 0.001). Based on eta squared, 71% of the BVP increase in phase 2 was attributed to the relaxation technique. A multiple regression analysis indicated that none of the other examined variables affected by diabetes were significant predictors of BVP increase.

Conclusions

Data indicate that diabetic patients show significant increases in peripheral blood circulation with this technique. This noninvasive method could serve as an adjunct treatment for limited blood flow in some complications of diabetes.
Twice-Daily Humulin Ultralente Insulin Decreases Morning Fasting Hyperglycemia
Authors: Johnson Nnacy B , Kronz Kathleen K , Fineberg Naomi S , Golden Michael P
Published: March 2007

OBJECTIVE

To test whether a two-injection regimen of HUL/R would improve FBG and metabolic control in pediatric IDDM patients with a dawn rise in FBG compared with our standard twice-daily therapy, HL/R.

RESEARCH DESIGN AND METHODS

Seventy-seven patients with fasting hyperglycemia (prebreakfast mean FBG ≥ 8.3 mM (150 mg/dl) during the preceding 2 wk) were evaluated with twice-weekly midsleep (0230–0330) FBG for 2 wk. Forty-seven patients (61%) had a mean dawn rise between midsleep and prebreakfast of ≥ 2.8 mM (50 mg/dl). Patients continued on HL/R for an additional 4 wk, after which 31 patients were then randomized into a double-blind 12-wk trial of either HUL/R (n = 14) or HL/R (n = 17) administered before breakfast and the evening meal. Midsleep FBG was obtained twice weekly with weekly insulin adjustment as needed to optimize glycemic control. FBG was monitored and verified with memory glucometers (Glucometer M). HbA1c levels were measured at the time of physician visits at 0, 6, and 12 wk.

RESULTS

Prebreakfast FBG was lower in the HUL/R-treated patients (10.6 ± 0.6 vs. 12.6 ± 0.6 mM [191 ± 6.4 vs. 227 ± 11.2 mg/dl], P < 0.02). The dawn rise was diminished in the HUL/R patients (0.5 ± 0.5 vs. 2.6 ± 0.7 mM [9 ± 8.3 vs. 46 ± 11.7 mg/dl], P < 0.02). FBG at lunch, dinner, bedtime, and midsleep were similar in both groups, and HbA1c did not differ between groups or change significantly in either group during the 12-wk trial. Insulin dose, percentage R, day-night dosage split, and episodes of hypoglycemia (FBG < 3.3 mM [60 mg/dl]) were similar in both groups.

CONCLUSIONS

A 12-wk trial of twice-daily HUL/R improved fasting glycemia in pediatric patients with a dawn rise but did not improve metabolic control as measured by HbA1c.
Restoration of Fuel Homeostasis in IDDM Patients During Pregnancy by an Open-Loop Insulin Infusion System
Authors: Foss Milton C , Aoki Thomas T
Published: March 2007

Objective— To characterize the effects of subcutaneous insulin pump therapy on the metabolic response (CHO and lipid oxidation, and nonoxidative glucose metabolism) to a glucose challenge of diabetic women at early pregnancy.

Research Design and Methods— Seven nondiabetic and seven IDDM pregnant patients on insulin pump therapy were studied at the first trimester. Fuel oxidation rates were determined by indirect calorimetry, and blood levels of substrates and hormones were measured before and for 2 h after ingestion of a 50 g oral glucose load.

Results— The increments in npRQ and CHO oxidation rates after the glucose meals in the diabetic women on insulin pump therapy were similar to those in the normal subjects. The glucose disposal data during the 2 h of the studies revealed that the amounts of oxidative and nonoxidative glucose utilization in the control subjects and in the IDDM patients on insulin pump therapy did not show significant differences.

Conclusions— This investigation demonstrated that the treatment of IDDM patients during early pregnancy by an open-loop insulin infusion system is sufficient to normalize their glucose-processing capability with respect to cellular oxidative and nonoxidative glucose metabolism in response to an oral glucose challenge, but some abnormalities in their blood profiles of glucose, lactate, and pyruvate persisted.
Diabetes and Its Complications Among Selected Tribes in North Dakota, South Dakota, and Nebraska
Authors: Stahn Ruggles M , Gohdes Dorothy , Valway Sarah E
Published: March 2007

Objective— To determine the prevalence and incidence rates of diabetes and two specific complications for selected American-Indian tribes in North Dakota, South Dakota, and Nebraska.

