bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin sensitivity in hypertensive Type 2 diabetic patients after 1 and 19 days' treatment with trandolapril
Authors: New J. P. , Bilous R. W. , Walker M.
Published: March 2003

Aims The aims of this study were to examine the effects of trandolapril, a long acting angiotensin converting enzyme (ACE) inhibitor with high tissue uptake, on insulin sensitivity and lipid concentrations in hypertensive patients with Type 2 diabetes mellitus.

Methods Insulin sensitivity was assessed after an acute dose (day 3) and 19 days continuous treatment (days 3–21) using the isoglycaemic, hyperinsulinaemic glucose clamp with
d[3–3H] labelled glucose, a variable
d[3–3H] priming dose and a ‘hot’ glucose infusion. Rates of glucose appearance (Ra) and glucose disappearance (Rd) were isotopically determined during the basal and insulin stimulated periods of the clamp. Twenty‐four (5 female) hypertensive (blood pressure > 75th centile for age and sex) patients with Type 2 diabetes mellitus were studied. Patients were randomized, in a double‐blind manner, to either trandolapril 4 mg daily (T) or placebo (P).

Results Baseline (day 1) systolic (mean ±sd; P 164 ± 14 and T 168 ± 13 mmHg) and diastolic (P 93 ± 6, and T 98 ± 10 mmHg) blood pressures were comparable. On days 3 and 21, significant reductions were observed in both groups (P < 0.001). In the trandolapril‐treated group, serum trandolapril concentrations were > 200 pg/ml on days 3 and 21, in all patients apart from one subject at a single visit, while trandolapril was undetectable in the placebo group. Body mass index (BMI) was greater in T compared with P (32.2 ± 5.4 v 28.3 ± 4.6, P = 0.07). After correcting for BMI, basal hepatic glucose output (HGO) P 2.6 (95% CI 2.23–3.13) and T 1.91 (1.33–2.51) mg.kg−1.min−1 and clamped HGO P 0.32 (−0.44–1.09) and T 0.87 (0.40–1.34) mg.kg−1.min−1 were similar in both groups. The insulin sensitivity index was comparable in both groups on all days. Total cholesterol concentrations were similar in both groups throughout the study. Triglyceride concentrations were significantly lower in group P 1.38 (1.07–1.68); T 2.14 (1.70–2.58) mmol/l, P < 0.01), no significant treatment effect being observed.

Conclusions An acute dose and 19 days' continuous treatment with trandolapril resulted in no change in insulin sensitivity or plasma lipid profiles in patients with Type 2 diabetes mellitus and hypertension. These data support the metabolic neutrality of trandolapril in patients with Type 2 diabetes mellitus and hypertension.
Microcirculatory response of skin to benzoic acid and methyl nicotinate in patients with diabetes
Authors: Koivukangas V. , Oikarinen A. , Salmela P. I. , Lahti A.
Published: March 2003

Aims In view of the relationship between microvascular pathology and organ complications in diabetes mellitus, the aim of the present study was to examine the microvascular response of upper arm skin to non‐immunological contact irritants in 17 insulin‐dependent diabetic patients and 11 non‐diabetic controls.

Methods Non‐immunological contact urticaria, an inflammatory reaction mediated in a unique way, not previously studied in diabetic patients, was examined. The test agents were benzoic acid and methyl nicotinate. The intensity of the reactions was measured using laser‐Doppler flowmetry and colorimetry. The patients were divided into two groups, depending on whether they had had diabetes for less or more than 10 years.

Results There were no differences in the maximal blood flow responses between the groups, but the diabetic patients showed increased blood flow responses to the lowest irritant concentrations compared to the controls. The reactions in the two groups of diabetic patients were similar.

Conclusions The present study suggests that the microvascular reactivity of diabetic skin to non‐immunological contact irritants is increased.
Beneficial effects of C‐peptide on incipient nephropathy and neuropathy in patients with Type 1 diabetes mellitus
Authors: Johansson B. ‐L. , Borg K. , Fernqvist‐Forbes E. , Kernell A. , Odergren T. , Wahren J.
Published: March 2003

Aims Recent studies have indicated that proinsulin C‐peptide shows specific binding to cell membrane binding sites and may exert biological effects when administered to patients with Type 1 diabetes mellitus. This study was undertaken to determine if combined treatment with C‐peptide and insulin might reduce the level of microalbuminuria in patients with Type 1 diabetes and incipient nephropathy.

Methods Twenty‐one normotensive patients with microalbuminuria were studied for 6 months in a double‐blind, randomized, cross‐over design. The patients received s.c. injections of either human C‐peptide (600 nmol/24 h) or placebo plus their regular insulin regimen for 3 months.

Results Glycaemic control improved slightly during the study and to a similar extent in both treatment groups. Blood pressure was unaltered throughout the study. During the C‐peptide treatment period, urinary albumin excretion decreased progressively on average from 58 μg/min (basal) to 34 μg/min (3 months, P < 0.01) and it tended to increase, but not significantly so, during the placebo period. The difference between the two treatment periods was statistically significant (P < 0.01). In the 12 patients with signs of autonomic neuropathy prior to the study, respiratory heart rate variability increased by 21 ± 9% (P < 0.05) during treatment with C‐peptide but was unaltered during placebo. Thermal thresholds were significantly improved during C‐peptide treatment in comparison to placebo (n = 6, P < 0.05).

Conclusion These results indicate that combined treatment with C‐peptide and insulin for 3 months may improve renal function by diminishing urinary albumin excretion and ameliorate autonomic and sensory nerve dysfunction in patients with Type 1 diabetes mellitus.
Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy
Authors: Bott U. , Bott S. , Hemmann D. , Berger M.
Published: March 2003

SUMMARY

Aims  To evaluate a treatment and teaching programme including psychosocial modules for patients with Type 1 diabetes mellitus on intensified insulin therapy who failed to achieve their treatment goals despite participation in standard programmes.

Methods  The 5‐day inpatient programme comprises small groups of 4–6 patients, focusing on individual needs and problems. Beyond the teaching lessons (most topics are deliberately chosen by the patients), the programme provides intensive group discussions and offers individual counselling concerning motivational aspects, psychosocial problems and coping strategies. Of the first consecutive 83 participants, 76 were re‐examined after 17.5 ± 5.5 months (range 9–31 months).

Results  At follow‐up, HbA1c was not improved compared to baseline (8.0 ± 1.3% vs. 8.1 ± 1.5%). However, the incidence of severe hypoglycaemia per patient/year (glucose i.v., glucagon injection) was substantially decreased: 0.62 ± 1.5 episodes at baseline compared to 0.16 ± 0.9 at follow‐up (P < 0.001). Twenty‐six per cent of the patients at baseline, and 4% at re‐examination had experienced at least one episode of severe hypoglycaemia during the preceding year (P < 0.001). Sick leave days per patient/year decreased from 17.0 ± 38.5–7.7 ± 13.6 days (P < 0.05). Patients improved their perceptions of self‐efficacy, their relationship to doctors and felt less externally controlled (P < 0.001). The majority of patients perceived an improved competence regarding diet (80.6%) and adaptation of insulin dosage (82.4%), an improved knowledge (82.2%), and a renewed motivation for the treatment (84.5%). Treatment success was significantly associated with baseline HbA1c, stability of motivation, frequency of blood glucose self‐monitoring, control beliefs and change in subsequent outpatient care.

Conclusions  The programme improved glycaemic control mainly as a result of a substantial reduction in the incidence of severe hypoglycaemia. Patients with persistent poor glycaemic control may benefit from structured follow‐up care focusing on motivational aspects of self‐management and psychosocial support.
Hyperinsulinaemia in offspring of Type 2 diabetic patients: impaired response of carbohydrate metabolism, but preserved cardiovascular response
Authors: Frontoni S. , Pellegrinotti M. , Bracaglia D. , Farrace S. , Caselli A. , Baroni A. , De Angelis C. , Menzinger G. , Gambardella S.
Published: March 2003

SUMMARY

Aims  To investigate the effects of endogenous insulin on haemodynamics in nine offspring of Type 2 diabetic patients (P), compared with 18 subjects without family history of diabetes (C), all with normal glucose tolerance.

Methods  All subjects underwent a 180‐min oral glucose tolerance test with continuous blood pressure and ECG recording. Low‐to‐high frequency ratio (LF/HF), an index of the sympatho‐vagal balance, was calculated by heart rate spectral analysis.

Results  At baseline, LF/HF correlated with fasting plasma insulin (r = 0.44, P < 0.03) and with insulin/glucose ratio (r = 0.46, P < 0.03). Plasma insulin, basally similar in the two groups, was significantly increased in P (342 ± 34.2) when compared to C (177.6 ± 25.2 pmol/l), P < 0.005 from time 30 min onward. Blood glucose, also similar at baseline, remained not significantly different in P (5.74 ± 0.25) vs. C (5.08 ± 0.27 mmol/l), throughout the study. Diastolic blood pressure significantly decreased in P, but not in C during the first hour of the study. Finally, LF/HF ratio significantly increased in P (2.5 ± 0.4 vs. C, 1.7 ± 0.2) during the first hour.

Conclusions  In conclusion, the offspring of Type 2 diabetic patients with normal glucose tolerance display an increased insulin secretion; however, they are not resistant to the haemodynamic effects of insulin, as suggested by the reduction of diastolic blood pressure. This, in turn, may determine a chronic sympathetic activation, which could be involved in the pathogenesis of Type 2 diabetes mellitus.
Type 2 diabetes mellitus, impaired glucose tolerance and associated factors in a rural Palestinian village
Authors: Husseini A. , Abdul‐Rahim H. , Awartani F. , Giacaman R. , Jervell J. , Bjertness E.
Published: March 2003

SUMMARY

Aims  To investigate the prevalence of Type 2 diabetes mellitus and impaired glucose tolerance (IGT) and to identify risk factors associated with diabetes in a rural Palestinian village.

Methods  A cross‐sectional, population‐based study investigating 500 adults aged 30–65 years (response rate 85%) determined the diabetes status using the oral glucose tolerance test (OGTT). A standard questionnaire, a simple clinical examination and laboratory tests assessed blood lipids, blood pressure, waist‐to‐hip ratio (WHR), body mass index (BMI) and other risk factors for diabetes

Results  The prevalence of Type 2 diabetes was 9.8% (95% confidence interval 7.3–12.3) and IGT 8.6% (6.1–11.1), while the prevalence standardized to the European population was 11.6% (8.8–14.4) for Type 2 diabetes and 10.3% (7.6–13.0) for IGT. Age, positive family history, high triglycerides level, and high WHR were significantly associated with Type 2 diabetes.

Conclusions  Of the factors associated with diabetes, WHR and triglycerides levels are potentially modifiable, and should be addressed by preventive health activities. The high prevalence of Type 2 diabetes mellitus and its potential increase as a result of the ageing of the Palestinian population constitutes a major public health problem.
Incidence and predictors of drug‐treated diabetes in elderly French subjects. The PAQUID Epidemiological Survey
Authors: Bourdel‐Marchasson I. , Dubroca B. , Letenneur L. , Fourrier A. , Richard‐Harston S. , Decamps A. , Rainfray M. , Emeriau J. ‐P. , Dartigues J. ‐F.
Published: March 2003

SUMMARY

Aims  To estimate the incidence and predictors of drug‐treated diabetes in elderly subjects.