Research Design and Methods— A descriptive epidemiological study was conducted using ambulatory care data during 1987 for prevalence and diabetes registries and complication case reporting during 1988 from IHS facilities on reservations in these states.

Results— The Winnebago and Omaha tribes had the highest age-adjusted diabetes rates, with prevalence 8.8 times and incidence 7.7 times the respective U.S. rates. The diabetes prevalence rate of combined data for the Sioux was 3.7 times the U.S. rate. Among Sioux Indians, the age-adjusted incidence rate for ESRD was 4.8 times the American-Indian/Alaska-Native rate and 13.4 times the rate for U.S. whites. The proportion of new diabetes-related ESRD (86%) was almost 3 times greater than the general U.S. population rate (30%). Also, among the Sioux, the age-adjusted incidence rate for LEA (86.7/10,000 diabetic population) was 1.5 times higher than the U.S. rate; the proportion of diabetes-related LEA (84%) was 1.8 times higher than the general U.S. population rate (45%).

Conclusions— The age-adjusted rates of diabetes and certain complications among these Northern Plains tribes are greater than the U.S. rates. Improved health services to detect and monitor diabetes and its complications and community-based prevention activities directed at the epidemic of diabetes among the various Indian tribes are urgently needed.
Increasing Prevalence of Diabetes Among the Three Affiliated Tribes
Authors: Brosseau James D
Published: March 2007

The findings from a 1988 audit of medical records of the Three Affiliated Tribes (the Mandan, Arickara, and Hidatsa) at the Fort Berthold, ND, Indian Reservation were compared with the findings from a 1975 audit. The total population served by the IHS clinic there has remained about the same. However, the number of people diagnosed as having diabetes has increased by >40%. This increase in known cases is caused largely by an increase in the number of women aged >40 yr who have diabetes. The actual prevalence of diabetes among people aged >40 yr has increased very little, presumably because the clinic population has aged somewhat over this period of time.
Diabetes in Mississippi Choctaw Indians
Authors: Johnson Lynda G , Strauss Karen
Published: March 2007

Objective— To establish a registry of patients with diabetes and determine the point prevalence of diabetes in the Mississippi Choctaw Indians at the end of September 1989.

Research Design and Methods— A survey of diabetes cases was conducted, using the NDDG criteria for diagnosis with comparison to U.S. rates determined from the 1979–1981 NHIS. IHS-supported hospital and outpatient clinics serving the Choctaw Indians of Mississippi were the setting. Medical charts of patients on the computer record of outpatient visits seen for diabetes and laboratory lists of patients who had elevated blood glucose levels in 1988 were reviewed.

Results— The age-adjusted prevalence of 163.2/1000 population was 6.5 times (95% CI 4.3–9.8) the U.S. rate. The prevalence of diabetes in the Choctaw Indians was significantly higher than the U.S. rates for all age-groups except for those <15 yr of age.

Conclusions— Intervention programs are urgently needed to prevent or delay the onset of diabetes and its complications in this southeastern tribe. The registry system is being used to gather information on the prevalence and incidence of diabetic complications and associated risk factors to guide programs.
A Follow-Up Study of Diabetic Oklahoma Indians: Mortality and causes of death
Authors: Lee Elisa T , Russell Dana , Jorge Nisa , Kenny Susan , Yu Mei-Lin
Published: March 2007

OBJECTIVE— To determine the mortality rates and causes of death for diabetic Oklahoma Indian adults by sex and age.

RESEARCH DESIGN AND METHODS— This was a cohort follow-up study with baseline examination between 1972–1980 and the mortality follow-up between 1986 and 1989. Mean follow-up time was 10 ± 4 yr. A quasi-random sample of 1012 (379 men and 633 women) NIDDM American Indians in Oklahoma was performed. Mean age was 52 yr and duration was 7 yr at baseline. Mean degree of Indian blood was 92% (77% full blood). At follow-up, 548 (54%) were alive, 452 (45%) were decreased, and 12 (1%) could not be traced.

RESULTS— Death certificates were obtained and coded (ICD-9) for 439 (97%) of the deceased. Mean annual mortality rates were 4.99% for men and 4.17% for women, with an increasing trend with age for both sexes. Compared with the general population of Oklahoma, the observed/expected ratios for number of deaths were 2.92 for men and 4.09 for women (P < 0.0001). The three leading causes of death were circulatory disease (38%), diabetes (24%), and malignant neoplasms (12%).