Methods  The PAQUID epidemiological survey, a population‐based study, has followed up 3777 subjects older than 65 years since 1988. At each visit (baseline, 1, 3, 5 and 8 years), treatment regimen was used to identify new drug‐treated diabetic subjects. Potential predictors of drug‐treated diabetes were collected during the baseline visit (body mass index (BMI), educational level, cigarette smoking and wine consumption, physical activity, depressive symptomatology, subjective health, treatment, and hypertension) and analysed by using a multivariate backward stepwise regression Cox model with delayed entry.

Results  The prevalence rate of drug‐treated diabetes was 7.5% at baseline and 7.1% after 8 years' follow‐up. The incidence rate of drug‐treated diabetes was 3.8/1000 person‐years, 5.9/1000 person‐years in men and 2.4/1000 person‐years in women, with no significant variation according to age group. Male sex (relative risk (RR) 2.4, 95% confidence interval (CI) 1.4–4.0, P < 0.001, attributable risk (AR) 0.36), elevated BMI (for one point increase, RR 1.1, 95% CI 1.1–1.1, P < 0.001, ≥ 25 vs. < 25, RR 2.1, 95% CI 1.2–3.5, AR 0.33), thiazide diuretics used alone (RR 5.9, 95% CI 1.8–19.6, P = 0.02), and poorer subjective health (‘the same’ vs. ‘better’ RR 1.8, 95% CI 1.0–3.1, P = 0.04; ‘worse vs. ‘better’ RR 2.3, 95% CI 0.9–5.7, P = 0.06) were independent predictors of drug‐treated diabetes in this population.

Conclusions  In older French individuals, men seem to be particularly exposed to drug‐treated diabetes although being overweight was found to be a strong predictor as in younger populations.
Comparison of ADA 1997 and WHO 1985 criteria for diabetes in south Indians – the Chennai Urban Population Study
Authors: Deepa R. , Rani S. Shanthi , Premalatha G. , Mohan V.
Published: March 2003

SUMMARY

Aims  To compare the American Diabetes Association (ADA) fasting criteria and World Health Organization (WHO) 2‐h criteria for diabetes in an urban south Indian population.

Methods  Subjects were drawn from the Chennai Urban Population Study. Of the 1001 subjects studied, 52 (5.2%) were diagnosed as having diabetes according to WHO 2‐h criteria and 32 (3.2%) according to the ADA fasting criteria.

Results  Twenty‐five (48%) of the subjects diagnosed with diabetes by the WHO 2‐h criteria were not classified as having diabetes by the ADA fasting criteria. Similarly, of the 78 subjects (7.8%) classified as having impaired glucose tolerance (IGT), only eight (10.3%) had impaired fasting glucose (IFG) according to the ADA fasting criteria. The overall agreement between the WHO 2‐h criteria and ADA fasting criteria was poor (κ = 0.40).

Conclusions  Use of the ADA fasting criteria results in a lower prevalence rates of diabetes in this lean urban south Indian population.
Intramuscular injection of insulin lispro or soluble human insulin: pharmacokinetics and glucodynamics in Type 2 diabetes
Authors: Milicevic Z. , Profozic V. , Wyatt J. , Ristic S. , Woodworth J. R. , Seger M. , Kaliterna D. , Bates P. , Metelko Z.
Published: March 2003

Aim  The aim of the study was to compare the pharmacokinetics and glucodynamics of insulin lispro and soluble human insulin following intramuscular (i.m.) injection in patients with Type 2 diabetes with secondary failure of sulphonylureas.

Methods  Single 15‐U i.m. doses of insulin lispro or soluble human insulin were administered to 16 patients in a two‐way, randomized, crossover design. Glucodynamic and pharmacokinetic parameters were determined over 6 h after insulin injection using clamp techniques.

Results Insulin Cmax was significantly higher (971 ± 217 vs. 659 ± 141 pmol/l, P < 0.001) and Tmax was significantly shorter (46.9 ± 27 vs. 94.7 ± 50.1 min, P = 0.002) with insulin lispro. Glucose infusion rate (GIR) curves showed clear separation 20 min after injection and were significantly greater for insulin lispro during the 40–60, 60–80 and 80–100‐minute time intervals. Total glucose infused was only approximately 5% larger with insulin lispro during the 6‐h follow‐up, due to lower insulinaemia at later time points. The glucose Rmax and TRmax were not statistically different between insulin treatments.

Conclusion  This study shows that i.m. injection of insulin lispro is followed by its more rapid absorption, which results in stronger metabolic effect in the first 2 h when compared with soluble human insulin under the same test conditions.

Diabet. Med. 18, 562–566 (2001)
Limited joint mobility and plantar fascia function in Charcot's neuroarthropathy
Authors: Chuter V. , Payne C.
Published: March 2003

Aim  The aim of this study was to investigate the prevalence of limited joint mobility at the first metatarsophalangeal joint (MPJ) and dysfunction of the plantar fascia in people with diabetes mellitus and Charcot's neuroarthropathy and a control group.

Methods  Fifteen subjects with a history of mid‐foot Charcot's neuroarthro pathy and 26 controls with sensory neuropathy but no Charcot's neuro arthropathy were recruited. Ranges of ankle and first MPJ dorsiflexion were measured for each participant. Plantar fascia function was assessed using Jack's test.

Results The range of dorsiflexion at the first MPJ was significantly reduced in the subject group compared with the control group (51.2 vs. 64.8; P < 0.001). Jack's test demonstrated the plantar fascia to be ruptured or dysfunctional in all feet in the subject group and to be functioning in all feet in the control group.

Conclusions  It is not possible to determine from this study if the limited joint mobility at the first MPJ and dysfunction of the plantar fascia preceded or followed the development of Charcot's neuroarthropathy; however, these results are a previously unreported finding in Charcot's neuroarthropathy.

Diabet. Med. 18, 558–561 (2001)
Avascular necrosis not Charcot's
Authors: Samarasinghe Y. P. , Brunton S. L. , Feher M. D.
Published: March 2003

Background  A case of avascular necrosis (AN) of the navicular bone, in a 24‐year‐old woman with Type 1 diabetes with peripheral neuropathy, in the absence of any history of direct trauma is presented. The clinical and radiological features at presentation suggested an evolving Charcot arthropathy (CA), but subsequent serial X‐rays clearly confirmed AN.

Conclusions Swelling and foot deformity in association with long‐standing diabetic peripheral neuropathy is suggestive of CA, although AN, a less common condition, may show the same clinical features. It is therefore important to undertake further confirmatory radiological investigations if there is any doubt about the diagnosis.

Diabet. Med. 18, 846–848 (2001)
Cognitive function and information processing in Type 2 diabetes
Authors: Cosway R. , Strachan M. W. J. , Dougall A. , Frier B. M. , Deary I. J.
Published: March 2003

Aims  To determine whether uncomplicated Type 2 diabetes is associated with impairment of cognitive function and information processing ability.

Methods  Thirty‐eight participants with uncomplicated Type 2 diabetes and 38 non‐diabetic controls were studied. The two groups were comparable for age and premorbid intellectual ability, and did not have other medical disorders likely to affect cognitive function. An extensive battery of tests was administered which assessed different levels and domains of cognitive functions including verbal and visual memory, executive function, general mental ability and efficiency of information processing.

Results  No significant differences were found between the diabetic and control groups on any measure of cognitive function or information processing. The performance on these tests was not associated with recent glycaemic control (assessed by HbA1c). Duration of diabetes, however, correlated significantly with poorer performance on several measures of verbal memory.

Conclusions  The results of the present study suggest that some aspect of Type 2 diabetes (as indexed by the estimated duration of the disorder) does relate significantly to cognitive function within the group with diabetes. However, other diabetes‐related factors, such as macrovascular disease, hypertension and depression, may contribute more to previously observed cognitive decrements in Type 2 diabetes.

Diabet. Med. 18, 803–810 (2001)
Risk of diabetes in siblings of index cases with Type 2 diabetes: implications for genetic studies
Authors: Weijnen C. F. , Rich S. S. , Meigs J. B. , Krolewski A. S. , Warram J. H.
Published: March 2003

Aims The goal was to estimate the sibling recurrence‐risk ratio for Type 2 diabetes in families with diabetes occurring in middle age. Because diabetes aetiology involves environmental exposures and genetic susceptibility, we sought to identify determinants of the recurrence risk.

Methods We surveyed patients diagnosed at ages 35–59 years (n = 563) to obtain information on the occurrence of diabetes in their relatives, particularly siblings (n = 1675). Age‐specific prevalences of diabetes in the US population were used for comparison.

Results The overall sibling recurrence‐risk ratio for diabetes was low, about 1.8 in the Joslin families and even lower in three other studies that were reanalysed for comparison. In all studies, the diabetes risk in siblings of index cases without a history of diabetes in a parent was similar to that in the general population, suggesting that genetic factors contributed to the occurrence of diabetes in only a minority of these siblings. The fact that recurrence‐risk ratios were elevated only in families with one or two diabetic parents indicates that susceptibility to Type 2 diabetes is transmitted primarily through an affected parent. In addition, the sibling recurrence‐risk ratios were elevated even further in families with diabetes in both a parent and grandparent of the index case, and in siblings of non‐obese index cases (percent ideal body weight < 120%).

Conclusions The selection of families with non‐obese index cases and vertical transmission of diabetes through three generations may improve the success of efforts to map susceptibility genes for Type 2 diabetes.
Paraoxonase gene cluster is a genetic marker for early microvascular complications in Type 1 diabetes
Authors: Kao Y. , Donaghue K. C. , Chan A. , Bennetts B. H. , Knight J. , Silink M.
Published: March 2003

Background Paraoxonase is a serum enzyme, which prevents oxidation of low‐density lipoprotein (LDL) by hydrolyzing lipid peroxides. Two polymorphisms in PON1 gene have been associated with cardiovascular and microvascular diseases in both diabetic and non‐diabetic patients.

Aims The current project was designed to investigate the association between the polymorphisms of two PON genes and diabetes microvascular diseases (retinopathy and microalbuminuria) and any potential linkage between Met54Leu of PON1 and Cys311Ser of PON2 gene.

Methods Diabetic retinopathy and albumin excretion rate were assessed in 372 adolescents with Type 1 diabetes who were genotyped for the two polymorphisms.

Results We confirmed the increased susceptibility for diabetic retinopathy for the Leu/Leu genotype (odds ratio (OR) 3.34 (confidence interval (CI) 1.95, 5.75), P < 0.0001). The Ser/Ser genotype was significantly more common in those patients with microalbuminuria (albumin excretion rate ≥ 20 µg/min) compared with those with albumin excretion rate < 20 µg/min (OR 4.72 (CI 2.65, 8.41), P < 0.0001). The Ser311 of PON2 was in strong linkage disequilibrium with Leu54 of PON1 gene (Δ = 23 × 104, P < 0.001). The delta value was higher for those without complications (28 × 104, P < 0.001) compared with those with complications (15.5 × 104, P < 0.001).