CONCLUSIONS— There is an excessively high mortality among diabetic Oklahoma Indians compared with the general population in the state and with diabetic patients in other populations.
Factors Associated With Failure to Complete Treatment for Diabetic Retinopathy Among Navajo Indians
Authors: Sugarman Jonathan R , Bauer Mark C , Barber Elouise L , Hayes Janet L , Hughes James W
Published: March 2007

OBJECTIVE— To determine the proportion of patients with suspected proliferative diabetic retinopathy who did not receive the recommended follow-up ophthalmological evaluation and care, and to examine associations between various patient characteristics and the failure to obtain care.

RESEARCH DESIGN AND METHODS— The study cohort included all Navajo Indians identified by a retrospective review of records who had proliferative diabetic retinopathy diagnosed at an Indian Health Service Optometry Clinic between 1 October 1985 and 30 September 1988. Follow-up data were obtained by medical record reviews and by interviews with subjects.

RESULTS— Of 69 patients identified, 57 of 61 living patients were interviewed. Twenty-three (40.4%) had failed to obtain recommended follow-up. The RR for incomplete treatment among those without a vehicle in the household compared with those with a vehicle was 1.91 (95% CI 1.32–2.76). Other factors associated with incomplete treatment were female sex and marital status other than currently married. Twelve (21%) patients answered “no” to the question, “Have you been told that diabetes was affecting your eyes?” Eight of 38 (21%) who confirmed that they had been told that diabetes was affecting their eyes responded “no” to the question, “Do you think that diabetes is affecting your eyes?” However, the answers to these questions did not distinguish between patients who obtained or did not obtain recommended care.

CONCLUSIONS— Interventions to increase the proportion of Navajo Indians with diabetic retinopathy who receive appropriate ophthalmologic care must address the issue of transportation.
Does Crossing the Legs Decrease Arterial Pressure In Diabetic Patients With Peripheral Vascular Disease?
Authors: Levin Marvin E , Sicard Gregorio A , Baumann Dirk S , Loechl Barbara
Published: March 2007

OBJECTIVE

To evaluate the effect of crossing the legs at the knee and the ankle on peripheral arterial pressures.

RESEARCH DESIGN AND METHODS

A prospective study of 6 diabetic patients with known peripheral vascular disease and 5 nondiabetic control subjects without peripheral vascular disease was conducted. Peripheral arterial pressures were taken at the ankle and at the great toe before and after crossing the legs at the knees and ankles. Comparisons were made of measurements obtained in the supine and sitting positions. All crossed leg measurements were taken in the sitting position.

RESULTS

Ankle arm indexes and digital arm indexes pressures taken in the sitting position were equal to or higher than supine pressures, with the exception of one subject, GB. In this patient, ankle arm indexes and digital arm indexes on the right extremity were lower in the sitting position, but increased with the legs crossed at the knees and ankles compared with the uncrossed sitting position. In all patients, lower extremity pressures that decreased slightly with crossing the legs remained higher than pressures obtained in the supine position. Statistical analyses showed no significant differences. Wave forms did not change even when there was a slight decrease in ankle arm indexes or digital arm indexes. Control subjects without peripheral vascular disease showed no change in pressures with crossing the legs.

CONCLUSIONS

Crossing the legs at the knees and ankles does not result in a significant decrease in peripheral arterial pressures in diabetic patients with peripheral vascular disease.
Metformin Improves Glucose, Lipid Metabolism, and Reduces Blood Pressure in Hypertensive, Obese Women
Authors: Giugliano Dario , De Rosa Nicoletta , Di Maro Giosuè , Marfella Raffaele , Acampora Rita , Buoninconti Raffaello , D'Onofrio Felice
Published: March 2007

OBJECTIVE

To determine the effects of metformin on blood pressure, left ventricular mass, and some metabolic and endocrine parameters in nondiabetic, obese, hypertensive women.

RESEARCH DESIGN AND METHODS

Twelve obese, nondiabetic, hypertensive women received 850 mg metformin 2 times/day for 12 wk and placebo for another 12 wk, according to a double-blind, cross-over, randomized design. All patients were hospitalized 4 times, i.e., before randomization and after each treatment (metformin or placebo), to conduct metabolic and cardiovascular investigations (oral glucose tolerance test, euglycemic clamp associated with indirect calorimetry, and echocardiography).