Conclusions This study supports the hypothesis that diabetic microangiopathy is genetically heterogeneous. PON1 Leu/Leu increases the risk for retinopathy and PON2 Ser/Ser increases the risk for microalbuminuria.
Glycaemic control, disease duration and β‐cell function in patients with Type 2 diabetes in a Swedish community. Skaraborg Hypertension and Diabetes Project
Authors: Östgren C. J. , Lindblad U. , Ranstam J. , Melander A. , Råstam L.
Published: March 2003

Aims To examine determinants for glycaemic control in primary care patients with Type 2 diabetes.

Methods In a community‐based surveillance of primary care patients with Type 2 diabetes, 190 men and 186 women were consecutively identified and examined for cardiovascular risk factors. Insulin resistance and β‐cell function were estimated using homeostasis model assessment (HOMA). Good glycaemic control was defined as HbA1c < 6.5%.

Results Following adjustment for age and gender, HbA1c≥ 6.5% was associated with duration of diabetes (10.6 vs. 6.4 years, P < 0.001), lower levels of serum insulin (6.3 vs. 8.0 mU/l, P = 0.012), higher serum triglyceride levels (2.0 vs. 1.7 mmol/l, P = 0.002) and impairment of β‐cell function (HOMA index 19.5 vs. 45.8, P < 0.001). The association between HbA1c levels and duration remained with adjustment for age, gender, waist–hip ratio (WHR) and serum triglycerides (odds ratio (OR) for HbA1c≥ 6.5% by 5 years diabetes duration = 1.7; 95% confidence interval (CI) 1.4–2.1) but was lost following additional adjustment for β‐cell function (OR for HbA1c≥ 6.5%= 1.3; 95% CI 0.96–1.7). In a separate linear regression with β‐cell function as the dependent variable there was a significant association with HbA1c after adjustments for differences in age, gender, WHR, serum triglyceride levels and diabetes duration (P < 0.001).

Conclusions Increasing HbA1c by time was associated with declining β‐cell function.

Diabet. Med. 19, 125–129 (2002)
Evaluation of a district‐wide screening programme for diabetic retinopathy utilizing trained optometrists using slit‐lamp and Volk lenses
Authors: Hulme S. A. , Tin‐U A. , Hardy K. J. , Joyce P. W.
Published: March 2003

Background Debate exists about the optimum way to screen for diabetic retinopathy. Cameras produce a permanent record, but offer patients less choice about when and where to be screened. Optometrists offer flexibility but sensitivity and specificity of schemes have varied considerably, perhaps because of variability in screening methodology and that there is frequently no quality assurance programme.

Aims To audit our district‐wide (population 340 000) screening programme for diabetic retinopathy against national targets: sensitivity > 80%, specificity > 95% and referral to review < 3 months.

Methods Trained optometrists performed slit‐lamp examination with Volk lenses (78 dioptre) with standardized reporting. Audit was by ophthalmologist with slit‐lamp and Volk lenses through dilated pupils.

Results We examined 872 eyes of 439 patients; 64% were normal, 29% background diabetic retinopathy, 7% sight‐threatening eye disease (STED). Sixty‐three percent of patients were seen within 6 months of the original screen. Of these, sensitivity for any retinopathy was 72%, specificity 77%, positive predictive value (PPV) 53%, negative predictive value (NPV) 88%. For STED, in this group, sensitivity was 87% and specificity 91%, PPV 30%, NPV 99%. Median interval referral to ophthalmological review was 11.5 weeks with 73% reviewed in under the 13‐week target. Of those referred 25% received laser therapy. Eleven patients found to have referable eye disease at their initial screen were not referred to an ophthalmologist by their GP.

Conclusions We conclude that effective district‐wide screening for diabetic retinopathy by optometrists using slit‐lamp and Volk lenses is possible; however, only 36% of identified people with diabetes in the district were screened over a 4‐year period.
Post‐prandial glucose excursions following four methods of bolus insulin administration in subjects with Type 1 diabetes
Authors: Chase H. P. , Saib S. Z. , MacKenzie T. , Hansen M. M. , Garg S. K.
Published: March 2003

Aims To determine if one method of short‐acting insulin bolus administration is superior to other methods in managing a meal high in carbohydrates, calories and fat.

Methods Nine subjects receiving continuous subcutaneous insulin infusion using insulin lispro (Humalog®) agreed to consume the same meal high in carbohydrates, calories and fat on four occasions 1 week apart. They received the same dose of bolus insulin on each of the four occasions randomly assigned and beginning 10 min prior to the meal as either a single bolus, two separate boluses of one‐half the same total dose (the second after 90 min), the entire bolus given as a square‐wave (over 2 h) or a dual‐wave (70% as a bolus and 30% as a square‐wave over 2 h). Blood glucose levels were measured at –60 and –30 min and at zero time, and then every half‐hour for 6 h using the Hemacue® in the out‐patient clinic.

Results Changes in blood glucose values from fasting were the lowest after 90 and 120 min (P < 0.01) when the dual wave was administered. When the dual or square‐wave methods of insulin administration were used, subjects had significantly lower glucose levels after 4 h in comparison with when the single or double boluses were used (P = 0.04).