RESULTS

Fasting glucose, HbA1c, fasting and glucose-stimulated insulin, blood pressure and left ventricular mass, cholesterol, triglycerides, and fibrinogen decreased significantly after metformin treatment, whereas high-density lipoprotein cholesterol increased. The improvement in glucose metabolism resulted from increased sensitivity to insulin.

CONCLUSIONS

These findings suggest that metformin treatment in obese, nondiabetic, hypertensive women produces a more favorable cardiovascular risk profile.
Microalbuminuria in a Middle-Aged Workforce: Effect of hyperglycemia and ethnicity
Authors: Metcalf Patricia A , Baker John R , Scragg Robert K R , Dryson Evan , Scott Alastair J , Wild Chris J
Published: March 2007

OBJECTIVE

To determine the prevalence of microalbuminuria in a mixed, thnic population and to find the extent that ethnic variation in microalbuminuria can be explained by abnormal glucose metabolism, obesity, hypertension, hypertriglyceridemia, and life-style factors.

RESEARCH DESIGN AND METHODS

Urinary albumin concentrations were measured in 5467 middle-aged Maori, Pacific Islander, and European workers who participated in a health-screening survey of 46 New Zealand companies. Participants provided a first-voided, morning urine sample; had a 75-g oral glucose tolerance test; had weight, height, and blood pressure measured; and completed a self-administered questionnaire about past medical history and sociodemographic status.

RESULTS

A significantly higher prevalence of microalbuminuria was found in individuals with new cases of diabetes mellitus (24.1%), in cases of diabetes mellitus previously diagnosed (20.6%), and in those with impaired glucose tolerance (16.1%) compared with nondiabetic individuals (4.0%). Moreover, in the general population, a piecewise linear relationship was detected between albuminuria and plasma glucose with significant changes of slope corresponding with 2 h plasma glucose concentrations (95% confidence interval) of 6.7 (6.4–7.0) and 9.2 (8.6–9.8) mM, respectively. After adjusting for sex, obesity, hypertension, hypertriglyceridemia, cigarette smoking, and heavy alcohol consumption in a multivariate model, glycemia was the most significant determinant of urinary albumin concentrations in all three ethnic groups. However, blood glucose concentrations did not completely explain the higher relative risk (95% confidence interval) of microalbuminuria in Maori (5.97; 4.48–7.78) and Pacific Islander (5.33; 4.13–6.87) workers compared with European workers.

CONCLUSIONS

Of the variables investigated, hyperglycemia was the most important factor explaining the high prevalence of microalbuminuria in Maori and Pacific Islander workers compared with the European workers. However, only 14.9% of the variation in urinary albumin concentrations was found in our multivariate model, and we have speculated on the contribution of other factors such as diet and coexisting renal diseases.
Incidence of IDDM In Mauritian Children and Adolescents From 1986 to 1990
Authors: Tuomilehto Jaakko , Dabee Jaydev , Karvonen Marjatta , Dowse Gary K , Gareeboo Hassam , Virtala Esa , Tiihonen Marja , Alberti K George M M , Zimmet Paul Z
Published: March 2007

OBJECTIVE

To document the incidence of IDDM in Mauritian children and adolescents 0–19 yr of age from 1986 to 1990.

RESEARCH DESIGN AND METHODS

We used a population-based register that used pediatricians, physicians, nutritionists, and general practitioners as a primary source of restrospective case ascertainment. The denominator data were obtained from the Statistics Office of the Ministry of Health (Port Louis, Mauritius).

RESULTS

In 1990, 37 newly diagnosed IDDM cases (22 females and 15 males) were identified between 1986 and 1990 among the population ≤19 yr of age. The average incidence density per year was 1.9/100,000 people and was slightly higher among girls (2.2/100,000) than among boys (1.5/100,000). The average agestandardized incidence density was 2.1/100,000 people (95% confidence interval 1.5–3.0) among children ≤14 yr of age, 2.5/100,000 people (95% confidence interval 1.5–3.9) among girls, and 1.8/100,000 people (95% confidence interval 1.0–3.0) among boys. The incidence was similarly low in Mauritians of Asian Indian, Chinese, and Creole (predominantly African) origin.