Conclusions We conclude that the dual wave provided the most effective method of insulin administration for this meal. The dual‐ and square‐wave therapies resulted in lower glucose levels 4 h after the meal in comparison with the single and double‐bolus treatments.
Impaired vascular reactivity is present despite normal levels of von Willebrand factor in patients with uncomplicated Type 2 diabetes
Authors: Ihlemann N. , Stokholm K. H. , Eskildsen P. C.
Published: March 2003

Background Type 2 diabetes is associated with an increased risk of cardiovascular disease. Endothelial dysfunction is thought to be an early marker of atherosclerosis. The purpose of this study was to assess whether endothelial function, judged by measurements of flow‐mediated vasodilatation (FMD) and nitroglycerine (NTG)‐induced vasodilatation as well as serum levels of von Willebrand factor, was affected in patients with uncomplicated Type 2 diabetes and normal levels of urinary albumin excretion (UAE).

Subjects and methods Twenty‐three patients with Type 2 diabetes, normal UAE and no vascular complications were examined. Twenty‐three healthy subjects matched for age, gender, body mass index and resting vessel size served as controls. All participants were non‐smokers. Endothelial function was assessed by high‐resolution ultrasound which measures changes in diameter of the brachial artery during flow‐mediated and NTG‐induced vasodilatation. We also measured serum levels of von Willebrand factor.

Results In Type 2 diabetic patients FMD (3.2 ± 0.5% vs. 4.8 ± 0.5%, P = 0.019) as well as NTG‐induced vasodilatation (15.9 ± 0.6% vs. 18.5 ± 0.9%, P = 0.021) were significantly reduced compared with controls. Levels of von Willebrand factor were not different between groups (0.88 ± 0.07 vs. 0.88 ± 0.07 in patients and controls, respectively) and were not correlated to FMD or NTG‐induced vasodilatation.

Conclusion Impaired vascular reactivity is present in uncomplicated Type 2 diabetes and seems to be a more sensitive marker of vascular dysfunction than von Willebrand factor.
Glucose intolerance and associated factors in Mongolia: results of a national survey
Authors: Suvd J. , Gerel B. , Otgooloi H. , Purevsuren D. , Zolzaya H. , Roglic G. , King H.
Published: March 2003

Aims Prevalence of glucose intolerance—diabetes and impaired glucose tolerance (IGT)—and of related conditions such as obesity and hypertension, was studied in six population samples in Mongolia in 1999.

Methods Diagnosis of glucose intolerance was made on the basis of 2‐h blood glucose concentration, according to criteria recommended by the latest report of a WHO Expert Group.

Results Crude prevalence of diabetes was 2.9% (2.6% in men and 3.2% in women). Prevalence of IGT was 10.2% (9.3% in men and 10.8% in women). Age standardization to the standard world population of Segi resulted in a total sample prevalence of 3.1% for diabetes and 9.2% for IGT. Prevalence of abnormal glucose tolerance differed according to district of residence. Approximately one‐third of the subjects with diabetes were diagnosed prior to the survey. Of those who were diagnosed previously, approximately one‐half were not under any form of treatment. Subjects with abnormal glucose tolerance were older, more obese and had higher blood pressure and prevalence of hypertension than those with normoglycaemia. One‐half of men and almost one‐half of women were hypertensive. Three‐quarters of the diabetic subjects were hypertensive. One‐third of all subjects were centrally obese. Considering the conditions of principal interest—glucose intolerance, hypertension and obesity—one‐half of all subjects demonstrated one or more of these conditions. Central obesity was the most common condition, followed by hypertension and then glucose intolerance. Central obesity and hypertension was the most common combination (17% of all subjects) and 4% exhibited all three conditions.

Conclusions Non‐communicable diseases are already a threat to public health in Mongolia. Although the prevalence of diabetes is not high by international standards, the relatively high prevalence of IGT suggests that the situation may deteriorate in the future in the absence of concerted action to prevent and control diabetes and related conditions.
The prevalence of the mitochondrial DNA 16189 variant in non‐diabetic Korean adults and its association with higher fasting glucose and body mass index
Authors: Kim J. H. , Park K. S. , Cho Y. M. , Kang B. S. , Kim S. K. , Jeon H. J. , Kim S. Y. , Lee H. K.
Published: March 2003

Aims To evaluate the prevalence of the 16189 variant of mitochondrial DNA in Korean adults and its association with insulin resistance.

Methods We investigated 160 non‐diabetic subjects from a community‐based diabetes survey conducted in Yonchon County, Korea in 1993. We extracted the DNA from peripheral blood and examined the 16189 variant by polymerase chain reaction and restrictive enzyme digestion. We compared body mass index (BMI), blood pressure, fasting plasma glucose, 2‐h plasma glucose after 75 g glucose load, fasting insulin, cholesterol, and homeostasis model assessment of insulin resistance and β‐cell function between the subjects with 16189 variant and wild type.

Results The prevalence of the 16189 variant in Korean adults was 28.8% (46 of 160). Subjects with the 16189 variant had higher fasting glucose and BMI than those with wild type, but fasting insulin, homeostasis model assessment of insulin resistance and β‐cell function, cholesterol, and blood pressure were not different between two groups.

Conclusion Our results provide evidence for an association of a frequent mitochondrial polymorphism with higher fasting glucose and the risk factors of diabetes mellitus.
Continuous subcutaneous insulin infusion (CSII) in the Veneto region: efficacy, acceptability and quality of life
Authors: Bruttomesso D. , Pianta A. , Crazzolara D. , Scaldaferri E. , Lora L. , Guarneri G. , Mongillo A. , Gennaro R. , Miola M. , Moretti M. , Confortin L. , Beltramello G. P. , Pais M. , Baritussio A. , Casiglia E. , Tiengo A.
Published: March 2003

Aim To study the effect of continuous subcutaneous insulin infusion (CSII) on metabolic control and well‐being in patients with Type 1 diabetes.