CONCLUSIONS

The incidence of IDDM in Mauritian children and adolescents is among the lowest yet reported. This sharply contrasts with the very high risk of NIDDM found among the adult population in this rapidly modernizing country.
Prepregnancy Weight and Antepartum Insulin Secretion Predict Glucose Tolerance Five Years After Gestational Diabetes Mellitus
Authors: Metzger Boyd E , Cho Nam H , Roston Susan M , Radvany Ruta
Published: March 2007

OBJECTIVE

To identify phenotypic, genotypic, and metabolic parameters measured at the time of antepartum diagnosis of gestational diabetes mellitus that can indicate the risk of diabetes mellitus at early postpartum (≤6 mo after delivery) and at a 5-yr follow-up.

RESEARCH DESIGN AND METHODS

The recommendations from the National Diabetes Data Group and International Workshop Conferences on Gestational Diabetes Mellitus were used for screening, diagnosing, and subclassifying gestational diabetes mellitus. National Diabetes Data Group criteria were also used for classification of glucose tolerance postpartum. Plasma glucose, insulin, and free fatty acids were measured after an overnight fast. Plasma glucose and insulin were measured 15, 30, 60, 120, and 180 min after the 100-g oral glucose load. Postpartum glucose tolerance was evaluated at 3–6 mo (early), 1 yr, and annually thereafter.

RESULTS

The 5-yr cumulative incidence of diabetes during follow-up after gestational diabetes mellitus was nearly 50%. Among those who had diabetes within 5 yr, a history of diabetes in only the mother was nearly threefold more common than a history of diabetes in only the father (30 vs. 11%, P < 0.01). Those who displayed diabetes at early postpartum (≤6 mo) testing had significantly higher antepartum glucose levels at 60, 120, and 180 min compared with those whose early postpartum results were normal. They were also relatively insulinopenic at antepartum testing. Their fasting, acutely stimulated (15 and 30 min), and integrated 3-h response to oral glucose were all significantly lower relative to women who remained normal or had impaired glucose tolerance at early postpartum testing. Women who developed diabetes between 6 mo and 5 yr postpartum were more obese before the index pregnancy, and they had lower fasting, acutely stimulated (15 and 30 min), and integrated (1–3 h) insulin levels compared with women who remained normal or displayed impaired glucose tolerance at 5 yr postpartum. A multiple logistic regression model showed that diabetes present at early postpartum testing was independently associated with higher 2-h glucose and lower basal and total integrated insulin level. Later (≤6 mo-5 yr postpartum) development of diabetes was independently associated with prepregnancy weight and impaired insulin secretion at diagnosis of gestational diabetes mellitus.

CONCLUSIONS

Impaired β-cell function and obesity at diagnosis of GDM were associated with the development of diabetes during a 5-yr, follow-up period. Studies designed to prevent diabetes in this high-risk group should examine strategies to maintain both optimal β-cell function and maximum insulin sensitivity.
Diabetes and Associated Risk Factors Among Native Americans
Authors: Muneta Ben , Newman Jeff , Wetterall Scott , Stevenson John
Published: March 2007

OBJECTIVES

To estimate the prevalence of diabetes and related risk factors among Native Americans.

RESEARCH DESIGN AND METHODS

We used 1988–1989 data from the Behavioral Risk Factor Surveillance System to calculate the overall, age-adjusted prevalence of diabetes, obesity, sedentary life-style, hypertension, and smoking among Native Americans. The SESUDAAN software package was used to derive confidence intervals.

RESULTS

The prevalence of diabetes was 11.6% among the 768 Native American Behavioral Risk Factor Surveillance System respondents (95% confidence interval 7.8–15.4) and 4.7% among the 121,986 white respondents (95% confidence interval 4.6–4.8). The age-adju ted prevalence of diabetes was 2.5 times higher among Native Americans than among whites. The prevalence of obesity was higher among Native Americans (34.4; 95% confidence interval 31.7–37.1) than among whites (23.9%; confidence interval 23.7–24.1). The prevalences of sedentary lifestyle (58%), hypertension (16%), and smoking (28%) were similar among both populations.

CONCLUSIONS

The Behavioral Risk Factor Surveillance System may prove as a useful tool for surveying Native Americans living on and off reservations for inclusion in national estimates of diabetes prevalences.
HLA-DQ Associations Distinguish Insulin-Resistant and Insulin-Sensitive Variants of NIDDM in Black Americans
Authors: Banerji Mary Ann , Norin Allen J , Chaiken Rochelle L , Lebovitz Harold E
Published: March 2007

OBJECTIVE

NIDDM in black Americans exists as two variants: one with a primary defect in insulin action (insulin-resistant variant) and the other with normal insulin action and a primary defect in insulin secretion (insulin-sensitive variant). The objective of this study was to determine whether these two variants were genetically distinct from each other and from normal control subjects as determined by HLA typing.

RESEARCH DESIGN AND METHODS

Insulin action was measured with the euglycemic insulin clamp with a 1 mU · kg−1 · min−1 insulin infusion with [3-3H]glucose. A glucose disposal of < 278 μmol · kg−1 · min−1 was considered insulin resistant, and a value greater than this was considered insulin sensitive. The study population consisted of 21 insulin-resistant and 25 insulin-sensitive black NIDDM patients and 89 normal, nondiabetic black control subjects from an urban hospital. HLA typing was performed with serological methods.

RESULTS

The frequency of HLA-DQW7 in the insulin-resistant population (76%) was significantly greater than that in the insulin-sensitive population (32%, corrected P < 0.018) and the normal control population (21%, corrected P < 0.001). The frequency of HLA-DQW6 was increased in the insulin-sensitive population (76%), corrected P < 0.023, as compared with the normal control subjects (33%). The relative risk of HLA-DQW7 in identifying insulin-resistant NIDDM patients compared with control subjects was 7.

CONCLUSIONS

At least one component that differentiates insulin-resistant and insulin-sensitive NIDDM in black Americans is under different genetic control. One or more loci responsible for insulin-resistant and insulin-sensitive NIDDM are likely to be in linkage disequilibrium with the DQ locus of the human MHC region of chromosome 6.
Sporting Activity and Hyperglycemia in Middle-Aged Men
Authors: Perry Ivan J , Wannamethee S Goya , Walker Mark K , Shaper A Gerald
Published: March 2007

OBJECTIVE

To assess the relationship between self-reported frequency of participation in sporting activity and the prevalence of hyperglycemia (nonfasting glucose level > or = 7.8 mM) in middle-aged men.

RESEARCH DESIGN AND METHODS

We used a cross-sectional study of 7617 British middle-aged men, drawn from 24 general practices in England, Wales, and Scotland, who were participants in the British Regional Heart Study. The response rate was 78%. Patients with diabetes (physician-diagnosed) were excluded from our analysis. Frequency of participation in sporting activity was determined by the respondents and reported as none (61%), occasionally (12%), or frequently (27%).

RESULTS

The age-adjusted prevalence odds ratio for hyperglycemia was 0.86 (95% confidence interval, 0.6–1.2) in those reporting occasional, and 0.62 (95% confidence interval, 0.4–0.85) in those reporting frequent sporting activity, compared with those reporting none. This effect of frequent sporting activity on the prevalence of hyperglycemia was independent of body mass index, occupational status, smoking status, systolic blood pressure, use of antihypertensive therapy, and time of sampling.

CONCLUSIONS

Frequent sporting activity in middle-aged men is associated with a reduced prevalence of hyperglycemia and may reduce the risk of NIDDM.
Population-Based Incidence of IDDM in the State of São Paulo, Brazil
Authors: Ferreira Sandra RG , Franco Laercio J , Vivolo Marco A , Negrato Carlos A , Simoes Antonio CP , Ventureli Carlos R
Published: March 2007

OBJECTIVE

To study the incidence of IDDM among children, infants to 14 yr of age, in the state of São Paulo, Brazil, 1987–1991.

RESEARCH DESIGN AND METHODS

A prospective population-based register was established, using physician reports of newly diagnosed IDDM patients < 15 yr of age as the primary source of case identification and school surveys as the main secondary source. Data were collected according to the methods recommended by the Diabetes Epidemiology Research International group.

RESULTS

Case ascertainment was estimated at 95.0, 92.8, and 98.8% complete for each of the three cities studied. The average annual IDDM incidence was 7.6/100,000 inhabitants (95% confidence interval, 5.6–9.7). We found a higher incidence rate in girls than boys.

CONCLUSIONS

The incidence of childhood IDDM in a tropical region in South America (São Paulo, Brazil) is in the middle incidence range observed in developed countries throughout the world. Increased incidence of IDDM in girls compared with boys will be tested by the ongoing Brazilian incidence study being developed in 18 other centers across the country.