Methods Efficacy, safety and interference with everyday life associated with CSII were studied retrospectively in 138 diabetic patients from the Veneto region treated for 7.4 ± 0.4 years.

Results Glycosylated haemoglobin decreased during the first year of CSII from 9.3 ± 0.2% to 7.9 ± 0.1% (P < 0.0001), and then remained unchanged. Serious hypoglycaemia decreased from 0.31 ± 0.07/year to 0.09 ± 0.02/year (P < 0.003), as did ketoacidosis (from 0.41 ± 0.12/year to 0.11 ± 0.03/year, P < 0.013). During the first year of therapy daily insulin requirement decreased from 49 ± 1 to 42 ± 2 U/day (P < 0.0001) and did not change thereafter. The number of out‐patient consultations and hospital admissions per year also decreased significantly. CSII was associated with a progressive increase of body weight (P < 0.05) and with 0.2 ± 0.04 infections/patient per year at the infusion site. Infection was rated as mild in 72%, moderate in 18%, severe in 10%. Patients reported that CSII improved metabolic control (71%), sense of well‐being (41%), and allowed more freedom (40%). Quality of life, assessed using the DQOL, after 7 years of CSII was rated as good by patients (score of 73.0 ± 1.8 on a scale from 0 to 100).

Conclusions This retrospective analysis suggests that CSII improves metabolic control in Type 1 diabetic patients, reduces hypoglycaemic and ketoacidotic events, is well accepted, allows a good quality of life and decreases out‐patient consultations and hospital admissions.
Improved glycaemic control with metformin–glibenclamide combined tablet therapy (Glucovance®) in Type 2 diabetic patients inadequately controlled on metformin
Authors: Marre M. , Howlett H. , Lehert P. , Allavoine T.
Published: March 2003

AimsTo evaluate the efficacy and safety of two dosage strengths of a single‐tablet metformin–glibenclamide (glyburide) combination, compared with the respective monotherapies, in patients with Type 2 diabetes mellitus (DM) inadequately controlled by metformin monotherapy.

MethodsIn this 16‐week, double‐blind, multicentre, parallel‐group trial, 411 patients were randomized to receive metformin 500 mg, glibenclamide 5 mg, metformin–glibenclamide 500 mg/2.5 mg or metformin–glibenclamide 500 mg/5 mg, titrated with the intention to achieve fasting plasma glucose (FPG) ≤ 7 mmol/l.

ResultsDecreases in glycated haemoglobin (HbA1c) and FPG were greater (P < 0.05) for metformin–glibenclamide 500 mg/2.5 mg (−1.20% and −2.62 mmol/l) and 500 mg/5 mg (−0.91% and −2.34 mmol/l), compared with metformin (−0.19% and −0.57 mmol/l) or glibenclamide (−0.33% and −0.73 mmol/l). HbA1c< 7% was achieved by 75% and 64% of patients receiving metformin–glibenclamide 500 mg/2.5 mg and 500 mg/5 mg, respectively, compared with 42% for glibenclamide and 38% for metformin (P = 0.001). These benefits were achieved at lower mean doses of metformin or glibenclamide with metformin–glibenclamide 500 mg/2.5 mg and 500 mg/5 mg (1225 mg/6.1 mg and 1170 mg/11.7 mg) than with glibenclamide (13.4 mg) or metformin (1660 mg). Treatment‐related serious adverse events occurred in two patients receiving glibenclamide. Plasma lipid profiles were unaffected and mean changes in body weight were ≤ 1.0 kg.

ConclusionsIntensive management of Type 2 DM with a new metformin–glibenclamide combination tablet improved glycaemic control and facilitated the attainment of glycaemic targets at lower doses of metformin or glibenclamide compared with the respective monotherapies, without compromising tolerability.

Diabet. Med. 19, 673–680 (2002)
Perceptions of diabetic retinopathy and screening procedures among diabetic people
Authors: Trento M. , Bajardi M. , Borgo E. , Passera P. , Maurino M. , Gibbins R. , Owens D. R. , Cavallo F. , Porta M.
Published: March 2003

Aims To assess how diabetic patients perceive retinopathy, screening for sight‐threatening lesions and their own role in preventing blindness.

Methods A questionnaire was administered to 258 consecutive patients after screening for retinopathy, according to the European Field Guide‐Book procedure, in Turin (n
 
=
 130) and Wales (n   =  128, W). All Welsh patients and 70 in Turin (T1) were on standard diabetes care at their clinic or general practitioner, whereas 60 in Turin (T2) were on permanent group education.

Results According to 65%, 84% and 100% of patients in W, T1 and T2, respectively, diabetes may damage the eyes. Retinopathy had been heard of by 48% (W), 67% (T1) and 100% (T2). In T2, 82% of patients could give a meaningful description of retinopathy but only 17% could use correctly the word ‘retina’. In W and T1, 16% and 19% could describe retinopathy but none could describe the retina. In W and T1, 47% and 57% believed they could not help with eye care, whereas 78% in T2 replied that they should control diabetes and 20% that eyes should be checked regularly. Regarding reasons for screening, 100% of patients in T2 answered ‘prevention and checks’, against 61% in T1 and only 9% in W. In T1 and W, 33% and 37% did not know why they were being screened.

Conclusions Patients’ health perceptions and internal control mechanisms may be insufficiently developed for optimal participation in retinopathy screening. Diabetes care by long‐term group education may address this problem.
C‐reactive protein is more strongly related to post‐glucose load glucose than to fasting glucose in non‐diabetic subjects; the Insulin Resistance Atherosclerosis Study
Authors: Festa A. , D’Agostino R. , Tracy R. P. , Haffner S. M.
Published: March 2003

Aims It has been suggested that cardiovascular disease may be more strongly related to post‐challenge glycaemia than to fasting glucose concentrations. We hypothesized that subclinical inflammation, as indicated by elevated serum levels of C‐reactive protein (CRP), may partially explain the association of cardiovascular disease with post‐challenge glycaemia.

Methods We studied the relationship of CRP (measured with a highly sensitive immunoassay) with fasting glucose and 2‐h glucose concentrations during an oral glucose tolerance test in non‐diabetic subjects from the Insulin Resistance Atherosclerosis Study.

Results Spearman correlation analyses and multiple linear regression analyses showed a significant association of both fasting glucose and 2‐h glucose concentrations with CRP levels, after adjusting for demographic covariates (age, sex, ethnicity, clinical centre; Spearman correlation coefficients: r = 0.18 for fasting glucose, r = 0.27 for 2‐h glucose, both P < 0.0001). However, after additional adjustment for body mass index and waist–hip ratio only 2‐h glucose (and not fasting glucose) was significantly related to CRP (r = 0.03 for fasting glucose, P = NS; r = 0.14 for 2‐h glucose, P < 0.0001). Adding insulin sensitivity to the multivariate models further weakened the relationship of CRP to 2‐h glucose (r = 0.07, P < 0.05). CRP mean values increased by 2‐h glucose category (normal vs. impaired glucose tolerance vs. isolated post‐challenge hyperglycaemia).

Conclusions Chronic, subclinical inflammation, as indicated by elevated circulating CRP levels, is more strongly associated with post‐challenge glycaemia than with fasting glucose levels in non‐diabetic subjects. This association is partially independent of body fat and insulin resistance.

Diabet. Med. 19, 939–943 (2002)
Differing aspects of insulin resistance in diabetes complications: the shape of things to come. RD Lawrence lecture 2000
Authors: Chaturvedi N.
Published: March 2003

The anticipated global epidemic of diabetes, largely as a consequence of increased rates of obesity, will particularly impact on people of South Asian and African Caribbean descent, two populations at elevated risk of insulin resistance. This article contrasts the consequent heightened risk of heart disease on the one hand in South Asians, and the paradoxical protection from heart disease in African Caribbeans on the other. Protection from the hypertriglyceridaemic effects of insulin resistance is likely to account for much of the African Caribbean paradox, although the mechanisms remain unclear. The growing evidence that insulin resistance is commonly observed in people with Type 1 diabetes, as well as those with Type 2 diabetes, and that features of insulin resistance may play a crucial role in the development of microvascular, as well as macrovascular complications, is also discussed. This indicates novel targets for the prevention and treatment of diabetes complications.

Diabet. Med. 19, 973–977 (2002)
A comparison of pinewood and moorland soils in the Abernethy Forest Reserve, Scotland
Authors: Wilson Brian , Puri Geeta
Published: March 2003

Despite considerable published literature on the above‐ground ecology of the pinewoods of Scotland, little research has considered the way in which pinewood soils differ from those under other vegetation types. Soil properties were compared between ancient, semi‐natural Scots pine forest and moorland on three soil types in the Abernethy Forest Reserve in the Cairngorm Mountains of Scotland. Soil morphology differed considerably between the vegetation types on each soil type, principally in the thickness of organic layers. Forest soils had thicker organic layers and this was particularly true of the F horizon. Forest soils were slightly less acid than equivalent moorland soils and had accumulated significantly more carbon. Forest soils in this environment therefore have the capacity to sequester larger amounts of carbon than moorland, and therefore represent a significant potential carbon sink. The quantity of nitrogen and phosphorus was also consistently larger in the organic layers under pine forest and since little difference existed in these properties in the mineral horizons, it was concluded that this accumulation was real and represented a net addition to the tree‐soil system.
An avifaunal zonation of Switzerland and its relation to environmental conditions
Authors: Pasinelli Gilberto , Naef‐Daenzer Beat , Schmid Hans , Keller Verena , Holzgang Otto , Graf Roman , Zbinden Niklaus
Published: March 2003

We propose a quantitative zonation of Switzerland based on the distribution of breeding birds. We use a combined dataset from two nationwide bird censuses 20 years apart to account for distribution changes between the censuses. This approach approximates the ‘potential’ distribution of species more closely than a dataset from one period only.

 A numerical approach with correspondence analysis and non‐hierarchical clustering resulted in five avifaunal regions, consisting of two lowland regions north of the alpine arch, two alpine regions and one region of southern alpine valleys.

 We identified characteristic species for each region using the indicator value analysis of Dufrêne & Legendre (1997) and determined environmental conditions separating the regions with discriminant analysis.

 Our zonation partly corresponds with previous subdivisions of Switzerland, but has the advantage of being based on a numerical approach instead of expert knowledge.

 We discuss avifaunal and ecological differences between the regions and relate our zonation to the classical biogeographic regions of Europe. Finally, we evaluate the importance of the zonation for bird conservation.
Savanna–forest hysteresis in the tropics
Authors: Da Silveira Lobo Sternberg Leonel
Published: March 2003

A simple dynamic model relating forest area in a region, its contribution to dry season precipitation and the effect on its own establishment was developed. The model equation shows hysteresis between forest and savannas as a function of imported dry season precipitation. Regions are either dominated by forests or savannas, with each ecosystem showing stability despite changes in imported dry season precipitation. Deforestation beyond a certain threshold value, however, could cause a collapse of forest ecosystems and replacement by savannas in marginal areas. The predictions of this model corroborate pollen core analysis in the Amazon basin, where historical stability of tropical forest cover has been shown despite global climate change.